Diagnosis, Radiography and Treatment Planning for the Pediatric Patient Flashcards
Oral examination:
Answer
questions in axiUm chart
(i.e. gingival health,
presence of ulcers etc.)
Remember to look at the
gingival tissues as well as
the teeth
Role of Dental Prophylaxis
(4)
Remove
Demonstrate
Facilitate
Introduce
Remove
Remove plaque/calculus – You may need a
scaler if there is calculus
Demonstrate
Demonstrate proper hygiene methods to
parent/caregiver
Facilitate
Facilitate a thorough clinical examination
Introduce
Introduce the patient to dental procedures
SEQUENCE OF EVENTS
Remember that the dentist is
the one who prescribes
—
— is used to
determine how the patient
may respond to radiographs
COMPLETE THE ORAL EXAM
AND PROPHYLAXIS BEFORE
DECIDING WHAT
— TO TAKE
radiographs
Prophylaxis
RADIOGRAPHS
Charting
Primary teeth (A-T)
Permanent teeth (un-
erupted, missing)
Charting
Chart —
after your clinical exam
Use this information to
determine which
— you want to
take.
Then re-chart adding
areas of — that can be
seen radiographically
caries and teeth
radiographs
decay
Occlusal Examination
Evaluate presence/absence of
— – developmental
— present or absent
Note — status ie. Mesial step, Distal step or Flush terminal plane
Note — relationship ie. Class I, II or III
Note crowding
spacing
Primate Spaces
occlusal
Canine
Primate spaces are present in two locations:
(2)
Maxillary Primate Space - between the primary maxillary
canine and primary maxillary lateral incisor.
Mandibular Primate Space – between the primary
mandibular canine and primary mandibular first molar.
Developmental Spaces
Developmental spaces are the spaces between the primary
anterior teeth maxillary and mandibular.
These spaces along with the primate spaces help to alleviate
crowding during the transition from the primary dentition to
the mixed dentition and permanent dentition.
Molar Relation
If the permanent first molars are unerrupted use the molar
relation terminology of
mesial step, flush terminal plane, or
distal step.
If the patient has permanent molars, use Angle’s Classification
of Class I, II, and III.
PRIMARY DENTITION
When looking at the primary dentition to determine
the molar relationship you want to focus on the
relation of the
distal surfaces of the maxillary and
mandibular primary second molars.
Flush Terminal Plane –
the distal surface of the
maxillary and mandibular second primary molars
are in the same plane.
Mesial Step –
the distal surface of the mandibular
second primary molar is mesial to the distal
surface of the maxillary second primary molar.
Distal Step –
the distal surface of the mandibular
second primary molar is distal to the distal
surface of the maxillary second molar.
FIRST PERMANENT MOLARS
When looking at the molar relation and the patient has
firstpermanent molars focus on the MB cusp of the maxillary firstmolar in relation to the buccal groove of the mandibular firstmolar.
Class I -
the MB cusp of the maxillary first permanent molaris located in the buccal groove of the mandibular firstpermanent molar.
Class II –
the MB cusp of the maxillary first permanent
molar is located mesial to the buccal groove of themandibular first permanent molar.
Class III –
the MB cusp of the maxillary first permanent
molar is located distal to the buccal groove of the mandibularfirst permanent molar.
Canine Relation
Class I -
the distal incline of the mandibular canine
occludes with the mesial incline of the maxillary canine.
Canine Relation
Class II -
the distal incline of the mandibular canine occludes distal to the
mesial incline of the maxillary canine.
Canine Relation
Class III -
the distal incline of the mandibular canine occludes mesial to
the mesial incline of the maxillary. canine
End to End -
when the patient is in centric occlusion
and the incisal edges of the upper and lower incisors are
contacting.
Open Bite -
when the patient is in centric occlusion
and the posterior teeth are in contact but the upper and
lower incisors are not overlapping.
OVERBITE
The amount of vertical overlap that is present between the
incisal edge of the maxillary central incisors and
mandibular central incisors.
Malocclusion
Class I -
Normal relationship of molars, but the line
of occlusion incorrect because of malposed teeth,
rotations, or other causes.
Malocclusion
Class II -
Upper molar mesially positioned relative tolower molar.
Malocclusion
Class III -.
Upper molar distally positioned relative tolower molar
CROWDING
Inadequate arch length to accommodate the mesial-
distal width of all the teeth in the arch.
SPACING
Excess arch perimeter compared to the total mesial-distal
width of all the teeth in the arch in the permanent or
mixed dentition, not including space from lost primary
teeth or developmental spaces in the primary dentition.
Crossbite
Anterior –
maxillary incisors occlude lingual to the
mandibular incisors.
Crossbite
Anterior
oUnilateral -
occurs on one side of the arch or only on
one tooth.
Crossbite
Anterior
oBilateral -
occurs on both sides of the arch.
Crossbite
Anterior
oFunctional -
caused by an occlusal interference that requires the mandible
to shift anteriorly in order to achieve maximum occlusion.
Crossbite
Posterior -
buccal cusps of the maxillary posterior teeth
occlude lingual to the buccal cusps of the mandibular posterior
teeth.
Crossbite
Posterior
oUnilateral -
occurs on one side of the arch or only on one
tooth.
Crossbite
Posterior
oFunctional shift –
caused by an occlusal interference that
requires the mandible to shift laterally in order to achieve
maximum occlusion. Most posterior crossbites in pediatric
patients are functional in nature
Crossbite
Posterior
oBilateral -
occurs on both sides of the arch.
