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Principles and Practice of Pedodontics
Arathi Rao
CHAPTER 1:
Introduction
INTRODUCTION
DEFINITION
PEDODONTICS IN INDIA
AIMS AND OBJECTIVES OF PEDODONTIC PRACTICE
SCOPE OF PEDODONTICS
SPECIFIC DIFFERENCES BETWEEN CHILD AND ADULT PATIENTS
Physiologic and Anatomic Differences2–5
Body Size
Body Fluids
Respiratory System
Cardiovascular System
Urinary System
Pharmacokinetics6–8
Uptake of the Drug and Absorption
Drug Distribution
Drug Metabolism
Drug Excretion
Emotional Differences
RESPONSIBILITIES OF THE PEDODONTIST
QUESTIONS
CHAPTER 2:
Morphology of Deciduous Teeth
INTRODUCTION
DIFFERENCES BETWEEN A DECIDUOUS TOOTH AND A PERMANENT TOOTH (FIG. 2.1)
Features of a Deciduous Crown
Features of a Deciduous Pulp
Features of a Deciduous Root
MORPHOLOGY OF INDIVIDUAL DECIDUOUS TEETH
Maxillary Incisors (Figs 2.2 and 2.3)
Mandibular Incisors (Figs 2.4 and 2.5)
Maxillary Canines (Fig. 2.6)
Mandibular Canines (Fig. 2.7)
Maxillary First Molars (Fig. 2.8)
Mandibular First Molars (Fig. 2.9)
Maxillary Second Molars (Fig. 2.10)
Mandibular Second Molars (Fig. 2.11)
PRACTICAL APPLICATION OF UNDERSTANDING TOOTH MORPHOLOGY
QUESTIONS
CHAPTER 3:
Case History, Examination and Treatment Planning
INTRODUCTION
NEED FOR PATIENT EVALUATION
VITAL STATISTICS
Hospital Registration Number
Date
Name
Chronologic Age
Sex
Class and School
Parent's Name and Occupation
Address
CHIEF COMPLAINT
HISTORY
History of Chief Complaint
Medical History
Prenatal History
Natal History
Postnatal History
Recent Medical History
Past Dental History
Family History
Personal History
Oral Habits History
Oral Hygiene History
Diet History
EXAMINATION
General Examination
General Well-being of the Child
Height and Weight (Figs 3.1 and 3.2)
Built
Gait
Speech
Local Examination
Extraoral Examination
Shape of the Head (Fig. 3.5)
Shape of the Face (Fig. 3.7)
Facial Profile (Fig. 3.9)
Facial Symmetry
Facial Divergence (Fig. 3.12)
Facial Height (Fig. 3.13)
Temporomandibular Joint
Examination of TMJ (Figs 3.14 to 3.16)
Path of Closure: Altered
Lymph Nodes (Figs 3.17A and B)
Eyes
Nose
Forehead
Nasolabial Angle (Fig. 3.18)
Lips
Mentolabial Sulcus (Fig. 3.22)
Chin (Fig. 3.23)
Intraoral—Soft Tissue Examination
Change in Color
Change in Contour
Change in Consistency
Gingiva (Figs 3.24 and 3.25)
Tongue
Saliva
Halitosis
Intraoral—Hard Tissue Examination
(a) Teeth Present (Fig. 3.30)
FDI System
Zsigmondy-Palmer Tooth Numbering System
(b) Hard Tissue Status
(a) Occlusion
(i) Overjet
(ii) Overbite
(d) Curve of Spee
(e) Breathing Pattern
(f) Swallowing Pattern
(g) Physiologic Spacing (Fig. 3.40)
(h) Dental Midline
(i) Mobility/Depressibility of Teeth
PROVISIONAL DIAGNOSIS
INVESTIGATION
Percussion
Radiographic Examination
Pulp Testing
Thermal
Response to Vitality Testing
Electric Pulp Testing
Study Models and Model Analysis
Photographs
Cephalometric Study4,5 (Fig. 3.43)
Use of Cephalometrics
Supplemental Diagnostic Aids
FINAL DIAGNOSIS
TREATMENT PLANNING
Advantages of Treatment Planning
Emergency Phase
Medical/Referral Phase
Systemic Phase
Preventive Phase
Corrective Phase
Maintenance and Recall
Modification
Guideline and Recommendations based on Age for the Periodicity of Examination and Dental Services (AAPD Recommendation, 2009)6
6 to 12 Months
12 to 24 Months
2 to 6 Years
6 to 12 Years
12 Years and Older
Informed Consent
QUESTIONS
CHAPTER 4:
Growth and Development
DEFINITION OF GROWTH AND DEVELOPMENT
FACTORS INFLUENCING GROWTH
Genetic Factors
Maternal Factors
Environmental Factors
NORMAL HUMAN GROWTH
Scammon's Growth Curve
Features Seen at Birth (Fig. 4.2)
3–6 Years
6–12 Years
>12 Years (Adolescence)
GROWTH SPURTS
Clinical Importance
MEASURES OF GROWTH
Growth Assessment Parameters
Chronologic Age
Behavioral Age
Facial Age
Mental Age
PRACTICAL SIGNIFICANCE OF PREDICTING DEVELOPMENT
MECHANISMS OF GROWTH
Endosteal and Periosteal Bone Growth (Fig. 4.6)
Cortical Drift
Relocation and Remodeling
Expanding ‘V’ Principle (Fig. 4.7)
Surface Principle (Fig. 4.8)
Growth Fields
Displacement (Figs 4.9A and B)
Functional Matrix Theory
POSTNATAL GROWTH
Cranium
Cortical Drift and Remodeling
Elongation at the Synchondroses
Sutural Growth
Postnatal Growth of Maxilla
Displacement
Growth at Sutures
Surface Remodeling
Postnatal Growth of Mandible (Fig. 4.13)
QUESTIONS
INTRODUCTION
DEFINITION
Psychology
Behavior
Developmental Psychology
Child Psychology
VALUES OF KNOWING THAT CHILDREN DEVELOP DIFFERENTLY
Different Expectations
Basis of Individuality
Child Rearing must be Individualized
Prediction is Difficult
MAJOR DEVELOPMENTAL PERIODS IN THE DEVELOPMENT OF A CHILD TO A FULL MATURED ADULT
Prenatal Period (Conception to Birth)
Newborn (Birth to 10–14 Days)
Conditions Influencing Adjustment to Postnatal Life
Characteristics of an Infant
Babyhood (2 Weeks to 2 Years)
Characteristics of the Period
Childhood (2 Years to 11 Years)
Characteristics of the Period
Puberty/Adolescence (11 Years to 16 Years)
Characteristics of Puberty
Characteristics of Adolescence
THEORIES OF PSYCHOLOGICAL DEVELOPMENT
Psychodynamic Theories
Behavior Learning Theories
PSYCHODYNAMIC THEORIES
Psychoanalytical Theory (Sigmund Freud, 1905)
Id
Superego
Ego
Defense Mechanisms
Freud's Notion of Unconscious Process
Psychosexual Stages
Oral Stage: 0–1 Year
Anal Stage: 1–3 Years
Phallic Stage: 3–6 Years
Latency Stage: 7–12 Years
Genital Stage: >12 Years
Result of Genital Stage Disturbance
Psychosocial Theory (Erik Erikson, 1963)
1. Trust vs Mistrust (Infants, 0 to 1 Year)
2. Autonomy vs Shame and Doubt (Toddlers, 2 to 3 Years)
3. Initiative vs Guilt (Preschool, 4 to 6 Years)
4. Industry vs Inferiority (Childhood, 7 to 12 Years)
5. Identity vs Role Confusion (Adolescents, 13 to 19 Years)
Hierarchy of Needs (Abraham Maslow, 1954)
Behavior Learning Theories
Classic Conditioning (Ivan Pavlov, 1927) (Pavlovian or respondent conditioning, Pavlovian reinforcement)
First Visit
Second Visit
Operant Conditioning Theory (BF Skinner, 1938) (Instrumental Conditioning; Stimulus-Response Theory)
Cognitive Theory (Jean Piaget, 1952)
Sensorimotor Period: Birth to 24 Months
Preoperational Period: 18 Months to 7 Years
Period of Concrete Operations: 7–11 Years
Period of Formal Operations: 11–18 Years
Social Learning Theory (Albert Bandura, 1963)
Acquisition of Behavior
Performance of the Behavior
QUESTIONS
INTRODUCTION
CONDITIONS RESPONSIBLE FOR EMOTIONAL MATURATION
