Pediatric Restorative Treatment

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Questions and Answers

What is the current trend in the time allocation of dentists?

No significant change in time allocation

More time to preventive procedures and less time to routine restoration (correct)

More time to routine restoration and less time to preventive procedures

Equal time to preventive and restorative procedures

What continues to be among the important services provided by pediatric dentists and general practitioners?

Community fluoridation programs

Dental health education

Application of preventive dentistry advances

Restoration of carious lesions in primary and young permanent teeth (correct)

What is the focus of the course 'Pediatric Dentistry II'?

The Principles of Restorative Treatment in Pediatric Patient (correct)

Advances in preventive dentistry

The nature of fluoridation

Dental health education

What is the purpose of the caries management plan in pediatric dentistry?

To consider child and parent preferences, age, medical and dental history, and extent of treatment needs Signup and view all the answers

What is the purpose of the patient registration form in pediatric dentistry?

To gather personal information, health status, past dental experience, extraoral and intraoral findings, and treatment planning Signup and view all the answers

Why is anamnesis crucial in pediatric restorative treatment?

It includes medical, social, nutritional, and dental history, essential for correct diagnosis and proper treatment planning Signup and view all the answers

What is the purpose of using FDI numbering for recording teeth in pediatric dentistry?

To use permanent teeth numerals and primary teeth Roman numerals for accurate recording Signup and view all the answers

Why are behavioral guidance techniques crucial in pediatric dentistry?

They are crucial for successful treatment, followed by the establishment of an accurate diagnosis Signup and view all the answers

Who is considered to have a stake in guiding a child through the dental experience, according to the text?

Both the family and the dental team Signup and view all the answers

What was the focus of behavior guidance in the context of pediatric dentistry in the past?

Different things to different people Signup and view all the answers

According to McElroy33 in 1895, what would render a dental appointment a failure?

Child leaving in tears Signup and view all the answers

What is the aim of the course 'Paediatric Dentistry at a Glance'?

Teaching child psychology and dentist-patient relationships Signup and view all the answers

In the triangle of society, family, and dental team, who is at the apex according to the text?

The child Signup and view all the answers

What is the involvement of dental auxiliaries in providing care for children, according to the text?

Invaluable involvement Signup and view all the answers

What does behavior guidance in pediatric dentistry involve according to the text?

The total dental health team's involvement Signup and view all the answers

Which of the following is emphasized in modern behavior guidance for pediatric dental patients?

Communication techniques Signup and view all the answers

What is one of the vital aspects in the delivery of efficient service to children in private practice, according to the text?

Quadrant dentistry Signup and view all the answers

What is one of the key factors in the fundamentals of behavior guidance, as mentioned in the text?

Attitude and integrity of the entire dental team Signup and view all the answers

What is recognized as important in building trust in caring for children, according to the text?

Recognizing and acknowledging a patient's fear and anxiety Signup and view all the answers

What is highlighted as a method of behavior modification in pediatric dentistry, according to the text?

Distraction Signup and view all the answers

What is one of the key focuses of the American Academy of Pediatric Dentistry, as mentioned in the text?

Enhancing communication and partnering with the child and parent Signup and view all the answers

What is crucial in the treatment of children, according to the text?

Recognizing individual tolerance levels and being flexible in treatment plans Signup and view all the answers

What is recognized as a change in today's children compared to past generations, according to the text?

Earlier school starts and increased awareness through the media Signup and view all the answers

What is one of the objectives of restorative treatment planning in pediatric patients?

To ensure that the child reaches adulthood with optimum achievable dental health Signup and view all the answers

Why is it important to restore primary teeth in pediatric patients?

To repair or limit the damage of dental caries Signup and view all the answers

What is the focus of the course 'Restorative Treatment Planning in Pediatric Patient'?

Treatment planning for different stages of dental caries in pediatric patients Signup and view all the answers

What is the purpose of using a rubber dam in restorative treatment for pediatric patients?

