1. Introduction to Paediatric Dentistry
Dr. Lamis Elsharkasi

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

3. 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

4. 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

5. 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)

6. 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 years.

7. 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

8. 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

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

10. Paediatric triangle
Child
Dentist
Parents

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

12. 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

13. 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.

14. 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.

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

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

17. 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

18. Malocclusion
Mixed dentition
Early loss of primary teeth
habits

19. 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

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

21. 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