STAGES OF EMOTIONAL AND SOCIAL DEVELOPMENT
Infancy
Babyhood
Common Emotional Patterns
Social Development
Childhood
Common Emotional Patterns
Factors Influencing Emotions
Late Childhood
Influence of the Family
Adolescence
Emotional Dominance
QUESTIONS
INTRODUCTION
DEFINITION
STAGES OF SPEECH AND LANGUAGE DEVELOPMENT
Infant
Babyhood
Early Childhood
Late Childhood
Adolescence
INTRODUCTION
PRINCIPLES OF MOTOR DEVELOPMENT
STAGES OF MOTOR DEVELOPMENT
Sequence of Motor Development
LEARNING MOTOR SKILLS
Methods of Learning Motor Skills
INTRODUCTION
DEVELOPMENT OF TEETH
Based on Change of Shape
Based on Physiologic Changes
Bud Stage/Initiation
Cap Stage/Proliferation
Bell Stage/Morphological and Histological Differentiation
Advanced Bell Stage/Apposition
ROOT FORMATION
Permanent Dentition
Chronology of Human Dentition
TOOTH ERUPTION
Various Factors Influence the Timing of Eruption
Genetic Factor
Sex
Socioeconomic Condition
Birth Weight
Systemic Disorders
Hormones and Vitamins
Local Causes
Sequence of Eruption
ERUPTION PATTERN
Pre-eruptive Movements
Eruptive Movements
Theories of Mechanism of Tooth Eruption
Posteruptive Movements
Problems during Eruption of Teeth
Difficult Eruption/Teething
Management
Eruption Hematoma/Eruption Cyst
Eruption Sequestrum
Natal and Neonatal Teeth
Epstein Pears, Bohn's Nodules and Dental Lamina Cysts
Ankylosis (Submerged Tooth)
Management of Ankylosed Tooth
Delayed Eruption
QUESTIONS
PREDENTAL/DENTATE PERIOD
Gum Pads
Features of Gumpads (Figs 4.25 and 4.26)
DECIDUOUS DENTITION PERIOD
Eruption Age and Sequence of Deciduous Dentition
Features of Deciduous Dentition Period
Spacing in Deciduous Dentition (Fig. 4.28)
Terminal Plane Relation of the Deciduous Molars (Figs 4.30A to C)
Flush Terminal Plane
Mesial Step Terminal Plane
Distal Step Terminal Plane
Deep Bite (Fig. 4.31)
MIXED DENTITION PERIOD
First Transitional Period
Eruption and Attainment of Occlusion of the First Permanent Molars (Figs 4.32A to C)
Occlusion of First Permanent Molar when Deciduous Molars are in Flush Terminal Plane Relation
Occlusion of First Permanent Molar when Deciduous Molars are in Mesial Step Terminal Plane Relation
Occlusion of First Permanent Molar when Deciduous Molars are in Distal Step Terminal Plane Relation
Exchange of Incisors
Incisal Liability is Overcome by the following Factors
Inter-transitional Period
Second Transitional Period
Leeway Space of Nance (Fig. 4.33)
Ugly Duckling Stage (Broadbent Phenomenon) (Figs 4.34A and B)
PERMANENT DENTITION PERIOD
Self-correcting Aromalies/Transient Malocclusion and their Correction
QUESTIONS
CHAPTER 5:
Behavior Guidance in Dental Practice
INTRODUCTION
DEFINITION2,3
EMOTIONAL DEVELOPMENT
Characteristics of Commonly Seen Emotions in a Child3,4
Distress or Cry
ANGER
FEAR
Types of Fear
Objective Fear
Subjective Fear
Nature and Value of Fear
Anxiety
Phobia
ADAPTIVE CHANGES SEEN IN CHILDREN AT DIFFERENT STAGES OF DEVELOPMENT3,5
Birth to 1 Year
1–3 Years
3–6 Years
6–12 Years
>12 Years
Methods to Deal with an Emotionally Upset Child
FACTORS INFLUENCING CHILD'S BEHAVIOR6–9(FIG. 5.1)
Factors Involving the Child
Growth and Development
IQ of the Child
Past Dental Experience
Social and Adaptive Skill
Postion of the Child in the Family and Child's Behavior (Ordinal—Position Syndrome)
Factors Involving the Parents
Family Influence
Parent-Child Relationship
Over-protective/Over-anxious Parents
Maternal Anxiety
Attitude of Parents to Dentistry
Factors Involving the Dentist
Appearance of the Dental Office
Personality of the Dentist
Time and Length of Appointment
Dentist's Skill and Speed
Avoiding the use of Fear Promoting Words10
Use of Subtle, Flattery, Praise and Reward
PARENT COUNSELING
CHILD-PARENT SEPARATION
CLASSIFICATION OF CHILDREN'S BEHAVIOR12
Wright's Classification of Behavior (1975)12
Cooperative Behavior
Lacking Cooperative Behavior
Potentially Cooperative Behavior
Frankl's Behavior Rating Scale (1962)11
Wright (1975)12 Added Symbolic Modifications
Lampshire's Classification6
Kopel's Classification (1959)6
BEHAVIOR GUIDANCE
Objectives of Behavior Guidance
Behavior Guidance Techniques
Advanced Behavior Guidance Techniques
Preappointment Behavior Modification
Child's First Dental Visit
Communication12,13
Objectives of Communication
Behavioral Shaping14
Modeling
HOME: Hand Over Mouth Exercise also Called as Hand Over Mouth Technique
Advanced Behavior Guidance
Protective Stabilization
Disadvantages
Premedication
Agents used for Premedication for General Anesthesia
Agents used for Premedication Sedation
Non-narcotic Analgesic
Narcotic Analgesics/Opoids
Administration of Premedication
Care during Premedication
Postoperative Instruction
Factors Influencing Dosage
Sedation
Moderate Sedation/Conscious Sedation
Indications
Contraindications
Objectives for Sedation in Pedodontic Practice24
Requisites for Performing Treatement Under Sedation
Patient Monitoring25–29
General Precautions
Specific Precautions
Routes of Administration of the Drug
Patient Consent
Instruction to the Parents
Inhalation Sedation
Nitrous Oxide (N2O
Actions (Pharmacodynamics) of Nitrous Oxide
Techniques
Difference between Conscious Sedation and General Anesthesia
Patient Symptoms Obtained at Various Nitrous Oxide Levels
Common Problems Associated with Nitrous Oxide37–40
Other Drugs used for Sedation
General Anesthesia
Indications
Contraindications
Steps in Hospital Procedures
QUESTIONS
CHAPTER 6:
Preventive and Interceptive Orthodontics
INTRODUCTION
GUIDELINES FOR MONITORING DURING EACH PHASE OF DENTITION
PREVENTIVE ORTHODONTICS
Role of Radiographs in Preventive Orthodontics
Role of Study Models in Preventive Orthodontics
Prenatal Advice to Mother as a Part of Preventive Orthodontics
Postnatal Care as a Part of Preventive Orthodontics
INTERCEPTIVE ORTHODONTICS
Aims of Preventive and Interceptive Orthodontics
SERIAL EXTRACTION
Historical Perspective
Indications
General Rules
Diagnostic Records
Technique of Serial Extraction
Alternative Methods
PROBLEMS ENCOUNTERED IN PRIMARY AND MIXED DENTITION PERIODS AND ITS MANAGEMENT
CROSSBITE MANAGEMENT7–12
Anterior Crossbite
Treatment Considerations
Appliances Used for Correction of Anterior Crossbite
Tongue Blade Therapy (Fig. 6.1)
Inclined Plane (Figs 6.2 and 6.3)
Composite Plane
Reverse Stainless Steel Crown (Fig. 6.4)
Maxillary Appliances with Z' Springs and Posterior Bite Plane (Figs 6.5A and B).
