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DR. NOEL V. VALLESTEROS President Elect, Philippine Pediatric Dental Society Inc. Executive Director, Pediatric Dentistry Center Philippines
The specialty of Pediatric Dentistry is the practice and teaching of and research in comprehensive preventive and therapeutic oral health care of children from birth through adolescence. It shall include care for special patients beyond the age of adolescence who demonstrate mental, physical and/or emotional problems.
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We recognize that providing both primary and comprehensive preventive and therapeutic oral health care to individuals with special health care needs (SHCN) is an integral part of the specialty of pediatric dentistry. Individuals with SHCN may be at an increased risk for oral diseases throughout their lifetime. AAPD Reference Manual 2013 Oral diseases can have a direct and devastating impact on the health and quality of life of those with certain systemic health problems or conditions.
t a h t s t s e g g u s y l g n i s a e l r a c t n n i e e d c g n n i t n e v Evide e r p t a l u f s s e c c u n s i e g e b t to b s u m s t s i t e n h e t d n , i e h s t i w s disea n o i t n e v r e t n i e v i t n e v e r p . e f i l f o r a e y t s r i f
AAPD 2011
E T A L O O T S I TWO
DENTIN CARIES
PULP CARIES
Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in both the temporary and permanent teeth.
Bethesda, MD, 1997 Conference on ECC
Upper Tooth Central Incisor Lateral Incisor Canine First Molar Second Molar Lower Tooth Central Incisor Lateral Incisor Canine First Molar Second Molar
When It Arrives When It Leaves (Month) (Year) 7.5 9 18 14 24 When It Arrives (Month) 6 7 16 12 20 7 8 11 9 11 When It Leaves (Year) 6 7 10 9 10
CARIES
FOOD
BACTERIA (PLAQUE)
SUGAR
ACID
DEMINERALIZATION
TOOTH DECAY
REMINERALIZATION
DEMINERALIZATION
DENTAL CARIES
is a dietary-carbohydrate and saliva-modified infectious bacterial disease
Remineralization (Saliva is the sole source of Calcium and Phosphate essential for rebuilding hydroxyapatite structures.) Protection against demineralization Buffering acidic challenges (bicarbonate in stimulated saliva) Flushing the oral cavity
In Western civilization, infants generally are weaned from the breast or bottle by 1 year of age.
(Illingsworth 1975; Rudolph 1977)
Problems of
Dental disease was found to have an impact on childrens well being. There was a significant change in complaint of pain, eating preferences, quantity of food eaten, and sleep habits before and after treatment of dental caries.
( Low et al. 1999)
PAIN
Comprehensive dental rehabilitation resulted in catch-up growth, such that children with a history of nursing caries no longer differed in percentile weights from comparison patients.
(Acs et al. 1999)
INFECTION
MALOCCLUSION
PREMATURE LOSS OF PRIMARY TEETH
Arch length deficiency can produce or increase the severity of malocclusions with crowding, rotations, ectopic eruption, crossbite, excessive overjet, excessive overbite, and unfavorable molar relationships.
Children are hard to manage. More dentists are afraid of children ? T than children afraid of dentists. N ME Oral rehabilitation is difficult. Pediatric dental treatment is expensive.
T A E R T O N
FLUORIDE
Reduction in acid solubility of enamel Remineralization of early carious lesions Increase in the rate of post-eruptive enamel maturation Inhibition of acid formation by plaque bacteria
O P S E T I H W E H T
V E R T is
! E L B I S R E
Lesions as white spots and dentine caries can be remineralized and healed with fluoride.
ten Cate 2001
Fluoride Varnish Application for Nursing Caries Prevention applied at 9 mos. of age reapplied every 6 mos. up to 3 years of age.
1. TIMING
Primary anticaries effect of fluoride is topical (post eruptive).
Burt BA, Eklund SA, 1999
Best choice is the toothpaste with 1000 to 1500 ppm free fluoride.
FDI and WHO Recommendation
Current best practice includes recommending twice daily use of a toothpaste containing 1000 ppm F for children in optimally fluoridated and fluoride deficient communities
500-700 ppm F
Ice cream-, candy- flavored toothpastes should NOT be used for children.
WHO , 1994
NON-FLUORIDE TOOTHPASTES?!
Plaque removal by toothbrushing alone or with unfluoridated toothpaste is not effective in caries reduction.
Sutcliffe, 1996
Knee-toKnee Position