1 / 136

Pediatric Dentistry Seminar

Pediatric Dentistry Seminar. Dr. Christine Bell, DMD, Cert.Ped.Dent, FRCD(C) Pediatric Medical Residents Seminar Series January 2013. Objectives. Provide a basic overview of pediatric dentistry Answer frequently asked questions raised by Family Medicine and Peds Medicine Residents.

Download Presentation

Pediatric Dentistry Seminar

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.


Presentation Transcript

  1. Pediatric Dentistry Seminar Dr. Christine Bell, DMD, Cert.Ped.Dent, FRCD(C) Pediatric Medical Residents Seminar Series January 2013

  2. Objectives • Provide a basic overview of pediatric dentistry • Answer frequently asked questions raised by Family Medicine and Peds Medicine Residents

  3. Overview • Normal Dental Development • Abnormal Dental Development • Early Childhood Caries • Common Pediatric Dentistry • Recommendations for Parents • When to Refer and For What • Special Needs Patients • Trauma

  4. Education: General Dentist and Specialist • Undergraduate Training • 3-4 years • Dental School • 4 years • General Dentist • Specialty Training • 2-4 years depending on the specialty and the program

  5. Dental Specialists • Endodontist • Oral and Maxillofacial Surgeon • Orthodontist • Pedodontist/Pediatric Dentist • Periodontist • Prosthodontist

  6. When should the first dental check up be?

  7. The American & Canadian Academy of Pediatric Dentistry recommend a dental home be established as early as 6 months of ageor6 months after the eruption of the first tooth and definitelyby 1 year of age Age One

  8. First Dental Visit • Comprehensive oral examination • acute care, preventive services • assess for oral diseases and conditions • asses the need for fluoride • Anticipatory guidance • teething, digit/pacifier habits, trauma, prevention • Oral hygiene instructions • Dietary counseling • Prolonged breast/bottle feeding, sippy cup, juice • Caries- risk assessment • determine individualized dental health plan

  9. Who can children see for dental exams/treatment? • Family/General Dentist • Pediatric Dentist • Typically treats children from birth to age 18 • Some offices stop seeing patients at an earlier age • Hospital Pediatric Dentist

  10. Alberta Children’s Hospital

  11. Alberta Children’s Hospital Pediatric Dental Clinic • Patients are seen by referral only • Referrals • Physicians/Medical Specialists • Community physicians/pediatricians • In-and Out-patient clinics/physicians • Oncology, cardiology, nephrology, hematology, GI • Perinatology, endocrinology, genetics, infectious disease • Developmental Clinic, Neuromotor Clinic • Cleft Palate & Craniofacial Clinic, ENT, Plastics • Emergency Department • Community general and pediatric dentists

  12. ACH Dental Clinic Patients • Medically compromised and special needs patients from birth up to 18 years • Syndromes, autism • Immune compromised • Bleeding disorders • Oncology, transplant patients • Cardiac/vascular diseases • Uncontrolled seizure disorders, etc… • Children with craniofacial/structural anomalies • Genetic disorders, cleft lip and palate, craniofacial anomalies velopharyngeal incompetency, sleep apnea • Healthy patients under the age of 4 years with significant dental issues

  13. Significant Dental Issues • Urgent, extensive or special oral needs • Early childhood caries • Dental/periodontal abscesses, facial cellulitis • Oral/dental trauma • Oral surgery needs(surgical extraction, frenectomy, gingivectomy, soft tissue biopsy) • Unusual/rare dental conditions (amelogenesis imperfecta, dentinogenisis imperfecta, ectodermal dysplasia, cleidocranial dysostosis etc)

  14. Cleft Lip and Palate Infants • Cleft lip and palate infants are referred to the ACH Dental Clinic for consult by a Pediatric Dentist certified in Nasoalveolar Molding (NAM) Therapy

  15. Nasoalveolar Molding Appliance • Consists of an intra-oral acrylic plate with extra-oral nasal stent. • Adjustments are made weekly to the appliance to guide tissues into a more desired position prior to initial lip closure procedure

  16. NAM: Objectives • Reduce the severity of cleft deformity • Approximate alveolar and lip segments • Decrease nasal base width • Shape nasal dome and alar cartilage • Promote columella elongation • Allow one-stage lip and nose repair • No need for lip adhesion surgery

  17. a c d b

  18. Behavior Management Options ACH Dental Clinic • Non-pharmacologic techniques • tell-show-do • positive reinforcement • voice control • distraction • medical stabilization • Nitrous oxide inhalation sedation • Oral conscious sedation • Combination of oral and inhalation sedation • General anesthesia

  19. Dental Development 2013 Pediatric Resident Seminar Series - Dr. Christine Bell

  20. Basic Structure of a Tooth • Two “parts” • Crown • Root • Tooth Structure • Enamel • Dentin • Pulp • Cementum Crown Root

  21. Dental Development • Two sets of teeth: • Primary Dentition • ‘baby’ or ‘milk’ teeth • 20 teeth • Secondary Dentition • ‘adult’ or ‘permanent’ teeth • 32 teeth

