Pediatric Dentistry Quiz

Diagnosis and Treatment Planning for Children

• Successful dental treatment for children is achieved by recording a detailed history, complete clinical examination, appropriate investigations, diagnosis, and treatment plan.
• Obtain all relevant information and informed consent before treatment.
• First examination should be completed by the eruption of the first tooth and no later than 12 months of age.

Treatment Planning

• Treatment plan is a sequential arrangement of treatment needs for maximum patient benefit.
• Aims to correct existing oral problems and prevent anticipated future problems.
• Advantages of treatment planning include: avoiding re-diagnosis, giving serial appointments, preparing instruments before patient arrival, estimating time, number of appointments, and total fee.
• Modifications in treatment planning may be required based on patient/parent cooperation, condition of teeth and oral hygiene, need for extractions, type of tooth movement, and required appliance.

Data Collection from Children

• Accurate data collection from children is difficult.
• Guardians usually provide data, which may be inaccurate and influenced by the child's emotional maturity.
• Children's behavior in the clinic may differ from their behavior at home or with teachers.

Referrals

• Patients with positive medical history should be referred to a paediatrician for evaluation and consent.
• Dosage adjustments or changes to medications may be necessary based on underlying systemic conditions.
• Any medication given to modify dental treatment (like premedication for behavior management or antibiotic prophylaxis) should be determined according to the child's specific needs (e.g., congenital cardiac defects).

Phases of Treatment

• Preventive phase: Aimed at preventing or minimizing dental disease, and involves plaque control, diet counseling, orthodontic consultation, topical fluoride application, pit and fissure sealant application, and educating the child and parent on home oral hygiene practices.
• Corrective phase: Includes extractions, restorations (short and simple procedures to build trust), minor surgical procedures, space maintainers, minor orthodontic corrections, and prosthetic rehabilitation.

Pediatric Dentistry Treatment Triangle

• A major difference in treating children versus adults is the relationship.
• Adult treatment is usually one-to-one (dentist-patient).
• Child treatment involves a one-to-two relationship (dentist-patient-parent/caregiver).
• The child is the central focus of attention for both the family and dental team.
• The process involves aspects like dialogue, voice tone, facial expressions, body language, and touch.

Intellectual Development

• Intellectual development (mental development) is the quantification of mental abilities relative to chronological age.
• IQ is calculated using the Binet IQ formula: IQ = (mental age/chronological age) x 100.
• A child with mental age and chronological age that is equal has an IQ of 100.
• Individuals with intellectual disabilities may require special behavioral guidance.

Behavior Management

• Pre-appointment behavior modification involves strategies to positively influence a child's behavior before a dental appointment.
• This can include video clips of children undergoing dental treatment or live models like siblings.
• Behavior modification techniques used include:
  • Communicative management (desensitization, modeling, distraction)
  • Hand-over-Mouth (HOM)
  • Patient immobilization

Fears

• Objective fears: Acquired through direct physical stimulation (seen, felt, smelled, or physically encountered), and not related to parental origin. These can arise from unpleasant experiences with dentistry or repeated hospital stays.
• Subjective fears: Suggested to the child by others (imitative fears) without direct experience, or through imaginative fears. Suggestive fears may be unintentionally transmitted by caregivers.

Anxiety and Fear

• Fear (apprehension) is a primal emotion rooted in a recognized source of potential harm (e.g., a needle).
• Anxiety is a primary emotion stemming from anticipating unknown danger.
• Fear and anxiety can exacerbate pain.

Behavior Rating Scale

• Frankl's Behavior Rating Scale categorizes patient behavior during treatment.
• Ratings include: Definitely negative (refusal of treatment), Negative (reluctance to accept treatment), Positive (acceptance of treatment), and Definitely positive (good rapport, laughter, enjoyment).

Wright's Clinical Classification

• Cooperative: Relaxed, minimal apprehension; straightforward treatment.
• Lacking cooperative ability: Very young children or those with specific disabilities, where establishing communication is difficult.
• Potentially cooperative: Children able to cooperate but choose not to. These patients require further classification.

Factors Contributing to Child Behavior

• Scheduling: Children are often freshest in the morning, and long wait times can lead to tiredness and restlessness.
• Appointment length: Long appointments can lead to loss of concentration. Appointments are typically limited to 30-45 minutes per quadrant.
• Dental attire: Some children may have negative experiences with white coats or masks, potentially influencing their behavior. Dentists may choose colorful clothes as an alternative.

Voice Control

• Appropriate voice control (tone and facial expressions) by the dentist are essential.
• Discussing voice control with parents beforehand can reduce misunderstanding.
• It's indicated for uncooperative and inattentive patients, but contraindicated due to age, disability, or mental/emotional immaturity if the patient will not understand.

Behavior Shaping

• Behavior shaping is a gradual procedure that reinforces successive approximations of the desired behavior until it occurs.
• It's based on the association between stimulus and response.

Types of Reinforcers

• Materials reinforcers: Gifts (e.g., toothbrush kits, drawing kits, stickers).
• Social reinforcers: Appreciation and praise (e.g., pats, handshakes, hugs).
• Activity reinforcers: Allowing a child to engage in favorite activities as a reward (e.g., watching TV).

Pharmacologic Management

• Pharmacologic management utilizes drugs to manage pediatric patient behavior during dental procedures.
• This includes inhaled gases, oral medications, IV infusions, and IM injections.
• Different levels of sedation exist, from minimal sedation (anxiolysis) to deeper states of consciousness.

