PEDODONTICS 1-1 Dr. Abdullah Abumoamar

Introduction

Introduction Starting ? Age ?

Introduction Pedodontics is a specialized subject that deals with the management of oral and dental problems in children. Pedodontists are specialists who have mastered these skills and are in a position to manage children

Introduction It is a challenging venture where only few dare to go. Pedodontists are in an excellent position to alter the growth pattern and improve the resistance to diseases, as he or she deals with children during their formative periods. Managing and convincing a child as a patient for any dental procedure requires extra effort

Introduction DEFINITION : According to the American Academy of Pediatric Dentistry (AAPD) and Approved by the Council on Dental Education, American Dental Association (1995) : ( Pediatric dentistry is an age-defined specialty that provides both primary and specialty,comprehensive, preventive and therapeutic oral health care for infants and children through adolescence including those with special health care needs )

Introduction Pedodontics First textbook describing the dental problems and management for children was published in the year 1924.

Introduction The American Society for the Promotion of Dentistry for Children was established at Detroit in the year 1927. The name was later changed to American Society of Dentistry for children in the year 1940. The American Academy of Pedodontics was started in the year 1947 and later in the year 1984 was changed to American Academy of Pediatric Dentistry

Introduction List of some of the pedodontic associations : American Academy of Pediatric Dentistry (AAPD) British Society of Pediatric Dentistry (BSPD) International Association of Pediatric Dentistry (IAPD ) Indian Society of Pedodontic and Preventive Dentistry (ISPPD)

Introduction Pedodontics and related Journals : -Journal of Dentistry for Children -International Journal of Pediatric Dentistry -Journal of Clinical Pediatric Dentistry -Journal of Dental Traumatology

Introduction AIMS AND OBJECTIVES OF PEDODONTIC PRACTICE : 1- The services rendered to the child must be focused from the point what is best for the child at that moment and also for the adult into whom the child will eventually grow. ( need restoration now )

Introduction AIMS AND OBJECTIVES OF PEDODONTIC PRACTICE : 2- The child should be treated as a whole. Effort must be made for the general and oral health to be in accordance with each other. (Not only pain )

Introduction AIMS AND OBJECTIVES OF PEDODONTIC PRACTICE : 3- Prevention of oral diseases must be the prime motive and should begin if possible from before the birth, directing the expectant mothers.

Introduction AIMS AND OBJECTIVES OF PEDODONTIC PRACTICE : 4- Educating parents regarding importance of deciduous teeth, dental treatment and preservation of teeth.

Introduction AIMS AND OBJECTIVES OF PEDODONTIC PRACTICE : 5- Developing dentition and jaws should be observed regularly so that any developing malocclusion can be intervened at the right time. (Serial extraction)

Introduction AIMS AND OBJECTIVES OF PEDODONTIC PRACTICE : 6- Relief of pain and sepsis forms one of the main theme of a care provider. 7- To achieve and maintain esthetics.

Introduction AIMS AND OBJECTIVES OF PEDODONTIC PRACTICE : 8- Improving personal information data bank is very important and can be done thorough updating of both clinical and theoretical knowledge on a regular basis.

Introduction SPECIFIC DIFFERENCES BETWEEN CHILD AND ADULT PATIENTS : Child is in a dynamic state of growth and development and is thus a changing person. The differences between a child and an adult are obvious. But there also exists significant difference between a 2-year and a 13-year-old child. Therefore, a child is unique and different at each stage of his or her pediatric life.

Introduction SPECIFIC DIFFERENCES BETWEEN CHILD AND ADULT PATIENTS : Three general areas in which pediatric patients are unique compared to the adults are: 1. Physiologic and anatomic differences 2. Pharmacokinetics 3. Emotional differences

Introduction Physiologic and anatomic differences A- Body Size 1- Less amount of drug is needed to reach an effective plasma level but less is also needed to produce toxicity in children due to small body size.

Introduction Physiologic and anatomic differences A- Body Size 2- Height and weight of children are less than that of adults, their proportions also differ from adults. 3- Smaller the patient, the higher is the basal metabolic rate, oxygen consumption and fluid requirement per hour

Introduction Physiologic and anatomic differences B- Body Fluids 1- Children have larger volume of total body water (TBW). Child’s TBW is 80% of body weight and that of an adult’s is 50-60%. This has direct bearing on pharmacokinetics of water soluble medications. Because these drugs are distributed to a relatively larger volume once absorbed, a larger dose is necessary to achieve therapeutic effect in a small child.

Introduction Physiologic and anatomic differences B- Body Fluids 2- Total body fat also varies: Fat content in a premature infant is about 1% of the body weight, whereas a full-term infant’s body fat is about 16% of the body weight. In a one year old it forms 22% of body weight, four year old 12% and in 10-11 years it forms 18-20% of body weight

Introduction Physiologic and anatomic differences B- Body Fluids The child with the smaller percentage of body fat thus requires a smaller dose of a lipid soluble drug. Lipid soluble drugs such as barbiturates and diazepam may require higher dosage in an obese child as most of it will be distributed to fat tissues, therefore, decreasing their effective plasma levels.

Introduction Physiologic and anatomic differences C - Respiratory System : Respiratory rate of the child is higher due to higher metabolic rate , thus requiring greater oxygen consumption and carbon dioxide production.

Introduction Physiologic and anatomic differences C - Respiratory System : Respiration rate Newborn—30-60/min 1 year—20-35/min 5-year—20-25 /min 15-year—15-20 /min Adult—12-20/min

Introduction D- Cardiovascular System : Relative blood volume in children is greatest at birth and decreases with age. - In a newborn, it is 85 ml/kg and in adult it is 70 ml/kg. - Heart rate is highest in infants.

Introduction D- Cardiovascular System : Heart rate is highest in infants. Heart rate Newborn—115-170/min 1 year—90-135/min 5-year—80-120 /min 15-year—70-100 /min Adult—70/min

Introduction D- Cardiovascular System : Systolic blood pressure Newborn—60-75 mm/Hg 1 year—96 mm/Hg 5-year—100 mm/Hg 15-year—120 mm/Hg Adult—120-125 mm/Hg

Introduction Emotional differences : 1- The major difference between the treatment of children and an adult is the treatment relationship. Treatment relationship between the dentist and the adult patient is one to one whereas in case of a child patient there is a one to two relationship, with the child being the focus of attention of the dentist as well as the parent.

Introduction Emotional differences : This is represented by the pedodontic treatment triangle as given by Wright :

Introduction Emotional differences : The child occupies the apex of the triangle and is the focus of attention of both the dentist and the parent. All the three are interrelated and the arrows denote that the communication is reciprocal. Recently society has been added, meaning that the influence of the society on the child has to be considered affecting the treatment modalities.

Introduction Emotional differences : 2- Children exhibit a fear of the unknown 3- They do not know to rationalize

Introduction Emotional differences : 4- Behavior management modalities differ, depending on the age and understanding. 5- Children have less concentration time. Therefore, treatment time should be restricted to not more than 20-30 minutes

Introduction Emotional differences : 6- Treatment appointments should be preferably given during the morning time and avoided during their nap time. 7- Adult patient seeks treatment by his own will, but the child patient visits the dentist usually by the will of his parents.

Introduction AIMS AND OBJECTIVES OF PEDODONTIC PRACTICE : 8- Improving personal information data bank is very important and can be done thorough updating of both clinical and theoretical knowledge on a regular basis.

REFERENCES

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