14: Pediatric Dentistry: Dentistry for Children

CHAPTER 14 Pediatric Dentistry

Dentistry for Children

Pediatric dentistry has evolved because of the special psychological challenges of children and the occasional peculiar clinical conditions that are present in children. most dentistry performed for children is rendered by general dentists, but many situations are treated best by a pediatric dentist (children’s specialist). your general dentist can advise you on whether your child should see a pediatric dentist, or you may prefer to find a pediatric dentist just because most of them have practices that are oriented completely toward the special needs of children.

Many oral conditions of children are not so different from those conditions of adults, and you will be referred to other parts of this book for details on those conditions. However, continuing growth of the body, and eruption and eventual loss of the primary (baby) teeth during childhood present some special challenges. Also, a major problem observed in some children is a tremendous fear of health practitioners, developed by a previous bad experience or by unknowing family or friends. These psychological challenges usually require more special effort for the practitioner than do the clinical challenges.

Initial childhood dental experiences often set children’s lifelong attitudes toward dentistry. Preventive concepts initiated and maintained for children relate directly to their long-term oral health. The level of a child’s oral hygiene relates to the retention of the natural teeth for life or their premature loss. It is highly important that a proper introduction to dentistry be made for children as early as possible (age 6 to 12 months), and that close observation and/or therapy be continued every 6 months for life.

This chapter discusses only those conditions and treatments that are specific to children (from birth to teens), because the other conditions, which occur in both adults and children, are covered elsewhere in this book and are referenced.


Conditions, Signs, or Symptoms Related to Pediatric Dentistry

1. Holes in Primary (Baby) Teeth, Often Discolored (Black, Gray, Brown, Yellow, Chalky)

(FIG. 14.1). Dental caries (decay) in children is similar to adult tooth decay. However, in children the disease may be in the primary (baby) teeth. These smaller teeth do not have a great amount of enamel on them, and the decay process can progress rapidly. When decay is found at an early stage, typical fillings can be placed in the primary teeth with reasonable assurance of years of longevity. When dental caries has progressed to involve the dental pulp (nerve) (FIG. 14.2), either a root canal can be done on a permanent tooth (p. 40), or a pulpotomy (p. 124) can be done on a primary tooth.


FIG. 14.1 Decayed primary (baby) teeth.

(From Cameron A, Widmer R: Handbook of pediatric dentistry, London, 1997, Mosby-Wolfe.)


FIG. 14.2 Tooth decay with pulp (nerve) involvement. Note dark holes in teeth.

(From McDonald RE, Avery DR: Dentistry for the child and adolescent, ed 7, St Louis, 2000, Mosby.)

If the dental carious lesion is large and/or the pulp (nerve) is exposed, it is likely that in the back teeth a stainless steel crown (cap), or in the front teeth a tooth-colored crown (cap) will be required to strengthen primary teeth. Alternatives include the following:

F. Pulpotomy (p. 124) and crown (cap) (p. 146)

FIG. 14.5 Stainless steel crowns (caps) are unpleasant in appearance, but they serve well.

(From Mcdonald RE, Avery DR: Dentistry for the child and adolescent, ed 7, st Louis, 2000, Mosby.)


FIG. 14.7 A to D, Space maintainers are of various types and are essential when back teeth are lost.

(From Proffit WR, Fields HW Jr: Contemporary orthodontics, ed 3, St Louis, 2000, Mosby.)

2. Permanent Tooth Won’t Erupt (Come into Mouth)

(FIG. 14.8). After the primary teeth exfoliate (come out), the permanent teeth are usually present within a few days or weeks. However, permanent teeth occasionally are slow to come in for several reasons: premature loss of primary teeth stimulated by trauma; abnormal positioning of permanent or primary teeth, not allowing permanent teeth to erupt (FIG. 14.9); and lack of formation and presence of permanent teeth. Usually it is of little concern when teeth are slow to erupt, but occasionally there is a problem. If you have any question, you should consult a professional. Alternatives include the following:


FIG. 14.8 Unerupted teeth.

(From Koch G et al: Pedodontics: a clinical approach, Copenhagen, 1991, Munksgaard.)


FIG. 14.10 A to D, Radiographs of unerupted teeth show permanent teeth held in unerupted state by primary (baby) teeth retained too long.

(From McDonald RE, Avery DR: Dentistry for the child and adolescent, ed 7, St Louis, 2000, Mosby.)

3. Dark-Colored Primary Tooth

(FIG. 14.12). Children often suffer an accidental blow to a primary tooth. Sometimes the parent may not even know it happened. Later the tooth turns dark. Usually the tooth pulp (nerve) (FIG. 14.13) has been injured, and the dark coloration is caused by degenerative pigments in the blood supply to the nerve inside the tooth. This condition may or may not be painful. Alternatives include the following:

C. Remove the tooth (p. 126) and place a space maintainer (FIG. 14.14), (p. 128).

FIG. 14.12 A and B, Dark primary (baby) tooth caused by trauma.

(From McDonald RE, Avery DR: Dentistry for the child and adolescent, ed 7, St Louis, 2000, Mosby.)


FIG. 14.13 The pulp (nerve) of a child’s tooth has been exposed by trauma, requiring pulp capping and a filling (restoration).

(From Cameron A, Widmer R: Handbook of pediatric dentistry, London, 1997, Mosby-Wolfe.)


FIG. 14.14 Space maintainers.

(From Cameron A, Widmer R: Handbook of pediatric dentistry, London, 1997, Mosby-Wolfe.)

4. Primary or Permanent Tooth Accidentally Forced into Gum Tissue and Bone

(FIG. 14.15). A primary or permanent tooth may be accidentally pushed forcefully into the underlying bone and soft tissue. If the child is only a few years old, there may be a problem with the underlying partially developed permanent tooth; the primary tooth could injure the developing tooth bud of the permanent tooth. However, if the child is older, and depending on which tooth is involved, the underlying permanent tooth may not be damaged. Damage to an underlying permanent tooth cannot be determined completely until the suspect tooth erupts later. If the primary tooth is severely fractured under the gum, it may need to be removed. If the tooth is a permanent one, the damage is usually related only to the tooth receiving the blow. Alternatives include the following:


FIG. 14.15 A, The primary tooth forced into gum. B, Tooth re-erupted during a period of 8 months.

(From Mcdonald RE, Avery DR: Dentistry for the child and adolescent, Ed 7, St Louis, 2000, Mosby.)

5. Infant or Young Child With Multiple Decayed Teeth, Especially in Front of Mouth

(FIG. 14.17). This condition is often called the bottle mouth syndrome or baby bottle syndrome. It involves allowing the child to suck a bottle of any sugar-containing substance for hours at a time. Teeth are usually decayed slightly to severely and require selection of one of the alternatives described previously in the first section “Holes in Primary Teeth” (p. 113).

Jan 3, 2015 | Posted by in General Dentistry | Comments Off on 14: Pediatric Dentistry: Dentistry for Children
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