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Pedodontics Practice and Management
Badrinatheswar GV
1:
Introduction to Pedodontics
MEANING
DEFINITION OF PEDIATRIC DENTISTRY
According to Stewart, Barber, Troutman, Wei (1982)
According to American Academy of Pediatric Dentistry (1999)
MILESTONES IN EVOLUTION OF PEDIATRIC DENTISTRY
Father of Pedodontics
Evolution in India
PEDIATRIC DENTISTRY–ITS SIGNIFICANCE
Pedodontic Triangle
EVOLVING TRENDS IN PEDIATRIC DENTISTRY
Scope of Pedodontics
2:
Case History, Examination, Diagnosis and Treatment Planning
OBJECTIVES
SYSTEMATIC APPROACH TO CASE HISTORY DOCUMENTATION
Vital Statistics
Hospital Registration Number/Case Number
Date
Name
Age
Sex
School and Class
Name of Parent/Guardian; Occupation
Address
Source of Referral
Chief Complaint
History
History of Presenting Illness
Medical History
Prenatal History
Natal History
Postnatal History
Dental History
Family History
Personal History
Clinical Examination
General Examination
Local Examination
Occlusion
Provisional Diagnosis
Investigations
Percussion
Radiographic Examination
Pulp Testing
Conventional Pulp Testing Methods
Final Diagnosis
Treatment Planning
Definitive Treatment Planning
3:
Radiology in Pediatric Dentistry
INTRODUCTION
DIAGNOSTIC VALUE
METHODS OF REDUCING RADIATION EXPOSURE
GUIDELINES FOR PRESCRIBING RADIOGRAPHS (TABLE 3.1)
Development of Dentition as Criterion
Primary Dentition
Early Transitional Dentition
Early Permanent Dentition
Risk of the Patient for Dental Caries as Criterion
Types of Findings Anticipated as Criteria
CHILD PREPARATION AND MANAGEMENT
Tips to Assist in the Radiograph Process
TYPES OF EXAMINATION
General Survey
Examination of Specific Areas
Special Surveys
Four Film Surveys
Eight Film Survey
Twelve Film Survey
Sixteen Film Survey
Complete Mouth Surveys
TYPES OF FILMS
COMMONLY USED RADIOGRAPHIC TECHNIQUES
Radiographic Technique
Bitewing Radiographs
Indications
Technique (Figs 3.5 and 3.6)
Periapical Radiographs (Fig. 3.7)
Indications
Technique
Occlusal Radiograph (Fig. 3.8)
Indications
Film Sizes
Technique
Combined Occlussal Film
Panoramic Radiographs (Fig. 3.9)
4:
Development and Eruption of Teeth
INTRODUCTION
DENTAL LAMINA (FIG. 4.4)
VESTIBULAR LAMINA
TOOTH DEVELOPMENT (TABLE 4.2)
Bud Stage (Fig. 4.5)
Cap Stage (Fig. 4.6)
Outer Enamel Epithelium
Inner Enamel Epithelium (Fig. 4.7)
Stellate Reticulum
Enamel Knot (Fig. 4.8)
Dental Papilla
Bell Stage (Fig. 4.10)
Inner Enamel Epithelium
Stratum Intermedium
Stellate Reticulum
Outer Enamel Epithelium
Dental Papilla
Dental Sac
Advanced/Late Bell Stage (Fig. 4.11)
ROOT FORMATION
ERUPTION OF TEETH
Eruption Pattern
Pattern of Tooth Movement
Stages of tooth eruption:
Pre-eruptive Tooth Movement
Eruptive Tooth Movement (Fig. 4.17)
Posteruptive Tooth Movement
Shedding or Exfoliation of Primary Teeth (Fig. 4.18)
Histological Features of Root Resorption (Fig. 4.19)
Teething
Symptoms
Management of Teething
5:
Morphology of Primary Teeth
INTRODUCTION
LIFE CYCLE
NOMENCLATURE
Numbering of Primary Teeth
Numbering of Permanent Teeth
Important Functions of Sound Primary Teeth
GENERAL CHARACTERISTICS OF PRIMARY TEETH CROWN MORPHOLOGY (FIG. 5.3)
DIFFERENCES BETWEEN THE ROOTS OF DECIDUOUS AND PERMANENT DENTITION
MORPHOLOGIC DESCRIPTION OF DECIDUOUS TEETH
Maxillary Central Incisor (Figs 5.6 and 5.7)
Maxillary Lateral Incisors (Figs 5.6 and 5.7)
Maxillary Canine (Figs 5.6 and 5.7)
Mandibular Central Incisors (Figs 5.6 and 5.7)
Mandibular Lateral Incisors (Figs 5.6 and 5.7)
Mandibular Canine (Figs 5.6 and 5.7)
Maxillary First molar
Buccal Surface (Fig. 5.8)
Lingual Surface (Fig. 5.9)
Mesial Surface
Distal Surface
Occlusal Surface (Fig. 5.10)
Roots
Maxillary Second Molar
Buccal Surface (Fig. 5.8)
Lingual Surface (Fig. 5.9)
Proximal Surface
Occlusal Surface (Fig. 5.10)
Roots
Mandibular First Molar
Buccal Aspect (Fig. 5.11)
Lingual Aspect (Fig. 5.12)
Proximal Contours and Contacts (Figs 5.13 and 5.14)
Occlusal (Fig. 5.15)
Roots
Mandibular Second Molar
Buccal Aspect (Fig. 5.11)
Lingual Aspect (Fig. 5.12)
Proximal Contact and Contours (Figs 5.13 and 5.14)
Occlusal (Fig. 5.15)
Roots
Pulps of Primary Teeth
