Dr. Feras Aalam

Introduction to Pediatric Dentistry

Pediatric Dentistry/ Pedodontics

• A branch of dentistry that is concerned with the dental care and treatment of children

• Pediatric dentistry is one of the most important branches of dentistry

Objectives of Pediatric Dentistry

1. Giving comfort, relieving pain, removing infection, and restoring functions

2. Allaying fear and anxiety and modifying the child behavior

3. Promoting optimal oral health by prevention and education

Objectives of Pediatric Dentistry

4. To develop a positive attitude and behavior towards oral health

5. Implement the principles of preventive dentistry from birth

6. Parental guidance and counseling regarding different facets of preventive dentistry and treatment modalities

Objectives of Pediatric Dentistry

7. Early diagnosis of the disease and treatment

8. Occlusal guidance and early treatment of developing mal-occlusion

9. Managing children with special needs (physically, mentally and medically)

Most common dental diseases in children

1. Baby bottle caries

2. Sucking of a finger or thumb

3. Trauma

4. Malocclusion

1. Baby bottled caries

Baby bottled caries

• Prolonged use of a bottle at bedtime containing:

Cow's milkbreast milkformulafruit juicesoft drinks

Baby bottled caries

• Early stages of tooth decay appear as chalky white

• Later on brown staining and the enamel could be eroded or pitted.

• Infection may be present in the form of a bubble or abscess, on the "gum" near the decayed tooth

Tips for prevention of baby bottled caries

• Clean by gauze. • Don't dip soothers in sugar or honey. • Brush teeth as soon as they appear. • Check your baby's mouth regularly• Don't put your baby to bed with a bottle • If you notice discoloration or white spots go to the

dentist

2. Sucking of a finger or thumb

There is no evidence that sucking habits can be prevented

Early intervention is usually not recommended.

When the permanent teeth start to erupt, at age five to six intervention is indicated.

Habit Braking Appliances

A reminder appliance (cribs) to prevent thumb sucking habit

Most common dental diseases in children

1. Baby bottle caries

2. Sucking of a finger or thumb

3. Trauma

4. Malocclusion

3. Trauma

4. Malocclusion

• Mixed dention

• Consult Orthodontics

• Early loose of primary teeth leads to malocclusion

Elements of Comprehensive Pediatric Dental Care

A. Patient recordB. Parent consentC. Diagnosis and treatment planningD. Delivery of dental careE. Behavior managementF. Guidance of developing occlusionG. Types of treatment in pedodontics patients

i. Restorative treatmentii. Pulp therapyiii. Extraction Restorative treatmentiv. Gingival and surgical procedures

A. Patient record

The dental record should provide an accurate picture of the patient’ status.

The following data should be included:

• Medical history

• Chief complaint

• History of present illness

• Oral hygiene habits

• Clinical examination data

- Extra oral

- Intra oral

• Diagnostic aids :

- Radiographs

- Other aids such as study models

B. Parent consent: An explanation of any treatment procedure must

be provided to the parents

C. Diagnosis and treatment planning: - Emergency treatment should be carried out first. - Non emergency treatment should progress from simpler procedures to more complex ones.

D. Delivery of dental care:

1. Education regarding etiology of dental diseases and oral hygiene measures

2. Prophylaxis

3. Appropriate fluoride therapy

4. Pit and fissure sealants

5. Dietary analysis and counseling

6. Preventive recall system.

1. OHI

2. Dental prophelaxis

What do we need??

• Prophylactic paste

• Low speed hand piece

• Rubber cup or brushes

Dental prophylaxis using prophylactic paste and rubber cup

3. Appropriate fluoride therapy

Topical application

• Act by inhibiting acid demineralization of tooth enamel and promoting remineralization.

• Types :

1. F gel

2. F varnish

3. F mouth wash, toothpaste

Systemic administration

• Fluoride is absorbed by the developing teeth in the jaw

from before birth to 13 years

of age

1. Water dose 0.7-1 ppm

2. Tablets dose 0.25-0.5mg

Fluoride Gel and Trays

Insertion into the patient’s mouth with the saliva ejector for 4 minutes.

