Chapter 57

Pediatric Dentistry
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Introduction
Pediatric dentistry is the specialized area of dentistry that is limited to the care of children from birth through adolescence, with particular focus on providing oral health care to patients with special needs.

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The Pediatric Dental Office

The office should display cheerfulness, a
pleasant environment with a nonthreatening decor. Treatment areas are designed with an open bay concept. Dental personnel dress in bright coordinating colors.

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The Pediatric Patient

Chronologic age
The child's actual age in terms of years and months. Mental age The child's level of intellectual capacity and development. Emotional age The child's level of emotional maturity.

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Stages of Childhood
Birth to age 2
Children learn to sit, stand, walk, and run. Vocally, they progress from babbling to using simple sentences. Can identify familiar faces and progress through periods of being friendly and then fearful of strangers. Too young to be expected to cooperate in dental treatment.

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Stages of Childhood- contd

Ages 3 to 5 years
This child needs to be allowed to develop autonomy and initiative. This child requires control and structure in his or her environment. Able to follow simple instructions. Welcomes an active role in the treatment experience.

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Stages of Childhood- contd

Ages 6 to 11 years
Period of socialization. Learning to get along with people. Learning the rules and regulations of society Learned to overcome fears of objects and situations.

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Behavior Management

Be honest with a child. Consider the child's point of view. Use tell, show, do. Give positive reinforcement.

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The Difficult Patient

Premedication
Prescribed to calm and ease the patient prior to treatment. Nitrous oxide oxygen Method of mild sedation that can help calm a patient for treatment. Physical restraint Used to prevent a possible injury to the child, dentist and or assistant.

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Special Patients

Mental retardation Mild mental retardation describes individuals with IQs ranging from 50-55 to 70. Moderate mental retardation describes individuals with IQs ranging from 35-40 to 50-55. Severe mental retardation describes individuals with IQs ranging from 20-25 to 35-40. Profound mental retardation describes individuals with IQs ranging from below 20 to 25.

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Special Patients- contd

Down syndrome
Also named trisomy 21. These individuals have a chromosomal aberration that usually results in certain abnormal physical characteristics and mental impairment. The mental impairment may range from mild to moderate retardation.

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Special Patients- contd

Cerebral palsy is a nonprogressive neural
disorder caused by brain damage that occurred prenatal, during birth, or postnatal before the central nervous system reached maturity. Characterized by paralysis, muscle weakness, lack of coordination, and other disorders of motor function.

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Diagnosis and Treatment Planning

Medical and dental history
Past hospitalizations and surgeries. Date of child's last visit to the physician. Medications, daily medications. Unfavorable reaction to any medicine, allergies. Weight at birth and any problems at birth. Level of learning. Main concern about the child's dental health. Finger, thumb, or pacifier habits. Fluoride and toothbrush habits. Inherited family dental characteristics.

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Diagnosis and Treatment Planningcontd

Clinical examination
Radiographic examination Extraoral examination Intraoral soft tissue examination Clinical examination

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Preventive Dentistry
Oral hygiene
Geared to improving a child's brushing and flossing technique. Fluorides Children between 6 months and age 16 should take in fluoride daily. Diet Review specific nutrients a child needs to grow.

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Preventive Dentistry- contd

Sealants
Applied to the teeth to help keep them cavity-free. Oral/Facial development To identify malocclusion, crowded or crooked teeth, bite problems, and actively intervene. Sports safety Protective face equipment worn during any recreational sport that might injure the mouth area.

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Operative Procedures
Restorative
Amalgam Composite Endodontic procedures Pulp capping Pulpotomy Prosthodontic procedures Stainless steel crowns

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Traumatic Injuries
Causes of dental injuries to children
Automobile accidents Bicycle accidents Sports injuries Child abuse

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Fig. 57-16 Educating school personnel about traumatic injuries.

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Types of Injuries
Fractured anterior teeth Documentation of the accident includes:
Clinical examination Radiographs Vitality testing

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Types of Injuries- contd

Traumatic intrusion
The tooth is forcibly driven into the alveolus so that only a portion of the crown is visible.

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Types of Injuries- contd

Extrusion and lateral luxation
Teeth are actually displaced from their position, causing damage to the periodontal ligaments. Displaced teeth repositioned. Temporary splint placed.

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Types of Injuries- contd

Avulsed teeth
The process of a tooth being torn away, or dislodged completely by force. Recover the tooth immediately. Wrap the tooth in a moistened gauze. Go immediately to the dentist's office.

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Child Abuse
Child abuse must be suspected when:
Injuries are in various stages of healing. Chipped or injured teeth. Scars inside the lips or on the tongue and tears of the labial frena. Battering or other injuries around the head and neck. Facial bruises, swelling of the facial structures, or black eyes. Bite marks. Injuries not consistent with the explanation presented by the parent.
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Reporting Child Abuse

Required information
The name, address, gender, age, height, and weight of the child. The name and address of the adult with custody of the child. A description of the current physical and emotional abuse or neglect of the child. Evidence of previous injuries or negligence. Any information that may assist in establishing the cause of the injuries. Sketches or photographs documenting the nature and location of the injuries.

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