Lecture 2: Paediatric examination Flashcards
How are children different to treat compared with adults?
May not be confident with strangers.
Cannot sit still for long.
Have little experience with noise, taste, smells, and parasthesia in the clinic
Teeth are smaller with proportionally larger pulps.
Access is more limited.
What should be included in history?
Referred by…
Routine examination.
Check what was done before if patient is a recall patient
Painful teeth should be investigated further.
Medical history should include CVS, CNS, endocrine, GI, Respiratory, bleeding, and urogenital disorders. Should also include allergies as well as past operation or hospital admissions.
What should we note about patient’s PC?
Pain history including nature, onset, type, and what relieves the pain and exacerbates pain.
Ability to sleep
Ability to eat
Irritability
Loose tooth/teeth
Broken tooth/restoration
What should be mentioned in the natal Hx of patients?
Length of confinement
Birth weight
Apgar scores
Type of delivery (including complications)
Antenatal/perinatal problems especially during delivery.
Prematurity and treatment in a special or neonatal intensive care nursery.
What should be investigated with growth and development?
Developmental milestones
Speech and language development
Motor skills
Socialization
What should be known about current medical treatments?
Medications, including complementary medications
Current treatments
Immunizations
What dental history information should we have about patients?
Previous dental treatment
What preventative treatment has been undertaken previously
Methods of pain control used previously
How the child coped with the treatment.
What information about family and social history can be investigated?
Family history of serious illness
Family make up
Place of birth
No of siblings
Schooling, performance in class
Speech and language problems
Likes, dislikes
Pets, hobbies, interests
Sports, TV, books, movies, video games
Why should parent’s comment be mentioned?
Concerns of parent may be different than the reason for the appointment
What should be assessed in addition to the typical things assessed in an extraoral examination?
General appraisal of child’s well being.
General interaction with the parent or peers
Child’s gait
Height and weight assessment
Frontal profile
Lateral profile
Skeletal pattern
Lips (competence)
Eyes (appearance)
Skin/soft tissue (Colour, appearance, etc)
What should be assessed in the intraoral examination?
Lips
Tongue
Mucosa
Gingiva
Frenums
FoM
Palate
Salivary glands
Oropharynx (tonsils, uvula)
Plaque, record, perio status
Dental hard tissues (Tooth identification, charting, caries/restorations, anomalies, abnormalities)
What are the types of habits that should be noted?
Digit sucking (protrusion of incisors and lateral crossbites)
Mouth breathing
Tongue thrusting
Which radiographs should be taken?
BW, PAs, Occlusal, OPGs, EO facial films. CBCT
What information can be obtained from radiographs?
Caries (IP and occlusal)
Alveolar bone health
Enamel defects
Root health
Developing teeth
Pulp chamber
Outline of restorations
Sequential radiographs
Disease progression.
What special tests can be done for extra diagnostic information?
Photographs
Diagnostic cast
Blood investigations (FBC, clinical chemistry)
Microbiology (Cultures, AB sensitivity, cytology, serology, direct and indirect immunofluorescence, plaque pH activity, S mutans count)
Salivary tests (quantity stimulated and unstimulated, salivary buffering capacity, quality of saliva)
Caries activity tests
Diet analysis
Caries risk assessment (past disease experience, current dental status, family history, diet considerations, oral hygiene, concomitant medical conditions, future expectations of disease activity)
Pulp sensibility tests