6:
Anomalies of Tooth Formation, Development and Eruption
INTRODUCTION
SUPERNUMERARY TEETH
Etiology
DEVELOPMENTAL ALTERATIONS IN SHAPE
Gemination
Fusion
Concrescence
Dilaceration
Talon's Cusp
Dens in Dente (Dens Invaginatus)
Dens Evaginatus
Taurodontism
DISTURbANCES IN STRUCTURE OF TEETH
Amelogenesis Imperfecta (Hereditary) (Figs 6.1 and 6.2)
Etiology
Clinical Features
Environmental Enamel Hypoplasia (Fig. 6.3)
Dentinogenesis Imperfecta
Dentin Dysplasia (Table 6.4)
Regional Odontodysplasia
DISTURBANCES OF ERUPTION
Premature Eruption
Delayed Eruption
Impacted and Embedded Teeth
DISTURBANCES OF EXFOLIATION
Early or Premature Loss of Deciduous Teeth
Ankylosed Primary Teeth (Submerged Teeth)
7:
Growth and Development
INTRODUCTION
VARIABLES INFLUENCING GROWTH
Genetic Factors
Maternal Factors
Environmental Factors
NORMAL HUMAN GROWTH
Prenatal Growth
Period of Ovum (Fertilization–End of 14th Day)
Period of Embryo/Embryonic Period (14th-56th Day/2-8 Weeks)
Period of Fetus/Fetal Period (3rd-9th Month/57th-270th Day)
Postnatal Growth
At Birth
3-6 Years
6-12 Years
>12 Years
GROWTH PATTERN
Mechanisms/Theories of Growth
Genetic Theory
Sicher's Sutural Dominance Theory (1955)
Scott's Hypothesis
Enlow and Bang's “V” Shaped Principle or Area Relocation Theory (Fig. 7.3)
Functional Matrix Theory of Moss
POSTNATAL GROWTH
Postnatal Growth of Cranial Base (Fig. 7.4)
Sphenooccipital Synchondrosis (Fig. 7.5)
Spheno-ethmoidal Synchondrosis
Intersphenoid Synchondrosis (Fig. 7.6)
Intraoccipital Synchondrosis
Postnatal Growth of Cranial Vault
Growth of Maxilla (Nasomaxillary Complex)
Sutural Growth (Fig. 7.7)
Surface Remodeling
Postnatal Growth of Mandible (Fig. 7.10)
8:
Development of Dental Arch and Occlusion
INTRODUCTION
PREDENTATE PERIOD
Features of Gum Pads (Fig. 8.1)
Relation of Gum Pads (Fig. 8.2)
DECIDUOUS DENTITION PHASE
Characteristic Features
Spaces in the Primary Dentition (Figs 8.3 and 8.4)
Occlusal Relationship of Second Primary Molars
Size of the Dental Arch
Shape of Dental Arch
Other Features
MIXED DENTITION PHASE
First Transitional Period
Eruption of First Molar (Fig. 8.5)
Exchange of Incisors
Intertransitional Period
Second Transitional Period
Exchange of the Lateral Teeth (Canines and Premolars)
Eruption of the Second Permanent Molar
LOCAL FACTORS AFFECTING THE EXCHANGE OF TEETH
Dental Caries of the Primary Teeth
Dental Abnormalities
Permanent Tooth Related Factors
9:
Pernicious Oral Habits in Children
DEFINITION OF HABIT
CLASSIFICATION OF HABITS
William James Classification (1923)
Useful Habits
Harmful Habits
Kingsley's Classification (1956)
Earnest Klien Classification (1971)
Intentional/Meaningful Habits
Unintentional/Empty Habits
Graber Classification
Finn and Sim's Classification (1975)
Compulsive Oral Habits
Non-compulsive Oral Habits
THUMB/FINGER SUCKING
Sucking Reflex
Theories of Thumb Sucking
Oral Theory of Sears and Wise (1950)
Benjamin's Theory
Psychosexual Theory Sigmund Freud
Oral Gratification Theory – Sheldon (1932)
Classification of Thumb Sucking
Normal Thumb Sucking
Abnormal Thumb Sucking
Other Classification
Johnson (1993) Classified
Clinical Features of Thumb Sucking (Fig. 9.1)
Management of Thumb Sucking Habit
Discussion with Child
Discussion with Parents
Measures of Correcting Thumb Sucking Habit
Habit Breaking Appliances
Mechanotherapy (Figs 9.2 to 9.4)
TONGUE THRUSTING
Etiology
Classification of Tongue Thrust
Moyer's Classification
Braner and Holt Classification
Simple Tongue Thrust (Fig. 9.5)
Complex Tongue Thrust
Retained Infantile Swallow
Treatment
Training of Correct Swallow and Tongue Posture
Appliance Therapy
Other Measures
MOUTH BREATHING
Classification
Anatomic Type
Obstructive Type
Habitual Type
Etiology
Clinical Features (Fig. 9.6)
Facial Form
Dental Effects
Speech Defects
Lip (Fig. 9.7)
Gingiva
Clinical Tests for Diagnosis
Treatment Considerations
BRUXISM
Types
Etiology
Clinical Manifestation
Treatment
LIP BITING
Etiology
Clinical Manifestations
Treatment
10:
Preventive and Interceptive Orthodontics
PREVENTIVE ORTHODONTICS
Predental Procedures
Care for Deciduous Dentition
Patient and Parent Education Program
