Illustrated Pediatric Dentistry Part I

By Bentham Science Publishers

Illustrated Pediatric Dentistry is intended to be a guide to undergraduate and postgraduate students in their understanding of pediatric dentistry.
This textbook is modernized with the latest information and techniques in pediatric dentistry. The chapters cover primary pediatric dentistry, its clinical aspects, preventive dentistry, and information about the latest trends in the specialty. The text will equip readers with the knowledge suited to the changing environment of this vital domain. This textbook's editor has over forty-four years of teaching experience in pediatric dentistry and gives their broad perspective through the book content. This book is also the amalgamation of the thoughts of numerous subject experts of international repute.

Part 1 of this book features information about the developmental psychology of a child, dental caries, craniofacial growth and development, growth of the maxilla and mandible, dentition and occlusion, and oral mucosa.

Key Features:
- The 15, structured chapters keep the latest trends of the subject in mind
- The book content is illustrated with quality clinical images,
- Chapters cover contemporary concepts of problems experienced when treating multiple dental disorders
- The contributions exhibit distinct clinical expertise and the capability of imparting inimitable knowledge to budding professionals
- The book includes modern and current state-of-the-art techniques used in the clinic
- Topic outlines help to quickly review and easily locate content. Also, the Contents of the book are well structured and presented in a very lucid manner, making it easy to understand for students.

• Language: English
• Publisher: Bentham Science Publishers
• Release date: Jun 28, 2003
• ISBN: 9789815051483

Book preview

Introduction to Pediatric Dentistry

Satyawan Damle¹, ², *

¹ Former Professor of Pediatric Dentistry, Dean Nair Hospital Dental College, Mumbai, India

² Former Vice Chancellor, Department of Pediatric Dentistry, Maharishi Markandeshwar University, Mullana, Ambala, India

Abstract

Pediatric dentistry is the only speciality that has an abundance of knowledge for the management and treatment of the oral health care needs of infants and children. Pediatric dentistry concentrates on the integration of appropriate tactics and knowledge of various specialities into a framework of quality oral health care for children. It is necessary to implement procedures that are safe, comprehensive, accessible, affordable, high quality, and respectful for children. The role of a Paediatric dentist is to promote the dental health of children as well as serve as a resource person to the parents.

Keywords: Pediatric Dentistry, Infants, Children, Parent, Management.

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* Corresponding author Satyawan Damle: Former Professor of Pediatric Dentistry, Dean Nair Hospital Dental College, Mumbai, India & Former Vice Chancellor, Department of Pediatric Dentistry, Maharishi Markandeshwar University, Mullana, Ambala, India; Tel: [phone]; E-mail: [e-mail]

INTRODUCTION

Various authors have rightly equated children with flowers. A few of them quoted: Let them bloom by giving them our warm smiles, our soft gentle words falling on them like rain and our art of confidence. Water them with love, nourish them with praise, and compliment them every day. Be their sun when all you see is rain. Protect them from storms and shelter their pain. Children are like flowers that blossom every day (Fig. 1).

Fig. (1))

Children are as lovely as flowers.

To put it into a nutshell, children are the flowers of life! They bring joy and happiness to our world. Let us be kind to them, let us make them happy and let us help them to save that child inside them for the rest of their lives!

Pediatric dentistry a branch of Dentistry deals with these delightful children.

Definition

It is an age-specified speciality that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs (Fig. 2). Pediatric dentistry is a speciality that adjusts techniques and procedures from general dentistry and other specialities to provide primary and comprehensive preventive and therapeutic oral health care for children [1, 2].

Fig. (2))

Definition of Pediatric Dentistry (AAPD 2020).

Pediatric dentistry encompasses a variety of disciplines, techniques, procedures, and skills that reveal a common basis with other specialities however these practices are modified and adapted to the unique requirements of infants, children, adolescents, and those with special health care needs (Fig. 3). Being an age-specific speciality, pediatric dentistry encompasses disciplines such as behaviour guidance, care of medically and developmentally compromised and disabled patients, supervision of orofacial growth and development, caries prevention, sedation, pharmacological management, and hospital dentistry, as well as other traditional fields of dentistry. These skills are applied to the needs of children during their ever-changing stages of development and to treating conditions and diseases unique to growing individuals [3].

Fig. (3))

Pediatric Dentistry Encompasses Different Aspects.

DENTISTRY ENCOMPASSES DIFFERENT ASPECTS

An Important Aspect of Children Being Treated in a Separate Speciality.

What is the most appealing about children?

Is it their cute faces?

Their playfulness?

