Introduction to

Paediatric
Dentistry
Yosra Abdelfatah Ali
 Contents
• Definition of paediatric dentistry
• The importance of the deciduous dentition
• How to start
o Dental home
o Anticipatory guidance/counseling
o History and examination
o Investigations
o Diagnosis
o Treatment plan
o Follow up
 Definition of Paediatric Dentistry
• Paediatric dentistry 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.
The Importance of the Deciduous Dentition

• Speech, smile and esthetics

• Articulation
• Mastication, feeding and nutrition
• Space maintainer for the permanent
• Proper alignment, spacing, and occlusion of the
permanent teeth
 How to start
• The first dental visit
• History
• Examination
• Diagnosis
• Treatment plan
• Follow up
• The AAPD recommends the child’s first visit to be no
later than age one, but preferably when the first
tooth erupts.
• By visiting the dentist at that time, a Dental Home
can be established and Anticipatory Guidance be
made part of the child’s total health care experience.
 Dental home
• The ongoing relationship between the dentist and
team and the patient, inclusive of all aspects of oral
health care delivered in a comprehensive,
continuously accessible, coordinated, and family-
centered way.
• Establishment of a dental home begins no later than
12 months of age
• Evidence-base oral health care including acute care and
preventive services.
• Comprehensive assessment for oral diseases and conditions.
• Individualized preventive dental health program based upon a
caries-risk assessment and a periodontal disease risk
assessment.
• Anticipatory guidance regarding growth and development.
• Management of acute/chronic oral pain and infection.
• Management of and long-term follow-up for acute dental
trauma.
• Information about proper care of the child’s
teeth and gingivae, and other oral structures.
This would include the prevention, diagnosis,
and treatment of disease of the supporting
and surrounding tissues and the maintenance
of health, function, and esthetics of those
structures and tissues.
• Dietary counseling.
• Referrals to dental specialists when care
cannot directly be provided within the dental
home
• Education regarding future referral to a
dentist knowledgeable and comfortable with
adult oral health issues for continuing oral
health care.
 Anticipatory guidance/counseling
• Anticipatory guidance is the process of providing practical
developmentally appropriate information about
children’s health to prepare parents for the significant
physical, emotional, and psychological milestones.
• Individualized discussion and counseling should be an
integral part of each visit.
Topics to be included
• Oral hygiene and dietary habits
• Injury prevention
• Non-nutritive habits
• Substance abuse
• Intraoral/perioral piercing
• Speech/language development
History and examination
• Basic patient information
• Medical history
• Dental history
• Clinical assessment
• Caries risk assessment
• Informed consent and documentation
• Diagnosis
• Treatment plan
• Progress notes
 Basic patient information
• Personal Data: • School / kindergarten and
• Name educational level
• Nickname • Grade
• Date of birth • Number of siblings
• Age • Child no.
• Gender • Father and mother education
• Residence and phone number • Name of referring party
Chief complaint
• What is the reason for the patient to
visit the dentist?
• Recorded in the patient's own words
• Gives rise to differential diagnosis
• Determines urgency of treatment
• Confirmed by examination and special
tests
• Pain
• Onset , site, duration, severity, nature,
exacerbating factors, relieving factors,
sleep interference, provoked
/spontaneous.
• Swelling
• Onset, contour (regular, irregular), site,
size, pain, surface (smooth, rough),
shape, tenderness, temperature
• Trauma
 Medical history
Prenatal /natal/postnatal history
• Prenatal history (mother health,
medication, pregnancy duration)
• Birth details and complications (mother,
infant)
• Postnatal history (developmental
milestones, speech, feeding habits,
traditional treatment, injuries, illness)
• Vaccination
Systems review
• Cardiovascular, Respiratory, Gastrointestinal
, Cerebrovascular, Endocrine,
Hematological, Immunological, Allergies
• Hospitalization(when, reason, age, how
long)
• Current medication
• Family history
Dental history
• Previous dental visit, how many times,
reason
• Cooperation level
• Home care and oral hygiene: brushing,
flossing frequency, supervised/ assisted,
technique
• Fluoride use/exposure history
• Dietary habits: breast feeding/bottle
feeding/no-spill training, snacks, meals,
beverages –type, amount and frequency
• Habits (biting, lip/finger sucking, bruxism,
tongue thrusting, mouth breathing, other)
duration, frequency
Clinical examination
• General health/growth assessment
• Extra-oral examination
• Intra-oral examination
• Radiographic assessment
• Caries risk assessment
• Assessed behaviour of child
 General examination