Management of Dental Anomalies
Supernumerary Teeth
Congenital Missing Teeth
Ankylosed Deciduous Teeth
Ectopic Eruption (Fig. 10.1)
Early Loss of Deciduous Teeth
Prolonged Retention of Deciduous Teeth
Early Management of Carious Lesions
Occlusal Equilibration
Abnormal Frenal Attachments (Figs 10.2 and 10.3)
Oral Habits
Space Maintenance
Ideal Requisites of Space Maintainer
Classification of Space Maintainer (Fig. 10.5)
Space Maintenance for Premature Loss of Deciduous First Molar
Space Maintenance for Premature Loss of Deciduous Second Molars
Space Maintenance of Premature Loss of Deciduous Second Molar Prior to Eruption of First Molar
Space Maintenance for Premature Loss of Deciduous Incisors
Space Maintenance for Premature Loss of Deciduous Canines
Nance Palatal Holding Arch (Fig. 10.6)
Transpalatal Arch
Lingual Arch (Figs 10.7 and 10.8)
Distal Shoe Space Maintainer (Fig. 10.9)
Removable Partial Denture (Fig. 10.10)
Band and Loop Space Maintainer (Fig. 10.11)
Band and Bar Space Maintainer
Crown and Loop/Bar Space Maintainer (Fig. 10.12)
INTERCEPTIVE ORTHODONTICS
Space Regainence
Correction of Anterior and Posterior Cross bites (Figs 10.13A to C)
Elimination of Oral Habits
Muscle Exercises
Removal of Soft or Hard Tissue Impediments to Pathway of Eruption
Resolution of Crowding
Clinical Analysis of Crowding
Hereditary Crowding
Environmental Crowding
Management of Crowding
Serial Extraction
Indications
Contraindications
Diagnosis and Treatments Planning
Types of Serial Extraction Methods
11:
Child Psychology and Behavior Management
DEFINITION
INTRODUCTION
FREUD'S PSYCHODYNAMIC THEORY
Structure of Personality
The Id
The Ego
The Superego
Development of Personality
Oral Stage
Anal Stage
Phallic Stage
Latency Stage
Genital Stage
Concept of Fixation
Cause of Fixation
ERIKSON'S PSYCHOSOCIAL THEORY OR THEORY OF PERSONALITY DEVELOPMENT
Basic Trust vs. Mistrust
Autonomy vs. Shame or Doubt
Initiative vs. Guilt
Industry vs. Inferiority
Identity vs. Role Confusion
JEANS PIAGET'S COGNITIVE THEORY (FIG. 11.1)
Periods of Cognitive Development
Sensorimotor Period
Preoperational Stage
The Concrete Operational Period
Formal Operational Period
LEARNING AND DEVELOPMENT OF BEHAVIOR
Classical Conditioning
Operant Conditioning
Positive Reinforcement
Negative Reinforcement
Omission
Punishment
Observational Learning (Modeling)
Stone and Church Classification of Child Development
Infant
Toddler (15 Months to 2 Years of Age)
Preschooler (Child of 2 to 6 Years of Age)
Middle Years Child (Child of 6-12 Years Age)
Adolescent (from Age 12 to Maturity)
Separation-Individuation Theory by Margaret s Mahler
Normal Autistic Phase: Birth to 4 Weeks
Normal Symbiotic Phase: 4 Weeks to 5 Months
Separation-Individuation Phase
Theory of Hierarchy of Needs by Abraham Maslow (Fig. 11.5)
Physiological Needs
Safety Needs
Love and Belonging Needs
Esteem Needs
Self-Actualization Needs
Emotional Development
Distress or Cry
Types of Cry Seen in Children
Anxiety and Fear
Mental and Emotional Development (Maturation) with Age
Birth to Two Years
Two Years Old
Three Years Old
Four Years Old
Five Years Old
Six to Twelve Years Old
Teenage
BEHAVIORAL SCIENCE AND MANAGEMENT
Terminology
Classification of Behavior Patterns in Children
Wilson's Classification (1933)
Frankel's Behavior Rating Scale (1962)
Lampshire Classification (1970)
Wright's Classification (1975)
Behavior Management
Basic Behavior Management
Communicative Management
Behavioral Shaping
Nitrous Oxide/Oxygen Inhalation Sedation
Advanced Behavior Management
Introduction
Hand–over–Mouth Exercise (HOME)
Medical Immobilization/ Restraints
Sedation
General Anesthesia
12:
Pediatric Pharmacology
INTRODUCTION
PHYSIOLOGIC MECHANISMS
PHYSICAL FACTORS
AGE AS A CRITERION
BODY SIZE/BODY WEIGHT
Clark's Rule
BSA of an Individual can be Calculated from Dubois Formula
Augsburg Formula
Fred's Formula
ANTIBIOTIC PROPHYLAXIS
Guidelines for Antibiotic Prophylaxis for Patients at Risk
Patients with Cardiac Conditions Associated with Endocarditis
Patients with Compromised Immunity
Patients with Shunts, Indwelling Vascular Catheters or Medical Devices, etc.
