"Pediatric dentistry "

Pediatric dentistry : is a field of dentistry that deals with children .

*we do same treatments that we do for adult but in a different way and because you deal with a child the way you talk to him & the way you start the treatment is reliable on a big art & science on behavior management. History taking ~ very simple & you must learn it for clinics as dr Saied in the 1st two months we will stay just taking history for the patient checked for us ~ 1- taking patient details : Name , age , date of birth , sometimes nickname for the child that help you as dr to deal with him , address , parent name , occupation (or called social demographic details) *well in clinic you will have a special form that we just fill on blank so we dont need to remember all these details 2- asking about chief complain : (why did patient come = the reason he came for ) for example : *pain on a certain side of patient mouth. *trauma the child fall on his teeth. *esthetic if the child not happy with his teeth even because of orthodontic treatment or color of teeth also if he have missing teeth. * functional defect . *check up .

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3- taking history of present component : for example: -painyou ask about side ,duration ,interval ,frequency ,factors that increase or decrease pain ,is it relief by analgesic or not ,it regress during day or night all these info taken because it help you to diagnose pulp status for example -esthetic - you ask what bother patient on his teeth -trauma- you ask where did trauma occur , when it occur , the cause & so on 4-Medical history : it is very IMPORTANT because sometimes it change the way of treatment like uncontrolled diabetes , immuncompromized patient which actually divided into two types genetically (IGg deficiency ) & secondary type like patient under radiography for example , also you ask parents if the child hospitalized before & the cause of hospitalization for example blood transfusion that mean to you as dentist your patient is at risk of blood transmitting disease such as HIV , actually in clinic a special form given to parents before the child enters clinic to tip the boxes about medical history for their child that your question on the clinic relined to what written on this sheet then you quickly reassure that if he take any medication or have allergy for example , some patient have to be under antibiotic for all their life like sickle cell anemia that mean to you as dentist he is at high dose of sugar all the time so you must do a procedure to avoid the risk of caries as using fluoride gel & teach him how to brush his teeth. 5- dental history : have he ever go to the dentist or not if it's a first visit to the child you want him to be happy & introduce the procedure to the child on a very pleasant way , you know that drilling is unpleasant to everyone so you must show him for example the slow speed pair put a paste on it & show the child how he can bullish his figure nail with it to show him how it is not harmful or Saied to him if he have an electronic tooth brush at home that this is me electronic tooth brush just to make him satisfied with my treatment , parent should stay with
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him on his first visit especially if he is under 6 years old , but if he is a regular visitor its less complicated procedure you just open the patient file & see where you stop last time & start ,also on the dental form of dental history we have to ask about the sort of treatment that the child take before so you know what experience he have before . 6- social data : where he live , if the house rented or owned , these info help you to know economic states of patient it help you on two ways if you work on private clinic it tell you if he can pay or not another is related to dental awareness sometimes when the patient is in a good economical states he may be more aware about his teeth so he will be happy to pay for some extra preventive procedures vs those who not aware enough they came just tell you plz remove that tooth & his pain!! but in this situation you are the dr you must do what it must done for this case & with time they will appreciate that you do the right thing .. so attitude for people is different.

Examination : intraoral & extraoral 1-extraorally : we examine the soft & hard tissue *the hard tissue : - look to the face from different position: lateral position to check the face profile [anteroposterier relationship ] which divided to , convex (most of children has a convex profile bcz they still growing the mandible will be smaller than the maxilla ) straight , concave (after puberty its genetically pure thing which depend on the way maxilla & mandible grow) . sagittal position which show the facial height ( from mid of eyeball to chin ) & the lower facial height (from tip of nose to
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chin) when the lower facial height increase & the mouth is open at rest position this called anterior open bite while if lower height decrease patient will have deep bite , also we have something called over bite (overlapping b/t incisal edge of upper & incisal edge of lower teeth ) . transverse or horizontal plane -cross bite : if the maxilla doesnt grow enough anteriorly , if it doesnt grow enough laterally we call it lateral or posterior cross bite & it can be unilateral or bilateral depend on the side which the maxilla grow to . -Scissor bite : if the maxilla grow so0o0o much more than normal . finally you palpate TMJ & facial bone generally . *the soft tissue : we take general look , little asymmetry b/t face sides is normal & acceptable , palpate lymph node (submental & submandibular) if they are tender,swallow or fixed vs mobile (for children mobile lymph nodes are acceptable bcz they have many infections just like tonsillitis at this age ) & finally lips we have competent lips which seal together vs incompetent lips (short upper lip) which form a gap b/t lips & need some force at the muscle to close the mouth also we have something called elevated lip the vermillion border of the lip upward (high) .

2- intraorally : hard & soft tissue. *the hard tissue: (teeth ) We just count them (20 teeth in primary dentition)& take a general look at hygiene for example.