Identify any oral habits that the patient exhibits. This may include but is not limited to:
(4)
Mouth breathing
Tongue thrusting
Thumb/Digit sucking
Lip biting
Oral Habits
(4)
Pacifier versus thumb
Frequency, duration, intensity
Alters oral structures
Can be reversed
Low Risk =
Optimal fluoride exposure
Consumption of cariogenic
foods at mealtime
High caregiver socioeconomic
status
Regular use of dental care
Moderate Risk =
Suboptimal fluoride exposure
Occasional between-meal snacks
with cariogenic snacks
Midlevel caregiver socioeconomic
status
Irregular use of dental services
High Risk =
Suboptimal fluoride exposure
Frequent cariogenic snacks
Low-level caregiver
socioeconomic status
No usual source of dental
care
Prescribing Radiographs:
New Patient
Primary Teeth/No visible caries/No closed contacts
=
= NO BITEWINGS
Prescribing Radiographs:
New Patient
Primary Teeth/No visible caries or pathology/Closed
contacts=
BITEWINGS
Prescribing Radiographs:
New Patient
Mixed Dentitions/No visible caries/Closed Contacts
=
BITEWINGS AND PANORAMIC FILM OR SELECTED
PERIAPICAL FILMS
Panoramic Films
Mixed dentition –
preferably after first permanent molars and
permanent incisors have all erupted
Delaying until those teeth have erupted will give you a better
idea of permanent canine positioning
Take another panoramic film after the 2nd permanent molars
have erupted to evaluate the presence of 3rd molars
Prescribing Radiographs :
Return Patients (Recall Patients)
– Based upon Caries risk and
clinical findings
Recall patients with clinical caries
or ↑ caries risk=
Bitewings every
6-12 months if contacts closed
Recall patients with primary
dentition and no clinical caries and
↓ caries risk=
Bitewings every 12 -
24 months if contacts closed
Recall patients with mixed
dentition and no clinical caries and
↓ caries risk =
Bitewings every 18-
36 months if contacts closed
radiographsAdditional Films
“Sandwich bite” films sometimes
prescribed to evaluate anterior teeth
(maxillary and/or mandibular) These
are prescribed as periapical films
Particularly if there is a history of
missing teeth in the family
Can be used to introduce the child to
radiographs
Bitewing
Radiographs
Should capture
distal of
cuspids and extend
posteriorly
Position tube head
perpendicular to
embrasures
to open contacts
Vertical angulation of +—
degrees
Sometimes use vertical
bitewings to help patient
tolerate —
10
films
BitewingsRemember that children have
“—” mandibles and
maxillae
You need to position the cone
accordingly
shorter
Periapical
RadiographsIndicated for suspected or identified
Evaluate (4)
pathology
Evaluate dental development
Evaluate trauma
Evaluated deep caries
Evaluate oral aspects of suspected
systemic disease
Periapical films
Bisecting angle technique:
central ray directed perpendicular to
the plane that bisects the angle created by the long axis of the
tooth and film
What size film?
In most cases size – film
is used for bitewings
and periapical films in
young children
Progress to size – films
as soon as the patient
can tolerate the size
0
2
Other Risk Factors –
Health Conditions
(3)
Active Caries Present in Mother
Children with special health care
needs
Conditions that impair salivary
flow/composition
Infant/Toddler Examination
Should be recommended
to occur at
12 months of
age or within 6 months of
the eruption of the first
tooth
Knee-to- Knee position
facilitates exam
How to prepare:
- Check out BOE (for
mirror) - Wear full PPE (do not
need glasses or bib for
patient) - Doctor’s chair facing
chair with no wheels for
parent & patient outside
the cubicle - Place overhead light
over chairs within reach
When your patient arrives:
Get
Let
Complete
child’s height and weight if child is cooperative (if they are very young
and/or unable to stand, ask parent if they know recent approximate height
and weight)
child sit comfortably with parent while obtaining medical history and
medications
appropriate forms for child’s age and fill out all questions you can
without having to look in the child’s mouth
GRAB A MEMBER OF THE
PEDO FACULTY — YOU
DO YOUR EXAM!
BEFORE
Anticipatory Guidance for
Caregivers
Anticipatory guidance is the process of
providing practical, developmentally-
appropriate information about children’s
health to prepare parents for the significant
physical, emotional, and psychological
milestones.
Individualized discussion and counseling
should be an integral part of each
visit. Topics to be included are oral hygiene
and dietary habits,
injury prevention, nonnutritive habits,
substance abuse,
intraoral/perioral piercing, and
speech/language development.
Treatment Sequence
Avoid — procedures on first appointment if at all possible
traumatic
– We don’t extract teeth first if we don’t have to do so
Mandibular versus maxillary arch injections –
Variable among faculty and practitioners
Quadrant dentistry is ideal but may not be practical with dental
students who are learning
Nitrous oxide/oxygen analgesia recommendations –
using nitrous must be “justified” in the notes.
Why are we using it???
Appointment
Based UMKC
Sequence
1st Appointment
Exam and prophy/radiographs and
treatment plan
Remember we do not “screen”
patients. They are your patients to
begin providing care to immediately.
Re-appoint for restorative care if
needed. If no care needed place the
patient on a 6 month recall
Ask faculty for help and don’t be
afraid to ask questions
Peers may not have the correct
information
Inactivations/transfers must be done
with Pedo faculty only
ee