13:
Introduction to Dental Caries
INTRODUCTION
ETIOLOGY OF CARIES
Proteolysis Theory
Proteolysis Chelation Theory
Miller's Chemicoparasitic or Acidogenic Theory
KEYE'S TRIAD (FIG. 13.1)
Modification of Keye's Triad (Fig. 13.2)
Non-exclusive Contributory Disease Model (Fig. 13.4)
Latest Concept
ROLE OF EACH FACTOR IN CARIES
Host Factors
Tooth Factors
Saliva
Microflora
Role of Microorganisms in Caries
Role of Dental Plaque
Properties of Cariogenic Plaque
Environment Factor
Diet
Time
Stress
Area of Caries Susceptibility
Caries Risk Assessment (Tables 13.4 and 13.5)
CARIES ACTIVITY TESTS
Advantages
Types
1. Lactobacilli Colony Test
2. Alban's Test
Cariogram (Fig. 13.6)
CLASSIFICATION OF CARIES
Based on the Location/Anatomic Site
Pit and Fissure Caries
Smooth Surface Caries
Root Caries
Based on the Severity of Lesion
Incipient Caries
Occult Caries
Cavitation Lesions
Based on Progression
Arrested Caries
Secondary/Recurrent Caries
Based on Chronology
Rampant Caries (Figs 13.7A and B)
Nursing Bottle Caries (Fig. 13.8)
Treatment Protocol for Rampant Caries/Nursing Caries
14:
Pediatric Restorative Dentistry
INTRODUCTION
STRUCTURAL DIFFERENCES BETWEEN DECIDUOUS AND PERMANENT TEETH
AIDS IN CARIES DIAGNOSIS
Methods Available for the Clinical Diagnosis of Dental Caries
Clinical Method/Visual-Tactile (Table 14.1)
Radiographic Method
Tooth Separation
Fiber Optic Transillumination (FOTI)
Dyes in Caries Detection (Fig. 14.1)
Digital Radiographic Methods
Electrical Resistance Measurements (ERM)
Light-Induced Fluorescence (Lasers in Caries Detection)
Ultrasonography
Xeroradiography
Digital Fiber Optic Transillumination (DIFOTI)
Novel Methods for Caries Detection
Endoscopic Filtered Fluorescence Method (EFF)
CLASSIFICATION OF CAVITIES
GV Black Classification of Cavities (Fig. 14.2)
Class I Lesion
Class II Lesions
Class III Lesions
Class IV Lesions
Class V Lesions
Class VI Lesions
Charbeneu's Classification
Sturdevant's Classification
Finn's Modification of Black's Cavity Preparation for Primary Teeth
Class I
Class II
Class III
Class IV
Class V
Baume's Classification
Classification of Mount and Hume (Table 14.2)
PRINCIPLES OF CAVITY PREPARATION
Conventional Concept – Black's Concept
Outline Form
Resistance Form
Retention Form
Convenience Form
Removal of any Remaining Infected Dentin
Finishing Enamel Walls
Cleaning of the Cavity
Class I Cavity Preparations in Primary Teeth and Its Modifications (Figs 14.3 A to C)
First Primary Molar
Second Primary and First Permanent Molars
Second Permanent Molars
Developmental Pits occur in these Areas
Class II Cavity Preparation (Figs 14.4 A to C)
Fin's Modification
Cavity Preparation
Class III Cavity Preparation
Finn's Modification
Primary Incisor Tooth
Primary Canine
Modified Class III Cavity (Fig. 14.6)
Class IV Cavity Preparation
Finn's Modification
Class V Cavity Preparation (Fig. 14.7)
Finn's Modification
Preparation Alternatives to Conventional Cavity
Air Abrasion
Ozone Therapy
Lasers (Table 14.3)
ADVANCED RESTORATIVE DENTISTRY
The Hydrochloric Acid—Pumice Microabrasion Technique
Indications
Armamentarium
Technique
Localized Composite Resin Restorations
Indications
Armamentarium
Technique
Composite Resin Veneers
Indications
Contraindications
Armamentarium
Technique
Porcelain Veneers
Adhesive Metal Castings
Indications
Armamentarium
Technique
Indirect Composite Resin Onlays
ATRAUMATIC RESTORATIVE TREATMENT (ART)
Principles of ART
Reasons for Using Hand Instruments Rather than Electric Driven Handpieces
Reasons for using Glass Ionomers
List of Essential Instruments and Materials (Table 14.4)
15:
Stainess Steel Crowns
INTRODUCTION
TYPES OF STAINLESS STEEL CROWNS
CLASSIFICATION OF STAINLESS STEEL CROWNS
Stainless Steel Crowns
Austenitic Types
Ion Crown
Aluminium Crowns (Fig. 15.2)
Advantages
Availability
Composition
Nickel-Base Crowns
OBJECTIVES
INDICATIONS
Extensive Caries
Developmental Enamel Defects
Following Pulp Therapy
As a Preventive Restoration
For Replacing Prematurely Lost Anterior Teeth
For Temporary Restoration of a Fractured Tooth
