Odontopediatrics Lesson 8 PDF

Odontopediatrics T 8 ODONTOPEDIATRICS- INTRODUCTION TO DENTISTRY ODONTOLOGY Agustina Muñoz Rodríguez Ø Pediatric dentistry has become an increasingly relevant part of the global health concept. Ø Children are not just small adults. Ø They are not always able to be patient and cooperative during a d...

Odontopediatrics T 8 ODONTOPEDIATRICS- INTRODUCTION TO DENTISTRY ODONTOLOGY Agustina Muñoz Rodríguez Ø Pediatric dentistry has become an increasingly relevant part of the global health concept. Ø Children are not just small adults. Ø They are not always able to be patient and cooperative during a dental exam. Ø Pediatric dentists know how to examine and treat children in ways that make them comfortable. In addition, pediatric dentists use specially designed equipment in offices that are arranged and decorated with children in mind. Ø A pediatric dentist offers a wide range of treatment options, as well as expertise and training to care for your child’s teeth, gums, and mouth. Ø When your pediatrician suggests that your child receive a dental exam, you can be assured that a pediatric dentist will provide the best possible care. Odontopediatrics Introduction 2 Pediatric dentistry is defined as the branch of dentistry that is responsible for the treatment, maintenance and prevention of dental health of the child from childhood to adolescence, since any untreated alteration in temporary teeth (deciduous teeth), can subsequently influence the permanent pieces. Odontopediatrics Introduction 3 Pediatric dentistry is a very close specialty with orthodontics. The restorative treatment mainly consists of treating the traumatisms, using sealants, which consists of slightly filling the teeth fissures without hardly removing dental material to avoid possible decay, and treating the caries produced and its consequences. Odontopediatrics Introduction 4 The main difference between regular dentistry and pediatric dentistry regarding the treatment of caries is the presence of temporary or deciduous teeth in children which causes the treatment to change, so that lesions that occurred in the temporary dentition will be treated in a less conservative way and more aggressive than those that occurred in permanent teeth, to avoid that, in the worst case, an inadequate treatment could be given to a temporary tooth that would later affect the permanent tooth. Odontopediatrics Introduction 5 It is essential to perform radiographs in children with dental problems if we suspect the possibility of very frequent pathologies such as dental agenesis, ectopias, supernumeraries and multiple caries. It’s important to keep the temporary pieces until the exfoliation by the permanent ones, so they must be treated in all cases without exception and if we lose any piece, no matter how temporary, we must take measures to avoid displacements of the other pieces. Odontopediatrics Introduction 6 Children in general are lazy to perform daily dental hygiene and even, general hygiene, so it is the parents’ duty to try to get the habit of brushing their teeth every day. It is more than proven that daily hygiene contributes to a great decrease in the suffering of dental diseases. If the child doesn’t have the habit of brushing his teeth, we must study the parents, in many cases it turns out that the parents don’t have it either, and then our mission and task becomes even more difficult. We must tint their teeth in the clinic to prove the existence of bacterial plaque, today there are many explanatory pamphlets for children that make pediatric patients understand that there are “bugs” that can destroy their teeth. Odontopediatrics Introduction 7 8 Many specialists prefer treating children without the presence of the parents, but if the parents want to be present, it is important that parents are present while explaining the plaque and at the time of dyeing their teeth. Odontopediatrics Introduction 9 Ø The dental pieces are in contact with each other at a point of maximum convexity, which is the so-called contact point. When we lose tooth contact, the teeth tend to move mesially (forward) and this can lead to the displacement of a whole tooth group, even permanent pieces, if there are already erupted. This alteration of the dental pieces is transmitted when the patient changes the temporary pieces for the permanent ones, arriving in most of the cases to an anomalous position of the dental pieces and the establishment of a bad dental occlusion. Ø Classically, temporary pieces have been sealed with amalgam, but today there are countries that have banned their use in children. The choice of a filling goes with the age of the child, their collaboration in the clinic and their risk of caries. Ø Composite resins modified with polyacid (Dyract®), have a very promising result, are easy to handle and are radiopaque. Odontopediatrics Introduction 10 Ø When a caries can’t be treated, and the only solution is the extraction of the piece, we must place some system to maintain space and prevent dental displacement as we will see later. Ø When we want to perform tooth extraction, it is essential to have an X-ray of the piece. In general, they are very easy extractions, the temporary pieces leave without roots because there has been a physiological reabsorption by the permanent piece, but it is very common that the piece has roots or some of them haven’t been reabsorbed. Odontopediatrics Introduction 11 PREMATURE LOSS OF TEETH Ø The early loss of temporary dental pieces, either by extraction or by trauma, produces some dental displacements so the pieces occupy spaces that correspond to other dental pieces and when they erupt chronically, having their space occupied, they can’t erupt properly and in most cases, dental crowding occurs, or ectopic eruptions. Ø To avoid these dental displacements, if the piece that must replace the lost one takes time to erupt, we must maintain the space and avoid the dental displacements, in these cases we will place some devices called space