Their smile? Of course, yes, however!

Beyond all these aspects, children are beautiful because they possess something unique, that we as adults have lost and that is innocence as well as purity (Fig. 4A).

Pediatric dentists encourage the oral and dental health of children as well as provide educational resources for parents. It is advised that a dental visit should occur: within six months after the presence of the first tooth or at least by a child's first birthday. It is important to create a comprehensive and accessible ongoing association between the dentist and patient, so the healthy and beautiful smile and natural teeth always remain beautiful (Fig. 4B).

Fig. (4A))

A Child: A Picture of Innocence.

Fig. (4B))

Healthy Primary Dentition.

The Key Role of a Pediatric Dentist is

To identify the treatment, need and devise a suitable treatment plan keeping in mind the child’s age.

Discuss the treatment to be delivered to the child must be acceptable to the child and the parent.

Therefore, the dentist must possess child management skills to be able to do the needful (Fig. 5).

However, it is also true that all Pediatric dentists, even today, do not practice dentistry exclusively for children. Though, a few do believe that they have the necessary knowledge, skill, and love for the subject they had been taught. It is also true that many general dentists are willing to practice dentistry for children but encounter difficulties due to a lack of practical training on key areas in child behaviour management in dentistry.

Fig. (5))

Components of Pediatric Dentistry.

Responsibilities of a Pediatric Dentist Include

Diagnose and manage oral diseases (preventive and restorative) and pathology pertains to the oral cavity.

Interpret x-rays and other diagnostic tests.

Devise treatment plans to restore the oral health of children, including those with special health care needs.

Monitor growth and development of the jaws and teeth.

Correct malocclusion through interceptive orthodontic treatment.

Perform surgical procedures on teeth, bone, and soft tissues of the oral cavity,

Provide emergency care (dental infection, pain, and dental trauma)

Treat patients under various stages of sedation (minimal, moderate, or deep), general anaesthesia (Fig. 6).

Fig. (6))

Pediatric dentistry – Multispecialty in itself.

Children are always tough to manage, especially those in pain due to oral or dental ailments. They possess mood swings, and their behaviour is entirely unpredictable. Pediatric dentists need to show great patience and effective techniques to oversee the children and eliminate their fear and pain (Fig. 7).

Fig. (7))

Pediatric Dentistry: Why?

Aims and Objectives of Pediatric Dentistry

The health of the child specifically concerned with oral health.

Early diagnosis and prompt treatment timings for better outcomes (Fig. 8).

Restoring good oral health

Relief of pain

Increasing knowledge of dental care

Instituting positive behaviour

Restoring lost tooth structure

Management of patients with specific needs.

Dentists and patients(parents/children) should have a strong relationship. Pediatric dentists should effectively and efficiently need to perform the treatment of children. They should have a clear, constructive, and positive attitude.

Fig. (8))

Aims and Objectives of Pediatric dentistry.

Establishing and maintaining communication with the child who is cooperative or uncooperative will result in the successful completion of dental procedures.

Interaction, Communication as well as the consultation will also lead the child to develop a positive attitude towards dentistry.

Every hour, in a dental office, a pediatric dental patient enters the treatment room. Immediately there is increased commotion, quivering knees and lips, tears rolling down cheeks. Unfortunately, this scenario can apply to both the patient and the treating dental team.

For a variety of reasons, there are dental practitioners and staff that have an aversion to treating pediatric patients, especially infants and toddlers. This is unfortunate for both the patients and the dentist.

By the institution of early oral health education and the application of preventive dentistry procedures, the pediatric dental patient can be insured for a lifetime of Excellent Dental health.

For the dental practice, ignoring or rejecting the infant and toddler population results in a missed opportunity to contribute to improved oral health for the overall population, establish dental homes early, and attract new patients to the practice.

HISTORY OF PEDIATRIC DENTISTRY

In 1909, Minnie Evangeline Jordon created the first dental practice in the United States dedicated exclusively to pediatric patients.

In 1925, she published the first textbook on pediatric dentistry, titled Operative Dentistry for Children.

The first dental care brought to public school was by Alfred C. Fones in 1914, which was 6 decades after the first woman, Lucy Hobbs Taylor, who received a DDS.

Plenty of things have changed and improved in pediatric dentistry since it was first revolutionized in 1900’s (Figs. 9 & 10).

Fig. (9))

History of Pediatric Dentistry.

Fig. (10))

History of Pediatric Dentistry.

PEDIATRIC DENTISTRY PROCEDURES

It is important to make it easy for the child to be comfortable. The dentist / pediatric dentist must decide whether the parents should be present in the operatory during the dental procedure or not.

