DTH 508

Paedodontics is a branch of Dentistry that deals with issues, treatment and prevention of
teeth problems in children 16years and below.
• Paediatric dentistry formerly Pedodontics [American English] or Paedodontics [common
wealth English] is the branch of Dentistry dealing with children from birth through
adolescence.
• This discipline focuses on paediatric, adolescent growth and development, disease
causality and prevention, child psychology and management, and all aspects of the highly
–specialized paediatric restorative techniques and modalities.
• Some paediatric dentists also specialize in the care of ‘special needs’’ patient such as
people with cerebral palsy, mental palsy, mental retardation and autism.
• Paediatric dentistry emphasizes the establishment of trust and confidence in children with
their dentists.
• Paediatric dentists promote the dental health of children as well as serve as educational
resources for parents. It is recommended by the American academy of paediatric
dentistry AAPD and the American academy of paediatrics AAP that a dental visit should
occur within six months after the presence of the first tooth or by a child’s first birthday.
It is important to establish a dental Home for a child.
• Paediatric dentistry emphasizes the establishment of trust and confidence in children with
their dentists.
• Paediatric dentists promote the dental health of children as well as serve as educational
resources for parents. It is recommended by the American academy of paediatric
dentistry AAPD and the American Academy of Paediatrics AAP that a dental visit should
occur within six months after the presence of the first tooth or by a child’s first birthday.
It is important to establish a dental Home for a child.
• The developmental classification of patients by Church and Stone, 1975 include
• Neonates: 28 days and below
• Infants: 28 days-15 months
• Toddlers: 15 months to 2years
• Preschool: 2 to 6 years
• Middle year children: 6 to 12 years
• Adolescents: 13 to 19 years
• An informant is usually needed during history taking.
• The child and/or the care giver can be the informant.
 • Both should be comfortable for adequate history taking
• Always introduce yourself to the patient and relatives
• Explain what you want to do and its relevance to patient in the language your patient will
understand (use interpreters)
• Do not take anything for granted
• In this era of litigations, you may never know who shall take offence for minor
indiscretions
HISTORY TAKING/BIODATA
• History will start with biodata. This includes
• Names
• Age,
• Record number
• Sex
• Date of birth
• Place of birth
• Address
• language
• occupation
• Nationality
• country of origin
• Tribe
• religion
• telephone number, etc.
• Address
• language
• occupation
• Nationality
• country of origin
 • Tribe
• religion
• telephone number, etc.
Universal precautions is an approach to infection control to treat all human blood and certain
human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne
pathogens,
PRESENTING COMPLAINTS
• In patient’s own words- put it in inverted comma-P/C or C/O{complaining of}
• History of presenting complaint:
• If symptoms are present
• Find out: onset & pattern
• When it started
• Is it getting better, worse, or same?
HISTORY OF PRESENTING COMPLAINTS
• Frequency
• How often
• How long
• Any particular time- day or night?
• Exacerbating and relieving factors
• What started it?
• What makes it better or worse?
• PAIN – SITE: record the exact site
• Time and mode of onset- record the time and date of onset and the way the pain began
• Severity – assess severity by its effect on patient
• Nature – aching, burning, stabbing, constricting, throbbing, distending, colic, sharp,
shooting, dull, etc.
• Progression of pain – is it getting better, getting worse, or remaining the same?
• End of the pain – describe how the pain ended. Spontaneously or by some action by
patient or doctor?
 • Duration- record the length of the pain
• Relieving factors
• Exacerbating factors
• Radiation- record time and direction. Note referred pain
• Cause- make a note of patient’s opinion of the cause of pain
• Associations- do you associate the pain with anything?
• Swelling or lump- site, shape, size, surface, edge, consistence, tenderness, temperature,
and reducibility, etc
• History of swelling or ulcer- duration (when fist noticed?), first symptom (what made
patient notice it?), other symptoms (what symptoms does it cause?),
• progression- how has it changed since it was first noticed?
• Persistence- has it ever disappeared or healed?
• Multiplicity- has the patient any other ulcers or lumps?
• Cause- what does the patient think caused it? etc.
PAST DENTAL VISITS
• Previous visits.
• Treatment received
PAST MEDICAL VISITS
• Important because it can affect treatment plan, may have oral manifestation
• A systematic approach is proposed.
• Common childhood diseases in this environment should be asked for: sickle cell, asthma,
epilepsy, haemophiliacs, infective endocarditis, diabetes,
• History of admissions and surgeries
DRUG HISTORY
• Current medications/routine drugs
• Allergy to any drug-sulphonamide, NSAIDS
• Immunization-in Nigeria NPI, tetanus toxoid following trauma
SOCIAL HISTORY/SOCIAL HISTORY
 • Class and type of school
• Parents occupation-keeping to appointment and ability to afford the treatment
• Pet name/pet
• Consumption of cariogenic diet/smoking/alcohol
• Toothbrushing frequency, tooth brush texture, fluoride containing toothpaste etc
• If any member of the family has the illness
GENERAL EXAMINATION
• Check for
• Pale
• Anicteric/icteric
• Afebrile/febrile.
• Not cyanosis
• No oedema,
EXTRAORAL EXAMINATION
• Facial assymetry
• Skeletal pattern
• Lip competency
• TMJ
• Scars
• Eyes
• Ears
• Scars, marks , tatoo etc
INTRAORAL EXAMINATION
• Oral hygiene
• Plaque and calculus.
• Soft tissue
• Gingiva: hyperaemic, pockets, ulcers etc
 • Hard tissue
• Teeth present
• Other pathologies
IMPRESSION/DIFFERENTIAL DIAGNOSIS
• Good history, examination is needed for making an impression
• Clinical pictures
• Study cast
• Radiograph
• Ultra sound
• MRI
• CT Scan/ cone beam CT
• Cephalometry
• MCS etc
RECORDS AND INVESTIGATIONS
• Clinical pictures
• Study cast
• Radiograph
• Ultra sound
• MRI
• CT Scan/ cone beam CT
• Cephalometry
• MCS etc
TREATMENT PLANNING
• Prioritise
• Immediate
• Medium term
• Long term
 • Definitive treatment
• Reassurance
• Parent/patient counseling/oral health education
• Restorations, extractions,, fluoride application etc
AFTER TREATMENT
• Recall/Follow up ; Using caries risk for instance
• High risk- 3 months
• Moderate risk- 6 months
• Low risk -1 year recall.
• Continue recall until patient is transferred to adult clinic.
CONSENT
• Informed consent is a process for getting permission before conducting a healthcare
intervention on a person. This process of understanding the risks and benefits of
treatment is known as informed consent.
• Treatment without consent is an assault
• Treatment with general consent but without explanation of what is involved is
negligence.
To be valid, consent must be informed
• Consent can be
• Written; preferable for extensive treatment
• Verbal: minimum obtained for treatment. A 3rd party should be present.
• Implied: by sitting on dental chair and keeping appointment, patient gives consent for
examination only.
REFERENCES
• Consent can be
• Written; preferable for extensive treatment
• Verbal: minimum obtained for treatment. A 3rd party should be present.
• Implied: by sitting on dental chair and keeping appointment, patient gives consent for
examination only.
PRIMARY TEETH can also be called baby teeth, deciduous, temporary, milk, predecessor, fall.
PERMANENT TEETH can also be called succedaneous, secondary
LOCATION------maxillary, mandibular
CLASSIFICATION OF TEETH-----
Temporary---incisors, canine, molars
Permanent ----incisors, canine, premolars, molars.
Anterior teeth [incisors, canine]
Posterior teeth [premolars and molars]
NOTATIONS-----Sigmondy palmer [chevron], Federation Dentaire Internationale [FDIAmerica
[universal], European notation
LAND MARKS
Crown—Anatomic crown is designated by the area above the cementoenamel junction.
--Clinical crown is any part visible in the mouth.

