Modern Pediatric Dentistry Vinay Kumar Srivastava
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Scope and Importance of Pediatric DentistryCHAPTER 1

Treating children can be one of the most enjoyable aspects of dental practice. A child spontaneity, honesty and sense of humor can provide the dentist a refreshing reprieve from the rigor's of a daily routine. Although, the majority of children are well behaved patients. Some have fear or anxieties about dentistry that makes their behavior extremely challenging and often frustrating for a pediatric dentist to manage.
According to American Academy of Pediatric Dentistry (1999); Pediatric Dentistry is an age defined specialty that provide both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
  • In India, the first Dental College was started in the year 1920 by Dr Rafiuddin Ahmed in Calcutta. Hence, he is also known as “The Grand Old Man of Dentistry”.
  • The foundation of Pedodontics was laid down in 1950 in Amritsar, Punjab.
  • Pedodontics did not exist as an independent specialty in the initial years of development of Dentistry but was included in the operative Dentistry Paper and later on in the Orthodontics paper.
  • In the year 1988, as per DCI rules it got its due importance and was treated as a separate entity.
Scope of Pedodontics
‘The Scope of Pedodontics’ pertinent to the range of activities considered in the practice of Pediatric Dentistry. Proper intake of nutritious diet is essential during growing phase of a child. A child stops eating, if his/her tooth hurts during mastication. Therefore, if caries is detected, the teeth should be immediately restored before any undesirable consequences develop.
In addition to be knowledgeable about the dental needs of the child patient, basics in the pediatric medicine, general and oral pathology, growth and development and child psychology, also need to be known. With the changing trends and the development there has been a tremendous increase in the scope of Pedodontics. Various factors responsible for this change are:
  1. Recognition of a child as patient: Majority of the parent don't give importance to decaying or decayed primary tooth of children. They says ‘Ohh’, it's a milk tooth eventually it's going to fall off. This attitude of parent has been slowly changing nowadays with the help of print and electronic media and school dental health education program.
  2. Public recognition of the dental health for general well being of the child.
  3. Recognition of fluoride as the most effective health agent in the prevention of dental caries.
  4. Improvement of various aesthetic agents in clinical use. Introduction of the system of the sophisticated plastics, i.e. composite, ionomer cement, pits and fissure sealant. It is also known as invisible or tooth colored filling.
  5. Radical changes to control virulent infections in any clinical content or in the dental office.
Pedodontics: Pedodontics and preventive dentistry is a vast subject. Pedodontist acts as an orthodontist, an Oral Surgeon, an endodontist, periodontist, a child psychologist and prosthodontist, etc. at a time.
“Vastness of Pedodontics”
  • Preventive Orthodontics
  • Endodontic
  • Periodontics
  • Allied Health Sciences
  • Special Care Dentistry
  • Forensic Dental Science
  • Material Science
  • Oral Rehabilitation
  • Oral Surgery
  • Preventive Dentistry
  • Cariology
  • Dental Radiology
  • Oral Medicine
  • Restorative Dentistry
  • Immunology
  • Neonatology
  • Child Psychology.
A significant portion of dental and oral disease is preventable. Oral diseases and conditions can begin at birth and result in pain, infection, tooth loss and other problems for a child. Early intervention may enable to experience optimal oral health and the life long benefits of a healthy mouth.
Procedures and Pictures
  • Silver fillings (Fig. 1.1)
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    Fig. 1.1: Silver amalgam filling (Postoperative)
  • Tooth colored fillings (Figs 1.2A and B)
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    Fig. 1.2A: Anterior tooth fracture (Preoperative)
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    Fig. 1.2B: Anterior composite resin restoration (Postoperative)
  • Endodontic treatment (Root Canal Treatment) (Fig. 1.3)
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    Fig. 1.3: IOPA- X-ray of endodontically treated primary tooth (arrow shows Dycal Obturation)
  • Stainless steel crowns (Fig. 1.4)
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    Fig. 1.4: Stainless steel crown adaptation on right and left lower primary second molar
Importance of Pedodontics
Pediatric dentists work towards the maintenance of the primary teeth until they are naturally lost. This is due to the importance they serve in permitting children to chew properly and therefore maintain good nutrition and health. Its role in speech development and the way it aid permanent teeth by saving space for them (Guiding Path).
“Previously, a Pediatric Dentist is a Dentist treating the teeth of children right from eruption to the ages of 12 to 14 years.” but nowadays, the pediatric age includes (adolescent) up to 19 years and even more in cases of handicapped condition.
The role of the pediatric dentist changes as children enter adolescence. Recognizing the growth importance of appearance and self-image in their clients, pediatric dentists work to ensure that adolescents’ dental needs are met.
In Pedodontics the service provided are as follows:
  1. Preventive Dental Care
    • Risk assessment
    • Fluoride treatment
    • Water fluoride analysis.
  2. Restorative Dental Care
    • Application of sealants
    • Treatment of dental injuries
    • Cosmetic dentistry: A very fast increase has been observed in this particular branch of dentistry, children have started becoming very conscious about their appearance.
    • Root canal treatment and restorations.
  3. Pediatric Oral Surgery
    • Hospital dental care
    • Treatment of emotionally challenged child
    • Treatment of physically challenged child.
  4. Preventive Orthodontics
    • Space Maintenance
    • Custom made athletic mouthguards: Can be made for children involving into heavy sports, such as boxing wrestling, martial arts and rugby, etc. where there are more chances of trauma or injury to the tooth.
    • Oral habit control.
  5. Behavior Management
    • Treatment of Dental Phobia
  6. TMJ Evaluation.
  7. Diet counseling: The diet counseling is an important part of the pediatric dentistry to prevent incidence of dental disease or stop disease progression. The black cavity generally appears first on the upper anterior teeth or on the lower posterior teeth.
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    • The characteristic that differentiates the pediatric dentist from the other dentists is the fact that he/she provides comprehensive health in the total to the patient, prevents the onset of the disease right from the beginning while considering the psychological need of the child patient thus instills a positive attitude to the dental health in future years to come.
    • In author opinion the importance of Pedodontics, should be spread at the community level by arranging school program and educating children about healthy teeth and its role and general health.
There will be six phenomenons that need to be a greater concern in the 21st century. These are as follows:
  • Child abuse and neglect
  • Children of poverty
  • Informed consent and risk management
  • Advance technology
  • Health care delivery strategies/payment strategies
  • Emergence of pediatric dentistry as a worldwide community.