The dentists should also practice non-verbal communication if needed during the procedure. It may be necessary if he cannot talk and guide the patient by facial expressions.

It is also important to distract the child’s attention to decrease the pain intensity; for example, the child can be given a mirror to hold or sunglasses to wear to avoid light exposure.

The dentist should be fully aware of the child’s history and prescribe suitable pediatric dentistry procedures for him.

Why Is Pediatric Dentistry Important? (Fig. 11)

Oral hygiene is a vital component of the overall health of a person. Without it, human beings’ health is incomplete. It is of paramount importance to convince the parent/child that if oral health is neglected, the body suffers and the child is unable to eat and drink anything, and the body gets insufficient important nutrients.

Fig. (11))

Importance of pediatric dentistry.

Pediatric Dentistry takes into Consideration

1. The advent of social medicine in pediatric health care.

2. Expanding knowledge about pediatric oral health risk and disease management.

3. Trends in oral health and dental care disparities and forces that propel them.

4. Perceived needs for dental care services and other barriers that propel the need for dental home utilization.

5. Dentistry as an independent profession.

6. Dental capacity system for all children, including children with special dental care needs.

The First Dental Visit

Parents are always excited about different milestones in their child’s life.

The first syllable convey, crawling, standing, and walking, and the parents celebrate the eruption of the first tooth.

There is a need to create a similar desire and preparation of the parent for the child’s first dental visit. Dentists should urge patients to give importance to pediatric dentistry as soon as their child gets their first tooth (Fig. 12).

It is suggested that a child should have his first visit to the dentist when he turns one year old. Early engraining of oral hygiene habits will develop strong teeth and gums in the child throughout life. A Paediatric dentist can be the child’s best friend and protect him from long term problems and lifelong complications.

The first visit often sets the tone for the future dental behaviours of an individual. When a child comes to the dental operatory in a non-threatening environment for a check-up, which often goes uneventful after a thorough oral and dental examination of the teeth [4], hence first visit makes the child look forwards to future visits.

On the other hand, if the first visit of the child is overdue until the child shows signs of tooth decay or the presence of a dental emergency, it is conducted in a stressful situation for the child and prepares the child’s mind to look forward to an unpleasant experience that would involve some form of dental treatment.

Delay in the first dental visit may also lead to irreversible progression and an increase in the severity of dental caries.

Conditions involving improper feeding habits can be detected, and counselling of the involved caregivers can be done to prevent early childhood caries. Certain developmental disturbances like cleft lip and palate and natal and neonatal teeth also require prompt diagnosis and intervention. Hence the American Academy of Pediatric Dentistry have recommended it to conduct the first dental visit within six months of the eruption of the first tooth but not later than twelve months of age.

At the first dental visit, the dentist should take a thorough medical history and review the pre-natal and post-natal history with an emphasis on any medications taken by the mother, access to fluoride supplements during pregnancy, and the presence of any maternal conditions that may affect the child’s oro-dental development.

The examination of the child should be done in a comfortable environment keeping the child as the focus of attention of both parent and the dental surgeon.

The dentist may choose to seat the child in a child-friendly low chair or examine in the knee-to-knee position commonly used for small children. The parent’s presence in the operatory is encouraged as they may help to relieve the anxiety and participate in keeping the child relaxed [2-4].

Fig. (12))

First visit of a child to Pediatric Dentist.

Outcomes of a First Dental Visit

Counselling of parents towards age-appropriate oral hygiene methods

Counselling of parents for diet and nutrition

Evaluation of the fluoride programme and supplementing fluoride wherever necessary

Advice on breastfeeding and discuss methods and the right time for weaning

Inform the parent about cariogenic habits like the use of honey-dipped or sweetened pacifiers

Thorough oral examination of the teeth and supporting structures if present

Examination of gum pads

Identify any development disorders of hard and soft tissues

Inform parents about the different preventive methods

Anticipatory Guidance

One of the important aspects of the first dental visit is anticipatory guidance. It involves identifying present problems and informing the parents about future anticipated problems due to the present condition.

When a child with improper feeding or highly cariogenic habits is discovered, the parents should be informed about the future effects and sequelae of dental caries.

Similarly, if developmental disturbances like ankyloglossia are noticed the parents should be informed about the anticipated speech problem later [5, 6].

As compared to general dentists, pediatric dentists have specific skills and expertise to treat oral diseases in infants, children, and teens.

Having a single pediatric dentist from the beginning will help the child in finding the right treatment for a child. They do not have to find a different dentist each time. The dentist will know the child’s history and treat him accordingly instead of adopting a new procedure every other time.

