Pedo Sheet #1 By Thana'a Al Hadeed

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Pedo Sheet #1 By Thana'a Al Hadeed

Post by Sura on 25/2/2012, 10:50 pm

http://www.4shared.com/file/5G2Iu86Z/PEDO_1.html


Last edited by Sura on 27/2/2012, 10:35 pm; edited 2 times in total
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Sura

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Re: Pedo Sheet #1 By Thana'a Al Hadeed

Post by Mohammad Abukar on 27/2/2012, 2:20 am

not working....

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قال رسول الله صلى الله عليه وسلم: "المؤمن القوي خير وأحب إلى الله من المؤمن الضعيف ، وفي كل خير احرص على ما ينفعك واستعن بالله ولا تعجزن ، وإن أصابك شيء فلا تقل : لو أني فعلت لكان كذا وكذا ، ولكن قل قدر الله وما شاء فعل فإن لو تفتح عمل الشيطان"
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Re: Pedo Sheet #1 By Thana'a Al Hadeed

Post by Sura on 27/2/2012, 10:37 pm

The link is edited .. sth wrong occur in mediafire so i upload it on 4shared .. I'll try to upload it once again on mediafire
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Sura

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Re: Pedo Sheet #1 By Thana'a Al Hadeed

Post by Mohammad Abukar on 28/2/2012, 12:46 am

Thanks...

_________________
قال رسول الله صلى الله عليه وسلم: "المؤمن القوي خير وأحب إلى الله من المؤمن الضعيف ، وفي كل خير احرص على ما ينفعك واستعن بالله ولا تعجزن ، وإن أصابك شيء فلا تقل : لو أني فعلت لكان كذا وكذا ، ولكن قل قدر الله وما شاء فعل فإن لو تفتح عمل الشيطان"
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Mohammad Abukar

عدد المساهمات : 762
النشاط : 21
تاريخ التسجيل : 2009-09-06

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Re: Pedo Sheet #1 By Thana'a Al Hadeed

Post by Shadi Jarrar on 2/3/2012, 12:56 am



Pediatric dentistry

This course includes:
1- introduction examination and treatment planning.
2- 2lectures of eruption and arch development
3- 3 lectures of leading management in pediatric dentistry
4- non pharmalogical behavioral management technique
5- pharmalogical behavioral management technique.
6-space maintainers
-Midterm exam –

7- 2 lectures for dr.Hawazen in morphological differences between the primary and the permanent teeth and the restorative technique for the primary teeth.
8- Dr. Mahmoud Hamdan will talk about: acid etch technique, caries prevention, local anesthesia, oral surgery.

References: Richard Warberry for Pediatric dentistry, 2005 3rd edition

website: American Academy of pediatric dentistry ( guidelines and updates)

Today we will talk about:
-Definition of pediatric dentistry.
- Aims and Scopes of pediatric dentistry.
-Function of primary teeth.
-Examination and Treatment Planning.

-Definition:

Pediatric Dentistry: it’s an age define specialty that provides both primary and comprehensive , preventive and therapeutic oral healthcare for infants and children through there adolescence including those with special health care needs.

So the key word / element of this definition … is the age defined specialty , so the procedure is defined ..endo.. perio…etc specific procedure for the patient. So there is an age define for specific group of patient.
There is no limitation for what type of treatment we provide . so when the patient came to our clinic we care about the whole oral cavity and we don’t focus on specific procedure.

Primary and comprehensive care………. What does that mean???

It means that … you don’t need a referral to visit a pediatric dentist  primary health providers without the need to referral.
Unlike the endodontic or a surgeon you need a referral to treat you.

AGE:
infants and children through adolescence.
Pediatric dentist sees patient from birth to their late teens.

When does pediatric dentistry definition finish??
Almost at 15-16 years old … but they usually don’t like to go to pediatric clinics BUT in the definition of pediatric from infants to their late teens.

SPECIAL HEALTH CARE NEEDS:
pediatric dentist are trained and experienced to treat patients that are medically compromised.
Special health care needs  children with Down syndrome or with cerebral palsy. Mostly these patients are treated under general anesthesia.
But the problem is when they get 20 who treat these patients??
Because general dentist or specialist don’t treat them, they end up in a pediatric clinic even they are not included in pediatric category.
AIMS of pediatric dentistry…..

To give a preventive care in such a way that gives positive attitude to the dental field .
So physically it’s easy to drag a child to a pediatric clinic to extract a tooth for example but in this way we relief the immediate pain but we give them a negative approaches to dentistry.
So there are 2 aims:
1- Child reaches adulthood in a state of good dental health.
2- Child develops a positive attitude to dental care.

There is an interesting statistic in Jordan …
when they did a study on the population in 2004 they found out that Jordan is a young community (under 15 years old) so about 47% of our population is pediatric so doesn’t underestimate the pediatric dentistry because you will treat a lot of them … so in Jordan we concern about pediatric dentistry.


What is the SCOPE of pediatric dentistry and what it covers?

1- Interested in the health of the child as a whole.
2- Prevention
3- restoration in case of caries
4- Orthodontic: a. to observe the child development
B. controlling the primary dentition.