IM and IV Routes

• IM (intramuscular) route relies on muscle tissue vascularity but may result in intravascular injection, air embolism, periostitis, hematoma, abscesses, cysts, or necrosis.
• IV (intravenous) route allows for rapid drug delivery and administration but requires venipuncture and careful patient restraint, making it less suitable for very young patients.

Nitrous Oxide

• Nitrous oxide (N2O) is a frequently used inhalation agent for pediatric sedation.
• It's a slightly sweet-smelling, colorless, heavier-than-air inert gas.
• It's a strong analgesic but acts as a weak anesthetic.
• It's absorbed rapidly and excreted through the lungs.
• Objectives of its use include reducing anxiety, improving cooperation, raising pain thresholds, and aiding patients with mental and physical disabilities.

Diffusion Hypoxia and Hallucinations

• Diffusion hypoxia is a potential complication of N2O use; it involves reduced oxygen levels in the alveoli due to its lower blood solubility. 100% oxygen for 10 minutes may be given to correct it.
• High concentrations of N2O can cause hallucinations.

Sedation Goals

• Safety: Protecting patient safety and minimizing physical discomfort and pain.
• Anxiety control: Minimizing psychological trauma, maximizing the potential for amnesia, and calming anxiety.
• Behavior control: Managing behavior or movement during treatment.
• Stable state: Returning the patient to a stable physiological state for safe discharge.

Apexification

• Apexification is a procedure performed before root canal therapy on immature, irreversibly diseased teeth with open apices.
• Its aim is to stimulate root end development to mature the root.
• It can be performed after calcific maturation.
• Steps include, isolating the tooth, establishing root length, removing pulp remnants, canal irrigation, filling the canal with Ca(OH)2 and sealing with cement.

Root Canal Irrigation

• Root canal irrigation relies on chemical debridement of the canal with minimal mechanical procedures.
• Sodium hypochlorite (1.5%) is used to disinfect and eliminate necrotic material. Higher concentrations have negative impacts on dental pulp stem cells.
• EDTA is used for final irrigation to prepare the dentin protein matrix.

Ankylosis

• Ankylosis results from injury to the periodontal ligaments and subsequent inflammation/invasion of osteoclastic cells.
• This results in irregular root resorption on the root surface.
• Ankylosed primary teeth are often removed to avoid complications with the permanent successor.

Tooth Displacement (Extrusion, Lateral Luxation)

• Extrusion: Displacement of tooth out of its socket, often leading to pulpal necrosis. Repositioning and stabilization are vital.
• Lateral luxation: Displacement of teeth in a non-axial direction. This is characterized by mobility, displacement, discomfort to percussion, bleeding in the gingival crevice, and radiographic PDL space widening on one side with lamina dura crunching on the other side. Early treatment is vital for the prognosis.

Classification of Tooth Fractures (Ellis and Davey)

• Various classification systems are used to describe the types of tooth fracture. This classification system distinguishes among different types of enamel, dentin, and pulpal involvement. Understanding the level of pulp exposure or presence is crucial in determining treatment.

Factors Affecting Space Maintainers

• Time: space closure generally occurs within 6 months.
• Space loss: Amount of space loss varies depending on whether the lost tooth is upper or lower primary molar.

Pulp Chamber Sealing

• Some methods of sealing the pulp chamber include using flowable composite materials to maintain the paste below the CEJ (cemento-enamel junction).

Pulpal Necrosis

• Pulpal necrosis is damage to the pulp, often related to a displacement injury or injury to the apical vessels resulting in vascular supply loss.
• Symptoms may not appear initially but will eventually arise, sometimes following treatment, leading to pain and infection.
• Teeth with severe pulpal necrosis often require extraction or endodontic treatment.

Arch Length Analysis

• Arch length analyses are used to determine the necessary space for the succedaneous teeth, predicting their growth pattern and alignment in the arch.

Deciduous Dentition Period

• Physiological spaces are common in deciduous dentition, including primate spaces mesial to canines in maxilla and distal to canines in mandible.
• Developmental spaces are critical in permanent dentition development.
• Non-spaced or closed spaces can lead to malocclusion.
• Dental arches are often wider U-shaped, with visible spaces between teeth during deciduous dentition.
• The terminal plane relation of deciduous molars tends to have a shallow curve of Spee and minimal cusp interdigitation.

Non-Pharmacological Local Pain Management

• Laser analgesia uses short pulses to temporarily disrupt nerve impulses (analgesic effect).
• Reversal of local anesthesia is often necessary to manage side effects like prolonged tissue anesthesia and issues with speech, eating, and altered facial appearance.

Silver Diamine Fluoride (SDF)

• SDF halts the cariogenic process, preventing new cavities.
• SDF's effectiveness is due to its strong stimulating effect on dentin formation and antimicrobial activity.

Quantitative Light-Induced Fluorescence (QLIF)

• QLIF is a method for assessing tooth demineralization using a light box and accompanying software.
• Analyzing captured images allows for quantifying demineralization patterns.
• Advantages include high reproducibility, detection of small lesions, image storage, improved patient motivation and transmission.
• Disadvantages include potential difficulty related to patient isolation procedures.

Test your knowledge on pediatric dentistry, focusing on treatment phases, preventive practices, and behavioral management techniques. This quiz covers essential concepts, including the optimal age for dental examinations and the development of treatment plans. Perfect for dental students and professionals looking to refresh their expertise.