The child will also be saved from the additional pain, and he will become familiar with the Pediatric dentist, and their bond will get stronger, resulting in a better understanding. This will be helpful in the successful treatment of the child and creates no worries for parents.

Considerations of Child Management in Dentistry

1. To desire, decide and learn the practice of dentistry for children is a great step in terms of patient care in dentistry.

2. The dentist willing to practice dentistry for children should possess good skills in general dentistry, including restorative procedures, extractions, endodontic treatment and above all, diagnosis and treatment planning (Fig. 13).

Fig. (13))

Comprehensive Pediatric Dental Care.

3. They must have dealt with children to an extent during their graduation or during their initial years of association with senior practitioners to understand what difficulties can be encountered while dealing with children.

4. To learn the art and science of child management in dentistry, they must either observe the work of a pediatric dentist or a dentist with reasonable skills in practicing dentistry for children.

5. The most difficult hurdle to overcome while beginning to practice dentistry for children is ‘to believe’ that child management principles work! Those who do, accept that, like most sciences, despite limitations,

‘child management’ can be practised with a certain predictability.

6. The dental surgeon must develop a team that he/she heads for practising dentistry for children. The team must continuously acquire knowledge and learn from experience while dealing with children. It is also important to decide policies in practice about specific child management techniques or aspects (for example: whether parent/s should be present in the operatory during the dental treatment of a child; whether a restraining technique is to be used.

7. Most children beyond a certain age are potentially cooperative for most dental procedures. They cannot be just classified as ‘cooperative’ or ‘uncooperative’.

8. The ‘child management methods’ apply to all children- cooperative as well as initially uncooperative. It is therefore mandatory to learn for the successful management of most children.

9. Children account for approximately one-third of the population; thus the onus of practising dentistry for children remains on dental surgeons practising dentistry with children.

10. Practicing dentistry for children is rewarding, satisfying and challenging profession.

11. Children are not small adults (Fig. 14). They behave and relate to their surroundings differently. They have their preferences, likes and dislikes. A dentist for children has to have an insight into their demands.12. There are certain rules for successful dental practice; for example, achieving adequate anaesthesia is a rule before tooth extraction; a correct instrumentation technique, working length determination, and use of proper irrigation are the basics of endodontic success. The success story of practising dentistry for children begins with good child management. It is important to have patience and sustained interest for success in the practice of dentistry for children.

Fig. (14))

The Childhood Shows the Man as Morning Shows the Day".

Concept of Dental Home

The Dental Home concept has been promoted by the AAPD to provide dental treatment to infants, children, and adolescents, including children with special health care needs, under one roof.

It allows the personnel involved in the oral health care management of children like parents, dental surgeons, dental professionals, and non-dental professionals to take part in the execution of dental treatment for children.

At the same time, various specialists who are commonly involved in the management of medically, physically, psychologically, and mentally challenged children are available at a single centre, thereby reducing the need for lengthy referrals, delays and inconvenience to parents and children with special needs [7].

The dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centred way. The establishment of a dental home begins no later than 12 months of age and continues through childhood and adolescence.

By establishing a Dental Home and taking preventive steps recommended by the pediatric dentist, parents can avoid their children contracting early childhood

caries, which is extensive devastating tooth decay that results in pain, failure to thrive, and in various cases, extensive and costly restorative work.

Dental home is an important concept for the dental profession to embrace. Evidence supports the advantages of receiving early professional dental care and intervention that are complemented by anticipatory guidance for parents, as well as periodic supervision visits based on the child’s risk of dental disease. The dental home could increase opportunities for preventive oral health services for children that can reduce disease disparities. The dental home is a concept that deserves support.

Habit counselling – children pick up some habits as they learn through socialization. Most of those habits should be inspired because they teach kids ways of life. However, certain of habits in infancy should be stopped as the child grows. These include thumb sucking, and using the pacifier. Some habits are not easy to stop.

Preventive dental care – children need preventive dental care more than anyone else. Their teeth are still developing, and their bone structures are changing. Preventive dental care makes sure their teeth are in perfect health through various stages. Preventive dental care includes services like fluoride treatment, dental sealants, space maintainers, etc.

Early diagnosis – another great benefit of pediatric dentistry is early diagnosis. In the medical world, detecting a problem early is the best way to curb it before it advances. Some oral problems like teeth misalignment, discolouration on teeth, gum recession, plaque build-up, among others, can be controlled early before they rise into complex problems.