maintainers. Odontopediatrics Introduction 12 SPACE MAINTAINER Ø Space maintainers can be removable or fixed types. Ø Fixed maintainers are devices that consist of a crown or a band of steel and a wire that is welded to it, and the wire that rests on the previous piece. The band or crown is cemented in the posterior piece and the tooth movement of both pieces is avoided. Odontopediatrics Introduction 13 PROLONGED RETENTION OF TEMPORARY PIECES Ø In the cases that the permanent tooth erupts, and the temporary has not fallen, we will proceed to extract the deciduous. Ø We will never extract a temporary tooth without first making sure that there is no dental agenesis, or an inclusion that makes it impossible for the piece to erupt. Odontopediatrics Introduction 14  Eruption cronology Ø Children begin to get their baby teeth during the first 6 months of life. Ø By age 6 or 7 years, they start to lose their first set of teeth, which eventually are replaced by secondary, permanent teeth. Ø Without proper dental care, children face possible oral decay and disease that can cause a lifetime of pain and complications. Ø Today, early childhood dental caries—an infectious disease—is 5 times more common in children than asthma and 7 times more common than hay fever. Odontopediatrics Introduction 15  History In 1909 Minnie Evangeline Jordon established the first dental practice in the United States devoted only to pediatric patients. In 1925 she published the first textbook on pediatric dentistry, titled Operative Dentistry for Children. Odontopediatrics History 16  Pediatric dentistry Ø Pediatric (also paediatric or pædiatric) dentists promote the dental health of children as well as serve as educational resources for parents. Ø It is recommended by the American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) that a dental visit should occur within six months after the presence of the first tooth or by a child's first birthday. Ø The AAPD has said that it is important to establish a comprehensive and accessible ongoing relationship between the dentist and patient – referring to this as the patient's "dental home". Odontopediatrics Pediatric dentistry 17  Pediatric dentistry Ø This is because early oral examination aids in the detection of the early stages of tooth decay. Ø Early detection is essential to maintain oral health, modify aberrant habits, and treat as needed and as simply as possible. Ø Additionally, parents are given a program of preventive home care (brushing, flossing and fluorides), a caries risk assessment, information on finger, thumb, and pacifier habits, advice on preventing injuries to the mouth and teeth of children, diet counseling , and information on growth and development. Odontopediatrics Pediatric dentistry 18  Pediatric dentistry Responsibilities of a pediatric dentist include: Diagnose oral diseases. Promote oral health for children and adolescents(healthy, sick or those with disabilities) Formulate treatment plans to restore oral health of pediatric patients. Interpret x-rays and diagnostic tests. Monitor growth and development of the teeth and jaws. Correct malocclusion through interceptive orthodontic treatment. Perform surgical procedures on the teeth, bone and soft tissues of the oral cavity. Treat dental caries and odontogenic infection. Manage dental trauma, including fractured, displaced, and knock-out teeth. Treat pediatric patients under various stages of sedation(minimal, moderate, or deep). Odontopediatrics Pediatric dentistry 19  Pediatric dentistry Ø One of their main concerns is tooth decay prevention. check alien Ø Not only do they work with the teeth, pediatric dentists also look at the gums, throat muscles and nervous system of the head, neck and jaw, the tongue, and salivary glands. Ø They do this to check for pathology and other anomalies. Ø Another duty of theirs is to test for oral cancer and perform biopsies, if needed. Odontopediatrics Pediatric dentistry 20  Pediatric dentistry Pediatric dentists provide comprehensive oral health care that includes the following: Infant oral health exams, which include risk assessment for caries in mother and child Preventive dental care including cleaning and fluoride treatments, as well as nutrition and diet recommendations Habit counseling (for example, pacifier use and thumb sucking) Early assessment and treatment for straightening teeth and correcting an improper bite (orthodontics) Odontopediatrics Pediatric dentistry 21  Pediatric dentistry Repair of tooth cavities or defects. Diagnosis of oral conditions associated with diseases such as diabetes, congenital heart defect, asthma, hay fever, and attention deficit/ hyperactivity disorder. Management of gum diseases and conditions including ulcers, short frenulae, mucoceles, and pediatric periodontal disease. Care for dental injuries (for example, fractured, displaced, or knocked-out teeth). Odontopediatrics Pediatric dentistry 22  Pediatric oral pathology DEVELOPMENTAL ORO-FACIAL CLEFTS PALATAL CYST OF THE NEWBORN CONGENITAL EPULIS NATAL/NEONATAL TEETH ANKYLOGLOSSIA CONGENITAL ABSENCE OF TEETH Odontopediatrics Pediatric oral pathology 23  Pediatric oral pathology DEVELOPMENTAL ORO-FACIAL CLEFTS ORO-FACIAL CLEFTS 1. Orofacial clefts are birth defects where the lip, palate or PALATAL CYST OF THE NEWBORN CONGENITAL EPULIS both may be involved. NATAL/NEONATAL TEETH 2. A cleft is a separation in a body structure, often ANKYLOGLOSSIA resulting from the failure of tissues to grow together CONGENITAL ABSENCE OF TEETH properly. 3. Cleft lip and cleft palate are the single most common congenital deformity affecting the orofacial structures and constitute about 13% of all reported anomalies. 4. Cleft lip and cleft palate can occur unilateral or bilateral. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both together. Odontopediatrics Pediatric oral pathology 24  Pediatric oral pathology ORO-FACIAL CLEFTS DEVELOPMENTAL ORO-FACIAL CLEFTS ETIOLOGY : many factors may be involved: PALATAL CYST OF THE NEWBORN Genetics. CONGENITAL EPULIS Environmental factors; alcohol consumption, NATAL/NEONATAL TEETH Smoking, hypoxia during pregnancy, dietary and vitamins ANKYLOGLOSSIA CONGENITAL ABSENCE OF TEETH deficiencies (like folic acid and vitamin A deficiency) Drugs: corticosteroids (anti-inflammatory), phenytoin (anti- convulsant). Infections during pregnancy. Maternal age. Problems with feeding can occur with orofacial clefts which requires treatment. TREATMENT Surgery Obturator Odontopediatrics Pediatric oral pathology 25  Pediatric oral pathology DEVELOPMENTAL PALATAL CYST OF THE NEWBORN (EPSTEIN’S PEARLS; BOHN’S ORO-FACIAL CLEFTS NODULES): PALATAL CYST OF THE NEWBORN Occur in 65-85% of newborns. CONGENITAL EPULIS Single or multiple, small (1- 3mm), white yellowish cysts found in the NATAL/NEONATAL TEETH palate of newborn infants. ANKYLOGLOSSIA If found at the median palatal raphe, they’re called Epstein’s pearls. CONGENITAL ABSENCE OF TEETH If scattered on the hard palate, they’re called Bohn’s nodules. PATHOGENESIS Researches have theorized that these cysts may arise in one of two ways: First, epithelial entrapment at the midline during the formation of secondary palate. (Epistein’s pearls) Second, arise from epithelial remnants derived from the development of the minor salivary glands of the palate. (Bohn’s nodules) TREATMENT No treatment is required, as they’re going to disappear several weeks after birth. Odontopediatrics Pediatric oral pathology 26  Pediatric oral pathology CONGENITAL EPULIS Clinical features: DEVELOPMENTAL A soft tissue tumor that occurs almost exclusively on the alveolar ridge ORO-FACIAL CLEFTS of newborns. PALATAL CYST OF THE NEWBORN Pink to red, smooth- surfaced mass. CONGENITAL EPULIS PATHOGENESIS NATAL/NEONATAL TEETH Most of these tumors are less than 2 cm, but can reach up to 7.5 cm ANKYLOGLOSSIA Two to three times more common on the maxillary ridge than CONGENITAL ABSENCE OF TEETH mandibular ridge. Most common in the area of lateral incisor and canine teeth. Shows a striking predilection for females (90% of the cases), which suggest a hormonal influence in its development. HISTOPATHOLOGY: The overlying epithelium shows atrophy of rete ridges Large-rounded cells with granular cytoplasm TREATMENT: Surgical excision. Will not recur, even with incomplete removal. In some patients, complete regression of the tumor without treatment. Odontopediatrics Pediatric oral pathology 27  Pediatric oral pathology DEVELOPMENTAL ORO-FACIAL CLEFTS NATAL/NEONATAL TEETH: PALATAL CYST OF THE NEWBORN Natal teeth are teeth that are present at birth. CONGENITAL EPULIS Neonatal teeth are teeth that emerge through NATAL/NEONATAL TEETH ANKYLOGLOSSIA the gingiva during the first month of life. CONGENITAL ABSENCE OF TEETH Most common site: mandibular central incisors area TREATMENT They can be extracted if causing a problem to the infant or the mother. They should be left in the mouth as long as possible to decrease the likelihood of removing permanent tooth buds with the natal tooth. Odontopediatrics Pediatric oral pathology 28  Pediatric oral pathology DEVELOPMENTAL TONGUE-TIE (ANKYLOGLOSSIA) ORO-FACIAL CLEFTS Most of us think of tongue-tie as a situation we find PALATAL CYST OF THE NEWBORN ourselves in when we are too excited to speak. Actually, CONGENITAL EPULIS tongue-tie is the non-medical term for a relatively NATAL/NEONATAL TEETH ANKYLOGLOSSIA common physical condition that limits the use of the CONGENITAL ABSENCE OF TEETH tongue, ankyloglossia. THE ETIOLOGY Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a frenulum. After birth, the lingual frenulum continues to guide the position of incoming teeth. As we grow, it recedes and thins. This frenulum is visible and easily felt if you look in the mirror under your tongue. In some children, the frenulum is especially tight or fails to recede and may cause tongue mobility problems. Odontopediatrics Pediatric oral pathology 29  > The dental Pediatric oral pathology pieces are in contact with each DEVELOPMENTAL other at a point of ORO-FACIAL CLEFTS PALATAL CYST OF THE NEWBORN TONGUE-TIE (ANKYLOGLOSSIA) maximum CONGENITAL EPULIS WHEN IS TONGUE- TIE A PROBLEM THAT which convexity, NEEDS NATAL/NEONATAL TEETH TREATMENT? ANKYLOGLOSSIA is the so-called In Infants Feeding ? A new baby with a too tight frenulum can CONGENITAL ABSENCE OF TEETH have trouble sucking and may have poorcontact weightpoint. gain. Such feeding problems should be discussed with your child's pediatrician who may refer you to an otolaryngologist? Head and neck surgeon (ear, nose, and throat specialist) for additional treatment. Odontopediatrics Pediatric oral pathology 30  Pediatric oral pathology DEVELOPMENTAL TONGUE-TIE (ANKYLOGLOSSIA) ORO-FACIAL CLEFTS WHEN IS TONGUE- TIE A PROBLEM THAT NEEDS TREATMENT? PALATAL CYST OF THE NEWBORN In Toddlers and Older Children Speech ? While the tongue is CONGENITAL EPULIS remarkably able to compensate and many children have no speech NATAL/NEONATAL TEETH impediments due to tongue- tie, others may. ANKYLOGLOSSIA Around the age of three, speech problems, especially articulation of CONGENITAL ABSENCE OF TEETH the sounds - l, r, t, d, n, th, sh, and z may be noticeable. Evaluation may be needed if more than half of a three year old child's speech is not understood outside of the family circle. Although, there is no obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the following associated characteristics are common: V-shaped notch at the tip of the tongue Inability to stick out the tongue past the upper gums Inability to touch the roof of the mouth Difficulty moving the tongue from side to side Odontopediatrics Pediatric oral pathology 31  Pediatric oral pathology DEVELOPMENTAL ORO-FACIAL CLEFTS TONGUE-TIE (ANKYLOGLOSSIA) PALATAL CYST OF THE NEWBORN As a simple test, caregivers or parents might ask themselves if CONGENITAL EPULIS the child can lick an ice cream cone or lollipop without much NATAL/NEONATAL TEETH difficulty. If the answer is no, they cannot, then it may be time ANKYLOGLOSSIA to consult a physician. Appearance ?For older children with CONGENITAL ABSENCE OF TEETH tongue-tie, appearance can be affected by persistent dental problems such as a gap between the bottom two front teeth. Your child's physician can guide you in the diagnosis and treatment of tongue-tie. If he/she recommends surgery, an otolaryngologist Head and neck surgeon (ear, nose, and throat specialist), can perform a surgical procedure called a frenulectomy. Odontopediatrics Pediatric oral pathology 32  Pediatric oral pathology DEVELOPMENTAL ORO-FACIAL CLEFTS PALATAL CYST OF THE NEWBORN CONGENITAL ABSENCE OF TEETH CONGENITAL EPULIS Congenital absence of teeth is a heritably NATAL/NEONATAL TEETH phenomenon probably most often passed to ANKYLOGLOSSIA each generation by an autosomal dominant CONGENITAL ABSENCE OF TEETH pattern with incomplete penetrance and variable expressivity. Correlation of hypodontia with systemic disease leads to the hypothesis that this frequent dental anomaly may in some cases be a microform of systemic ectodermal dysplasia. Odontopediatrics Pediatric oral pathology 33  Pediatric oral pathology DEVELOPMENTAL CONGENITAL ABSENCE OF TEETH ORO-FACIAL CLEFTS Ø In dentistry, hypodontia is the condition at which the patient PALATAL CYST OF THE NEWBORN CONGENITAL EPULIS has missing teeth as a result of the failure of those teeth to NATAL/NEONATAL TEETH develop (also called tooth agenesis). Hypodontia describes a ANKYLOGLOSSIA situation where the patient is missing up to five permanent CONGENITAL ABSENCE OF TEETH teeth, excluding the 3rd molars. Ø Missing third molars occur in 9-30% of studied populations. In primary dentition the maxilla is more affected, with the condition usually involving the maxillary lateral incisor. Ø The condition of missing over 5 (six or more) permanent teeth, excluding 3rd molars or wisdom teeth, has been called oligodontia. The condition for missing all teeth, either primary and/or permanent), is called anodontia. Odontopediatrics Pediatric oral pathology 34  Pediatric oral pathology DEVELOPMENTAL ORO-FACIAL CLEFTS CONGENITAL ABSENCE OF TEETH PALATAL CYST OF THE NEWBORN A similar condition is hyperdontia, in which there are CONGENITAL EPULIS more than the usual number of teeth, more commonly NATAL/NEONATAL TEETH called as supernumerary teeth. ANKYLOGLOSSIA CONGENITAL ABSENCE OF TEETH Many other terms to describe a reduction in number of teeth appear in the literature: aplasia of teeth, congenitally missing teeth, absence of teeth, agenesis of teeth and lack of teeth (a) Developmental absence of the primary upper lateral incisors in a 3-year-old child. (b) (b) Panoramic radiograph showing the absence of the upper lateral incisors as well as of one lower Odontopediatrics Pediatric oral pathology 35  Pediatric oral pathology ODONTOGENIC : PARULIS Parulis Eruption cyst Parulis is the end of a draining fistulous tract of a necrotic primary tooth. It is a soft , solitary, reddish papule located apical and facial to the abscessed tooth. Purulent drainage may be observe. Treatment is to extract the abscessed tooth or preform root canal therapy Odontopediatrics Pediatric oral pathology 36  Pediatric oral pathology ODONTOGENIC : Parulis ERUPTION CYST : Eruption cyst - Follicular enlargement appearing just before the eruption of tooth. - Blue-black in color (may contain blood). TREATMENT : None unless infected, reassure the child and parent, follicle will rupture, but may need to surgically opened if infected. Odontopediatrics Pediatric oral pathology 37  Pediatric oral pathology MUCOCELE REACTIVE Mucocele is a benign lesion characterized by an extravasation Mucocele or retention of mucous in submucosal tissue from minor salivary Chemical burn glands. Mucoceles are known to occur most commonly on the lower lip, followed by the floor of mouth (Ranula) and buccal mucosa being the next most frequent sites. Trauma and lip biting habits are the main causes for these types of lesions. Mucocele is a common oral mucosal lesion but it is rarely observed in the infant. Clinically they are characterized by single or multiple, spherical, fluctuant nodules, ranging from normal pink to deep blue in color, and are generally asymptomatic. Odontopediatrics Pediatric oral pathology 38  Pediatric oral pathology CHEMICAL BURN REACTIVE Mucocele Chemical burn Aspirin & tetracycline burn Caused by ingestion of household chemicals by children Or by ingestion of dentifrices or mouthwashes. Or iatrogenic burns, caused by acid etch to tooth surface reaching the soft tissue. CLINICAL FEATURES Thin, homogenous white film. Lateral pressure removes this white film expose painful ulceraltion. Odontopediatrics Pediatric oral pathology 39  Pediatric oral pathology HIV INFECTION : 1- Children most commonly acquire HIV infection during pregnancy or at birth from an infected INFECTIONS mother. 1- HIV infection 2- Blood products, transfusion, and breast milk are 2- Candidiasis other sources of pediatric HIV infection. 4- Primary Herpetic Gingivostomatitis 3- The fungal disease most commonly seen in 5- Scarlet fever children with HIV is oral candidiasis 4-HIV gingivitis is characterized by a linear erythema of the facial and interproximal gingival margins and is unresponsive to improved oral hygiene 5- HSV infection is the most common viral infection in children with HIV infection. 6- Of unknown cause, parotid swelling is more common in children than in adults with HIV. Odontopediatrics Pediatric oral pathology 40  Pediatric oral pathology CANDIDIASIS : 1- Acute pseudomembranous candidiasis, or thrush, INFECTIONS is the opportunistic overgrowth of the fungus 1- HIV infection Candida Albicuns. 2- Candidiasis 2- Candidiasis may be a sequelae of oral broad- 4- Primary Herpetic Gingivostomatitis spectrum antibiotics or may reflect other systemic 5- Scarlet fever alterations, such as immunode- ficiency. Clinically, oral lesions are characterized by creamy or curdy white plaques that can be wiped off, leaving a red, raw, and painful surface. Any mucosal surface in the oral cavity can be affected TREATMENT : Topical or systemic antifungal agent usually resolves the infection. Odontopediatrics Pediatric oral pathology 41  Pediatric oral pathology PRIMARY HERPETIC GINGIVOSTOMATITIS 1- The initial infection with herpes simplex virus (HSV) occurs in young children after contact with an infected INFECTIONS child or adult. 