Single Tooth Cross Bite
Severe Bruxism
As an Abutment for Space Maintainer (Fig. 15.3)
Abutments to Prosthesis
CONTRAINDICATIONS
CLINICAL PROCEDURE
Factors to be Considered in Preoperative Evaluation
Dental Age of the Patient
Cooperation of the Patient
Motivation of the Parents
Medically Compromised and Disabled Children
Procedure
Armamentarium
Selection of Crown
Tooth Preparation
Evaluate the Preoperative Occlusion
Local Anesthesia
Isolation
Recommendations for Preparation
Aims of Tooth Reduction
Steps in Stainless Steel Crown Procedure
Occlusal Reduction (Fig. 15.4)
Proximal Reduction (Figs 15.5A and B)
Buccal and Lingual Reduction
Evaluation Criteria for Tooth Preparation
Selection of Crown
Initial Adaptation and Retention
Festooning of Crown
Crown Contouring
Crown Crimping (Figs 15.6A and B)
Crown Finishing
Crown Polishing
Final Adaptation
Checking the Final Adaptation of the Crown
Radiographic Confirmation of the Gingival Fit
Cementation
Postoperative Instructions
Myer's Criteria for the Evaluation of Crown Defects
STAINLESS STEEL CROWN FOR PERMANENT MOLARS
Indications
Radiological Considerations
Anesthesia
Isolation
TOOTH PREPARATION
Occlusal Reduction
Proximal Reduction
Buccal and Lingual Reduction
Selection
Crown Placement
Radiographic Confirmation of the Gingival Fit
Final Finishing
Cementation
16:
Oral Hygiene Education
INTRODUCTION
TOOTH BRUSH
Classification
Based upon Type of Bristle Material
Based Upon Mechanism of Action
Based Upon Bristle Texture
Other Criterions
ADA Specifications
ADA Specifications for Acceptable Brushes
Acceptable Dimensions for an Ideal Pedodontic Brush
Types of Designs in Arrangement of the Tufts
Guidelines for Tooth Brush Usage
Dental Floss
Tooth Brushing Methods
Scrub Method (Fig. 16.1)
Roll Technique (Fig. 16.2)
Physiologic Technique (1930)
Fones Technique (1934)
Charter's Technique (1928)
Stillman Technique (Fig. 16.3)
Bass Technique (1948) (Fig. 16.4)
Modified Bass Technique
ORAL HYGIENE REGIMEN FOR CHILDREN
Assessment of Patient and Parent Dexterity
Disclosing Plaque (Fig. 16.5)
A Systematic Approach to Brushing
Time Devoted to Brushing
Frequency of Brushing
Appropriate Brushing Technique
AAPD GUIDELINES ON PERIODICITY OF EXAMINATION AND ORAL HEALTH CARE
Birth to 12 Months
12 to 24 Months
2 to 6 Years
6 to 12 Years
12 Years and Older
17:
Preventive Dentistry: Occlusal Sealants
INTRODUCTION
PREVALENCE OF OCCLUSAL CARIES IN CHILDREN
MILESTONES OF PIT AND FISSURE SEALANTS
OCCLUSAL SEALANTS IN PRIMARY TEETH
TERMINOLOGIES TO KNOW
MORPHOLOGY OF FISSURES
CLASSIFICATION OF PIT AND FISSURE SEALANTS
Based Upon Polymerization
Based Upon Resin System Used
Based Upon Fillers
Based Upon Color
REQUISITES OF AN EFFICIENT SEALANT (BRAUER 1978)
OCCLUSAL SEALANT TECHNIQUE
Age and Tooth Selection
Simensons Recommendations
Placement Technique
Step I: Isolation (Fig. 17.3)
Step II: Tooth Cleaning and Preparation (Fig. 17.4)
Step III: Etching (Fig. 17.5)
Step IV: Rinse
Step V: Sealant Application (Fig. 17.8)
Step VI: Evaluation (Figs 17.9A to C)
Step VII: Occlusal Evaluation/Adjustment
Step VIII: Re-evaluation
PREVENTIVE RESIN RESTORATIONS
According to Simensons Classification (1978b, 1978c)
Placement Technique
Type A Restoration (Fig. 17.10)
Type B Restoration (Fig. 17.11)
Type C Restoration
18:
Fluorides in Pediatric Dentistry
INTRODUCTION
Chemistry
Sources of Fluoride
Metabolism of Fluorides
Absorption
Deposition
Excretion
FLUORIDES IN CARIES PREVENTION
Increase Enamel Resistance
Increased Rate of Posteruptive Maturation
Remineralization of Incipient Lesion (Fig. 18.1)
Fluoride as an Inhibitor of Demineralization
Interference with Microorganisms
Modification in Tooth Morphology
FLUORIDE DELIVERY METHODS
Need for Fluoride Supplements
METHODS OF FLUORIDE ADMINISTRATION
Water Fluoridation
Source of Fluoride
Benefits
School Water Fluoridation
Dietary Fluoride Supplementation (Table 18.1)
Salt Fluoridation
Milk Fluoridation
Fluoride Supplements
Topical Fluorides
Professionally administered fluoride preparations (Fig. 18.2).