• General physical assessment

should be undertaken
• Height and weight
• Child’s overall health
 Extraoral examination
• Extra-oral examination:
Skull, Facial Symmetry, Facial Profile,
Lymph Nodes,
Hair, Skin, Eyes, Ears,
Nose, Nails, TMJ
• Other findings
Facial profile
Tempomandibular joints
Before any examination of the
temporomandibular joints is carried out the
patient should be asked about symptoms.
• The joints should be palpated simultaneously
by placing the middle finger over the condylar
head whilst the patient is instructed to open
and close and to move laterally.
• Any clicks, crepitus, and locking should be
recorded.
• Path of closure
Intraoral examination
Intra-oral soft tissue examination
• Lips
• Vestibule, Mucosa, Gingiva
• Hard and soft palate
• Tongue
• Frenulae
• Floor of mouth
• Tonsils/pharynx
 Soft tissues
Soft tissue: color ,contour, consistency, size, location,
extent and shape
Lips
• The form, tonicity and fullness of the lips
• Lip competence
• Lower lip position relative to the upper incisors
• The length of the upper lip and amount of
upper incisor shown.
• Oral hygiene index or score and periodontal
assessment
• Plaque, Calculus
• Gingival health, including an index or score
• Bleeding, Probing of pocket depth, Recession,
Furcation involvement
 Teeth examination
• Teeth present :structure, number ,size ,shape,
color, eruption, and mobility
• Dentition status: primary dentition (spaced
dentition non spaced crowded), mixed dentition
(early mixed, late mixed), or permanent
dentition
• Developing occlusion, occlusion discrepancy,
molar/ canine relationships
• Alignment, overjet, overbite, midline, crossbite
• Caries, restorations, fissure sealants, tooth
surface loss, traumatic injuries
• Influence of oral habits
• Appliances present
 OCCLUSION
• Deciduous dentition
– Mesial step
– Distal step
– Flush terminal plane

• Permanent teeth
– Skeletal pattern
– Molar relation
– Overbite/overjet
 Deciduous teeth numbering
system

Palmer’s notation system:

FDI 2-digits teeth numbering system:

 Use FDI system
• Permanent teeth Quadrant number 1,2,3and4 clock
wise then we add the tooth number
• Deciduous teeth quadrant number 5,6,7 and 8
clock wise then we add the tooth number
 Risk assessment

• Caries-risk assessment
• Trauma-risk assessment
• Periodontal Disease
• Erosion
Caries-risk assessment

• AAPD
Trauma-risk assessment
• Increased overjet > 9 mm
• Contact sport
• Previous dental trauma
• Motor disabilities
• Neurological disabilities
• Age: 1-2 and 8-10
• Gender: boys > girls.
 Investigations
• Radiographs
• Pulp sensibility: in case of dental trauma,
includes:
-Thermal (cold test with ethyl chloride,
warm test with heated gutta-percha,
electrical pulp test).
-Transillumination test: caries detection,
trauma, enamel infraction.
 Investigations
• Radiographic examination
• Percussion, mobility, sensibility
• Caries activity tests: diet history, salivary flow
rate, buffering capacity and streptococcus
mutans.
• Histopathology
• Study models
• Photographs
• Blood tests
• Microbiological investigations
Radiographic examination
• Bite-wing radiographs
• Periapicals radiographs
• Panoramic radiographs
• Occlusal films
• Extra-oral facial films
• Others
• Computerized axial tomography.
• Magnetic resonance imaging.
Radiographic examination
• Developmental anomalies
• Eruptive patterns/tooth positions/root
resorption
• Crestal alveolar bone level
• Pulpal/furcation/periapical pathology
• Caries presence, proximity to pulp,
demineralization/ remineralization
• Existing pulpal therapy/restorations
• Traumatic injury
• Explanation of inability to obtain diagnostic
image when indicated
 Diagnosis

• Provisional diagnosis
• Deferential diagnosis
• Final diagnosis
 Treatment Plan

• Emergency ,immediate treatment

• Preventive: Oral hygiene practice, diet

counseling, topical fluoride application,
fissure sealants, and parents and
patient education and motivation
 Treatment Plan

• Child management
• Patient and parents education and
motivation
• Oral hygiene instruction
• Emergency treatment

• Preventive: Oral hygiene practice, diet

counseling, topical fluoride application,
fissure sealants, and parents and
patient education and motivation
• Restorative treatment and Pulp therapy
Start with the teeth with priority, pulp
therapy or carious permanent molars
• Surgical procedures
• Orthodontic
• Prosthodontic and space maintenance
• Follow up visits
 Follow up

• Oral health check up

• Caries activity tests
• Reinforcement of home care measures
• Motivation and re-counseling of the
parent
• Follow up of treatment procedures
Thank you