  22. How are teeth numbered? • Different tooth numbering systems • Universal • International (FDI) • Palmer • Typically in Canada we use the International Tooth Numbering System

  23. International Tooth Numbering System • Two digit numbering system • First number is the quadrant number • Second number is the position/number of teeth from the midline

  24. Permanent Teeth Quadrant I Quadrant II Quadrant IV Quadrant III

  25. Primary Teeth Quadrant 5 Quadrant 6 Right Left Quadrant 8 Quadrant 7

  26. Typical Eruption Sequence: Primary Dentition • First tooth • lower central incisor • 6-10 months of age • General trends • right and left erupt around the same time • erupt in order from front to back except the canines • complete by 25 -33 months of age

  27. Timing of Tooth Eruption Permanent Dentition Primary Dentition

  28. Mixed Dentition Stage • 6 yrs – 14 yrs of age • typically initiated with eruption of the lower first permanent molar

  29. What to do for teething?

  30. Teething • Massage the gums, have baby chew on cold wash cloth, cold teething rings, give tylenol if necessary • We typically do not recommend oragel or baby oragel • Lidocaine or benzocaine content • Studies have not confirmed strong association between tooth eruption and a range of teething symptoms. • Study by King et.al. 1992 found HSV associated with almost 50% of infants with teething difficulties

  31. Herpes Simplex Virus • Everyone is exposed to it • 1% present with primary herpetic gingivostomatitis • Typically occurs in children <4 years of age • 7-18% end up with recurrent herpes labialis (cold sores)

  32. Primary Outbreak of Herpes Simplex • Primary Herpetic Gingivostomatitis • Fever • Malaise • Irritability • Not eating/drinking well • Red inflamed, possibly bleeding gingiva • Herpetic ulcerations intraorally, possibly extraorally • May not present with all signs/symptoms • Typically resolves within 14 days

  33. Treatment of Primary Herpetic Gingivostomatitis • Encourage fluids • Treat fever (Tylenol) • Encourage good hand hygiene • Educate family: viral, can spread/inoculate other sites (eyes, herpetic whitlow), contagious (others can acquire) • Antiviral meds of limited value • typically prescribed if outbreak is severe or patient is immune compromised (acyclovir)

  34. Dental Development Prior to Eruption

  35. Dental Development • Initiation of all primary teeth occurs while IU • Initiation of most permanent teeth occurs IU (with exception of the premolars, 2nd and 3rd molars)

  36. Dental Development • All primary teeth begin to calcify at 4 months IU • 1st permanent tooth to undergo calcification is the 1st permanent molar (birth) • All permanent teeth with the exception of the wisdom teeth are calcified by 6-7 years of age

  37. Dental Development • Complication or interruption of any of the processes of development (initiation, histodifferentiation, calcification or maturation) could result in dental issues

  38. Abnormal Dental Development 2013 ACH Pediatric Resident Seminar Series - Dr. Christine Bell

  39. Dental Anomalies • Natal/Neonatal teeth • Extra/supernumerary teeth • Missing teeth • Anodontia/oligodontia • Malformed teeth • Microdont/macrodont/conical/twinning/genination • Structural/mineralization anomalies • Hypocalcification/hypoplasia/fluorisis/amelogenesis imprefecta/dentinogenesis imperfecta

  40. Natal/Neonatal Teeth • Natal teeth • teeth present at birth • Neonatal teeth • Teeth/tooth erupt during 1st month following birth • Incidence 1:2500-3500 births • 85% are mandibular incisors • 90% are true primary teeth

  41. Treatment • Monitor vs extraction • Indications for extraction • hyper-mobility • difficulties with breast feeding • traumatic ulcerations on tongue (Riga Fede Disease)

  42. Dental Anomalies • Fused or geminated teeth • Hypoplastic tooth

  43. Some dental development issues may be linked to genetics &/or medical conditions • Dentinogenesis imperfecta • Osteogenesis imperfecta • Oligodontia, conical teeth • Ectodermal dysplasia • Multiple supernumerary teeth • Cleidocranial dysostosis

  44. Dentinogenesis Imperfecta Amelogenesis Imperfecta

  45. Ectodermal Dysplasia Conical teeth, severe oligodontia of the upper arch Anodontia of lower arch

  46. 4 year old male with Ectodermal Dysplasia and severe oligodontia

  47. Dental Caries (Cavities) 2013 ACH Pediatric Resident Seminar Series - Dr. Christine Bell

  48. Dental Caries/Cavities • The Centre for Disease Control & Prevention reports Dental Caries as being the ‘most prevalent infectious disease in our Nation’s children’ • 5x more common than asthma • Estimated that >40 % of children have caries by kindergarten • Preventable disease

  49. Etiology of Dental Caries • Multifactorial TIME Fermentable Carbohydrate Bacteria C A R I E S Tooth

  50. The Caries Process

More Related