Screws Embedded in Acrylic (Fig. 6.6)
Posterior Crossbite
Appliance Used for Correction of Posterior Crossbite
DIASTEMA MANAGEMENT
DEEP BITE MANAGEMENT
DEVELOPING MALOCCLUSIONS IN CHILDREN
Class II Malocclusion (AAPD)5
Class III Malocclusion
Tooth Size/Arch Length Discrepancy and Crowding13–17
APPLIANCE USED TO INTERCEPT DEVELOPING SKELETAL MALOCCLUSION
Preorthodontic Jaw Trainer18
Design of Preorthodontic Jaw Trainer (Figs 6.7A and B)
Method of Use
Indications of Preorthodontic Jaw Trainer
Contraindications of Preorthodontic Jaw Trainer
SPACE MANAGEMENT
Definitions
Space Maintenance
Space Management
CHANGES FOLLOWING PREMATURE19–20 TOOTH LOSS (FIGS 6.8 AND 6.9)
ETIOLOGY OF SPACE CLOSURE/ CONTRIBUTING FACTORS
Resulting Effects due to Premature Loss of Deciduous Teeth
Premature Loss of Anterior Teeth
Premature Loss of First Deciduous Molar
Premature Loss of Second Deciduous Molar
PLANNING FOR SPACE MAINTENANCE,20,22 FACTORS INVOLVED
Time Lapse Since Loss
Dental Age of the Patient
Amount of Bone Covering the Unerupted Tooth
Sequence of Eruption of Teeth
Type of Tooth Lost
Delayed Eruption of Permanent Tooth
Congenital Absence of Permanent Tooth
Presence of Oral Habits
Existing Malocclusion
SPACE ANALYSIS
Moyer's Mixed Dentition Analysis23
Johnson and Tanaka's Analysis24
Radiographic Method
Hixon and Oldfather25
SPACE MAINTAINERS
Definition of Space Maintainers
Requirements of a Space Maintainer27
Indications of a Space Maintainer
Containdications of a Space Maintainer
Adverse Effects Associated with Space Maintainers28–30
Classification of Space Maintainers
Removable Space Maintainers (Figs 6.13 to 6.15)
Indications of Removable Space Maintainer
Contraindications of Removable Space Maintainer
Advantages of Removable Space Maintainer
Disadvantages of Removable Space Maintainer
Types of Removable Space Maintainers
Ideal Requirements of Removable Space Maintainer
Fixed Space Maintainer
Advantages of Fixed Space Maintainer
Disadvantages of Fixed Space Maintainer
Types of Fixed Space Maintainer
Band and Loop Space Maintainers (Figs 6.16 and 6.17)
Modifications of Band and Loop Space Maintainers
Lingual Arch Space Maintainer (Fig. 6.28)
Transpalatal Bar Space Maintainer (Fig. 6.30)
Nance Palatal Arch33 (Figs 6.31 and 6.32)
Distal Shoe Space Maintainers34–37 (Fig. 6.33)
Fiber Reinforced Composite as Space Maintainers (Fig. 6.35)
Active Space Maintainers/Space Regainers
Indication of Active Space Maintainers
Factors to be Considered before Planning for Active Space Maintainer
Removable Space Regainer
Fixed Space Regainer
Gerber Space Regainer (Open Coiled Space Regainer) (Fig. 6.35)
Jackscrew Space Regainer
Space Maintainers that can be Used for Premature Loss of Deciduous Molars
Soldering Procedure
Technical Procedures
QUESTIONS
Definition
FACTORS THAT MAKE A HABIT—PERNICIOUS
CLASSIFICATION OF PERNICIOUS ORAL HABITS1,2
By Earnest Klein
By Brash
By Morris and Bohana
By Sydney Finn
By William James
THUMB SUCKING HABIT
Definition of Thumb Sucking
Classification of Thumb Sucking6,7
According to Cook (Figs 6.36A and B)
According to Subtleny (Figs 6.37A to D)
Theories Explaining Thumb Sucking Habit8–10
Psychosexual/Psychoanalytical Theory
Oral Drive Theory
Benjamin's Theory
Learning Theory
Clinical Features of a Child Practicing Thumb Sucking
Changes Seen in Orofacial Structures (Figs 6.39A and B)
Factors Influencing the Severity of Dental Defects due to Thumb Sucking4
Three Distinct Phases of Development of Thumb Sucking Habit
Management of Thumb Sucking Habit11
Discussion with the Child
Discussion with the Parents
Use of Rewards
Use of Habit Reminders
TONGUE THRUSTING HABIT
Definition
Different Types of Tongue Thrusting Habits10,13–15
According to Moyer
Features of Infantile Swallowing Pattern
Features of Adult Swallowing Pattern
Features of Swallow Associated with Simple Tongue Thrusting (Fig. 6.43A)
Features of Swallow Associated with Complex Tongue Thrusting (Fig. 6.43B)
Features of Retained Infantile Swallow (Fig. 6.43C)
Reasons for the Prevalence of Tongue Thrusting Habit in Children
Investigative Methods for Identifying Tongue Thrusting Habit10
Methods of Examination
General Clinical Features of Tongue Thrusting Habit (Figs 6.44A to C)
Management of Tongue Thrusting Habit
MOUTH BREATHING HABIT
Etiology of Mouth Breathing Habit
Clinical Features Seen in Mouth Breathing Habit16
Examination of a Child for Mouth Breathing Habit17
Management of a Child with Mouth Breathing Habit
Oral Screen/Vestibular Screen (Fig. 6.45)
BRUXISM17–19
Definition
Etiology
Features
Management
LIP BITING AND MENTALIS HABIT
Features of Lip Biting and Mentalis Habit
Mentalis Habit
Changes Seen due to the Lip Biting Habit
Management of Lip Biting Habit
NAIL BITING HABIT
Features and Management
Treatment
SELF-DESTRUCTIVE ORAL HABITS/MASOCHISTIC HABITS
QUESTIONS
CHAPTER 7:
Dental Caries and its Management
DEFINITION
ETIOLOGY OF CARIES
Role of Tooth in the Etiology of Caries
Anatomic Characteristics of the Teeth (Fig. 7.3)
Arch Form (Fig. 7.4)
Presence of Dental Appliances and Restoration (Fig. 7.5)
Composition of the Teeth
Role of Saliva in the Etiology of Caries
Composition of Saliva
Flow Rate of Saliva
Salivary Buffers
Viscosity of Saliva
Antibacterial Property
Microflora
Bacterial Colonization in the Oral Cavity
Bacteria Responsible for Smooth Surface, Fissure and Root Caries Varies
Streptococcus Mutans (S. mutans)11,13–15
Plaque
Definitions of Plaque1,18–20
Pathogenic Constituents of Plaque
Formation of Plaque1
Diet and Dental Caries
Definition of Diet
Cariogenicity of a Food
Eating Habits in Children
Role of Sugar in the Etiology of Caries22–23
EPIDEMIOLOGICAL STUDIES RELATING SUCROSE TO DENTAL CARIES
Vipeholm Studies25
Conclusion
Hope Wood House Study26
Hereditary Fructose Intolerance
Turku Sugar Studies27
PROTECTIVE FACTORS IN FOOD THAT HELP REDUCE CARIES28
Phosphates
Different Types of Phosphates that are Protective
Glycyrrhizinic Acid
Fats and Protein
Time
Trace Elements29
Possible Mechanism of Trace Element Action on Dental Caries
MECHANISM OF DENTAL CARIES
Various Theories Put Forward to Explain the Mechanism of Caries30–36
MICROSCOPIC STRUCTURE (FIGS 7.6A AND B)1,37
Microscopic Structure of Dentinal Caries (Fig. 7.7)
AREA SUSCEPTIBILITY FOR CARIES1,39–40
CLASSIFICATION OF CARIES41,42
Enamel Caries—Early Features
Pit or Fissure Caries (Fig. 7.9)
Smooth Surface Caries (Figs 7.11A and B)
Acute Dental Caries (Fig. 7.12)
Chronic Dental Caries (Fig. 7.13)
Recurrent Caries
Arrested Caries (Fig. 7.14)
Rampant Caries
Definition
Early Childhood Caries
Classification of ECC52
Type I (Mild to Moderate ECC)
Type II (Moderate to Severe ECC)
Type III (Severe ECC)
Features of ECC
Management of Dental Caries
QUESTIONS
INTRODUCTION
PRINCIPLES AND OBJECTIVES OF PREVENTIVE DENTISTRY
SCOPE
MINIMAL INTERVENTION DENTISTRY
Aim's and Objectives of Minimal Intervention Dentistry5
According to FDI World Federation, the Principles of Minimal Intervention Dentistry6