To prevent foreign objects from coming into contact with oral structures Signup and view all the answers

What is a characteristic feature of the crowns of primary teeth?

They are smaller and more bulbous than permanent teeth Signup and view all the answers

What necessitates special care in the formation of the gingival floor during class II cavity preparation in primary molars?

The sharp constriction at the neck of the primary molar Signup and view all the answers

How does the pulpal outline of primary teeth differ from that of permanent teeth?

It follows the dentino-enamel junction more closely Signup and view all the answers

What is the recommended restorative material for extensive caries in young children?

Stainless steel crowns Signup and view all the answers

What is the initial step in managing caries according to the text?

Temporizing open cavities with zinc oxide and eugenol cement Signup and view all the answers

What are the risks of restorative therapy mentioned in the text?

Reducing tooth longevity, recurrent lesions, restoration failure Signup and view all the answers

What is generally advocated for the pulpal floor in traditional cavity preparations for class I and class II lesions?

A flat pulpal floor Signup and view all the answers

What should be avoided in a two-surface preparation according to the text?

A sharp angle between the pulpal floor and the axial wall Signup and view all the answers

What does a sharp angle between the pulpal floor and the axial wall of a two-surface preparation lead to, according to the text?

Concentration of stresses Signup and view all the answers

What will rounded angles throughout the preparation result in, based on the text?

Less concentration of stresses Signup and view all the answers

What has replaced the traditional treatment for the most part, according to the text?

Conservative caries excavation and restoration with bonding restorative and sealant materials Signup and view all the answers

What is the recommended width of the preparation at the isthmus for traditional class II cavity preparation for amalgam?

One-third the intercuspal dimension Signup and view all the answers

What is the most frequent site of caries attack on the primary canine, making it difficult to restore adequately?

Distal surface Signup and view all the answers

What is the primary consideration when preparing a small conventional class III cavity for restoration with bonding materials?

Extent of lesion advancement into dentin Signup and view all the answers

What is the main reason for the greater buccal and lingual extension at the cervical area in cavity design?

Proper contact with adjacent teeth Signup and view all the answers

Why is extreme care necessary when breaking through the marginal ridge during the preparation of a class II cavity in a primary tooth?

To prevent damage to the adjacent proximal surface Signup and view all the answers

What percentage of 15-year-olds had obvious decay experience, based on the 2013 Child Dental Health Survey for England, Wales, and Northern Ireland?

46% Signup and view all the answers

What is the impact of caries on the daily life of children and adolescents, according to the 2013 Child Dental Health Survey for England, Wales, and Northern Ireland?

Significant impact reported Signup and view all the answers

What proportion of 12-year-olds had obvious decay experience, based on the 2013 Child Dental Health Survey for England, Wales, and Northern Ireland?

34% Signup and view all the answers

What is the recommended material for direct pulp capping according to the text?

MTA Signup and view all the answers

What is the primary aim of indirect pulp capping?

Leaving caries in the deepest part of the lesion Signup and view all the answers

What is the crucial factor in using any material for restoration according to the text?

Isolation of the pulp from the oral environment Signup and view all the answers

What is the recommended treatment for hypomineralized, hypomature, or hypoplastic first permanent molars when the intention is long-term maintenance of the molar?

Use of conventional restorative techniques with difficulty in determining margins Signup and view all the answers

What is a suitable restorative material for extensive caries in young children, according to the text?

Composite resins with an appropriate bonding agent in well-demarcated lesions Signup and view all the answers

What is a novel technology mentioned in the text for the prevention and restoration of carious lesions up to the first third of dentin (D-1)?

Resin infiltration technique Signup and view all the answers

What is recommended for the sensitivity of hypomineralized molars in pediatric patients?

Repeated application of 5% sodium fluoride varnish (Duraphat®) Signup and view all the answers

What is the purpose of using a simplified restorative system in the described case?

To reduce time-consuming and patient-friendly restorations Signup and view all the answers

What is the purpose of using cotton rolls during restorative procedures in the described case?

