Week 6 PP Flashcards
Orofacial Development for Pediatric Patients
Pediatric dentists will look to identify malocclusion, crowded or crooked teeth, and habits that can affect
the dentition later. Early preventive and interceptive orthodontic treatment can prevent the need for extensive treatment later.
What is Interceptive treatment for Pediatric Patients?
Prevents or eliminates irregularitites in the developing dentition.
What does interceptive treatment include?
- Preventing premature loss of primary teeth
-Use of space maintainers to save space for eruption of permanent teeth
-Use of applicances to correct oral habits (thumb sucking)
-Early detection of genetic and congenital anomalies that may influence development
-Supervise natural exfoliation
For interceptive treatment… The dentist intercedes to correct problems as they develop, such as:
-exctraction of primary teeth contributing to malalignment or crowding
-correction of cross-bite using a removable or fixed appliance
-correction of jaw size through appliances
What is different for pediatric instruments?
smaller sizes to provide better access
How does a pediatric dentist adapt to smaller mouth sizes?
Adapt to smaller mouth sizes by using special instruments, accesssories and techniques
What are some pediatric dental accessories ?
T-band, pedo sized tofflemire, child sized bit blocks
What are some pediatric specific techniques?
Using words such as “raincoat”, “sleepy juice”, “Mr. Slurpee”, etc.
What is a space saver?
Appliance to save space for an unerupted permanent tooth - to ensure it erupts in alignment.
What is a Thumb sucking appliance?
Stops a pediatic patient from being able to properly suck on thumb
What is a Palatal Expansion Appliance?
Spreads palalate appart to make space (median palatine suture is not completely fused)
What are some Endodontic Procedures in Children?
Pulp Therapy
Pulp Capping
What is Pulp Therapy?
An attempt to stimulate and preserve pulpal regeneration in primary teeth. This is accomplished through pulp capping
What is Pulp Capping
Procedure used when the decay is near the pulp chamber. The goal is to remove as much decay as possible without exposing the pulp.
What are the two main factors that affect pulp in children?
Deep caries & trauma (accidents, falls, etc)
What is Indirect Pulp Capping?
A technique that is used when the decay is near the pulp chamber but has NOT been exposed.
- Calcium Hydroxide (dycal.. secondary dentin) is placed
- Temporary restoration is placed
- After some time, the cavity is re-opened, and the remaining decay is removed
What is the goal of Indirect Pulp Capping?
The goal of treatment is to allow the pulp to form secondary dentin under the carious dentin so that a pulp exposure is avoided
When is Direct Pulp Capping indicated?
Indicated when the coronal portion of the pulp has been exposed. Performed when the tooth is still vital.
What is Direct pulp capping?
- Calcium hydroxide is placed directly on exposed portion of the pulp to allow healing
- Tooth is restored and monitored
It is important to let the patient know that problems may develop in the future and monitoring is necessary
What is a Pulpotomy?
The complete removal of the coronal portion of the dental pulp. The goal is to remove the inflamed portion of the pulp while maintaining the healthy vital pulp tissue within the canals of the primary tooth.
What 2 materials are used for Pulpotomy?
- Mineral Trioxide Aggregate (MTA)
-replaces the use of formocresol, is a cement that is biocompatible and capable of stimulating healing and osteogenesis - Calcium Hydroxide - used on permanent teeth with open apices, this type of treatment allows for further apical development so that endodontic treatment can be performed later (the apex is wide open, if you did a RCT the gutta percha would spill out into the tissues)
When are Stainless Steel Crowns indicated?
For severely decayed and endodontically treated teeth. Used to protect and maintain primary teeth until they exfoliate as they are cheaper and faster to place than regular fixed prosthodontics.
The benefits of stainless-steel crowns for children are..
-Can be placed in a single appointment
-Sufficiently durable
-Tolerated well by the gingiva
-Less expensive than cast restorations
Types of Stainless Steel Crowns?
Pretrimmed
Pre-contoured
What are Pre-trimmed Stainless Steel Crowns?
have straight sides and must be trimmed and contoured to fit the tooth
What are pre-contoured Stainless Steel Crowns?
Come pre-contoured and only require minimal adjustment
Dental Trauma for Pediatric Patients
Injury to the tooth of a young child can have long-term consequences. For example, injury to a primary tooth while the permanent tooth is developing underneath can cause the developing tooth to be affected as well.
Fractured Antterior Teeth
Children with fractured teeth should be seen as soon as possible
-complete documentation of the accident, clinical examination, vitality testing, radiographs are important
-treatment is usually delayed to allow the tooth time to heal and prevent further irritiation to the pulp
-pulp is monitored to determine vitality
Classes of Fractures of Teeth **
Class 1 - enamel fracture
Class 2 - Crown fracture without pulpal involvement (enamel & dentin)
Class 3 - Crown fracture with pulpal involvement
Class 4 - Entire tooth fractured
Class 5 - Root fracture involving cementum, dentin and the pulp may occur in the apical, middle, or coronal 1/3 of the tooth
What is Traumatic Intrusion?
An injury where the tooth is forcibly driven into the alveolus
- Teeth that are intruded should be allowed to erupt back naturally
-Teeth typically require endodontic treatment at a later time
-If a primary tooth is intruded it can damage the permanent tooth below, however, damage can not be determined until the permanent tooth erupts
What is Exrusion and Lateral Luxation?
Injuries that occur when the teeth are displaced from their position
-Severe damage to the periodontal ligaments usually occurs
-the DDS should reposition the teeth ASAP
-A temporary splint is made of resin and wire to stabilize the tooth
-Endodontic treatment is often required at a later date
-Primary teeth undergo root resoprtion quicker after trauma and may become mobile
Replanting Avulsed Teeth (knocked out teeth)
Avulsed teeth CAN be replanted with varying degrees of success. The QUICKER the tooth can be replanted the greater the success
Instructions for Alvused Teeth
- Recover the tooth as fast as possible
- Wrap the tooth in a moistened paper towel or cloth
- Go IMMEDIATELY to the dentist office
Implanting an Avulsed Tooth
The highest success rate for an avulsed tooth is if it is replanted within 30 MINUTES!* (Board exam question)*
1. Local anesthetic is administered
2. Radiographs are taken (reveal any bone fragments)
3. Surgical curette is used to remove any blood clot that has formed in the area
4. The avulsed tooth is washed with saline
5. The tooth is splinted into place
6. Post operative radiographs are taken
7. Endodontic treatment is performed 6-8 weeks after implantation
Child Abuse & Neglect
Healthcare professionals are required by law to report any case in which they suspect that a child is being neglected or abused
- The abuser ususally will make up a story about how the child sustained the injury
Child abuse must be suspected as the cause when a child presents with unexplained signs such as..
- Injuries at various stages of healing
- Repeated injuries
- Chipped or injured teeth
- Scars inside the lips or tongue
- Tears of labial frena
- Injuries on the head and neck
- Facial swelling, bruising or black eyes
- Fractured nose
- Bite marks
- Injuries not consistent with the explanation of the parent