Root----Anatomic root—it is found below the cemento enamel junction and is covered by
cementum whereas the clinical root is any part of a root visible in the mouth.
Surfaces---Labial-close to lip, buccal cheek, lingual -nearest to tongue, palatal on maxillary teeth
besides; on maxillary teeth beside the hard palate. Surfaces that aid in chewing are known as
occlusal on posterior teeth and incisal on anterior teeth.
Surfaces nearest the junction of the crown and root are referred to as cervical, those closest to the
apex of root are referred to as apical. The words: mesial and distal are also used as descriptions.
Mesial signifies a surface closer to the median line of the face, which is located on a vertical axis
between the eyes, down the nose and between the contact of the central incisors. Surfaces further
away from the median line are described as distal.
Cusp –any elevation on an occlusal surface of posterior teeth and canine
Canine has one cusp –hence called cuspid, premolars two cusps called bicuspid, molars-at least 4
cusps
An extra cusp or fifth cusp commonly found on the maxillary first permanent molars is known as
cusp of carabelli.
Cingulum –is a convexity found on the lingual surfaces of anterior teeth. It is frequently
identifiable as an inverted V-shaped ridge.

Ridge- is any linear flat elevations on teeth.

Embrasure------are triangularly shaped spaces located between the proximal surfaces of adjacent
teeth.
Mammelons are usually found as three small bumps on the incisal edges of anterior teeth.They
are the remnants of three lobes of formation of these teeth, the fourth lobe represented by the
cingulum.
Fossa: This is any major depression on the occlusal surfaces of the molars.
Groove or fissure--- this is a linear depression found chiefly on occlusal surfaces and separating
the cuspal areas.
DENTAL CONDITIONS IN CHILDREN
Caries
Traumatic Dental Injuries
Oral infections
Dental anomalies
Systemic manifestation off some diseases
Cyst
Tumours etc
BEHAVIOUR MANAGEMENT
CHILD’S BEHAVIOUR IS INFLUENCED BY
1] Past medical history
2] Past dental history
3] Office environment
4] Parental/ peer factor
Behaviour management techniques
Can be classified into pharmacological or non pharmacological
Non pharmacological
Tell-Show-Do
Desensitization
Modeling: direct and indirect
Behavior shaping
Positive reinforcement
Empathy
Hypnosis
Hand over mouth
Hand over nose
Restraints (protective stabilization)
Pharmacological
Conscious sedation and Local Anaesthesia
General anaesthesia

CONSERATIVE DENTAL PROCEDURES IN CHILDREN

For adequate management, it requires trainng , supervision, practice. Children have different
behaviours and the clinician needs to understand that.
Procedures include
1. Atraumatic restoration using GIC
Indication: When caries is not involving the pulp and not multi surfaced
2. Minimal preparation with hand piece and using GIC to restore the caries. Be mindful of the
tongue movement, lips. Etc
Traumatic Dental Injuries
1. Immediate re-implantation of an avulsed teeth and refer for splinting
Other procedures are
Pulpotomy
Pulpectomy
Lesion sterilization and tissue regeneration
Cyst enucleation
Tumour excision
Jaw resection
etc