Dental Conditions

Fighting Dental Anxiety – dental anxiety and phobias are common among children. Particularly, if the child has gone through many medical interventions, it is hard to get them to go forward with others in the future. Visiting a dentist regularly is part of good oral health practice. It is a known fact that it is a tug of war to get the child to the dentist if he has anxiety and phobias. Pediatric dentists know their way around dental anxiety. They can help the children get comfortable with the idea of dental intervention.

Overall health care – a paediatric dentist capable of a lot more than parents are aware. They are trained health experts who know a lot about the human body. With the mouth being the first contact point of things that get into the body, dentists participate in overall health care.

Why Pediatric Dentistry is Better for Children?

Professionals working in pediatric dentistry are dedicating themselves exclusively to children and are therefore better equipped to manage any problems occurring in their mouths. This will include tooth decay, cavities, delayed eruption, loss of baby teeth, and even wisdom teeth. These professionals are qualified to administer sedation to children to undergo invasive and intensive dental treatments.

Maintaining calmness is easy for pediatric dentists because they are working with children every day. They tailor their approach according to every patient’s specific area of concern. Children feel more comfortable in the pediatric dentists’ chair because of their experience in keeping children calm.

Pediatric dentists design their offices keeping young children in mind. They are equipped to provide treatment to children for any oral health issue to help them keep a smile on their faces.

CONCLUSION

Children are unique in their stages of development; hence there is a need for a separate dental speciality for children. Pediatric dentists have specific skills and expertise to treat oral diseases in infants, children, and teens. It is recommended that a child should have his first visit to the dentist when he turns one year old. Early engraining of oral hygiene habits will develop strong teeth and gums in the child throughout life. Paediatric dentist can be the child’s best friend and can protect him from long-term problems and lifelong complications. By introducing early oral health education and applying preventive dentistry procedures, the pediatric dental patient can be insured for a lifetime of Excellent Dental health.

CONSENT FOR PUBLICATION

Not applicable.

CONFLICT OF INTEREST

The author(s) declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENT

Declared none.

REFERENCES

Emotional Development of a Child

Raghavendra M. Shetty¹, *, Trisha Gadekar², Aditi Pashine³

¹ Department of Clinical Sciences, College of Dentistry, Ajman University; Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, UAE

² Department of Pediatric Dentistry, Mamata Dental College, Khammam, Telangana, India

³ Associate Dentist, MyDentist, Aberystwyth, UK

Abstract

The emotional development of a child is the progressive process of the child’s ability to control their feelings. The emotions of the child are expressed through facial expressions. Emotions in a child are influenced by their inborn temperament depending on the inherited genes. Crying, laughing, anger, fear, anxiety, or phobia represent different types of emotions. The impact of dental anxiety and fear often leads to avoidance or delay of dental treatment. Moreover, such individuals are difficult to treat and have behavioral problems further resulting in an unpleasant dental experience. All these factors lead to worsening oral health, which often requires complicated dental procedures. Hence, it becomes difficult for the patient to get out of this vicious cycle. Management of such patients is critical and requires careful handling and assessment. Various behaviour management techniques and advanced specialist care in the dental setting can assist fearful patients in attaining optimum oral health and significant overall improvement towards dentistry.

Keywords: Anxiety, Assessment Scale, Emotion, Fear.

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* Corresponding author Raghavendra M. Shetty: Department of Clinical Sciences, College of Dentistry, Ajman University; Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, UAE;

Tel: [phone]; Fax: [phone]; E-mail: [e-mail]

INTRODUCTION

The emotional development of children and adolescents is symbolised by a vast variation according to age, maturity, intellectual development, temperament, experience, family background, and cultural background. These factors play a vital role in influencing the child’s development and underlying emotions.

Crying, laughing, and anger represent the physiological response of the emotions, whereas fear, anxiety, or phobia represents physiological causes of emotions. Fear and anxiety are considered evolutionary mechanisms essential for human existence. While every human being is afraid and anxious, it may be difficult to

manage and understand another person's similar emotions. Usually, adults are aware of their fear and anxiety and often times, they have identified ways to regulate and control their anxiety, whereas it is a complex and sensitive issue while dealing with a child’s fear and anxiety, especially in a dental setting. This is primarily due to its unknown nature and, secondly, due to difficulty in tackling the situation in the unique dental environment. Though pediatric dentists possess expertise in building and instilling a positive attitude toward dentistry during childhood, neutralizing a child’s fear and anxiety requires proper implementation of behaviour shaping and management knowledge. They must be able to recognize the underlying reasons and provide an effective foundation for effective oral health care throughout an individual’s