To promote moisture control Signup and view all the answers

What is the characteristic feature of firm dentin during carious tissue removal?

It does not deform when an instrument is placed into it Signup and view all the answers

What is the aim of using a self-etching adhesive in the described restorative procedure?

To simplify the bonding process Signup and view all the answers

What is the significance of using bulk fill composite in the described restorative procedure?

To eliminate additional composite layers and multiple steps Signup and view all the answers

What is considered the most suitable restorative material for a specific case involving carious lesions and aesthetic concerns?

Composite resin Signup and view all the answers

What was required before placing the rubber dam for restorative treatment in pediatric patients?

Local anesthesia Signup and view all the answers

What was used to fill the cavities in a case involving carious lesions and aesthetic concerns?

Resin Modified Glass Ionomer Cement Signup and view all the answers

What was removed using a low-speed bur in restorative treatment for pediatric patients?

Carious tissue Signup and view all the answers

What was the observation regarding pulp exposure in the restorative treatment of pediatric patients?

Pulp exposure was not observed Signup and view all the answers

Which type of crown is relatively inflexible compared to traditional SSC?

Polycarbonate Crowns Signup and view all the answers

What is a drawback of using Composite Strip Crowns?

They require great amount of tooth reduction Signup and view all the answers

For which condition are Zirconia crowns commonly used in pediatric dentistry?

Aesthetic restoration of primary anterior-posterior and permanent first molar teeth Signup and view all the answers

For whom may a removable prosthesis be unsafe?

Epileptic patients Signup and view all the answers

What is the primary aim of using a rubber dam in the clinical procedure for stainless steel crown placement?

To prevent bur injuries to surrounding tissues Signup and view all the answers

What is the purpose of open-face stainless-steel crowns in dental procedures?

To provide a more esthetic alternative for anterior teeth with extensive proximal lesions Signup and view all the answers

What is the purpose of pre-veneered stainless-steel crowns in clinical applications?

To cover the buccal or facial surface with a tooth-colored coating Signup and view all the answers

Which of the following is a contraindication for using a stainless steel crown (SSC) in pediatric patients?

Extensive wear of the tooth Signup and view all the answers

In which situation would pediatric zirconia crowns be indicated for use in pediatric patients?

Restorations for primary teeth with hereditary anomalies, such as dentinogenesis imperfecta or amelogenesis imperfecta Signup and view all the answers

What is the armamentarium for stainless steel crown (SSC) according to the text?

2 Signup and view all the answers

Study Notes

Pediatric Restorative Treatment: Diagnosis and Introduction

Restorative treatment in pediatric dentistry is based on appropriate clinical examination and is part of a comprehensive treatment plan, as per the American Academy of Pediatric Dentistry (AAPD) reference manual revised in 2020.
The treatment plan considers the developmental status of the dentition, caries-risk assessment, patient’s oral hygiene, anticipated parental compliance, and the patient’s ability to cooperate for treatment.
The caries management plan should be tailored to the child and parent preferences, age, medical and dental history, and extent of treatment needs.
The examination process for a child patient's first visit to the pedodontics clinic is crucial, requiring the dentist to establish trust by communicating with the child and family.
A detailed history, including oral, intraoral, and radiological examinations, is essential during the first examination appointment, with parental information being important for diagnosis during anamnesis.
Behavioral guidance techniques are crucial for successful treatment in pediatric dentistry, followed by the establishment of an accurate diagnosis.
The patient registration form should include personal information, health status, past dental experience, extraoral and intraoral findings, and treatment planning.
The numbering recommended by the FDI is used for recording teeth, with permanent teeth registered with numerals and primary teeth with Roman numerals.
Anamnesis, including medical, social, nutritional, and dental history, is crucial for correct diagnosis and proper treatment planning.
Examination should be done under three main headings: extraoral examination, intra-oral examination, and radiological examination.
Diagnosis is the recognition of a problem, while treatment is the solution, illustrating the importance of accurate diagnosis in pediatric restorative treatment.
This information is from Dent 4002 Pediatric Dentistry II, by Associate Professor Banu Öter, DDS, PhD, at Bahçeşehir University School of Dental Medicine Department of Pediatric Dentistry.