1- HIV infection 2- The manifestations of primary herpetic infection may be 2- Candidiasis flulike symptoms i or subclinical. In primary 4- Primary Herpetic Gingivostomatitis gingivostomatitis, after an incubation period of 5- Scarlet fever approximately 1 week, the patient complains of fever, malaise, and irritability. 3- Marginal gingivae become fiery red, edematous, and may bleed easily. Clusters of small vesicles erupt throughout the mouth, then burst to form yellow vesicles surrounded by a red halo. 4- The vesicles coalesce to form large ulcers of the oral and perioral tissues. The lesions are accompanied by pain, fever, arthralgia, headache, and cervical lymphadenopathy. Odontopediatrics Pediatric oral pathology 42  Pediatric oral pathology SCARLET FEVER : 1- Most commonly affects children INFECTIONS 2- Scarlet fever is usually spread by inhalation. 1- HIV infection 3- Most of the clinical features are caused by 2- Candidiasis erythrogenic toxin, a substance produced by the 4- Primary Herpetic Gingivostomatitis bacterium Streptococcus pyogenes when it is 5- Scarlet fever infected by a certain bacteriophage. 4- Scarlet fever is characterized by: Sore throat, Fever, Bright red tongue with a "strawberry" appearance , Forchheimer spots (fleeting small, red spots on the soft palate) ,Paranoia and Hallucinations TREATMENT : There is no vaccine, but the disease is effectively treated with antibiotics. Odontopediatrics Pediatric oral pathology 43  Pediatric oral pathology RECURRENT APTHOUS ULCER ULCERATIONS Recurrent apthous ulcer The initial infection with herpes simplex virus (HSV) occurs in young children after contact with an infected child or adult. The manifestations of primary herpetic infection may be flulike symptoms or subclinical. In primary gingivostomatitis, after an incubation period of approximately 1 week, the patient complains of fever, malaise, and irritability. Odontopediatrics Pediatric oral pathology 44  Pediatric oral pathology BENIGN TUMORS BENIGN TUMORS HAEMANGIOMA Marginal gingivae become fiery red, LYMPHANGIOMA edematous, and may bleed easily. Clusters of GIANT CELL FIBROMA (RETROCUSPIC small vesicles erupt throughout the mouth, then PAPILLA) burst to form yellow vesicles surrounded by a red halo. The vesicles coalesce to form large ulcers of the oral and perioral tissues. The lesions are accompanied by pain, fever, arthralgia, headache, and cervical lymphadenopathy. Odontopediatrics Pediatric oral pathology 45  Pediatric oral pathology HAEMANGIOMA Infantile haemangiomas are benign vascular neoplasms that have a characteristic clinical course BENIGN TUMORS marked by early proliferation and followed by HAEMANGIOMA spontaneous involution. LYMPHANGIOMA Haemangiomas are the most common tumors of GIANT CELL FIBROMA (RETROCUSPIC infancy and usually are medically insignificant. PAPILLA) CLINICAL FEATURES: Bluish- red or purple colour. Homogeneous, sharp border, sessile prominence. Spongy to palpation, blanching( +ve). Asymptomatic. MANAGEMENT Excisional biopsy, unless the lesion is too large then injection of sclerosing solutions or cryosurgery are preformed, because biopsy to large hematomas lead to haemorrhage. Odontopediatrics Pediatric oral pathology 46  Pediatric oral pathology LYMPHANGIOMA Lymphangiomas are uncommon congenital hamartomas of BENIGN TUMORS the lymphatic system, usually diagnosed in infancy and early HAEMANGIOMA childhood. Commonly located at head and neck, they are rarely situated LYMPHANGIOMA in the oral cavity. GIANT CELL FIBROMA (RETROCUSPIC Preferred site of oral involvement is the tongue. In the PAPILLA) absence of proper therapy, lymphangiomas of the tongue are extremely recurrent. PATHOGENETIC THEORIES: Three theories have been proposed to explain the origin of this abnormality: The first suggests that a blockage or arrest of normal growth of the primitive lymph channels occurs during embryogenesis. The second that the primitive lymphatic sac does not reach the venous system. While the third advances the hypothesis that, during embryogenesis, lymphatic tissue lays in the wrong area. Odontopediatrics Pediatric oral pathology 47  Pediatric oral pathology BENIGN TUMORS LYMPHANGIOMA HAEMANGIOMA HISTOPATHOLOGY: Let’s watch this video to better understand the LYMPHANGIOMA histopathology for lymphangioma: GIANT CELL FIBROMA (RETROCUSPIC http://www.youtube.com/watch?v=x2-a2SyeI24 PAPILLA) MANAGEMENT Surgical intervention represents the treatment of choice. Lesion extension and involvement of vital structures can reduce, in some cases, the possibility of complete resection. Sclerosing therapy should be considered for recurrences. Odontopediatrics Pediatric oral pathology 48  Pediatric oral pathology GIANT CELL FIBROMA (RETROCUSPIC PAPILLA) Asymptomatic sessile or pedunculated nodule Usually less than 1cm in size Occurs more in females than males. BENIGN TUMORS Occurs more in maxilla than mandible. HAEMANGIOMA Not associated with trauma (not reactive) 60% of lesion diagnosed during the first 3 decades of life. LYMPHANGIOMA Occurs more in mandible than maxilla. GIANT CELL FIBROMA (RETROCUSPIC 50% of cases occur in gingiva PAPILLA) Can also occur on tongue and palate Retrocuspid papilla is a giant cell fibroma that occurs on the gingiva lingual to mandibular cuspids (canines). It’s usually bilateral, small pink papule. Retrocuspid papilla are quite common, they have been reported in 25% - 99% of children and young adults. HISTOPATHOLOGY: Connective tissue mass with Pseudoepitheliumatous hyperplasia Different giant cells; large stellate fibroblasts within the connective tissue Odontopediatrics Pediatric oral pathology 49  Pediatric oral pathology EMBRYONIC RHABDOMYOSARCOMA Rhabdomyosarcoma (RMS) is an aggressive malignant neoplasm of skeletal muscle origin that MALIGNANT TUMORS: represents 50% of all soft tissue sarcomas in EMBRYONIC RHABDOMYOSARCOMA childhood, with most cases occurring in the head MUCOEPIDERMOID CARCINOMA and neck 40%. Within the microscopical patterns, the embryonal type is the most frequent in the oral cavity. MANAGEMENT Overall 5-year survival rates have improved to more than 80% with the combined use of surgery, radiation therapy, and chemotherapy. However, in patients with metastatic disease, little progress has been made in survival rates, with a 5- year, event-free survival rate of less than 30% Odontopediatrics Pediatric oral pathology 50  Pediatric oral pathology MUCOEPIDERMOID CARCINOMA Salivary gland tumors are rare in children but when they involve the minor salivary glands, there is an increased risk that they will be malignant, and it is the palatal region that is the most common site. CLINICAL PRESENTATION: MALIGNANT TUMORS: The presentation of this malignancy is a painless, persistent EMBRYONIC RHABDOMYOSARCOMA enlargement. When the major salivary glandsand tongue are MUCOEPIDERMOID CARCINOMA involved, pain, paresthesia, and difficulty with swallowing are noted more frequently. Intraoral lesions appear as a localized fluctuant nodule with a bluish or reddish-purple, smooth, mucosal surface. MANAGEMENT: Management of a low grade mucoepidermoid of the minor salivary glands involves wide local excision with adequate tumor-free margins. High grade tumors require more aggressive surgery with or without postoperative radiotherapy and chemotherapy. Individuals with low grade tumors have a good prognosis with greater than a 90% cure rate. In contrast, high grade tumors have a poor prognosis with only a 20 to 30% survival rate Odontopediatrics Pediatric oral pathology 51  Pediatric oral pathology DOWN SYNDROME Also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It is typically associated with physical growth delays, characteristic facial features, and mild to moderate intellectual disability. SYNDROMES DENTAL MANIFESTATIONS: Down Syndrome. DELAYED ERUPTION OF BOTH PRIMARY AND PERMANENT DENTITIONS Papillon-Lefevre Syndrome MICRODONTIA ENAMEL HYPOCALCIFICIATION AND HYPOPLASIA COMMON 1/3 MORE CARIES RESISTANT THAN THEIR NON-DS SIBLINGS GINGIVITIS DEVELOPS EARLIER AND MORE RAPIDLY V-SHAPED PALATE, INCOMPLETE DEVELOPMENT OF THE MIDFACE COMPLEX, SOFT PALATE INSUFFICIENCY ABSENT INCISORS MAKE ARTICULATION DIFFICULT SCALLOPED, FISSURED TONGUE WITH BIFID UVULA, CLEFT LIP/PALATE, ENLARGED TONSILS/ADENOIDS REDUCED SALIVARY FLOW HIGHER INCIDENCE OF BRUXISM, PARTICULARLY IN AGES 0-6 YEARS. BRUXISM TENDS TO DECREASE AFTER AGE SIX Odontopediatrics Pediatric oral pathology 52 53  Pediatric oral pathology DOWN SYNDROME DENTAL MANAGEMENT SYNDROMES An aggressive preventive dental program is recommended for patients with Down syndrome. The program should Down Syndrome. include: Papillon-Lefevre Syndrome Three to four month recalls: Consistent preventive care can help reduce periodontal disease Dietary counseling and encouragement of good oral hygiene: Practical advice to minimize consumption of cariogenic foods and the effects of such foods on tooth structure Topical fluoride application: For caries prevention and/or reduction of dentinal hypersensitivity Chlorexidine gluconate 0.12% rinse: For reduction of bacteria that cause periodontal disease Odontopediatrics Pediatric oral pathology 54  Pediatric oral pathology PAPILLON-LEFEVRE SYNDROME : Also known as palmoplantar keratoderma with periodontitis, is an autosomal recessive genetic disorder SYNDROMES caused by a deficiency in cathepsin C Down Syndrome. charecter of the syndrome: Papillon-Lefevre Syndrome 1- hyperkeratosis of the palms and soles 2- premature loss of the primary and permanent dentitions 3- Hyperkeratotic lesions of the elbows and knees also may be found 4- Periodontal inflammation begins soon after the primary teeth erupt 5- Bone loss is severe, so that primary teeth are lost by 5 years of age (, permanent teeth also were lost within a few years of eruption) MANAGEMENT: conventional therapy with oral hygiene instruction, professional cleanings, frequent recalls, and antibiotics have failed to prevent tooth loss. Odontopediatrics Pediatric oral pathology 55  Pediatric oral pathology ENAMEL HYPOPLASIA TEETH ANOMALIES It is a defect of the teeth in which the enamel is hard but 1-Enamel hypoplasia thin and deficient in amount, caused by defective enamel 2-Amelogenesis imperfecta matrix formation with a deficiency in the cementing 3-Dentinogenesis imperfecta substance. Usually the condition involves part of the tooth 4-Tetracyclin staining of teeth having a pit in it. In some cases, the natural enamel crown has a hole in it, and in extreme cases, the tooth has no enamel, which doesn't mean the tooth doesn't exist because dentin is also a component of teeth. It can be caused by any of the following: 1-Trauma 2-Bacterial infection 3-Slow enamel formation 4-Celiac disease Odontopediatrics Pediatric oral pathology 56  Pediatric oral pathology TEETH ANOMALIES AMELOGENESIS IMPERFECTA (AI) presents with a rare abnormal formation of the enamel or external layer of the crown of teeth. Enamel is composed mostly of 1-Enamel hypoplasia mineral, that is formed and regulated by the proteins in it. Amelogenesis imperfecta is due to the malfunction of the proteins in the enamel: 2-Amelogenesis imperfecta ameloblastin, enamelin, tuftelin and amelogenin. People afflicted with 3-Dentinogenesis imperfecta amelogenesis imperfecta have teeth with abnormal color: yellow, brown or grey; this disorder can afflict any number of teeth of both dentitions. The teeth have a 4-Tetracyclin staining of teeth higher risk for dental cavities and are hypersensitive to temperature changes as well as rapid attrition, excessive calculus deposition, and gingival hyperplasia. GENETICS Mutations in the AMELX, ENAM,MMP20, KLK-4,FAM83H, WDR72, C4orf26, SLC24A4 LAMB3 and ITGB6 genes have been found