Fluoride varnish

Fluoride mouth washtooth paste

4. Pit and fissure sealants

• Pit and Fissure sealants prevent cavity causing bacteria from invading the deep pits and grooves.

• Sealants are clear or shaded plastic material that is applied to the chewing surfaces of the molars to form a protective barrier to bacteria. 

• Age of 6 and 12.• Last for years.

Prophylactic paste

Acid etching gel

Sealant Brush for prophylaxisCup and

Armamentarium

5. Dietary analysis and counseling

6. Preventive recall system

• Visit the dental clinic twice/ year

Elements of Comprehensive Pediatric Dental Care

A. Patient recordB. Parent consentC. Diagnosis and treatment planningD. Delivery of dental careE. Behavior managementF. Guidance of developing occlusionG. Types of treatment in pedodontics patients

i. Restorative treatmentii. Pulp therapyiii. Extraction Restorative treatmentiv. Gingival and surgical procedures

E. Behavior management:• It is a comprehensive methodology meant to

develop a relationship between the child patient and the dentist which builds trust and diminishes fear and anxiety.

• Objectives: 1. Establishes effective communication with the child.2. Gains child’s confidence and acceptance of dental

treatment.3. Provides a comfortable environment for the dental

team to work in.

Behavior management techniques

1. tell-show-do2. Modeling 3. Positive and negative reinforcement4. Distraction5. Voice control 6. Hand over mouth technique 7. Physical immobilization8. Pharmacological approach:

oral premedication (conscious sedation);nitrous oxide sedation; general anesthesia.

1. Tell-Show-Do (TSD)

• The dentist should use the TSD technique to create new and pleasant associations with every anxiety provoking dental procedure.

Tell-Show-Do (TSD)

• (Tell) describe to the child

• ( Show ) demonstration for the patient of different aspects of the procedure in a non-threatening setting

• (Do) then proceed to complete the procedure

2. Modeling• The method allows the

child to observe one individual who demonstrate appropriate behavior in the dental setting.

• Simulated models as films clips or video shows can be used to reinforce the desired behavior

Behavior management techniques

1. tell-show-do2. Modeling 3. Positive and negative reinforcement4. Distraction5. Voice control 6. Hand over mouth technique 7. Physical immobilization8. Pharmacological approach:

oral premedication (conscious sedation);nitrous oxide sedation; general anesthesia.

3. Positive and Negative Reinforcement

• Reinforcers can be:

1. Material- toys

2. Social- praising, positive facial expression

Positive and Negative Reinforcement

• Positive reinforcement- presentation of reinforces which increases the frequency of desired behavior

• Negative reinforcement- withdrawal of reinforces which increases the frequency of desired behavior

4. Distraction

• It is a technique used to divert the patient’s attention during the unpleasant procedures such as video tapes.

5. Voice Control

• It is a controlled alteration of voice volume, tone, and pace to:

- Gain the patient’s attention.

- establish authority.

• It is indicated for uncooperative children.

6. Hand Over Mouth Technique

• This method is used to establish communication with children who are able to cooperate but who exhibit a hysterical behavior to avoid treatment.

• A hand is placed over the child’s mouth and is told that the hand will be removed as soon as appropriate behavior begins.

• When the child responds, the hand is removed and the praised for his appropriate behavior

Behavior management techniques

1. tell-show-do2. Modeling 3. Positive and negative reinforcement4. Distraction5. Voice control 6. Hand over mouth technique 7. Physical immobilization8. Pharmacological approach:

oral premedication (conscious sedation);nitrous oxide sedation; general anesthesia.

Behavior Management Techniquescont.

7. Treatment immobilization:

a- immobilization by dentist / staff / parents

b- physical restraints

Treatment immobilization: a- immobilization by dentist / staff /

parents

b- physical restraints

papoose board

Physical Restraints

• Are used to provide partial or complete immobilization of the patient to protect the patient and the dental staff from injury while providing dental care

Behavior Management Techniquescont.