Behavioral Management Techniques in Pediatric Dentistry

The first mention in dental literature of measuring the success or failure of a child’s appointment by anything other than technical proficiency was made.
One definition of behavior guidance in pediatric dentistry is to effectively and efficiently perform treatment for a child while instilling a positive dental attitude.
Quadrant dentistry, utilizing auxiliary personnel, is vital in the delivery of efficient service to children in private practice.
The American Academy of Pediatric Dentistry emphasizes enhancing communication and partnering with the child and parent to promote a positive attitude and good oral health.
The attitude and integrity of the entire dental team are crucial in the fundamentals of behavior guidance.
Recognizing and acknowledging a patient’s fear and anxiety is important in building trust in caring for children.
Recognizing individual tolerance levels and being flexible in treatment plans are crucial in the treatment of children.
Distraction is a method that helps a child focus attention on a preferred activity to think less about another, and it is a form of behavior modification.
Today’s children differ from past generations due to earlier school starts and increased awareness through the media.
Parental concerns, legal, and ethical considerations have resulted in a decreased use of physical approaches in behavior guidance for pediatric dental patients.
Dental students and dentists must keep abreast of the times in this highly dynamic area of pediatric dentistry.
The modern behavior guidance for pediatric dental patients places a greater focus on communication techniques and decreased or discontinued use of physical approaches.

Restorative Treatment in Pediatric Patients: Key Points

Early childhood caries (ECC) is prevalent and affects children aged 71 months and younger, as well as their parents, with ECC defined as an infectious disease affecting any primary tooth.
The prevalence of ECC in developed countries was reported as 23.7% from 1994-2004, with efforts to decrease it to 11% by 2010, but it remains high (40.7%-69.8%) among preschool children in Turkey.
The initial step in managing caries involves temporizing open cavities with materials such as zinc oxide and eugenol cement or packable glass ionomer cement.
Historically, the belief that caries is a progressive disease requiring surgical and restorative intervention has shifted, recognizing that not all caries lesions require restoration.
Restorative therapy benefits include eliminating caries-susceptible areas, stopping tooth demineralization, restoring tooth structure and function, preventing infection spread, and preventing tooth shifting due to lost structure.
Risks of restorative therapy include reducing tooth longevity, recurrent lesions, restoration failure, pulp exposure, future pulpal complications, and iatrogenic damage to adjacent teeth, with primary teeth being more susceptible to restoration failures than permanent teeth.
Guidelines emphasize the importance of identifying individual risk for caries progression, understanding disease progression, and utilizing active surveillance, preventive services, and restorative therapy when indicated.
Decisions on when to restore caries lesions should consider clinical criteria like visual enamel cavitation, shadowing, and radiographic progression of lesions.
Definitive restoration techniques in young children should consider the active nature of the disease, with stainless steel crowns recommended for extensive caries, teeth affecting more than two surfaces, and teeth requiring pulpotomy or pulpectomy.
Commonly used restorative materials in preschool children include glass ionomer cements, resin-modified glass ionomer cements, polyacid-modified resins, and composite resins, all of which are moisture-sensitive and require adequate isolation, preferably under a rubber dam.
The maintenance of a clean operating field during cavity preparation and restorative material placement is crucial for efficient operation and development of a serviceable restoration, with rubber dams aiding in this maintenance and offering advantages such as time-saving, anxiety management, and saliva control.
The use of rubber dams is known to save time, aid in management, and control saliva, making it an important consideration during ideal cavity preparation for primary teeth.