Concepts of Minimal Intervention Dentistry
Concept of Identification
Concept of Prevention
Concept of Control
Components of Preventive Dentistry
Caries-risk Assessment10–17
Dental Home18–29
Definition (AAPD 2010)
AAPD Recommendation for a Dental Home
Anticipatory Guidance30–34
Oral Health Instructions as a Part of Anticipatory Guidance
For the Mother/Caregiver)
For the Child
Adolescent Oral Health Care
Caries Activity Tests35–37
Ideal Requisites of a Caries Activity Test
Some of the Caries Activity Tests
Lactobacillus Colony Count38,39
Snyder Test40
Salivary Reductase Test41
Saliva Tongue Blade Method42
Rapid Caries Activity Test by Resazurin Disk43
HEALTH EDUCATION44–46
Definition
Objectives of Health Education
Approaches to Public Health
Steps in the Adoption of New Ideas and Practices
Communication in Health Education
Key Element in Communication
DIET ASSESSMENT,36,47 ANALYZING AND COUNSELING
Diet Habit Assessment
Various Methods Employed for Collection
Dietary Goal at Modification
Diet Counseling
Three Basic Stages of Behavior Change
Areas of Influence for Promoting Dietary Behavior Modifications
Food with Low Cariogenic Potential
Remineralizing Agents
Casein Phosphopeptides (CPP)50–54
NovaMin55
Hydroxyapatite56,57
Lasers58–62
Ozone Therapy63,64
PIT AND FISSURE SEALANTS65–82
History
Requirements of the Materials Used as Pit and Fissure Sealant
Materials Used as Sealant
Classification of BIS GMA Sealants
Properties of BIS-GMA
Biocompatibility
Ease of Manipulation
Viscosity and Penetration
Dimensional Stability
Physical and Mechanical Properties
Microleakage and Bacterial Survival
Steps in the Placement of Sealant (Figs 7.17A to G)
ATRAUMATIC RESTORATIVE TECHNIQUE (ART)44,82
History
Advantages of Atraumatic Restorative Technique
Indication of Atraumatic Restorative Technique
Contraindications of Atraumatic Restorative Technique
Principles of Atraumatic Restorative Technique
Steps in Preparing the Cavity for Atraumatic Restorative Technique
PREVENTIVE RESIN RESTORATIONS (PRR)/ CONSERVATIVE ADHESIVE RESIN RESTORATION69,83,84
Types of Preventive Resin Restoration
Type A Preventive Resin Restoration (Fig 7.19)
Type B Preventive Resin Restoration (Fig. 7.20)
Type C Preventive Resin Restoration (Fig. 7.21)
CHEMOMECHANICAL CARIES REMOVAL CONCEPTS85,86
ORAL HYGIENE MAINTENANCE
Oral Hygiene Aids
Toothbrushes87–89
Components of a Brush (Fig. 7.22)
Ideal Pedodontic Brush
Modifications in Brushes
TOOTHBRUSHING PROGRAM FOR CHILDREN
Bass/Modified Bass Technique (Fig. 7.30)
Modified Stillman Technique (Fig. 7.31)
Charter's Method (Fig. 7.32)
Roll Technique (Fig. 7.33)
Scrub Technique (Fig. 7.34)
Physiologic Method (Fig. 7.35)
Fone's Technique (Fig. 7.36)
Recommended Brushing Techniques for Children
Guidelines for Home Oral Hygiene
Prenatal Counseling
Infant (0 to 1 Year Old) (Fig. 7.38)
Toddler (1 to 3 Years Old) (Figs 7.39A to C)
Preschooler (3 to 6 Years Old) (Fig. 7.40)
School Age (6 to 12 Years Old)
Adolescents (12 to 19 Years Old)
Dentifrices87
Composition
Dental Floss99–102
Classification of Dental Floss
Effectiveness of Dental Floss
Usage of Dental Floss (Figs 7.41A and B)
Disclosing Agents45,103
Uses of Disclosing Agents
Materials Used as Disclosing Agents
Use of Disclosing Agent (Figs 7.43A to C)
SUGAR SUBSTITUTES104–108
Noncaloric Sweetners
Sugar Substitutes/Caloric Sweetners
Commonly Used Substitutes
Xylitol
Sorbitol
Saccharin
Cyclamates
Aspartame
LEVELS OF PREVENTION, CARIES POINT OF VIEW45,109
Primary Prevention Level
Secondary Prevention Level
Tertiary Level
SCHOOL DENTAL HEALTH PROGRAM45,110–112
Objectives of School Dental Service
Advantages of a School Based Program
Disadvantages of a School Based Program
Elements of School Based Programs
INTRODUCTION
HISTORICAL EVOLUTION OF FLUORIDES AS CARIES PREVENTIVE AGENT113–120
Fluoride in the Lithosphere
In the Biosphere
In the Hydrosphere
In the Atmosphere
FLUORIDE IN INDIA
ABSORPTION OF FLUORIDE125,126
DISTRIBUTION OF FLUORIDE IN THE BODY126,127
Fluoride in Plasma
Fluorides in Soft Tissues
Fluorides in Teeth and Bone
Teeth
Bone
EXCRETION OF FLUORIDE128
MECHANISM OF ACTION OF FLUORIDE129–137
Decreasing the Solubility of Hydroxyapatite Crystals
Improving the Crystallinity of Hydroxyapatite
Remineralization
Enzyme Inhibition
Suppressing the Flora
Desorption of Protein and Bacteria
Lowering the Free Surface Energy
Alteration of Tooth Morphology
DIFFERENT MODES OF FLUORIDE ADMINISTRATION
SYSTEMIC FLUORIDES
Water Fluoridation
Definition
Important Studies138–140
Advantages of Water Fluoridation
Disadvantages of Water Fluoridation
School Water Fluoridation142
Disadvantages
Different Fluoride Compounds Used for Water Fluoridation
Salt Fluoridation142
Method of Production of Fluoridated Salt
Advantages
Disadvantages
Milk Fluoridation142
Disadvantages
Fluoride Tablets142
Availability
TOPICAL FLUORIDES
SOLUTION/THIXOTROPIC GELS/FOAM
Sodium Fluoride143
Knutson's Technique
Stannous Fluoride144–146
Application (Muhler's Technique)
Disadvantages
Acidulated Phosphate Fluoride (APF)147–149
Application (Brudevold's Technique)
Fluoride Gel150,151
Fluoride Foam150
Others
Methods of Increasing the Fluoride Uptake by the Enamel
FLUORIDE DENTIFRICES142,152–154
Amount of Fluoride Present in the Dentifrice
Abrasive Compatibility
FLUORIDE RINSES150,155
School Rinse Programs142,150
Advantage of School-based Rinse Programs
Disadvantage of School-based Rinse Programs
FLUORIDE VARNISHES142,156–158
Indications
Commonly Used Fluoride Varnishes
Steps Involved in the Application of Varnish
FLUORIDE TOXICITY
Dental Fluorosis
Management of Dental Fluorosis
Index used for Measuring Fluorosis
DEFLUORIDATION OF WATER122
Ion Exchange Method
Nalgonda Technique of Defluoridation
Mechanism of Defluoridation by Nalgonda Technique
QUESTIONS
INTRODUCTION
FEATURES OF DECIDUOUS TEETH COMPARED TO PERMANENT TEETH
DIAGNOSIS OF CARIES
Visual Evidence
Tactile Evidence
Infrared Laser Fluorescence (Diagnodent)
Digital Imaging Fiberoptic Transillumination (DIFOTI)
Quantitative Light Fluorescence (QLF)
CAVITY PREPARATION
Definition
Objectives
Factors to be Considered before Cavity Preparation
CAVITY CLASSIFICATION
Black's Classification4
Finn's Modification of Black's Classification for Deciduous Teeth
Classification by Mount and Hume (1998)5,6
Classification based on the Site of Occurrence of Carious Lesions
Classification based on the Size of Carious Lesions
AMALGAM RESTORATION FOR PRIMARY TEETH
Occlusal (Fig. 7.60)
Proximal Box
CONSERVATIVE APPROACH FOR PROXIMAL CARIES IN DECIDUOUS TEETH
Tunnel Preparation
Slot Preparation
Proximal Approach
MATRIX BANDS, RETAINERS AND WEDGES
Classification of Matrix Band (Fig. 7.64)
T-Band7
Spot-Welded Matrix Band (Fig. 7.68)
Wedges
Different Types of Wedges
Uses of Wedge
Results of Faulty Wedging
ISOLATION TECHNIQUES8
Objective of Isolation
Isolation Involves Three Conceptual Elements
Different Methods of Isolation
Rubber Dam7,9–12
