Stainless Steel Crowns
Pediatric dentistry is a specialized area of dentistry that is focused on providing oral healthcare for the needs of infants, children, adolescents, and individuals with special needs. The emphasis of the pediatric dental practice is to focus on developmental guidance, early detection, prevention, and treatment of dental diseases (Box 27-1).
The Pediatric Dental Office
The design of a pediatric dental office should portray a cheerful, pleasant, nonthreatening atmosphere to a child. Many pediatric dental offices are designed with several dental chairs arranged in one large treatment area or bay (Figure 27-1). This design provides reassurance from one child to another when they can see other children being treated. An open bay design can be psychologically effective because children are often hesitant to express fear or to misbehave in the presence of other children.
The pediatric office will also have a “quiet room.” This treatment area is separate from the open area and is used for children whose behavior may upset other children.
Behavioral Management Techniques
Children are treated differently from adult patients, and the techniques utilized in managing a child’s behavior will depend on the age of the child. See Table 27-1 for the stages of behavior. The dental team within a pediatric office has to make modifications in the way they practice dentistry for several reasons: age, size, and how the child is behaving (Figure 27-2).
|Age Range||Behavioral Characteristics|
|Birth through 2 years||Children may act friendly toward strangers, then become afraid of them. May have fear of separation from parent. Toddlers are too young to be expected to cooperate with dental treatment. It is easier if the parent is with the child during the initial examinations.|
|3 through 5 years||Learning to follow simple instructions. Children want autonomy. At this age, you want to allow them to make choices (e.g., have them choose the flavor of fluoride).|
|6 through 11 years||Children are in the period of socialization. They want to learn the rules. They have overcome most of their fears.|
|12 through 20 years||Through this age, young people have acquired self-certainty, and a sexual identity. They will seek leadership and will develop their own ideals.|
Patients With Special Needs
Physical and mental challenges can slow or challenge a child’s physiologic and social growth. Intellectual challenges such as, Down syndrome, and cerebral palsy can influence how individuals are able to care for themselves. Parents and caregivers may be required to take on more responsibilities for maintaining daily physical and oral health needs.
The pediatric dentist receives extensive education and training to care for patients with special needs. The severity of each individual patient’s disorder dictates whether treatment is provided in the pediatric dental office or the hospital setting. An evaluation of a patient’s medical and social history will help determine necessary modifications to the treatment plan.
Examination of the Pediatric Patient
According to the American Academy of Pediatric Dentistry, the first dental appointment for a child should take place around their first birthday. This initial examination is often the first dental experience for a child. The rapport that is developed with the child during this initial examination is what can establish a positive attitude toward dental health that will last for the child’s lifetime. (Rapport means a feeling of ease or comfort.)
The child’s parent or legal guardian must provide consent (permission) before any dental treatment is provided for a child younger than 18 years of age.
Medical and Dental Histories
The parent or guardian completes the medical history form, which includes information about the child’s general health background. If medical problems are noted, the dentist may choose to contact the child’s pediatrician to obtain a more complete medical background.
The dental history includes information about the eruption pattern of the teeth, past dental problems and care, fluoride intake, and current oral hygiene habits.
General Appraisal and Behavioral Assessment
General appraisal addresses physical conditions and developmental levels. It also includes vital signs and baseline health data for emergency situations.
Behavioral assessment is used to evaluate the communication skills of the patient and to determine whether behavioral management techniques are necessary.
The intraoral examination requires the use of a mouth mirror, an explorer, and gauze squares. Very young children may be uncooperative and may allow “fingers only” in their mouths. Other young children may allow only a mirror.
Ideally, each of the 20 primary teeth should be examined. Besides charting of erupted teeth, the occlusion is analyzed to determine spacing and crowding and the presence or absence of teeth.
A radiographic examination is necessary for the dentist to make a complete diagnosis; however, young children often have difficulty with the radiographic procedure, and the radiographic examination may have to be deferred until the child can comprehend the need to remain still and follow directions. When radiographs are possible, there are techniques that can be helpful when introducing the procedure to the child (Box 27-2).
The procedures described in this chapter are introduced to help maintain the health of the primary, mixed, and permanent dentition through early adult years.
Prevention is one of the most encompassing areas for a pediatric dental practice. It not only involves the complete dental team in educating the patient and parents; it also reaches to the community and local school systems. The role of the pediatric dentist is to communicate preventive dental health in such areas as oral hygiene, fluoride use, nutrition, and preventive and protective procedures.
Oral hygiene instructions are geared toward improving a child’s brushing and flossing techniques. This learning process is intended to eventually lead to cleaner teeth and healthier gums. When children are encouraged to develop the habit of brushing effectively twice a day with fluoride toothpaste and flossing once a day, they will maintain proper oral habits throughout their lives (see Chapter 17).
A healthy diet is one that is balanced and naturally supplies all the nutrients a child needs to grow. Chapter 17 describes the types of foods that children should eat for normal growth and identifies foods that can increase decay.
Fluorides have had a major role in bringing about the decline in dental caries; however, for many children, decay is still a major dental problem. Often these children are those who have not had the benefits of fluoride from birth. Professional topical application of fluoride is very important in controlling caries in children. (Fluorides are discussed in Chapter 17.)
Sealants are a common preventive tool provided in a pediatric office. Sealants protect the grooves and pitted surfaces of teeth, especially the chewing surfaces of molars and premolars, where most decay is detected. Sealants are made of a clear or tooth-colored composite resin and are applied to the pits and fissures to help keep them cavity free. See Chapter 18 for further discussion.
It is never too early to start evaluating a child’s oral and facial (orofacial) development. The pediatric dentist is the first to identify malocclusion, crowded or crooked teeth, and habits that can affect the dentition. The pediatric dentist can actively intervene or can refer the patient to an orthodontist to guide the teeth as they emerge in the mouth. Early preventive and interceptive orthodontic treatment can prevent more extensive treatment later.
• Use of a space maintainer to save space for the eruption of permanent teeth (Figure 27-3). Space maintainers most often are cemented in place and retained until the permanent tooth erupts.