5-Behavoir management: which is the corner score of our job and how can I provide a dental treatment and dental emergencies.


1- so we are interested in the child physical condition so you check the early signs of the disease and the development of an individual as a whole if it’s necessary , and if we see sth is worrying we should report that and refer the child for advice treatment .
Oral health is important in children because you may found sth called early childhood caries
you may found a child that all his teeth are carious a lot of abscesses and a lot of pain.
So oral health plays an important role in overall health of the children.



We need to observe the child’s mental and psychological development as well.


2-Prevention:

In pediatric dentistry we love to council the parents before the birth of the child to encourage their child to take care of their dental health and to give them the proper nutrition …. So these kind of advice could be given early,,,,, but we don’t see that much :/

But you can do that if you see a pregnant lady you can talk to her about treatment, counseling, feeding habits… etc. ideally these kind of counseling is really effective.
if not …we do that at the first dental visit which is ideally should be at the child’s 1st birthday i.e. when he’s 12 months of age.
At this visit reinforcement, advice, examination of the child should be provided.
But sadly children come to our clinic when they are in real pain or abscess is there so unfortunately, there is no pleasant procedure we can provide because we are gonna treat them under local anesthesia and then perform an extraction or a pulptomy or whatever is needed . and that’s not a simple procedure for the child at their 1st visit so your prevention counseling will be too much for the child .
to be able to provide an oral health prevention you should have a piece of knowledge of prevention, nutrition and systemic and topical fluoride.

3- restoration:
1st you need to convince the child and the parent to receive a dental treatment because most of the parents are not convinced to restore a primary tooth because it will be replaced eventually by a permanent one , but we should convince them about the importance of restoring an carious tooth bcuz it’s important to keep the primary teeth healthy for the development and the growth of the child !!
- Hard works and high technical standards
- good work and quality ideally should be enjoyable to the patient.
- early diagnosis leading to the simplicity of the treatment that is required
So it’s easier to do a class I than pulptomy .
- Early diagnosis using good examining techniques. so it’s not enough to see the children in the waiting room you should do that under good source of light.
- Sees the patient every 6 months
- Use local anesthesia when it’s necessary.
- Apply modern cutting equipments: using sharp cutting burs to finish the work quickly.
- In cases of orthodontic assist an orthodontic point of view to do that you should know timing and sequence of tooth eruption.
- Anything that is outside the normal u can tell and diagnose early and then refer it to the correct department . for example a child with locked upper central incisor or skeletal class III you should report it and refer it.
- You should try to preserve the deciduous as much as possible because as we all know if the deciduous teeth are extracted before the time of exfoliation you will create a lot of space , and that will affect the eruption of the permanent ones .and the occlusion . so you consider the use of space maintainer when it’s indicated

4- Behavioral management
we will talk about it a lot but generally, we manage the child in a different way than the adults.
and you have a wide spectrum of individuals , so we have a very young preteens disabled individual so we have different approaches when dealing with behavior.


Dental emergencies:

if a child came to your clinic with a trauma,,, a fractured centrals without a pulpal involvement for example in this case we don’t have to fill a class IV bcuz the child is in a stress instead we should close the dentinal tubules and put Glass ionomer and a layer of composite because at this stage our consideration is to deal with an emergency of an exposed dentine , then on the next visit you fill a classIV .
Zaman, they used to put a metal band and bind it to the tooth but now they invent the glass ionomer so the child can go home without a metal band in his face !!

There is a consult called Dental Home. It’s similar to the medical home.
it began in the 90’s … which they have the child’s record so any case of emergency you will be able to the child’s record… this is more effective likelihood they make the dental home.
so it’s the ongoing relationship between the dentist and the patient include all the aspect of the oral health care delivered comprehensive and continuously accessible ,co-ordinate in a family centered way.

Establishment of dental home begins no later than 20 months of age, included referral to dental specialist.
There’s a study done by #@%!! On 7200 patients. They found out that when having a dental home they are more likely to receive preventive services and experience lower dental cost,,, because of the early prevention.
By establishment a dental home and taking a preventive steps recommended by the pediatric dentist , the parent can prevent their children from having early childhood caries which is an extensive tooth decaying that results in pain and the need of restorative procedure which needs general anesthesia and it’s very costly for the parent…
soo:
1- very costly
2- Will expose the child to the danger of general anesthesia.
3- Will be a long time development because it has long time suffering from the dental pain …?????
(dunno what does that mean :///))


So we advice to prevent all this by consult a dental home.

FUNCTIONS OF THE PRIMARY TEETH:

1- Important for the digestion and assimilation of food.
2- Maintain space in dental arches for the permanent teeth … so the best space maintainer is the deciduous teeth,,,,, for example a lower E is exfoliated and it’s perfectly maintaining a space for the lower 5 .
3- Stimulation of the growth of the jaws
i.e. when the teeth are there that will stimulate the growth of the alveolar bone and when a congenital missing tooth there will be a wasting of the alveolar ridge .
4- Development of speech ما بيقروطوا
5- Maintainers and development of appearance this better for the psychology of the child.
EXAMINATION ASSESMENT AND TREATMENT PLANNING:

As we said in the lab,,. It’s the same as the examination of the adult but here we’re dealing with the parents too…


1) HISTORY :
It’s essential for the accurate treatment planning and the beginning of good relationship with child.
So it’s not just taking history it’s to get to know the child better,,, so take your time when you take history.