Mechanism of Action
Method of Application (Fig. 18.3)
Fluoride Solution
Sodium Fluoride
Stannous Fluoride
Acidulated Phosphate Fluoride
APF Gel
Iontophoresis
Dental Materials Containing Fluoride
Self Applied Topical Fluorides
Fluoride Dentifrices
Fluoride Mouth Rinses
Sustained Release Fluorides
FLUORIDE TOXICITY
Acute Fluoride Toxicity
Symptoms of Acute Fluoride Toxicity
Treatment
Chronic Fluoride Toxicity (Table 18.2)
On Enamel
Skeletal Effects
Knee and Spine
Renal Effects
19:
Pediatric Endodontics
INTRODUCTION
OBJECTIVES OF PULPAL THERAPY
DIAGNOSTIC EVALUATION
Subjective Examination
Tenative Diagnosis
Objective Examination
Extraoral Examination
Soft Tissue
Dentition
Clinical Tests
Periradicular Tests
Pulp Vitality Tests
Radiographic Examination
Special Tests
TREATMENT OPTIONS
Primary Teeth
Vital Pulp Therapy for Primary Teeth Diagnosed with a Normal Pulp
Nonvital Pulp Treatment for Primary Teeth Diagnosed with Necrotic Pulp
Young Permanent Teeth
Vital Pulp Therapy for Teeth Diagnosed with a Normal Pulp or Reversible Pulpitis
Nonvital Pulp Treatment
PULPAL MEDICAMENTS
Pulp Capping Agents
Calcium Hydroxide (Figs 19.1A and B)
Zinc Oxide Eugenol
Reinforced Zinc Oxide Eugenol
Pulpotomy Medicaments
Formocresol
Isobutyl Cyanoacrylates
Mineral Trioxide Aggregate (MTA) (Fig. 19.3)
Denatured Albumin
LASER
Glutaraldehyde
N2
Ferric Sulfate (Fig. 19.4)
Agents used for Devitalization Pulpotomy
Root Canal Materials for Primary Teeth (Fig. 19.5)
PULPAL THERAPY IN PRIMARY TEETH
Vital Pulp Therapy for Primary Teeth Diagnosed with a Normal Pulp or Reversible Pulpitis
Protective Base
Indirect Pulp Therapy (Fig. 19.6)
Direct Pulp Capping (Fig. 19.7)
Pulpotomy
Indications
Contraindications
Objectives
Devitalization
Formocresol Pulpotomy—Single Sitting (Fig. 19.8)
Formocresol Pulpotomy—Two Stage/Sitting
Preservation Pulpotomy
Mortal Pulpotomy
Pulpectomy (Figs 19.9 and 19.10)
Indications
Contraindications
Objectives
Procedure
PULPAL THERAPY IN YOUNG PERMANENT TEETH (FIG. 19.11)
Vital Pulp Therapy for Teeth Diagnosed with a Normal Pulp or Reversible Pulpitis
Nonvital Pulp Treatment in Young Permanent Teeth
Pulpectomy
Apexogenesis and Apexification
Apexogenesis
Apexification (Fig. 19.12)
20:
Trauma and its Management
INTRODUCTION
EPIDEMIOLOGY
INCIDENCE
DISTRIBUTION OF INJURIES
ETIOLOGY
CLASSIFICATION OF DENTOALVEOLAR INJURIES
Numerical Classification
Descriptive Classification
Descriptive Classification of Traumatic Injuries to Dentition (SHY Wei 1989)
Injuries of the Tooth
INVESTIGATION OF ORODENTAL INJURIES
History
Medical History
Dental, Social and Family History
Trauma History
Examination
Extraoral Examination
Intraoral Examination
Special Investigations
Radiographic Examination
DESCRIPTION OF TRAUMA TO DENTAL STRUCTURES
General Reaction of Tooth to Trauma
Dental Trauma
Infarction (Fig. 20.2)
Crown Fracture Uncomplicated (Fig. 20.3)
Crown Fracture Complicated (Fig. 20.4)
Crown/root Fracture (Fig. 20.5)
Root Fracture (Figs 20.6A to D)
Ideal Characteristics of the Splint
Instructions to Patients Having a Splint Placed
Acid Etched Bonded Splints (Fig. 20.7)
Concussion
Subluxation
Lateral Luxation
Intrusion (Fig. 20.8)
Extrusion (Fig. 20.9)
Avulsions (Figs 20.10 to 20.12)
Resorption
Inflammatory Root Resorption
Replacement Resorption (Fig. 20.17)
Splinting
Periodontal Ligament Injuries
Root Fractures
Types of Splinting
Provision of Mouth Guards in Sports
Criteria for Mouth Guard Construction
Mouth Guard Design
Types of Mouth Guards
Care of Mouth Guards
Special Considerations in Mouth Guard Design
21:
Oral Surgical Considerations in Children
INTRODUCTION
LOCAL ANESTHESIA
Duration of Action and Potency
Mechanism of Action (Fig. 21.1)
Composition of Local Anesthetic Agent (Fig. 21.2)
Topical Anesthetics
AAPD Recommendations
Topical Anesthetic that will Anesthetize Skin
EMLA Cream
AAPD Guidelines on Selection of Syringes at Needles
AAPD Guidelines on Injectable Local Anesthetic Agents
ADA Recommendations
Alternative Modes to Achieve Local Anesthesia
Jet Injectors
Electroanalgesia or TENS (Transcutaneous Electrical Nerve Stimulation)
INNERVATIONS OF PRIMARY TEETH
Superior Alveolar Branches of Maxillary Nerve
Anterior Palatine and Nasopalatine Branches of the Maxillary Nerve
Inferior Alveolar Nerve (Fig. 21.3)
Mental and Incisive Nerves
Long Buccal Nerve
Lingual Nerve
General Techniques
Use of Assistant
Use Topical Anesthetic