to cause amelogenesis imperfecta (non-syndromic form). About 5% of amelogenesis imperfecta cases are caused by mutations in the AMELX gene and are inherited in an X-linked pattern. A condition is considered X-linked if the mutated gene that causes the disorder is located on the X chromosome, one of the two sex chromosomes. In most cases, males with an X-linked form of this condition experience more severe dental abnormalities than affected females. Odontopediatrics Pediatric oral pathology 57  Pediatric oral pathology TEETH ANOMALIES 1-Enamel hypoplasia AMELOGENESIS IMPERFECTA (AI) 2-Amelogenesis imperfecta TREATMENT Preventive and restorative dental care is 3-Dentinogenesis imperfecta very important as well as considerations for esthetic 4-Tetracyclin staining of teeth issues since the crown are yellow from exposure of dentin due to enamel loss. Full-coverage crowns are sometimes being used to compensate for the abraded enamel. Usually stainless steel crowns are used in children which may be replaced by porcelain once they reach adulthood. In the worst-case scenario, the teeth may have to be extracted and implants or dentures are required. Odontopediatrics Pediatric oral pathology 58  Pediatric oral pathology DENTINOGENESIS IMPERFECTA It is a disorder of tooth TEETH ANOMALIES development. This condition causes the teeth to be discolored 1-Enamel hypoplasia (most often a blue-gray or yellow-brown color) and translucent. 2-Amelogenesis imperfecta Teeth are also weaker than normal, making them prone to rapid wear, breakage, and loss. These problems can affect both primary 3-Dentinogenesis imperfecta (baby) teeth and permanent teeth. 4-Tetracyclin staining of teeth Type I: Type of dentinogenesis imperfecta with similar dental abnormalities usually an autosomal dominant trait with variable expressivity but can be recessive if the associated osteogenesis imperfecta is of recessive type.] Type II : Occurs in people without other inherited disorders (i.e. Osteogenesis imperfecta). It is an autosomal dominant trait.. Type III: Type is rare; its predominant characteristic is bell- shaped crowns, especially in the permanent dentition. Unlike Types I and II, it involves teeth with shell-like appearance and multiple pulp exposures. Odontopediatrics Pediatric oral pathology 59  Pediatric oral pathology TEETH ANOMALIES DENTINOGENESIS IMPERFECTA The objectives of early treatment of DI in the primary dentition are 1-Enamel hypoplasia as follows: 2-Amelogenesis imperfecta 1. Maintain dental health and preserve vitality, form, and size of 3-Dentinogenesis imperfecta the dentition. 2. Provide the patient with an esthetic appearance at an early 4-Tetracyclin staining of teeth age, in order to prevent psychological problems. 3. Provide the patient with a functional dentition. 4. Prevent loss of vertical dimension. 5. Maintain arch length. 6. Avoid interfering with the eruption of the remaining permanent teeth. 7. Allow normal growth of the facial bones and temporomandibular joint (TMJ). 8. Establish a rapport with the patient and the patient’s family early in the treatment. Odontopediatrics Pediatric oral pathology 60  Pediatric oral pathology TETRACYCLINE STAINING OF TEETH Tetracycline can stain the teeth anywhere from a bright yellow shade to dark brown. Usually the staining starts out as a yellow color. Over time, as the tooth is exposed to light, a chemical reaction occurs and the TEETH ANOMALIES yellow turns to a dark brown color. 1-Enamel hypoplasia DRUGS THAT CAUSE STAINING OF TEETH Many of tetracycline’s 2-Amelogenesis imperfecta homologues (similar drugs) are all associated with discoloration. Chlortetracycline, demethylchlortetracycline and oxytetracycline can all 3-Dentinogenesis imperfecta cause brown/gray/yellow staining of the teeth. Ciprofloxacin is an 4-Tetracyclin staining of teeth antibiotic that can be given intravenously to infants for treatment of a Klebsiella infection. It can stain the teeth a green color, but the staining is usually more mild than tetracycline staining. Minocycline hydrochloride is an antibiotic used to treat acne and rheumatoid arthritis. PREVENTION : Tetracycline can cross the placental barrier and incorporate into the developing tooth. It should be avoided (if possible) by mothers who are pregnant and also in kids until they are at least seven or eight years of age. TREATMENT: It is very difficult to treat internal staining of teeth because it affects the dentin layer underneath the enamel. Odontopediatrics Pediatric oral pathology 61  Pediatric oral pathology ERUPTION PATHOLOGY 1. Alterations of chronology (loss) 2. Mucous membrane pathology a. Cyst eruption b. Haematoma eruption c. Marginal gingivitis d. Operculum Odontopediatrics Pediatric oral pathology 62  Pediatric oral pathology Band-loop OCCLUSION PATHOLOGY 1. Temporal dentition bad occlusion. Treatment: Causes: 1. Expectantly attitude. a. Inherited a. Reviews b. By habits b. Collaboration (desensitization) c. Consequence 2. Space maintainers d. Pathology (caries) – Fixed – Removable 3. Space recuperators: expansion plates Odontopediatrics Pediatric oral pathology 63  Pediatric oral pathology OCCLUSION PATHOLOGY 1. Temporal dentition bad occlusion. 2. Mixed or permanent dentition bad occlusion. Causes: a. Inherited b. By habits c. Consequently pathology (caries) Treatment: Orthodontic Odontopediatrics Pediatric oral pathology 64  Pediatric oral pathology PATHOLOGY DENTITION A. Alterations of intrinsic tooth structure : B. Surface tooth structure alterations. 1) Enamel alts. Deposits: § Dysplasias (congenital, environmental) 1) Black staining: Chromogenic 2) Dentin Alts 2) Green staining: Poor hygiene duration § Dentin dysplasias (Environmental..) 