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Published bySimon Dalton Modified over 9 years ago
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SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS
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OBJECTIVES Background Conditions that occur in pediatrics Treatment
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BACKGROUND Preoperative evaluation: Behavioral management
History of presenting complaint Medical history Dental history Examination Behavioral management
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Growth and Development
Injuries may have adverse effect to growth E.g. Injuries to the mandible: Ankylosis Limited mandibular functions Restricted growth Surgery for acquired/congenital anomalies may tamper with growth. Cleft Palate repairs cause palatal scarring resulting in maxillary constriction
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Maxillofacial Infections
Vary according to age: < 5 yrs Upper face infections: non-odontogenic >5 yrs lower face infections : odontogenic Treatment Non-odontogenic infections: Broad spectrum antibiotics and hydration Odontogenic infections: Antibiotics, hydration, drainage, treat underlying dental pblm odontogenic whose primary cause is dental in origin non-odontogenic infections include systemic infections with oral manifestations.
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Impacted Teeth Impacted Canines 2nd most impacted tooth
Treatment is by extraction of the primary canine (normal space and no incisor resorption) No improvement in canine position in a year, surgical and orthodontic treatment
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Supernumerary Teeth Mesiodens Most common supernumerary Treatment
No surgery for non-erupting primary mesiodens (damage to succedeneous tooth) Mixed dentition extract the mesiodens ensure 2/3rd of root formation of incisor Allow erupted primary mesiodens to shed
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Mesiodens
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Pediatric Oral Pathology
Epstein’s pearls Found in the median palatal raphe area Due to trapped epithelial remnants along the line of fusion of the palatal halves. Dental lamina cysts, Found on the crests of the dental ridges, most commonly seen bilaterally in the region of the first primary molars. From remnants of the dental lamina. They are both asymptomatic 1 mm to 3 mm nodules. Smooth, whitish in appearance, and filled with keratin.
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Epstein Pearl and Dental Lamina Cyst
Treatment: Reassure parents Disappear during the first 3 months of life.
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Congenital epulis of the newborn/ granular cell tumor / Neumann’s tumor,
Rare benign tumor seen only in newborns. Protuberant mass arising from the gingival mucosa. Found on the anterior maxillary ridge. Patients typically present with feeding and/or respiratory problems. Treatment: surgical excision.
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Neumann’s tumor
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Eruption cyst (eruption hematoma)
Soft tissue cyst that results from a separation of the dental follicle from the crown of an erupting tooth. Fluid accumulation occurs within this created fol-licular Most commonly found in the mandibular molar region. Color range from normal to blue-black or brown
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Eruption Cyst Difference from hemangiomas
Hemangiomas may undergo a rapid growth phase in the first year of life but then regress spontaneously. Eruption cysts resolve with eruption of the tooth.
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Natal and Neonatal Teeth
Natal teeth: teeth present at birth Neonatal teeth: erupt during the first 30 days of life Teeth most affected:mandibular primary incisors. In most cases they are part of the normal complement of the dentition
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Treatment Riga-Fede disease
Reassure parents Preserve and maintain in a healthy condition unless excessively mobile or causes feeding problems Monitor Closely Riga-Fede disease Caused by the natal or neonatal tooth rubbing the ventral surface of the tongue during feeding leading to ulceration. Treatment : conservative :Create round, smooth incisal edges If it does not correct: extraction is the treatment of choice to avoid ‘failure to thrive’
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Riga-Fede disease
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REFERRENCES AAPD. Guideline on Pediatric Oral Surgery. Reference Manual :6; AAOMS. Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgery. Journal of Oral and Maxillofacial Surgery Cawson R.A. and Odell E.A. Essentials of OralPathology and Oral Medicine. 7th Edition. Churchill Livingston Publishers
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