Patient Position
Body Control
The Non-working Hand
Syringe Management and Etiquette
Euphemisms
Distraction
Order of Extraction
Specific Injection Sites for Children
Use of Forceps and Force Applied
Key Points to be noted during and after Extraction
Postextraction Instructions
MINOR ORAL SURGICAL PROCEDURES PEDIATRIC DENTISTRY
Soft Tissue Abnormalities
Labial Frenum
Lingual Frenum
Mucocele (Fig. 21.5)
Excision
Ranula
Eruption Cyst
Hard Tissue Abnormalities
Extraction of Supernumerary Teeth
Extraction of Natal Teeth
22:
Comprehensive Management OF Cleft Lip and Palate
INTRODUCTION
INCIDENCE
ETIOLOGY
Genetics
Environmental
Unknown Causes
EMBRYOLOGY OF CLEFT LIP and PALATE
CLASSIFICATION OF CLEFT LIP/PALATE (FIG. 22.3)
Davis and Ritchie Classification
Veau Classification (Fig. 22.4)
Kernahan and Stark Classification (Fig. 22.5)
Harkins and Associates (1962)
Spina (1974)
International Confederation of Plastic and Reconstructive Surgery Classification
COMPLICATIONS AND PROBLEMS ASSOCIATED WITH CLEFTS
COMMON SYNDROMES ASSOCIATED WITH CLEFT LIP AND PALATE
Autosomal Dominant Inheritance
Autosomal Recessive Inheritance
Environment
Unknown Genesis
MANAGEMENT OF CLEFT LIP AND PALATE
ROLE OF PEDODONTIST IN MANAGEMENT OF CLP
Nutrition and Feeding Cleft Child
Advice Proper Feeding Techniques
Breastfeeding
Bottle Feeding (Fig. 22.6)
Mead Johnson cleft palate nurser (Fig 22.7)
Haberman feeder (Fig. 22.8)
Dental Management
23:
Gingiva and Periodontium in Health and Disease in Children
INTRODUCTION
NORMAL GINGIVA AND PERIODONTIUM
Division of Gingiva
Papillary Gingiva
Marginal Gingiva
Attached Gingiva
Alveolar Mucosa
Alveolar Bone
GINGIVAL DISEASES IN CHILDREN
Classification of Gingival Diseases in Children
Gingival Diseases
Non-plaque induced gingival lesions
Abscess
Plaque Induced Gingival Diseases
Common clinical findings include
Eruption Gingivitis
Pre-pubertal Gingivitis
Menstrual Cycle Associated Gingivitis
Leukemia Associated Gingivitis
Gingival Diseases Modified by Medication
Drug induced Gingival Enlargement
Gingival Disease Associated with Malnutrition
Scorbutic Gingivitis
Gingival Abscess
Pericoronitis
Acute Herpetic Gingivostomatitis
Acute Necrotizing Ulcerative Gingivitis
Synonyms
Clinical characteristics
Hereditary Gingival Fibromatosis
Synonyms
Clinical Features
Management
PERIODONTAL DISEASE AS IN CHILDREN AND ADOLESCENTS
Periodontal Abscess
Periodontal abscesses are
Management
Early Onset Periodontitis
Prepubertal Localized Periodontitis
Generalized Prepubertal Periodontitis
Aggressive Periodontitis
Systemic Diseases with Associated Periodontal Problems
Hypophosphatasia (Rathbun Syndrome)
Leukocyte Adhesion Defect
Papillon-Lefevre Syndrome
Down's Syndrome (Trisomy 21)
Chediak-Higashi Syndrome
Langerhans Cell Histiocytosis
Insulin-Dependent Diabetes Mellitus (Type 1)
24:
Dental Management of Children with Special Needs
INTRODUCTION
CLASSIFICATION OF CHILDREN WITH SPECIAL NEEDS
INTELLECTUALLY IMPAIRED
Cerebral Palsy
Overview
Types of Cerebral Palsy
Prenatal Risk Factors
Special Oral and Dental Health Concerns for Children with Cerebral Palsy
Oral Findings in Children with Cerebral Palsy
Role of the Dentist
Home Dental Care for Children with Cerebral Palsy
OROFACIAL REGULATION THERAPY
AUTISM
Etiology
Signs and Symptoms
Early Symptoms of Autism in Patients
Tips for Recognizing Children with Autism
Diagnosis
Indications for Formal Developmental Evaluation
Diagnosing Autism
Treatment
Behavioral Problems in Autism
Dental care Protocol for Autistic Child
Down syndrome
Etiology
Prenatal Diagnosis of Down Syndrome
Natal Diagnosis of Down Syndrome
Risk Factors for Down Syndrome
Craniofacial Features in Down Syndrome
Dental Features in Children with Down Syndrome
Role of a Dentist
Home Dental Care for Children with Down Syndrome
Moebius Syndrome
Etiology
General Features of Moebius Syndrome
Oral Features of Moebius Syndrome
Medical Treatment for Children with Moebius Syndrome
Oral Care for Children with Moebius Syndrome
CONGENITAL HEART DISEASE
Types
Cyanotic
Acyanotic
Management
RENAL DISEASE
Chronic Renal Failure
Oral Findings
Dental Management
DIABETES MELLITUS
Management
BRONCHIAL ASTHMA
Etiology
ORAL HEALTH CHANGES IN PATIENTS WITH BRONCHIAL ASTHMA
SEIZURE DISORDERS IN CHILDREN
BLOOD DYSCRASIAS
Sickle Cell Anemias
Dental Considerations
HEMOPHILIAS
Factor IX Deficiency (Christmas Disease)