Pediatric Cavity Preparation and Restoration Techniques

Traditional class II cavity preparation for amalgam requires buccal and lingual extensions to self-cleansing areas.
Cavity design should have greater buccal and lingual extension at the cervical area for proper contact with adjacent teeth.
The width of the preparation at the isthmus should be approximately one-third the intercuspal dimension.
Axiopulpal line angle should be beveled or grooved to reduce stress concentration and provide greater bulk of material.
Occlusal surfaces of molar teeth account for about 90% of caries in children, with the most rapid rise in decay rates during late childhood and adolescence.
Incipient class I cavity in very young children may require minimal restorative intervention and can be performed without a rubber dam or local anesthetic.
Use of preventive resin restoration, preceded by a dentin-bonding agent, may be considered if the child is cooperative.
Lesions in the inner half of the enamel of the mesial surface of the first permanent molar progress relatively fast between 6 and 12 years of age.
Extreme care must be taken when breaking through the marginal ridge to prevent damage to the adjacent proximal surface during the preparation of a class II cavity in a primary tooth.
Carious lesions on the proximal surfaces of anterior primary teeth may occur in children with arch inadequacy or crowding.
Small conventional class III cavity may be prepared and restored with bonding materials if the carious lesion has not advanced appreciably into the dentin and does not weaken the incisal angle.
The distal surface of the primary canine is a frequent site of caries attack, and restoring it adequately can be difficult due to the position of the tooth in the arch and the characteristically broad contact between the distal surface of the canine and the mesial surface of the primary molar.

Restorative Treatment for Young Permanent Teeth

A fifth of 12- and 15-year-old children reported difficulty eating, and half reported life impact due to teeth or mouth problems.
The eruption of first permanent molars often goes unnoticed until problems arise.
When first erupting, the roots of permanent teeth are incompletely formed and take up to 5 years to complete.
Three methods of caries removal have been compared, including complete excavation, stepwise excavation, and partial excavation.
Evidence shows that incomplete caries excavation reduces pulp exposures in primary and permanent teeth.
Indirect pulp capping involves leaving caries in the deepest part of the lesion and placing a base over the remaining carious dentine.
The crucial factor in using any material for restoration is good isolation of the pulp from the oral environment.
Studies found that remaining carious dentine mostly remineralizes and hardens without caries progression when using stepwise removal of caries and indirect pulp capping.
Direct pulp capping is used when a small exposure is encountered during cavity preparation, aiming to preserve pulp vitality.
Calcium hydroxide has traditionally been used as a remedial agent for direct pulp capping.
Successful results have been reported with MTA and Biodentine® as pulpcapping agents.
Before treatment, it is important to assess the situation correctly, ensuring no history of spontaneous pain, swelling, mobility, or discomfort.

Stainless Steel Crown Clinical Procedure and Variations

Stainless Steel Crown (SSC) is the most durable, long-lasting, and cost-effective method.
SSC offers better protection for the remaining tooth surface.
However, SSC lacks good esthetic properties.
The clinical procedure involves various steps including evaluation of pre-operative occlusion, local anesthesia administration, placement of rubber dam, appropriate crown size selection, tooth preparation and evaluation, crown adaptation, finishing and polishing, and cementation with removal of residual cement.
The rubber dam protects surrounding tissues from bur injuries and increases patient comfort.
The crown can be selected through measurement or trial and error methods.
Tooth preparation involves occlusal, proximal, buccal, and lingual/palatal reduction while preserving original contour and achieving smooth taper.
It aims to provide sufficient space for SSC, have sufficient tooth retention, and protect the gum.
Excess cement should be removed for gingival health.
For anterior teeth with extensive proximal lesions involving the incisal portion, the application technique is the same with posterior crowns.
Open-face stainless-steel crowns involve cutting labial metal and restoring with resin-based composite, providing a more esthetic alternative.
Pre-veneered stainless-steel crowns are covered on their buccal or facial surface with a tooth-colored coating of polyester/epoxy hybrid composition.

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Test your knowledge of pediatric restorative treatment with this quiz. Explore the crucial aspects of diagnosis and introduction to restorative treatment in pediatric dentistry, including examination processes, behavioral guidance techniques, and the importance of accurate diagnosis. Ideal for dental students, professionals, and anyone interested in pediatric dentistry.