Advantages of Rubber Dam
Disadvantages of Rubber Dam
Precautions to be Taken While Using Rubber Dam
Armamentarium Used for Rubber Dam Application
Placement of Rubber Dam13,14
High Volume Evacuators and Saliva Ejectors
Absorbents and Throat Shields
SILVER AMALGAM RESTORATIVE MATERIAL
Condensation and Carving of Silver Amalgam
Bonded Amalgam Restorations15
Mercury Hygiene
GLASS IONOMER (POLYALKENOATE) CEMENT16–22
Development of Glass Ionomer Restorative Material
Advantage of Glass Ionomers
Classification of Glass Ionomer Cement
Dispensing of Glass Ionomer Cements23
Composition of Glass Ionomer Cement
Powder
Liquid
Setting Reaction of Glass Ionomer Cement24,25
Different Stages in the Setting Reaction
Role of Moisture Contamination and Dehydration
Factors Affecting Setting Characteristic of Glass Ionomer Cement
Factors Affecting Rate of Setting of Glass Ionomer Cement
Properties of Glass Ionomer Cement26–29
Physical Properties
Esthetics
Adhesion
Biocompatibility
Steps Involved in Clinical Placement of Glass Ionomer Cement
Critical Procedures for Glass Ionomer Restoration
Modifications of Glass Ionomer Cement23,30–32
Resin Modified Glass Ionomer Cement
Composition
COMPOSITE RESIN RESTORATIVE MATERIAL
Composition
Classification of Composite Resins
Classification Based on Filler Particle Size
Based on the Mean Particle Size of the Major Filler
Based on the Method of Polymerization
Properties
Light Cured Composites
Acid Etch36–43
Liquid Etchant
Gel Etchant
Three Basic Types of Surface Characteristics in Etched Enamel44
Bonding Agent
Individual Components of Bonding Agents
Critical Factors Affecting Adhesion
Steps in Composite Restoration
Oral Prophylaxis
Shade Selection
Beveling of the Cavity Border
Acid Etching
Finishing and Polishing of Composites
Finishing and Polishing
Wear of Composites
Repair of Composites
Rebonding to Old Composite
Repair of the Newly Placed Restoration
Properties of Composite Resins
INDICATIONS OF STAINLESS STEEL CROWN RESTORATIONS49,50
CONTRAINDICATIONS TO STAINLESS STEEL CROWN RESTORATION
Stainless Steel Crowns are Used as Temporary Crowns for Permanent Teeth
COMPOSITION
CLASSIFICATION OF STAINLESS STEEL CROWNS
Classification of Crown-based on Shape (Figs 7.97A to C)
Based on the Metal
EQUIPMENTS
Burs (Figs 7.98A to D)
Pliers (Figs 7.99A to C)
STEPS INVOLVED IN ADAPTATION OF THE PREFORMED STAINLESS STEEL CROWN51–54
Crown Selection
Factors to be Considered during Crown Selection
Preoperative Occlusal Evaluation
Local Anesthesia Administration
Rubberdam Application
Placement of Wedges
Tooth Preparation (Figs 7.106A and B)
Occlusal Reduction
Proximal Reduction
Buccal and Lingual Reduction
Finishing
Trial Fitting, Trimming and Contouring the Crown (Figs 7.107 to 7.109)
Finishing the Crown
Cementation
Postcementation Instruction
MODIFICATIONS OF STAINLESS STEEL CROWN55–59
COMPLICATIONS THAT MAY DEVELOP DURING STAINLESS STEEL FABRICATION
QUESTIONS
CHAPTER 8:
Pulp Therapy
INTRODUCTION
Inflammatory Changes in the Pulp4–10
DIFFERENCE BETWEEN PRIMARY AND PERMANENT PULP11–16 (FIG. 8.1)
Etiology17–26
CLASSIFICATION OF PULPAL DISEASES27
Reversible Pulpitis
Definition
Clinical Features
Treatment
Irreversible Pulpitis
Definition
Clinical Features
Treatment
Hyperplastic Pulpitis (Pulp Polyp)
Clinical Features
Treatment
Internal Resorption
Definition
Clinical Features
Treatment
Necrosis of the Pulp
Clinical Features
Treatment
PERIRADICULAR DISEASES
Apical Periodontitis
Treatment
Condensing Osteitis
Acute Alveolar Abscess
Definition
Clinical Features
Treatment
Chronic Abscess
DIAGNOSIS OF PULP PATHOLOGY
Diagnostic Features4,27–30
Pain
Swelling
Discoloration
Mobility
Vitality Tests
Radiographs
INDIVIDUAL TOOTH ASSESSMENT
MANAGEMENT TECHNIQUES
Indirect Pulp Capping4,27,37,38
Aim
Indications
Contraindications
Procedure (Figs 8.11A to E)
Affected Vs Infected Dentin39,40
Direct Pulp Capping4,27,41
Definition
Indications
Contraindications
Treatment Considerations
Ideal Requirements of Material Used for Direct Pulp Capping
Materials Used for Direct Pulp Capping
Calcium Hydroxide42–53
Procedure of Direct Pulp Capping with Calcium Hydroxide (Figs 8.12A to E)
Histological changes
Drawbacks of Calcium Hydroxides
Mineral Trioxide Aggregate54–65
Advantages of MTA
Disadvantages of MTA
Steps Involved in the Placement of MTA Over the Pulp
Pulpotomy39,80–88
Definition
Objectives
Indications
Contraindications
Types of Pulpotomy
Partial Pulpotomy89,90
Formocresol Pulpotomy
Glutaraldehyde99
Pulpectomy28,100–106
Definition
Indications
Contraindications
Types of Pulpectomy
Single Visit Pulpectomy
Procedure of Single Visit Pulpectomy (Figs 8.16 to 8.19)
Multivisit Pulpectomy
Filling/Obturation of Deciduous Root Canals
Common Problems with Zinc Oxide Eugenol as Deciduous Tooth Obturation Material
Problems Encountered in Deciduous Tooth Pulpectomy
Evaluation of Success of Pulpectomy
Follow-up
Treatment Modalities for a Permanent Tooth with Extensive Involvement of the Pulp
Apexogenesis/Calcium Hydroxide Pulpotomy/ Cervical Pulpotomy (Figs 8.23A to C)
Aim
Apexification4,28,108,109 (Figs 8.24A to E)
Material
Procedure
Follow-up
Apical Plug with Mineral Trioxide Aggregate54,60
Steps Involved in MTA as Apical Plug Placement
Steps Involved in the Repair of Perforation
Pulp Revascularization/Regeneration110–114
QUESTIONS
CHAPTER 9:
Trauma and its Management
INTRODUCTION
EPIDEMIOLOGY
Incidence
Site
Sex Distribution
CLASSIFICATION OF TRAUMA TO ANTERIOR TEETH (FIGS 9.1 TO 9.14)
Ellis Classification (1961)2
Ellis and Davey Classification (1970)3
Hargreaves and Craig (1970)4
Hithersay and Morile (1982)5
WHO Classification (1978)6
Andreasen's Modification (1981) of WHO Classification
International Classification of Diseases7
Injuries to Teeth
Injury to Periodontal Tissues
Descriptive Classification8
Injuries to the Tooth
Trauma to the Supporting Bone
Soft Tissue Injury
CAUSES OF TRAUMA9,10
18 Months to 2 Years
2-5 Years (Toddler)
5-10 Years
>10 Years
PREDISPOSING FACTORS11–14
Accident Prone Profile
Inadequate Lip Coverage
Handicapped Children
Dental Anomalies and Caries
Mechanical Factors
Energy of Impact
Resiliency of the Impacting Object
Shape of the Impacting Object
Angle of Direction of the Impacting Force
PREVENTION OF TRAUMA
MANAGEMENT
Obtaining History
Clinical Examination15–17
Assessment of Injury
Extraoral Examination
Intraoral Examination
Vitality Tests
Providing First Aid
TREATMENT OF THE INJURY
Trauma to the Primary Teeth17
Enamel Fracture
Enamel and Dentin Fractures
Fracture Involving the Pulp
Root Fracture
Concussion
Mobility
Intrusion
Extrusion and Lateral Luxation Injuries
Splinting of Luxated Primary Teeth is not Preferred
Avulsion
Trauma to the Permanent Tooth
Crown Craze or Crack (Fig. 9.15)
Fractures Involving Enamel (Fig. 9.16)
Fractures Involving Enamel and Dentin (Figs 9.17 and 9.18)
Fracture Involving the Pulp (Fig. 9.19)
Fracture Involving Crown and Root
Without Pulpal Involvement