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*the soft tissue: Gingiva check for inflammation, color of mucosa(must be red ) Loe Gingival index (the table not for memorizing )
Gingival Index (GI) Loe and Silness Assesses severity of gingivitis based on color, consistency & bleeding

normal

mild inflam, slight color change and edema, no bleeding

2 3

moderate inflam, redness, edema, bleeds on probing severe inflam, marked redness and edema, ulceration, spontaneous bleeding

Loe Oral hygine index ( all criteria & calculations for your knowledge not for memorizing but it good to look at them )

Scores 0 1 No plaque

Criteria

A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque may be seen in situ only after application of disclosing solution or by using the probe on the tooth surface. Moderate accumulation of soft deposit s within the gingival pocket, or the tooth and gingival margin which can be seen with the naked eye.
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Abundance of soft matter within the gingival pocket and/or on the tooth and gingival margin.

CALCULATION EXAMPLE:

The following example shows how to calculate the scores for the index. Assuming a tooth with the following scores on the four surfaces

Surface Buccal Lingual Mesial Distal

Scores 2 1 1 2

Plaque Index = (2+1+1+2) / 4 = 1.5, according to the plaque index system this means the plaque index for the tooth is moderate accumulation of soft deposit within the gingival pocket, or the tooth and gingival margin which can be seen with the naked eye. The indices for the following six teeth may be grouped to designate the index for the group of teeth: 16, 12, 24, 36, 32, 44. The index for the patient is obtained by summing the indices for all six teeth and dividing by six.

Orthodontic relation on permanent teeth mesiobuccal cusp of upper molar should go on the buccal groove of lower molar (class I ) anterior to this (class II) distal or posterior to this will be (class III).

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canine the tip of the canine should be in the embrasure b/t lower canine & first premolar (class I ) if it look anterior to this (class II ) posterior (class III ).

anterior teeth incisal edge of lower incisor should bite at cingulum of upper incisor (class I ) anterior to this (class II ) posterior (edge to edge class III ).

On primary molars we have a new relation called bomes molar relationship(terminal plane) you look from distal edge (plane ) of the upper molar crown & distal edge of lower molar either they coinside called termed plane or flush , if upper molar go anterior it will look like step called distal step if it go posterior the step will called mesial step . Note : on mixed dentition you check the primary & permenant relations .
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-The 1st lecture summary :

1- take patient history patient details , chief complain (pain ,trauma ,esthetic ,functional ,check up), history of present component , Medical history ,dental history ,social data. 2-examination : **extraorally **hard tissue << lateral position to check the face profile [anteroposterier relationship ] convex (most of children has a convex profile ) straight , concave. sagittal position which show the facial height ( from mid of eyeball to chin ) & the lower facial height (from tip of nose to chin) if increase < anterior open bite> if decrease <deep bite> , < over bite> (overlapping b/t incisal edge of upper & incisal edge of lower teeth ) . transverse or horizontal plane -cross bite : maxilla doesnt grow enough anteriorly , if it doesnt grow enough laterally we call it lateral or posterior cross bite ,Scissor bite : if the maxilla grow more than normal . palpate TMJ & facial bone . **the soft tissue :little asymmetry b/t face sides is normal , palpate lymph node , lips competent lips seal together vs incompetent (short upper lip) a gap b/t lips , elevated lip high vermillion border of the lip. 2- intraorally : **the hard tissue: (teeth # & hygine ) **the soft tissue: Gingiva ( inflammation& color) ,loe gingival & hygiene index , Orthodontic relation << permanent teeth molar mesiobuccal cusp of upper molar should go on the buccal groove of lower molar (class I ) anterior (class II) posterior (class III). canine the tip of the canine should be in the embrasure b/t lower canine & first premolar (class I ) anterior to this (class II ) posterior (class III ). anterior teeth incisal edge of lower incisor should bite at cingulum of upper incisor (class I ) anterior (class II ) posterior (edge to edge class III ).<<< primary molars we have a new relation called bomes molar relationship (terminal plane)

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-past year questions about this lecture :

Q1- while performing intra oral examination of occlusion in the anteroposterior dimension, the primary molar relationship is referred to as: a- class I, II, and III b- Mesial step, distal step, transverse step c- Flush, mesial step, distal step d- Increased or decreased overbite e- all of the above Q2- During examination of a child patient, facial profile should be examined in: a- anterior and posterior plane b- Both transverse and anteroposterior planes c- Anteroposterior, vertical; and transverse plane d- Anteroposterior and vertical planes e- None of the above Q3- a well balanced facial profile of an 8-year old child should have the following: a- slightly convex to straight profile b- Equal facial thirds c- Symmetrical d- Only a, and b e- all of the above

Q4- the relationship of the distal surfaces of the maxillary and mandibular 2nd primary molars is termed a- angle classification b- Terminal plane c- Skeletal relationship d- Crossbite e- None of the above
Done by : Salam Ahmed Al-Bataeineh

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