Von Willebrand Disease
Dental Management of Hemophiliacs
Local Anesthesia
Conservative Dentistry and Prosthodontic
Pulpal Therapy
Oral Surgery
Post-Surgical Care
Orthodontic Therapy
General Care
LEUKEMIAS
FETAL ALCOHOL SYNDROME AND FETAL ALCOHOL EFFECTS
Characteristics of FAS/FAE
Physical Characteristics Related to FAS/FAE
Behavioral Characteristics Related to FAS/FAE
Other Effects may Include
Learning Difficulties Related to FAS/FAE
Difficulties may Include
Malbin (1994) on Inappropriate Social Skills Related to FAS/FAE
Positive Characteristics of Children with FAS/FAE
MENTAL RETARDATION
Oral Manifestations
Hearing Impairment
Types of Hearing Impairment
Etiology
Diagnosis
Treatment
Role of Dentist
25:
Oral Pathologic Conditions
INTRODUCTION
LESIONS OF THE ORAL SOFT TISSUES
INFECTIONS
Viral Infections
Herpetic
Herpes Varicella-zoster
Mumps
Measles
Rubella
Herpangina
Hand, Foot, and Mouth Disease
Infectious Mononucleosis
Human Papilloma Virus
Bacterial Infection
Staphylococcal Infections
Streptococcal Infections
Congenital Syphilis
Tuberculosis
Cat-scratch Disease
Fungal Infections
Candida
Actinomycosis
Protozoal Infections
ULCERS
VESICULOBULLOUS LESIONS
WHITE LESIONS
White Spongy Naevus
Leucoedema
Candidiasis
Geographic Tongue
CYSTS
Mucoceles
Ranula
Bohn's Nodules
Gingival Cyst of the Newborn/Epstein's Pearls (Fig. 25.1)
Dermoid Cysts
Lymphoepithelial Cyst
Thyroglossal Cyst
TUMORS
Congenital Epulis
Melanotic Neuroectodermal Tumor
Squamous Cell Papilloma
Verruca Vulgaris
Focal Epithelial Hyperplasia
Fibrous Epulis
Pyogenic Granuloma
Peripheral Giant Cell Granuloma
Hemangiomas
Sturge-Weber Syndrome
Lymphangiomas
Neurofibromas
Orofacial Granulomatosis
Melkersson-Rosenthal Syndrome
Malignant Tumors of the Oral Soft Tissues
Epithelial Tumors
Lymphomas
Rhabdomyosarcoma
LESIONS OF THE JAWS
Cysts (Table 25.1)
Primordial Cyst
Eruption Cyst (Fig. 25.2)
Dentigerous Cyst
Radicular Cyst
Odontogenic Keratocysts
Non-Odontogenic Fissural Cysts (Table 25.2)
Developmental Conditions
Osteodystrophies
Tumors of the Jaws
Odontome
Juvenile Ossifying Fibroma
Central Giant-Cell Granuloma
Histiocytosis
Ameloblastoma
Ameloblastic Fibroma
Primary Intraosseous Carcinoma
Sarcomas
ORAL MANIFESTATIONS OF SYSTEMIC DISEASE
26:
Child Abuse and Neglect
INTRODUCTION
Neglect
Historical Overview
TYPES OF CHILD ABUSE (FIG. 26.1)
Physical Abuse
Is Physical Punishment the Same as Physical Abuse?
Types of Physical Child Abuse
Shaken Baby Syndrome (SBS)
Battered Child Syndrome
Munchausen Syndrome by Proxy
Sudden Infant Death Syndrome (SIDS)
Sexual Abuse
Emotional Abuse
Neglect
Types of Neglect
Child Abuse and the Handicapped Child
Factors for Child Abuse (Fig. 26.2)
INDICATORS OF CHILD ABUSE
THE DENTIST'S ROLE IN CHILD ABUSE AND NEGLECT INTERVATION
Identification (Fig. 26.4)
Physical Abuse (Fig. 26.5)
Bite Marks
Sexual Abuse
Orofacial Manifestations
Emotional Abuse
Neglect
General Neglect
Assessment: History Taking and Diagnosis
Prevention (Table 26.1)
27:
Genetics in Pediatric Dentistry
INTRODUCTION
MODES OF GENETIC TRANSMISSION
METHODS AND CRITERIA IN GENETIC IDENTIFICATION
CLASSIFICATION OF CHROMOSOMAL ABERRATIONS
Structural Abnormalities
Numerical Abnormalities
Type of Chromosomal Abnormality
GENETIC BASIS OF DENTAL VARIATIONS
COMMONLY APPLIED METHODS FOR STUDYING ROLE OF GENETICS IN DENTISTRY
Twin Method
Family Line Pedigree
GENETIC COUNSELING
Gene Mapping Prior to Pregnancy
Prenatal Stage
Preimplantation Diagnosis
STEPS INVOLVED IN IDENTIFICATION OF GENETIC DISEASE
28:
Forensic Pedodontics
INTRODUCTION
SIGNIFICANCE OF FORENSIC PEDODONTICS
ROLE OF PEDODONTIST
Child Abuse
Mass Disaster
Age Determination
Bite Marks Evidence (Figs 28.1 and 28.2)
Lip Print Identification
Dental Record Maintenance
29:
General Epidemiology and Survey
INTRODUCTION
DEFINITIONS
COMPONENTS
Disease Frequency
Distribution of Disease
Determinants of Disease
AIMS OF EPIDEMIOLOGY
PRINCIPLES OF EPIDEMIOLOGY
BASIC MEASUREMENTS IN EPIDEMIOLOGY
Measurement of Mortality
Crude Death Rate
Specific Death Rate
Case Fatality Rate
Proportional Mortality Rate
Survival Rate
Measurement of Morbidity
Incidence Rate
Prevalence
EPIDEMIOLOGIC METHODS
Descriptive Epidemiology
Procedures involved
Analytical Epidemiology
Case Control Study
Cohort Study
Experimental Epidemiology
Aims
Types
Uses of Epidemiology
INDEX
TOC
Index
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