With Pulpal Involvement
Root Fracture
PERIODONTAL INJURIES
Concussion
Subluxation
Intrusion
Extrusion
Lateral Luxation
Avulsed Tooth
Features that may Improve the Prognosis of Replanted Permanent Teeth
Emergency Management of Avulsed Tooth
Treatment Modalities of Avulsed Tooth
Extraoral Dry Time Less than 30 Minutes with Closed Apex
Extraoral Dry Time Less than 30 Minutes with Open Apex
Extraoral Time of 30-60 Minutes with Either Open or Closed Apex
Extraoral Dry Time of >60 Minutes with Either Open or Closed Apex
Healing of Reimplanted Tooth29
Postoperative Supportive Management
A Traumatized Tooth is kept Under Observation
Follow-up and Evaluation
SPLINTING OF A TRAUMATIZED TOOTH
Properties of an Ideal Splint
Different Kinds of Splints Used
Stabilization Period
REACTION OF THE PULP TO TRAUMA
MANAGEMENT OF DISCOLORED TEETH
Bleaching of Vital Teeth
Procedure
Bleaching of Nonvital Teeth
In-office Bleaching Technique
Walking Bleach
EFFECTS OF TRAUMA ON DEVELOPMENT OF SUCCEDANEOUS TEETH
PREVENTION OF TRAUMA DURING CONTACT SPORTS
Face and Mouth Guards43
Ideal Requirement of a Mouth Protector
Classification of Mouth Protectors
Instructions to the Patient
QUESTIONS
CHAPTER 10:
Child Abuse and Management
INTRODUCTION
DEFINITION
TYPES OF ABUSE AND NEGLECT1–3
Physical Abuse
Sexual Abuse
Neglect
Health Care Neglect
Educational Neglect
Emotional Abuse
Intentional Poisoning/Drugging
Munchausen's Syndrome by Proxy
INJURIES ASSOCIATED WITH ABUSE5–7
Orofacial Injuries (Figs 10.1 to 10.3)
Injury to Skin and Subcutaneous Tissues
Head Injuries
Bone Injuries
Abdominal Injuries
CHARACTERISTICS OF AN ABUSED CHILD8,9
Features of Abused Child
Abuser
ROLE OF A DENTAL SURGEON10
Examination
Diagnosis
QUESTIONS
CHAPTER 11:
Dental Management of Children with Special Health Care Needs
INTRODUCTION
DEFINITIONS4,5
CLASSIFICATION
Cerebral Palsy
Definition
Incidence
Classification
Dental Consideration and Management
Behavior in Dental Clinic
Intellectual Disability
Definition
Incidence
Classification
Dental Considerations
Modifications in Treatment Plan
Congenital Cardiac Disease
Features and Dental Importance
Cleft Lip and Palate
Mechanism of Cleft Formation13,14
Etiology for Cleft Formation
Classification of Cleft Lip and Palate15–19
Symbolic Classification—Kernahans Striped Y
Clinical Features (Figs 11.2 to 11.4)
Management of Cleft Lip and Palate
Presurgical Management
Feeding Plate (Fig. 11.5)
Stage I: Management from Birth to 18 Months
Stage II: Management from 18 Months to 5 Years (Primary Dentition)
Stage III: Management from 6 Years to 11 Years (Mixed Dentition)
Stage IV: Management from 12 to 18 Years (Permanent Dentition)
Down's Syndrome
Dental Management of Patient with Down's Syndrome
Renal Diseases
Features and Dental Importance
Drugs to be Avoided
Liver Disease
Features and Dental Importance
Drugs to be Avoided
Diabetes Mellitus
Features and Dental Importance
Hypopituitarism
Features and Dental Importance
Hyperpituitarism
Features and Dental Importance
Hypothyroidism
Features and Dental Importance
Hyperthyroidism
Features and Dental Importance
Hypoparathyroidism
Features and Dental Importance
Hyperparathyroidism
Features and Dental Importance
Respiratory Disease (Asthma)
Features and Dental Importance
Immunodeficiency
Features and Dental Importance
Acquired Immunodeficiency Syndrome
AIDS is Diagnosed when an Individual with HIV Develops at Least one of these Conditions20
Epilepsy
Classification
Features and Dental Importance
Childhood Autism
Features and Dental Importance
Blindness
Features and Dental Importance
Deafness
Features and Dental Importance
Bleeding Disorder
Features and Dental Importance
Coagulation Disorders
Features and Dental Importance
Hemophilia A
Features and Dental Importance
Sickle Cell Anemia
Features and Dental Importance
Thalassemia
Dental Implications and Management
Leukemia
Dental Management
Dental Effects of Radiation Therapy
Dental Effects of Chemotherapy
Organ Transplantation
Dental Implication and Management
Bone Marrow Transplantation
Dental Management
Children on Anticoagulants
Dental Management
DENTAL OFFICE ACCESS
SPECIAL CONSIDERATIONS IN DENTAL MANAGEMENT
Radiographic Examination
Preventive Methodologies
Home Care
Diet and Nutrition
Fluoride
Pit and Fissure Sealant
Disabled Children can be Divided into three Groups for the Purpose of Teaching Oral Hygiene
Self-Care Group
Partial Care Group
Total Care Group
Position of the Child and the Caretaker
Modification of Toothbrushes
QUESTIONS
CHAPTER 12:
Radiology in Pedodontic Practice
INTRODUCTION
POINTS TO BE CONSIDERED BEFORE PLANNING FOR RADIOGRAPHS
PURPOSE FOR PRESCRIBING RADIOGRAPHS
Evaluation of the Development of Dentition
Pathologic Evaluation
Detection of Developmental Anomalies
Post-treatment Evaluation
Routine Evaluation based on Risk Assessment
Low-risk Child
High-risk Child
Film Surveys
CHILD PREPARATION AND MANAGEMENT (FIGS 12.3A TO C)
METHODS OF REDUCING RADIATION EXPOSURE
RADIOGRAPHIC TECHNIQUES COMMONLY USED IN CHILDREN
Intraoral Periapical (IOPA) Radiographs
Indications (Figs 12.7A to E)
Bite Wing Radiographs
Technique
Occlusal Radiograph
Panoramic Radiographs (Figs 12.18 and 12.19)
SPECIAL TECHNIQUE FOR THE HANDICAPPED CHILD
HAND-WRIST RADIOGRAPHS (FIGS 12.20 AND 12.21)
Indications of Hand-Wrist Radiograph
Hand-Wrist X-ray can be Correlated
MRI: MAGNETIC RESONANCE IMAGING (FIG. 12.22)
DIGITAL RADIOGRAPHY OR REAL-TIME IMAGING (FIG. 12.23)
Advantages
Disadvantages
DENTAL XERORADIOGRAPHY
Advantages
Cone Beam CT
RADIATION PROTECTION OR RADIATION HYGIENE MEASURES
QUESTIONS
CHAPTER 13:
Dental Extractions in Children
INTRODUCTION
NEUROLOGIC ANATOMY
Superior Alveolar Branches (Fig. 13.1)
Greater (Anterior) Palatine and Nasopalatine Branches (Fig. 13.2)
Inferior Alveolar (Mandibular) Nerve (Fig. 13.3)
Mental and Incisive Nerves (Fig. 13.4)
Long Buccal Nerve
Lingual Nerve
Mylohyoid Nerve (Fig. 13.3)
TOPICAL ANESTHESIA
Agents Used as Topical Anesthetics
Method of Application of Topical Anesthetic Agent
LOCAL ANESTHESIA
Definition (Malamed,1980)2
Local Anesthetics
Classification of Vasoconstrictors Used with Local Anesthetics
Classification of Local Anesthetic Agents
Composition of Local Anesthetic Solution
Anesthetic Agents Suitable for Children, that Rarely Evoke Allergic Reaction
Ideal Requirements of the Anesthetic Agent
Mode of Action of Local Anesthesia
Absorption, Metabolism and Excretion of Anesthetic Agent
Absorption
Metabolism
Excretion
Duration of Action of the Anesthetic Agent
Onset and Duration of Action of Anesthesia of 2% Lignocaine 1:100,000 Epinephrine
Onset of Action
Duration of Action
Contraindications for Local Anesthesia
Complications Following Local Anesthetic Administration
TYPES OF SYRINGE
Jet Syringe
Metal Cartridge Type Syringe (Aspirating Syringe)
Presterilized Disposable Syringe
Computer Controlled Local Anesthetic Delivery Systems (CCLD)
Properties of Adrenaline
TYPES OF INJECTION PROCEDURES
