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Copyright 2003, Elsevier Science (USA). All rights reserved.
Pediatric DentistryPediatric DentistryChapter 57Chapter 57
Copyright 2003, Elsevier Science (USA).
All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher.
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Produced in the United States of America
ISBN 0-7216-9770-4
Copyright 2003, Elsevier Science (USA). All rights reserved.
IntroductionIntroduction Pediatric dentistry is the specialized area of
dentistry that is limited to the care of children from birth through adolescence, with particular focus on providing oral health care to patients with special needs.
Pediatric dentistry is the specialized area of dentistry that is limited to the care of children from birth through adolescence, with particular focus on providing oral health care to patients with special needs.
Copyright 2003, Elsevier Science (USA). All rights reserved.
The office should display cheerfulness, a pleasant environment with a nonthreatening decor.
Treatment areas are designed with an open bay concept.
Dental personnel dress in bright coordinating colors.
The office should display cheerfulness, a pleasant environment with a nonthreatening decor.
Treatment areas are designed with an open bay concept.
Dental personnel dress in bright coordinating colors.
The Pediatric Dental Office The Pediatric Dental Office
Copyright 2003, Elsevier Science (USA). All rights reserved.
Chronologic age• The child's actual age in terms of years
and months. Mental age
• The child's level of intellectual capacity and development.
Emotional age • The child's level of emotional maturity.
Chronologic age• The child's actual age in terms of years
and months. Mental age
• The child's level of intellectual capacity and development.
Emotional age • The child's level of emotional maturity.
The Pediatric Patient The Pediatric Patient
Copyright 2003, Elsevier Science (USA). All rights reserved.
Birth to age 2 • Children learn to sit, stand, walk, and
run. • Vocally, they progress from babbling to
using simple sentences. • Can identify familiar faces and progress
through periods of being friendly and then fearful of strangers.
• Too young to be expected to cooperate in dental treatment.
Birth to age 2 • Children learn to sit, stand, walk, and
run. • Vocally, they progress from babbling to
using simple sentences. • Can identify familiar faces and progress
through periods of being friendly and then fearful of strangers.
• Too young to be expected to cooperate in dental treatment.
Stages of Childhood Stages of Childhood
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Ages 3 to 5 years• This child needs to be allowed to
develop autonomy and initiative.• This child requires control and
structure in his or her environment.• Able to follow simple instructions. • Welcomes an active role in the
treatment experience.
Ages 3 to 5 years• This child needs to be allowed to
develop autonomy and initiative.• This child requires control and
structure in his or her environment.• Able to follow simple instructions. • Welcomes an active role in the
treatment experience.
Stages of Childhood cont’d Stages of Childhood cont’d
Copyright 2003, Elsevier Science (USA). All rights reserved.
Ages 6 to 11 years• Period of socialization. • Learning to get along with people.• Learning the rules and regulations of
society• Learned to overcome fears of objects
and situations.
Ages 6 to 11 years• Period of socialization. • Learning to get along with people.• Learning the rules and regulations of
society• Learned to overcome fears of objects
and situations.
Stages of Childhood cont’d Stages of Childhood cont’d
Copyright 2003, Elsevier Science (USA). All rights reserved.
Be honest with a child. Consider the child's point of view. Use “tell, show, do.” Give positive reinforcement.
Be honest with a child. Consider the child's point of view. Use “tell, show, do.” Give positive reinforcement.
Behavior Management Behavior Management
Copyright 2003, Elsevier Science (USA). All rights reserved.
The Difficult Patient The Difficult Patient Premedication
• Prescribed to calm and ease the patient prior to treatment.
Nitrous oxide oxygen• Method of mild sedation that can help
calm a patient for treatment. Physical restraint
• Used to prevent a possible injury to the child, dentist and or assistant.
Premedication • Prescribed to calm and ease the
patient prior to treatment. Nitrous oxide oxygen
• Method of mild sedation that can help calm a patient for treatment.
Physical restraint • Used to prevent a possible injury to
the child, dentist and or assistant.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Mental retardation • Mild mental retardation describes individuals
with IQs ranging from 50‑55 to 70. • Moderate mental retardation describes
individuals with IQs ranging from 35‑40 to 50‑55.
