Introduction to Paediatric Dentistry Dr. Lamis Elsharkasi

Outlines Definition of Paediatric dentistry Objectives of Paediatric dentistry Importance of primary teeth Problem list in paediatric patients Most common dental diseases in children

Definition of Paediatric dentistry Paediatric dentistry: is an age-defined speciality 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 academy of paediatric dentistry 1999) Age defined: most specialities are procedure defined (endodontic, periodontics, etc) paediatric dentists provide care for their specific age group of patients . There is no limitation to what type of treatment hey provide

Paediatric dentistry is the most complex field of dentistry Need to know: Restorative dentistry, endodontic, oral surgery, preventive and interceptive orthodontic, the principle of prosthodontics, basic in paediatric medicine, general and oral pathology and growth and development, understanding the children`s emotional and psychological needs

Objectives of Paediatric dentistry Promoting optimal oral health by prevention and education Giving comfort, relieving pain, removing infection and restoring functions. Implement the principle of preventive dentistry from birth Early diagnosis of disease and treatment To develop a positive attitude and behaviour towards oral health Parental guidance and counselling regarding different facets of preventive dentistry and treatment modalities Managing children with special needs(physically, mentally and medically)

Why are primary teeth important?? Help in proper chewing and eating Speech development Appearance A child who can chew easily, speak clearly and smile confidently is a happier child Healthy primary teeth allow normal development of jaw bone and muscles, saves space for the permanent teeth and guide them to place Decayed primary teeth can cause pain, abscesses, infections which can spread to permanent teeth. General health can be affected if not treated Some Primary teeth are not replaced until the age of 10-13 years.

What should dentist do Examine Identify the problems Diagnose Treat/ prioritize treatment/ organize- sequence Prevent Educate follow In examination : use the complete medical and dental history radiographs and clinical examination appropriate treatment is planned

Problem list Socioeconomic Economic Guardianship Motivation Positive Seeks only urgent care Medical Allergies Compromising conditions Dental Pain Oral lesions- abscesses Developmental abnormalities Extensive Dental caries

Problem list Occlusion Alignment Premature loss Space management Behaviour/ fear/ anxiety Home care Aesthetic concerns Risk factors

Paediatric triangle Child Dentist Parents

Most common dental diseases in children Dental caries/ ECC Trauma Habits Malocclusion Supernumerary teeth

Early childhood caries Is the presence of 1 or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger. In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC) Nursing bottle caries Rampant caries

Nursing bottle caries Prolonged use of bottle at bed time containing: Milk Juice Soft drink Formula Early stage appear as chalky white– brown staining and enamel could be eroded or pitted Pulpal involvement of selected teeth A key feature of nursing caries is the usual absence of decay of the mandibular incisors, thus differentiating this condition from classical rampant caries.

Rampant caries The distinguishing features of rampant caries are: (1) many teeth are involved (2) lesion development is rapid (3) carious lesions occur on surfaces generally considered to be at low risk to decay, such as proximal surfaces of mandibular anterior teeth, facial surfaces of maxillary anterior teeth, and lingual surfaces of posterior teeth.

Dental trauma Primary teeth: Maxillary centrals most commonly affected Male= female Luxation commonest 2-4 years peak incidence

Dental trauma Permanent teeth: Maxillary central most commonly affected Male > female Uncomplicated crown # commonest 8-10 year peak incidence

Supernumerary teeth 2% adult population Very low prevalence in primary Male: female 2:1 Most commonly in premaxilla Conical mesiodens represents 75% of all sn teeth Natal – neonatal teeth – only 10% are supernumerary teeth Rationale for treatment: Poor aesthetic Malocclusion Pathology

Malocclusion Mixed dentition Early loss of primary teeth habits

Sucking habits Dummies or pacifiers have little effects on the dentition compared with thumb sucking which tend to be more detrimental to the dentition and more persistent where they continue into mixed dentition. The effect of thumb sucking depends upon the duration. Reminder Habit breaking appliance Child wants to stop

Treatment plan “ the foundation upon which the prevention and rehabilitation superstructure is constructed” Taking in consideration: Caries risk Treatment options Behaviour age

Advantages of treatment plan Diagnostic decisions are made at one time, no diagnosing at each apt. Saves chair time Permits the clinic and family to arrange a serious of apt in the correct time frame