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Carmen Savin

Pediatric dentistry (pedodontics) is an age-defined
specialty that provides both, primary and
comprehensive, preventive and therapeutic oral
health care for infants and children through
adolescence, including those with special health
care needs.

American Dental Association (ADA), 2000
Paedodontics - from the Greek words “pais-paidos” = boy/child and “odontos” = tooth
What are the key elements of this definition that
make it so unique?

 “age-defined”: most specialties are procedure defined (endodontics, periodontics, etc.),
while pediatric dentistry provides care for their specific age group of patients.

 “primary and”: pediatric dentists are primary providers. There is no
need for a referral of patients. Parents can choose to have their children evaluated and
treated by a pediatric dentist just like they can choose to have their child treated by a

 “infants and children through adolescence”: pediatric dentists manage patients at any age
from birth up to their late teens.

 “special health care needs”: pediatric dentists must have the training and experience to
evaluate and treat patients that are medically compromised. This includes patients with
hemophilia, leukemia, congenital syndromes, etc.
What are the “study objects” for Pediatric Dentistry?

infants and children through adolescence
normal and special health care needs children

What does provide Pediatric Dentistry?

primary and comprehensive preventive oral health care
primary and comprehensive interceptive oral health care
both primary and comprehensive therapeutic oral health
Paedodontics, or paediatric dentistry are synonymous
with dentistry for children.

It exists because children have dental and oral-
facial problems.

The genesis of dentistry for children is unquestionably
linked to dental caries, pulpitis as well as inflammation
and pain associated with infected pulp tissue and
sometimes with alveolar bone suppuration.
1. Growth and development of dental-maxillary system –
in an integrated psychological, social, somatic and
aesthetic concept.
2. Normal and pathological variability of growth and
development of dental-maxillary system.
3. Pain, dental anxiety, dental fear and child management
in dentistry.
4. Study of the morphological and structural, biological
and functional particularities of temporary
(primary/deciduous teeth) and young permanent
(immature) teeth.
5. Epidemiology, etiology, physiopathology, clinic and
therapy (preventive and curative) of:
 dental caries of TT and PT
 dental and periodontal trauma of primary and young
permanent teeth
 dental dystrophies
 periodontal diseases
 oral mucosa pathology in children and teenagers
6. “Lost of space” phenomenon.

7. Children and adolescents special restorative
8. Children’s oral surgery.

9. Orthodontics (preventive and interceptive).
I . First childhood (small childhood) =0 – 3 y.o. stage.
A. Prenatal period:
Prenatal growth from conception to birth is usually divided into three
trimesters, without any clear-cut borderlines between them.
1. First trimester (0-12 week) - embryo stage - is characterized by
differentiation of tissue and formation of organs. Mineralization of bones and teeth
has not started yet.
2. Second trimester (12-27 weeks) is characterized by a rapid growth and
maturation. Of special importance in this period is the development of the internal
organs and their preparation for postnatal function.
3. Third trimester (28-40 weeks) together with the second are named the
fetal period. The dominant factor in the third trimester is the increasing weight of
the fetus. Accumulation of the calcium due to the mineralization of bones and teeth
is also very important.
Some problems may occur due to:
 cellular differentiation disorders
 absence of facial buds union
 branchial membranes resorption problems.

To prevent these problems, some actions should be
 genetic advice
 avoidance of radiation, anaesthesia, alcohol, tobacco and
drugs in the first quarter of pregnancy
 treatment of mother's acute and chronic infections
before/during pregnancy

I. First childhood (small childhood) = 0 – 3 y.o. stage.
A. Prenatal period:
B. Birth moment
Is a traumatic moment. The compression of cephalic extremity
may cause hypoxia and determines hypomineralization of primary
teeth enamel (circular Stein caries).
I. First childhood (small childhood) = 0 – 3 y.o. stage.
C. 0- 30 days = new born baby period:
 nurseling stage
 incomplete immunitary system development.
D. 30 days - 1 year period:

The autonomic nervous system phenomena prevails in this
period: breast feeding is very important and it is possible due to the
inborn suckling reflex.
Advantages of breast feeding:
 nourishing principal contributionn
 immunity factors contribution
 harmonious psycho-somatic development
 continuation of mother-child affective symbiosis
 maxillary development
 first physiological mandible mesial movement (1
of occlusion)
D. 30 days - 1 year period:

 deficiencies in child’s oral hygiene and Candida albicans are
favorable factors for infectious stomatitis
 Riga-Fede lesion may occur, due to natal or neonatal incisors and/or
due to the cerebral palsy at this age
 permanent teeth mineralisation – around 3 – 4 months;
 temporary teeth eruption – around 6 months (may occur: eruption
gingivitis, Riga eruptive stomatitis)
 due to artificial feeding, in the nursling stage may occur repeated
dyspepsia and rickets.

