1. SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS

2. OBJECTIVES
Background
Conditions that occur in pediatrics
Treatment

3. BACKGROUND Preoperative evaluation: Behavioral management
History of presenting complaint
Medical history
Dental history
Examination
Behavioral management

4. 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

5. 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.

6. 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

7. 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

8. Mesiodens

9. 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.

10. Epstein Pearl and Dental Lamina Cyst
Treatment:
Reassure parents
Disappear during the first 3 months of life.

11. 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.

12. Neumann’s tumor

13. 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

14. 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.

15. 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

16. 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’

18. Riga-Fede disease

19. 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

20. THANK YOU