28 Pediatric Dentistry

2 Branch of dentistry that deals with children and patients with special needs

3 Pediatric Dental Office Pediatric dentists have special training in child growth, development, and behavior management. Treat children from birth through eruption of second molars Treat compromised adults Preventive treatment emphasized

4 Pediatric Dental Team Same as general dental office Staff needs to enjoy children

5 Role of the Dental Assistant Management of child Chairside work Educator

6 Behavior of Children at Different Ages Two to six years old –Likes playing –Likes being with parents and siblings –Able to respond to instructions –Short attention span –Feelings visible with facial expression –Parents very influential

7 Behavior of Children at Different Ages Age six to twelve –Asserts independence –Friends are important –Less difficult to manage –Aware of social groups and positions

8 Patient Management Tell, show, do Voice control Distraction Non-verbal communication Modeling Positive reinforcement Gentle restraints Hand-over-mouth Mild sedation General anesthesia

9 Patient Management Techniques Tell, show, and do

10 Role of Parents Best age is two to six years old Schedule before a problem occurs Let children watch other family members receive treatment Talk to child about visit before treatment

11 Role of Parents Have parent with best attitude toward dentistry bring child in for appointment Never transfer your phobias to child

12 Preventive Procedures Prophylaxis and fluoride treatment Sealants Fabricate sport guards Orthodontics: –Preventive and interceptive –Space maintainers –Crib appliance

13 Benefits of Sealants Prevent cavities from forming Act as a barrier to protect cavity-prone pits and fissures of teeth Cost-effective Painless Aesthetic Last five to seven years

14 Fluoride Treatments Tooth becomes more resistant to demineralization Assists in remineralization of enamel

15 Restorative Procedures Amalgams –Posterior teeth Composites –Anterior teeth Stainless steel crowns –Badly decayed teeth –Maintains space for permanent tooth

16 Indications for a Stainless Steel Crown Extensive decay Fractured tooth Need for space maintainer After pulpal therapy –Pulpotomy

17 Vital Pulp Therapy Indirect pulp treatment –Remove caries –Place medication –Temporize tooth

18 Vital Pulp Therapy Direct pulp capping –Remove caries –Place calcium hydroxide over exposed pulp –Temporary or permanent restoration placed

19 Vital Pulp Therapy Pulpotomy –Coronal portion of pulp removed –Radicular pulp remains

20 Indirect Pulp Capping Promote pulpal healing and stimulate reparative dentin Remove most decay –Place calcium hydroxide liner

21 Indirect Pulp Capping Place medicament (Formocresol) and temporary restoration zinc oxide- eugenol (ZOE) Retreat tooth in six to eight weeks Remove remaining decay

22 Cavity PreparationTemporary Restoration Indirect Pulp Capping Thin layer of dentin Medicament

23 Pulpotomy Sterile cotton pellet wetted with Formocresol solution Zinc oxide- eugenol cement

24 Nonvital Pulp Therapy Pulpectomy –Complete removal of the dental pulp –Followed by root canal treatment Extraction –May be necessary in extreme cases

25 Emergency Treatment Fractured teeth Traumatic intrusion –Tooth driven further into socket Displaced teeth Avulsed teeth –Tooth knocked out of mouth

26 Fractured Anterior Teeth Visit dentist X-ray Pulp testing Treat pulp Place temporary restoration Wait three to six months Permanent restoration if pulp heals

27 Traumatic Intrusion Tooth is forcibly driven into the alveolus Allow tooth to re-erupt May require endotreatment Permanent tooth may be damaged

28 Replacing an Avulsed Tooth Tooth is kept moist and site in mouth is examined Local anesthetic is administered X-rays are taken

29 Replacing an Avulsed Tooth Blood clot is removed from the alveolus Avulsed tooth is cleaned off in a saline solution –Inserted into alveolus

30 Replacing an Avulsed Tooth Splint is placed to retain the tooth in position Antibiotics, analgesics, and chlorhexidine rinses are prescribed Endodontic treatment may be required later

31 Forms of Child Abuse Physical Sexual Neglect Emotional

32 Possible Signs of Abuse Fractured teeth and jaw bones Lacerations around labial frenum Missing teeth Lack of personal hygiene Lack of dental treatment Bruises and scars Burn marks

33 Report to Child Protective Services Dental care professionals have a legal duty to report suspicions Nature of concern Description of injury

34 Report to Child Protective Services Clinical evidence –X-rays or photographs Patient’s and parent’s personal data Explanation given for injury Physician’s name

35 Indications for Sealants On occlusal pits and fissures of noncarious primary and permanent teeth On recently erupted teeth On patients with a high number of occlusal caries and deep fissures As preventive treatment

36 Contraindications for Sealants Teeth that have been carie-free for four or more years Teeth with shallow open grooves Teeth with well-coalesced pits and fissures Patients with occlusal decay or who have occlusal restorations

37 Role of the Dental Assistant Depending on the state practice act –Dental assistant will either assist dentist or place sealants themselves

38 Enamel Sealant Materials Dental composites Polymerization –Chemically cured –Light cured Acid etching and conditioning material

39 Placement of Enamel Sealants Children with newly erupted molars and premolars that are caries-free Partially erupted teeth may be sealed –Provided there is no a flap over occlusal surface that interferes with application