• Severe mental retardation describes individuals with IQs ranging from 20‑25 to 35‑40.
• Profound mental retardation describes individuals with IQs ranging from below 20 to 25.
Mental retardation • Mild mental retardation describes individuals
with IQs ranging from 50‑55 to 70. • Moderate mental retardation describes
individuals with IQs ranging from 35‑40 to 50‑55.
• Severe mental retardation describes individuals with IQs ranging from 20‑25 to 35‑40.
• Profound mental retardation describes individuals with IQs ranging from below 20 to 25.
Special Patients Special Patients
Copyright 2003, Elsevier Science (USA). All rights reserved.
Down syndrome• Also named trisomy 21. These
individuals have a chromosomal aberration that usually results in certain abnormal physical characteristics and mental impairment. The mental impairment may range from mild to moderate retardation.
Down syndrome• Also named trisomy 21. These
individuals have a chromosomal aberration that usually results in certain abnormal physical characteristics and mental impairment. The mental impairment may range from mild to moderate retardation.
Special Patients cont’d Special Patients cont’d
Copyright 2003, Elsevier Science (USA). All rights reserved.
Cerebral palsy is a nonprogressive neural disorder caused by brain damage that occurred prenatal, during birth, or postnatal before the central nervous system reached maturity. Characterized by paralysis, muscle weakness, lack of coordination, and other disorders of motor function.
Cerebral palsy is a nonprogressive neural disorder caused by brain damage that occurred prenatal, during birth, or postnatal before the central nervous system reached maturity. Characterized by paralysis, muscle weakness, lack of coordination, and other disorders of motor function.
Special Patients cont’d Special Patients cont’d
Copyright 2003, Elsevier Science (USA). All rights reserved.
Medical and dental history • Past hospitalizations and surgeries.• Date of child's last visit to the physician.• Medications, daily medications. • Unfavorable reaction to any medicine,
allergies. • Weight at birth and any problems at birth. • Level of learning. • Main concern about the child's dental health. • Finger, thumb, or pacifier habits. • Fluoride and toothbrush habits. • Inherited family dental characteristics.
Medical and dental history • Past hospitalizations and surgeries.• Date of child's last visit to the physician.• Medications, daily medications. • Unfavorable reaction to any medicine,
allergies. • Weight at birth and any problems at birth. • Level of learning. • Main concern about the child's dental health. • Finger, thumb, or pacifier habits. • Fluoride and toothbrush habits. • Inherited family dental characteristics.
Diagnosis and Treatment Planning Diagnosis and Treatment Planning
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Clinical examination• Radiographic examination• Extraoral examination• Intraoral soft tissue examination• Clinical examination
Clinical examination• Radiographic examination• Extraoral examination• Intraoral soft tissue examination• Clinical examination
Diagnosis and Treatment Planning cont’d Diagnosis and Treatment Planning cont’d
Copyright 2003, Elsevier Science (USA). All rights reserved.
Oral hygiene• Geared to improving a child's
brushing and flossing technique. Fluorides
• Children between 6 months and age 16 should take in fluoride daily.
Diet• Review specific nutrients a child
needs to grow.
Oral hygiene• Geared to improving a child's
brushing and flossing technique. Fluorides
• Children between 6 months and age 16 should take in fluoride daily.
Diet• Review specific nutrients a child
needs to grow.
Preventive Dentistry Preventive Dentistry
Copyright 2003, Elsevier Science (USA). All rights reserved.
Sealants • Applied to the teeth to help keep them
cavity-free. Oral/Facial development
• To identify malocclusion, crowded or crooked teeth, bite problems, and actively intervene.
Sports safety• Protective face equipment worn during
any recreational sport that might injure the mouth area.
Sealants • Applied to the teeth to help keep them
cavity-free. Oral/Facial development
• To identify malocclusion, crowded or crooked teeth, bite problems, and actively intervene.
Sports safety• Protective face equipment worn during
any recreational sport that might injure the mouth area.