ANESTHESIA FOR THE MAXILLARY TISSUES
ANESTHESIA FOR THE MANDIBULAR TISSUES
Others
Maxillary and Mandibular Infiltration
Posterior Superior Alveolar Nerve Block (Fig. 13.10)
Middle Superior Alveolar Nerve Block (Fig. 13.11)
Maxillary Anterosuperior Nerve Block (Fig. 13.12)
Infraorbital Nerve Block (Fig. 13.13)
Palatal Infiltration
Nasopalatine Nerve Block (Fig. 13.14)
Greater Palatine Nerve Block (Fig. 13.15)
MANDIBULAR ANESTHESIA
Inferior Alveolar Block (Figs 13.16 A and B)
Technique of Inferior Alveolar, Lingual and Long Buccal Nerve Block
Mental Nerve Block (Fig. 13.17)
Periodontal Ligament Injection (Intraligamentary Injection)
Intrapulpal Injection
Differences between a Child and Adult Patient
Factors Responsible for Successful Administration of a Local Anesthetic Agent in a Pediatric Patient
COMMONLY MADE MISTAKES
EXTRACTION OF TEETH
Rationale for Deciduous Tooth Removal
Acute Pathologic Involvement
Chronic Pathologic Involvement (Fig. 13.21)
Over Retained Deciduous Tooth
Ankylosed Deciduous Tooth
Cariously Involved, Nonrestorable Deciduous Tooth (Fig. 13.22)
Natal or Neonatal Tooth
Supernumerary Tooth (Figs 13.23A to D)
Fractured or Traumatized Tooth
Impacted Tooth
Contraindications to Tooth Removal
Acute Systemic Infections
Blood Diseases
Uncontrolled Diabetes Mellitus
Irradiated Bone
Acute Oral Infection
Position of the Operator and the Patient (Fig. 13.24)
TECHNIQUE FOR EXTRACTION
Precautions to be Taken
Primary Incisors and Canines
Procedure
Primary Molars
Procedure
ANALGESICS AND ANTIBIOTICS USED IN DENTISTRY
Anti-inflammatory Analgesics
Classification of Nonsteroidal Anti-inflammatory Drugs
Antimicrobial Agents Used in Dentistry
Advantage of Oral Antimicrobial Agents
Commonly Encountered Infections in Dental Practice
Antimicrobial Agents Commonly
Selection of Antimicrobial Agents
QUESTIONS
CHAPTER 14:
Gingival and Periodontal Diseases in Children
INTRODUCTION
DIFFERENCES BETWEEN THE CHILD AND ADULT PERIODONTIUM
Features Seen in a Child1–5
PHYSIOLOGIC GINGIVAL CHANGES ASSOCIATED WITH TOOTH ERUPTION
Pre-eruptive Stage
Eruptive Stage
Posteruptive Stage
Gingivitis
Stages of Gingivitis6
Stage I: Initial Lesion
Stage II: Early Lesion
Stage III: Established Lesion
Stage IV: Advanced Lesion
Clinical Features of Gingivitis
ETIOLOGY OF GINGIVAL DISEASES
Classification of Gingival Diseases7
I. As per the International Workshop for a Classification of Periodontal Diseases and Conditions
Classification of Periodontal Disease7
Chronic Periodontitis
Aggressive Periodontitis
Periodontitis as a Manifestation of Systemic Diseases
Necrotizing Periodontal Diseases
Abscesses of the Periodontium
Periodontitis Associated with Endodontic Lesions
Developmental or Acquired Deformities and Conditions
Gingival Disease
Periodontal Disease
Eruption Gingivitis
Gingivitis Associated with Poor Oral Hygiene
Gingivitis Associated with HSV I Infection
Gingivitis Associated with Aphthous Stomatitis
Acute Necrotizing Ulcerative Gingivitis (ANUG)
Associated with Acute Bacterial Infection
Associated with Chronic Nonspecific Gingivitis
Puberty Gingivitis
Hereditary Fibromatosis Gingival Enlargement (Fig. 14.7)
Drug-induced Hyperplasia (Fig. 14.8)
Scorbutic Gingivitis
Prepubertal Periodontitis
Localized Aggressive Periodontitis
Generalized Aggressive Periodontitis
Papillon-Lefevre Syndrome
QUESTIONS
CHAPTER 15:
Prosthodontic Considerations in Children
DEFINITION
INDICATIONS FOR PROSTHETIC REPLACEMENT/PROSTHESIS
AIMS OF PROSTHODONTIC REHABILITATION
Restoration of Esthetics
Restoration of Masticatory Efficiency
Prevention and Correction of Speech Abnormality
Prevention of Harmful Habits
Provision of Space Maintenance
Obturation of Congenital and Acquired Defects of Orofacial Structures
HARMFUL EFFECTS OF PROSTHESIS AND ITS PREVENTION
Caries
Periodontal Disease
Effects of Growth and Development
Loss of Alveolar Bone
Oral Mucosal Disorders
EXAMINATION, DIAGNOSIS AND TREATMENT PLANNING
Mouth Preparation
TYPES OF PROSTHESIS
Removable Partial Denture (Figs 15.1A and B)
Indications
Ideal Requirements
Design for Removable Partial Denture in Children
Parts of a Removable Partial Denture
Procedure for Constructing Removable Partial Denture
Instructions to the Patient and the Parents
Advantages of Removable Denture
Disadvantages of Removable Denture
Complete Denture
Indications
Patient Instructions
Overdentures
Fixed Partial Dentures
Types of Fixed Prosthesis
Resin Bonded Retainers (Maryland Bridge)
Indications
Contraindications
Advantages
Disadvantages
Procedures—Anterior Teeth Replacement
Posterior Teeth Replacement
Partial Veneer Crown Retainers
Laminate Veneers
Acid-Etch Composite Veneers
Inlay Retainers
Advantages
Tooth Preparation
Complete Crown Retainers
Cantilevered Prosthesis
Design
Indications
Requirements
Criteria for Case Selection
Improved Designs
Advantages
Restorations for a Single Tooth
Resin Jacket Crown (Figs 15.3 and 15.4)
All Ceramic Crown
Metal Ceramic Crown
All Ceramic and Metal Ceramic Crowns Supported by Posts and Cores
Implant Prosthesis
Implant Usage before Growth Completion
Implants for Orthodontic Anchorage
Recall Program following Prosthodontic Replacement
QUESTIONS
CHAPTER 16:
Common Oral Pathologic Conditions
INTRODUCTION
DISORDERS OF THE TONGUE
Microglossia
Macroglossia
Ankyloglossia
Fissured Tongue
Median Rhomboid Glossitis
Benign Migratory Glossitis
Hairy Tongue
Lingual Thyroid
DISORDERS OF THE BUCCAL MUCOSA
Fordyce's Granules
Leukoedema
Focal Epithelial Hyperplasia
DISORDERS OF THE LIPS
Commissural Lip Pits
Double Lip
Cleft Lip
Peutz-Jegher's Syndrome
DISORDERS AFFECTING THE SHAPE OF THE TEETH
Microdontia
Macrodontia
Dilaceration
Talon Cusp
Dens Evaginatus
Dens in Dente
Taurodontism
Supernumerary Roots (Fig. 16.7)
Fusion (Figs 16.8 and 16.9)
Gemination
Concrescence (Fig. 16.10)
Odontome
DISORDERS AFFECTING THE NUMBER OF TEETH
Supernumerary Teeth (Figs 16.11A to C)
Anodontia
Hypodontia
Ectodermal Dysplasia
Anhidrotic Eectodermal Dysplasia (Figs 16.14A to C)
DISORDERS AFFECTING THE STRUCTURE OF THE TEETH
Enamel Hypoplasia/Enamel Hypocalcification
Dentinogenesis Imperfecta (Hereditary Opalescent Dentin)
Amelogenesis Imperfecta
Dentin Dysplasia
Dentin Dysplasia (Type I)
Dentin Dysplasia (Type II)
BENIGN TUMORS OF THE ORAL CAVITY
Hemangioma
Lymphangioma
Congenital Epulis
Neurofibromatosis
White Sponge Nevus
Blue Nevus
CYSTS OF ORAL CAVITY
Primordial Cyst
Dentigerous Cyst (Follicular Cyst)
Odontogenic Keratocyst
Radicular Cyst
Nasopalatine Duct Cyst
Globulomaxillary Cyst
Dental Lamina Cyst of the Newborn
DISORDERS OF THE JAW
Agnathia
Micrognathia
Macrognathia
Osteomyelitis
Fibrous Dysplasia
Cherubism
DISORDERS OF THE FACE
Facial Hemihypertrophy
Facial Hemiatrophy
BACTERIAL INFECTIONS
Scarlet Fever (Scarlatina)
Diphtheria
Tuberculosis
Actinomycosis
Tetanus (Lock-jaw)
Syphilis
Noma (Cancrum Oris)
Pyogenic Granuloma (Granuloma Pyogenicum)
VIRAL INFECTIONS
Herpes Simplex Virus Type I Infection
Herpangina