3) Orange staining: Poor hygiene duration 4) White Staining: Recent deposit plaque C. Dental decay Odontopediatrics Pediatric oral pathology 65  Pediatric oral pathology PATHOLOGY DENTITION C. Dental decay 1. Prevention: a. Hygiene reinforcement techniques b. Dietary Journal c. Fluoridations d. Sealed cracks Odontopediatrics Pediatric oral pathology 66  Pediatric oral pathology PATHOLOGY DENTITION C. Dental decay 1. Prevention 2. Restoration Materials to restore: Ø Cavitary funds: Calcium hydroxide Ø Temporary materials: Ionomer Ø Final materials: Composite Odontopediatrics Pediatric oral pathology 67  Pediatric oral pathology INJURIES Oral pathology more frequent between 7-11 years. Complications: – Avulsion – Fracture tooth – Dislocation tooth Tooth fracture: Ø Treatment without pulp exposure: Conventional restoration Ø Treatment with pulp exposure: 2mm minor injury: direct coating + restoration Odontopediatrics Pediatric oral pathology 68  Pediatric oral pathology INJURIES Oral pathology more frequent between 7-11 years. Complications Tooth fracture: Ø Treatment without pulp exposure: Conventional restoration Ø Treatment with pulp exposure: 2mm minor injury: direct coating + restoration Ø Treatment with pulp exposure 2mm further injury: a. Closed apex: Endodontics b. Open apex: - DT affected pulp root: Root Pulpotomy – DT root -pulp unaffected: Pulpotomy - DP pulp affected : Apexification Odontopediatrics Pediatric oral pathology 69  Pediatric oral pathology PULP PATHOLOGY IN DT Pulpotomy: “Total elimination affected coronal pulp to be replaced by a biocompatible material”. Indications: 1. Spontaneous pain. 2. Pulp affectation, visible in rx, even asymptomatic. 3. Heavy bleeding Pulpotomy sequence. 4. Pulp removal 1. Medical history. Diagnosis 5. Matters covered fixing 2. Anesthesia. 6. Restoration 3. Isolation. 7. Crown protection Odontopediatrics Pediatric oral pathology 70  Pediatric oral pathology PULP PATHOLOGY IN DT Pulpotomy Pulpectomy. A pulpectomy is complete removal of pulp from the crown and roots. Indications Pulpectomy: 1. Pulp pathology with nerve root involvement 2. Recent fistula Not perform if it started root resorption or it is an area of infection involving the DP. Treatment: extraction + space maintainer Pulpectomy failure or infectious area of great magnitude. Alternative: extraction + space maintainer Odontopediatrics Pediatric oral pathology 71  Pediatric oral pathology PULP PATHOLOGY IN DT Pulpotomy Pulpectomy sequence. Pulpectomy 1. Clínic, diagnosis, rx history 2. Anesthesia 3. Isolation 4. Use root pulp removal files 5. Hypochlorite irrigation 6. Drying ducts 7. Fill conducts with biocompatible material 8. Restoration 9. Preformed crown Odontopediatrics Pediatric oral pathology 72  Pediatric oral pathology PULP PATHOLOGY IN OPEN APEX IN DP. Indications apexification: 1. Extensive pulp exposure 2. Pain 5. Conductometry (rx, pager) 3. Abscesses 6. Endodontic instrumentation DP apexification sequence. instrumental Manual 1. Diagnosis. 7. Calcium hydroxide shutter 2. Anesthesia 8. Change hydroxide 3. Opening 9. Radiographic control every 6 m 4. Isolation : Rubber dam, Clamp, Drill clamp, 10. Final sealing duct when closed Holder levees apex 11. Rx end Odontopediatrics Pediatric oral pathology 73  Pediatric oral pathology PULP PATHOLOGY IN DP. APEX CLOSED. Sequence endodontics: 1. Diagnosis 5. Conductometry (rx, pager) 2. Anesthesia 6. Instrumentation: 3. Opening a. Manual instrum endodontic 4. Isolation: b. Instrumentation rotary a. Rubber dam 7. Radiograph b. Clamp 8. Duct sealing final c. Holder clamp 9. Rx end d. Dykes drill Odontopediatrics Pediatric oral pathology 74  Pediatric oral pathology PULP TREATMENT FAILURE: EXTRACTION Space maintainers. Types: Ø Fixed: § band-tie § palatal bar Ø Removable § removable plate with hooks Adams Odontopediatrics Pediatric oral pathology 75  Pediatric oral treatment TREATMENT PHASES 1. Clinic history. a. Medical history (previous pathologies) b. Dental history 2. Reason query priority 3. Rate behavior 4. Eruptive State 5. Magnitude of treatment 6. Age-level collaboration Odontopediatrics Pediatric oral treatment 76  Pediatric oral treatment TREATMENT PHASES 1. Clinic history 1. Clinic history. Dental history. Exploration intraoral. Asses: a. Medical history (previous pathologies) a. Restourer needs b. Dental history b. Endodontic needs 2. Reason query priority c. Orthodontic needs 3. Rate behavior Radiographic study ALWAYS !!!!!!! 4. Eruptive State 5. Magnitude of treatment 6. Age-level collaboration Odontopediatrics Pediatric oral treatment 77  Pediatric oral treatment TREATMENT PHASES 1. Clinic history 1. Clinic history. 2. Reason for consultation a. Medical history (previous pathologies) 3. Rate behaviour b. Dental history 1. Child contributor 2. Reason query priority 2. Stoic partner (will not repeat) 3. Rate behavior 3. Uncooperative 4. Eruptive State 4. Rejection treatment 5. Magnitude of treatment 6. Age-level collaboration Odontopediatrics Pediatric oral treatment 78  Pediatric oral treatment TREATMENT PHASES Rate behaviour Techniques to improve behavior: 1. Modulated behavior (technique: Tell-show-beam) 2. Positive reinforcement 3. Premedication 4. Conscious sedation (nitrous oxide) 5. Intravenous sedation 6. General anesthesia Odontopediatrics Pediatric oral treatment 79 Odontopediatrics Pediatric oral pathology 80  Exercise 1 Say where this patient have decay: 0 Odontopediatrics Exercises 81  Exercise 2 Name this lesion epulus Odontopediatrics Exercises 82  Exercise 3 What happen in this case: Noadult teeth Odontopediatrics Exercises 83  Exercise 4 Name the teeth that not exist (agenesia) in this case: ORG ULS 28 LRY LLS Odontopediatrics Exercises 84  Exercise 5 What is the difference between these children: v22 consorfooth URIEN fused together Odontopediatrics Exercises 85  Exercise 6 What could we do(treatment/kind of treatment) with these children: crowns EM a'Eoth Odontopediatrics Exercises 86  Exercise 7 What are these devices and what for? steelorn space maintanet Odontopediatrics Exercises 87  Exercise 8 Count the permanent teeth in this case, is it right? 29 Odontopediatrics Exercises 88  Exercise 9 What kind of rx is this? Is it an adult or a child? child Odontopediatrics Exercises 89  Exercise 10 What kind of treatment is this? took filling babs Odontopediatrics Exercises 90