8. Pharmacological approach:

i. - Nitrous oxide / oxygen inhalation.

ii. - Conscious sedation.

iii. - General anesthesia.

i. Nitrous oxide

• Oxygen and nitrous oxide. • Nitrous oxide/oxygen is

given through a small breathing mask

• relax, but without putting them to sleep.

• Very safe, effective

ii. Conscious Sedation

• Tablets

• Syrup

• Quite drowsy, and may even fall asleep, but they will not become unconscious.

iii. General anethesia

Elements of Comprehensive Pediatric Dental Care

A. Patient recordB. Parent consentC. Diagnosis and treatment planningD. Delivery of dental careE. Behavior managementF. Guidance of developing occlusionG. Types of treatment in pedodontics patients

i. Restorative treatmentii. Pulp therapyiii. Extraction Restorative treatmentiv. Gingival and surgical procedures

F. Guidance of developing occlusion:

i. - intra oral and extra oral radiographs

ii. - use of study models

iii. - space analysis

iv. - space maintainers

v. - habit braking appliances

vi. - consultation with specialists

Stainless Steel Crown

Study modelsSpace analysis

• Space maintainers

Band and loop space maintainer:Band and loop space maintainer:

Space maintainer for the 1stprimary Molar area :

Space maintainer for the 1st primary Molar area:

Loss of space for 2nd premolar due to early extraction of 2nd primary

molar

• A-Lingual arch : For A-Lingual arch : For mandibular archmandibular arch

Space maintainer for multiple loss of teeth:Space maintainer for multiple loss of teeth:

Nance Space Maintainer :Nance Space Maintainer :

for for maxillary arch

Elements of Comprehensive Pediatric Dental Care

A. Patient recordB. Parent consentC. Diagnosis and treatment planningD. Delivery of dental careE. Behavior managementF. Guidance of developing occlusionG. Types of treatment in pedodontics patients

i. Restorative treatmentii. Pulp therapyiii. Extraction Restorative treatmentiv. Gingival and surgical procedures

G. Types of treatment in pedodontics patients

i. Restorative treatment

ii. Pulp therapy

iii. Extraction of hopeless teeth

i. Restorative treatment

Types of dental restorationsfor primary teeth

• Amalgam restorations

• Composite resin restorations

• Glass ionomer restorations

• Strip crowns: full coverage restoration for anterior teeth

• Stainless steel crowns for primary molars

Strip Crown Composite Restoration For Primary Anterior Teeth

Strip crowns

Trimming of the crownCrown selection

Trial fitting of the crowns Filling the crown with composite

Positioning of the filled crown

and removal of the excess

composite resin

Light cure the composite resin

then peel the crown form away

Strip crowns

Before After

Stainless steel crowns for primary molars

Stainless steel crowns

Stainless steel crowns

Full mouth rehabilitation using stainless steel crowns and composite restorations

ii. Pulp therapy

• a. Pulpotomy• b. Pulpectomy

a. Pulpotomy(Primary and Permanent teeth)

• It is the surgical removal of the coronal portion of the pulp which has been judged to be inflamed or infected.

Pulpotomy

• 1. opening• 2. application of medication• 3. temporary filling

b. Pulpectomy= RCT

iii. Extraction of hopeless teeth

Armamentarium for placement of S.S crowns

• From right to left:• Crown cutting scissors• Adams pliers• Johnson 114 pliers• Crimping pliers

(Unitek 800-108)

Rubber Dam For Tooth Isolation

Instruments of RD

Rubber dam clamps Rubber dam punch

Rubber dam holdersRubber dam material

Instruments for fitting space maintainer band

Band removerpliers

Band seater

band pusher

Summary

• Definition and objectives of pedodontics• Most common dental diseases in children• Elements of comprehensive pediatric dental care• Types of treatment in pedodontics patients

– Restorative treatment

– Pulp therapy

– Extraction

• Etiology of dental caries