Measles (Rubeola)
Chickenpox (Varicella)
Herpes Zoster (Shingles)
Mumps (Epidemic Parotitis)
AIDS—Acquired Immunodeficiency Syndrome
FUNGAL INFECTIONS
Acute Pseudomembranous Candidiasis (Thrush)
OTHERS
Pre-eruptive “Caries”
Intrinsic Stains
Discoloration in Erythroblastosis Fetalis
Discoloration in Porphyria
Discoloration in Cystic Fibrosis
Discoloration in Tetracycline Therapy
Mucocele
Ranula
Recurrent Aphthous Stomatitis
QUESTIONS
CHAPTER 17:
Infection Control
INTRODUCTION
ROUTES OF TRANSMISSION OF INFECTION1–2
GENERAL GUIDELINES FOR ALL DENTAL OFFICE STAFF3–7
BARRIER PRECAUTIONS8–10
HANDWASHING AND CARE OF HANDS11–13
USE AND CARE OF SHARP INSTRUMENTS AND NEEDLES13
STERILIZATION OR DISINFECTION OF INSTRUMENTS14
Pre-sterilization Cleaning
Sterilization Methods
Autoclave (Steam under Pressure)
Unsaturated Chemical Vapor Sterilizer
Dry Heat Sterilizer
Chemical Sterilization of Instruments
Post-sterilization Procedures
CLEANING AND DISINFECTION OF DENTAL UNIT AND ENVIRONMENTAL SURFACES
DISINFECTION AND THE DENTAL LABORATORY
CARE OF HANDPIECES
SINGLE-USE DISPOSABLE INSTRUMENTS
DISPOSAL AND TREATMENT OF HEALTH CARE WASTE MATERIALS8,15–21
Incinerators
Types of Incinerators
Pyrolytic Incinerators
Single-chamber Incinerator
Rotary Kiln
Chemical Disinfection
Types of Chemical Disinfectants
Wet Thermal Treatment
Disadvantages
Advantages
Microwave Irradiation
Encapsulation
Safe Burying
Inertization
QUESTIONS
CHAPTER 18:
Genetics in Pedodontic Practice
INTRODUCTION
TERMS COMMONLY USED
CLASSIFICATION OF CHROMOSOMAL ABERRATIONS
Down Syndrome (Mongolism)
Types of Down Syndrome
Etiology
Clinical Features
Trisomy 18 (Edward's Syndrome)
Clinical Features
Trisomy 13 (Patau Syndrome)
Cri-du-Chat (Cat Cry Syndrome)
Turner's Syndrome (Gonadal Dysgenesis)
Clinical Features
Klinefelter's Syndrome
Clinical Features
GENETICS AND DENTAL CARIES
GENETICS AND PERIODONTAL DISEASE
GENETICS AND MALOCCLUSION
GENETIC COUNSELING
Definition
Information Conveyed during Genetic Counseling
Process Involved in Genetic Counseling
Psychological Aspects of Counseling
QUESTIONS
CHAPTER 19:
Survey Procedures and Indices
INTRODUCTION
DEFINITION
TYPES OF SURVEYS
Descriptive Survey
Analytic Survey
Cross-sectional Survey
Longitudinal Survey
SURVEY METHODS
Health Interview Survey (Face-to-Face Survey)
Health Examination Survey
Disadvantages
Health Records Survey
Disadvantages
Questionnaire Survey
Advantages
Disadvantages
USES OF SURVEYS
Monitoring Trends in Oral Health and Disease
Policy Development
Program Evaluation
Assessment of Dental Needs
Providing Visibility of Dental Issues
STEPS IN SURVEYING
Establishing the Objectives
Designing the Investigation
Survey Protocol
Obtaining Approval from Authorities
Budgeting
Scheduling
Emergency Care and Referral
Selecting the Sample
Sampling
Advantages of Sampling
Requisites for a Reliable Sample
Sampling Methods
Other Types of Sampling
Conducting the Examinations
Basic Requirements for an Oral Examination
Classification of Types of Inspection and Examination
Selection of the Examiners
Analyzing the Data
Drawing the Conclusions and Publishing the Report
ORAL HEALTH SURVEYS (PATHFINDER SURVEYS)
Classification of Pathfinder Survey
Pilot Survey
National Pathfinder Survey
INDICES USED IN ROUTINE DENTAL PRACTICE
Definition
Criteria for Selecting an Index
Oral Hygiene Index-Simplified (OHI-S Index)
Criteria for Classifying Debris (Fig. 19.2)
Criteria for Classifying Calculus
Calculation
Plaque Index
Scoring Criteria
Gingival Index
Calculation
Decayed-Missing-Filled Index (DMF Index)
Rules in Recording DMFT
WHO Modification of DMF Index (1986)
Calculation of DMFT Index
DMFS
Caries Indices for Deciduous Dentition
‘def’ Index
‘DMF’ Index
QUESTIONS
CHAPTER 20:
Dental Auxiliaries
INTRODUCTION
DEFINITION
CLASSIFICATION OF DENTAL AUXILIARIES
WHO Classification (Suggested at the Conference Conducted by the WHO in New Delhi in 1967)
Revised Classification
Dental Surgery Assistant
Dental Secretary/Receptionist
Dental Laboratory Technician
Dental Health Educator
School Dental Nurse (New Zealand Type)
Dental Therapist
Dental Hygienist
Expanded Function Dental Auxiliary
QUESTIONS
CHAPTER 21:
Practice Management
INTRODUCTION
COMPONENTS OF A SUCCESSFUL DENTAL PRACTICE
Personnel Systems
Patient Systems
Operational Systems
PRODUCTION AND COLLECTIONS
DENTAL OFFICE SETTING
QUESTIONS
CHAPTER 22:
General Epidemiology
INTRODUCTION
DEFINITION
COMPONENTS OF EPIDEMIOLOGY
Disease Frequency
Prevalence Rate
Incidence Rate
Interrelationships of Prevalence and Incidence
Distribution of Disease
Determinants of Disease
AIMS OF EPIDEMIOLOGY
PRINCIPLES OF EPIDEMIOLOGY
EPIDEMIOLOGIC METHODS
DESCRIPTIVE STUDIES
Procedures in Descriptive Epidemiology
Defining the Population to be Studied
Defining the Disease Under Study
Describing the Disease: By Time, by Place, by Person
Measurement of Disease
Comparing with Known Indices
Formulation of a Hypothesis
Uses of Descriptive Epidemiology
ANALYTICAL EPIDEMIOLOGY
Case Control Study
Selection of Cases and Controls
Matching
Measurement of Exposure
Analysis
Bias in Case Control Studies
Advantages and Disadvantages of Case Control Studies
Cohort Study
Distinguishing Features of Cohort Studies
Indications for Cohort Studies
Types of Cohort Studies
Elements of a Cohort Study
Advantages and Disadvantages of Cohort Studies
EXPERIMENTAL EPIDEMIOLOGY
Aims of Experimental Studies
Randomized Controlled Trials (RCTs)
Blinding
USES OF EPIDEMIOLOGY
QUESTIONS
CHAPTER 23:
Medical Emergencies in Dental Clinic
INTRODUCTION
EQUIPPING FOR AN EMERGENCY
Equipping Himself
Equipping the Office
PRECAUTIONS AGAINST AN EMERGENCY
Recording ASA Classification for the Child
Recording Physical Signs
Careful Use of Drugs
MANAGEMENT DURING AN EMERGENCY
PABC Assessment and Management (BLS/CPR)
P: Position
A: Airway
B: Breathing
C: Circulation
D: Definitive Therapy
MANAGEMENT OF EMERGENCY SITUATIONS
Acute Asthmatic Attack
Presenting Signs and Symptoms
PABC Assessment
Check Medical History
Definitive Therapy
Acute Adrenal Insufficiency
Presenting Signs and Symptoms
PABC Assessment
Check Medical History
Definitive Therapy
Hypersensitivity Reactions
Delayed Onset Skin Reaction
Rapid Onset Skin Reaction
Respiratory Signs with or without Skin Signs
Laryngeal Edema
Generalized Anaphylaxis
Foreign Body Obstruction
Partial Airway Obstruction
Total Airway Obstruction
Local Anesthesia (LA) Overdosage
Mild Overdosage Reaction
Severe Overdose Reaction
Syncope
Physical Signs and Symptoms
PABC Assessment and Management
Check Medical History
Definitive Therapy
Seizures
Presenting Signs and Symptoms
PABC Assessment and Management
Check Medical History
Definitive Therapy
Hypoglycemic Attack
Presenting Signs and Symptoms
Conscious Patient
Unconscious Patient
Hyperventilation
Presenting Signs and Symptoms
PABC Assessment and Management
Check Medical History
Definitive Therapy
QUESTIONS
INDEX
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