E. Small child period = 1 – 3 y.o.
 fontanels closing
 skull ossification (1 – 2 years)
 slow rhythm of growth
 perfecting the locomotor’s function
 development of a second system of signal speaking
 child contact with children’s community and the first contagious
diseases of childhood
 metabolic problems (2.5-3 years old) and sometimes severe teeth
 sequential continuation and finalizing eruption of primary teeth may lead to
odontiasic stomatitis
 first occlusion elevation – around 18
months, related to the first temporary
molar clinical eruption
 occurence of the vicious habits
 the function of maxillary-facial’s system is more complex
 early caries of child (ECC), severe early caries of child (SECC) (due to oral
hygiene and child nutrition and/or lack of oral hygiene after repetitive night oral
administration of medical sweetened syrups).
E. Small child period = 1 – 3 y.o.
This stage (age 1-3 years) is favorable for a proper insertion of a correctly
oral and nutritional hygiene and for general fluoridation (in close interrelation
with the fluoride concentration in air, water and food).
I I . Second childhood (middle childhood) =3 – 6 y.o. stage:
 general rhythm of growth slows down
 psycho-somatic development increases
 contact with preschool’s community - contagious disease of childhood creates
favorable conditions for:
 teeth hypoplasia
 teeth hypocalcification
 caries (as consequences of dehydration and loss of minerals)
 from psycho-intellectual, behavioural and emotional point of view:
 at 4-5 years old – qualitative leap – bursts of questions and answers
 at the same age (4-5 y.o.) – the first emotional and behavioural negativism
(denying) crisis.
 from the dental point of view: in this period appears the temporary teeth’s
attrition (bluntness), which favors the 2
physiological mandible mesial
movement (2
occlusal mesialisation);
I I I . Third childhood (big childhood) =6/7 – 14/16 y.o.stage:
 initial development has a slow rithm
 8-9 y.o. is the age of some becoming permanent elements, concerning:
 temper
 child personality structure.

 from the dental point of view:
 temporary teeth root resorption and exfoliation
 coexistence of the temporary and permanent teeth
 period of teeth changing - instability in occlusal relation.
 the prepuberty stage (10-11/12 years):
 it is an “ungrateful age stage” [Maxim et al.]
 a crochet's development:
- for boys prevail statural growth
- for girls prevail weight growth
 very active metabolism: it is the period of accelerated internal
burns - insatiable hanger, peaks of polyphagia
 hormonal period, when general affections may occur
 this is the second psychological-behavioural-emotional
negativism stage.
I I I . Third childhood (big childhood) =6/7 – 14/16 y.o.stage:
I V. The puberty stage =14 – 16 y.o. stage
It is a passing stage from childhood to adolescence:
 appearance of secondary sexual character difference debut between sex (the
children’s morphology is typical for this stage)
 profound psycho-somatic transformation, which are reflected in behavior
 awareness of self personality
 from the dental point of view:
 sequential eruption of the permanent teeth may still continue;
 permanent teeth eruption finalizing (inclusion of the second molar may be
 the 2
(around 6 years the eruption of 1
permanent molar) and the 3

(around 12 years the eruption of 2
permanent molar) physiological
occlusion elevation (highest occlusion).
Wrong dental care habits during the mixed dentition may lead to:
 caries (symmetric caries with increased prevalence)
 gingivitis of eruption
 periodontal irritation events
 prepuberal periodontitis
 juvenile periodontitis
 transitory (self adjustments) or permanent dental alveolar-maxillary

This age stage is favorable for:
 establishing the correct habits and preoccupations concerning oral, nutritional
and functional hygiene.
I V. The puberty stage =14 – 16 y.o. stage
V. The adolescence (teenage) =16 – 20 y.o. age
It is a passing stage from puberty to young adult, characterized by:
 entirely development of the psychic characters
 residual growth which may occur
 “identity, individual autonomy and social insertion crisis”
[Maxim et al.]

VI . The young adult:
 the destiny develops in terms of emphasizing the independence and the
individual autonomy
 the individualization of a psycho-somatic equilibrium, more or less
harmoniously, between desires and reality.