Preventive Dentistry cont’d Preventive Dentistry cont’d
Copyright 2003, Elsevier Science (USA). All rights reserved.
Restorative• Amalgam• Composite
Endodontic procedures• Pulp capping• Pulpotomy
Prosthodontic procedures • Stainless steel crowns
Restorative• Amalgam• Composite
Endodontic procedures• Pulp capping• Pulpotomy
Prosthodontic procedures • Stainless steel crowns
Operative Procedures Operative Procedures
Copyright 2003, Elsevier Science (USA). All rights reserved.
Causes of dental injuries to children• Automobile accidents• Bicycle accidents• Sports injuries• Child abuse
Causes of dental injuries to children• Automobile accidents• Bicycle accidents• Sports injuries• Child abuse
Traumatic Injuries Traumatic Injuries
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 57-16 Educating school personnel about traumatic injuries. Fig. 57-16 Educating school personnel about traumatic injuries.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Types of InjuriesTypes of Injuries
Fractured anterior teeth Documentation of the accident includes:
• Clinical examination• Radiographs • Vitality testing
Fractured anterior teeth Documentation of the accident includes:
• Clinical examination• Radiographs • Vitality testing
Copyright 2003, Elsevier Science (USA). All rights reserved.
Traumatic intrusion• The tooth is forcibly driven into the
alveolus so that only a portion of the crown is visible.
Traumatic intrusion• The tooth is forcibly driven into the
alveolus so that only a portion of the crown is visible.
Types of Injuries cont’dTypes of Injuries cont’d
Copyright 2003, Elsevier Science (USA). All rights reserved.
Extrusion and lateral luxation• Teeth are actually displaced from
their position, causing damage to the periodontal ligaments.
• Displaced teeth repositioned.• Temporary splint placed.
Extrusion and lateral luxation• Teeth are actually displaced from
their position, causing damage to the periodontal ligaments.
• Displaced teeth repositioned.• Temporary splint placed.
Types of Injuries cont’dTypes of Injuries cont’d
Copyright 2003, Elsevier Science (USA). All rights reserved.
Avulsed teeth• The process of a tooth being torn
away, or dislodged completely by force.
• Recover the tooth immediately.• Wrap the tooth in a moistened
gauze. • Go immediately to the dentist's
office.
Avulsed teeth• The process of a tooth being torn
away, or dislodged completely by force.
• Recover the tooth immediately.• Wrap the tooth in a moistened
gauze. • Go immediately to the dentist's
office.
Types of Injuries cont’dTypes of Injuries cont’d
Copyright 2003, Elsevier Science (USA). All rights reserved.
Child abuse must be suspected when:• Injuries are in various stages of healing. • Chipped or injured teeth. • Scars inside the lips or on the tongue and tears of
the labial frena. • Battering or other injuries around the head and
neck. • Facial bruises, swelling of the facial structures, or
black eyes.• Bite marks.• Injuries not consistent with the explanation
presented by the parent.
Child abuse must be suspected when:• Injuries are in various stages of healing. • Chipped or injured teeth. • Scars inside the lips or on the tongue and tears of
the labial frena. • Battering or other injuries around the head and
neck. • Facial bruises, swelling of the facial structures, or
black eyes.• Bite marks.• Injuries not consistent with the explanation
presented by the parent.
Child AbuseChild Abuse
Copyright 2003, Elsevier Science (USA). All rights reserved.
Required information• The name, address, gender, age, height, and
weight of the child.• The name and address of the adult with custody
of the child. • A description of the current physical and
emotional abuse or neglect of the child. • Evidence of previous injuries or negligence.• Any information that may assist in establishing
the cause of the injuries.• Sketches or photographs documenting the nature
and location of the injuries.
Required information• The name, address, gender, age, height, and
weight of the child.• The name and address of the adult with custody
of the child. • A description of the current physical and
emotional abuse or neglect of the child. • Evidence of previous injuries or negligence.• Any information that may assist in establishing
the cause of the injuries.• Sketches or photographs documenting the nature
and location of the injuries.
Reporting Child Abuse Reporting Child Abuse