• Standard forms are helpful to remember all the required questions so luckily the log book contains all these questions.
• Make sure that the child is accompanied by leading guardian for the consultation and it must be the parents ,,,, in our country they found out that leading guardian is the FATHER.

SOCIAL HISTORY:
Name
Age
Address
Occupation
No. of siblings

-Establish some kind of communication.
-Try to make an assessment with the child social background where the child comes from .
For example if we have a low socioeconomic patient we can’t tell them to come every week., even the prevention message you delivered should be different  so you must have a more realistic approach.
So social history helps in formulating a realistic prevention plan ,,,it gives an idea how easy is going to be for the parent to bring the child to the clinic.

MEDICAL HISTORY:
It should be reviewed systemically with a relevant data being taking to the treatment plan.
We ask the PARENT about the medical history .
Medical conditions are common in childhood and necessary for the safe delivery of the dental care.in case of Immunocomprimised children their parents will be anxious so they need different encouragement than the normal children .


DENTAL HISTORY:
For previous attendance
Because the child may have visited many dentists before because he can’t open his mouth for example so you must treat him under general anesthesia
We should take that from the child itself … why???
For the child to feel that he is the centre of attention and we take the feedback from the child about the exact position of pain and areas of discomfort.

So full history of child complaints to evaluate the child and the parents attitude toward the dental treatment .
Ask about previous dental experiences and that will give an indication whether the child is gonna co-operate with the dental treatment or not

QUESTIONS:
1- did they attend to the dentist regularly
2- if they have previous dental treatment if so is it with or without local anesthesia .
3- treating under general anesthesia and whether the child developed any kind of complications medically and pschycologically.


CLINICAL EXAMINATION:

We start examining the child at the moment he/she enters the clinic , we consider the overall impression of the child’s health.
-learn to distract the child by continuing carry out a careful examination.
DISTRACT + DOING THE WORK at the same time
 You have to learn this skill!!
-Extra oral examination:
1- The way the child walks
2-size of the patient is it normal or not.
3- If the speech is normal
4- Biting and finger cuffing (not sure !!!)
6- T MJ, L.N and submandibular area.
-Intra oral Examination:
*Soft tissue
*Peridontium
*Oral hygiene: poor fair good
*Plaque score : by giving the child a disclosing tablet after brushing his teeth and let them to count his plaque score,,, and that will be a game for them because it’s colorful :D and it’s untraumatizing approach .

*Occlusion
*Examine :
Overjet
Overbite
Molar relationship
Crossbite
Habits
Deciduous and permanent teeth
Canines are palpable at 9 years of age


Finally the TEETH
1) Count the teeth!
E’s are like the 6’s so when you see an E you will assume that it’s a 6 s, to avoid that count the teeth starting from the midline to the find which one is the deciduous and the permanent.

2) Routine examination staring from the upper right reaching the lower right.
3) Report cases of hypoplasia and discoloration.
4) Clean each tooth individually for proper assessment and examine under good source of light and careful use of the probe.
5) Record any unerupted teeth/ missing teeth/ carious teeth / teeth to be extracted/ any present restoration or fissure sealant/ any dental anomalies.
Radiographic Examination:
1) Aid to diagnose any dental caries.
2) To predict abnormalities in dental development
3) To detect bony and dental pathology.

Radiograph requesting should be justified and appropriate and we should store these x-ray to avoid asking for x-ray each session and expose the child to an x-ray …
For caries we take a Bite-wing radiograph to diagnose proximal caries esp. deciduous teeth and to diagnose wide contact area.
So clinically even in a good source of light you cannot tell that there’s a carious lesion until you take an x-ray.

This is esp. true for carious lesions you detect because in the 90’s they found out that there are about 50% of interproximal caries is dismissed until you take a bite-wing x-ray. Because you need to catch the caries early and to prevent it to reach the pulp, because the caries can progress rapidly to the pulp.

Indications of Bite-wing:
1) Interproximal caries
2) To detect any hidden caries under sound looking enamel esp. in the 6’s
OPG / panoramic:
1) For abnormalities in the dental development
2)Unerupted teeth
3) Congenitally missing teeth
4) Ectopic teeth
5) Supernumerary teeth
Parallax sth. Technique?? To find any impacted teeth esp. the maxillary canines.
Periapical radiograph:
1) Increase details of particular tooth are required.
2) Pulpal involvement, suspected trauma.
3) Assess tooth development and resorption for extractions.


SPECIAL INVESTIGATIONS:
In case of trauma we need vitality testing but it’s not very reliable in children because there are a lot of false positives … but we need to do it to get a base line reference.


TREATMENT PLANNING:
 Pain management
If a child comes to your clinic with pain and he/she can’t sleep at night, we can’t do a fissure sealant for him/her … so:
1) Management of pain is essential.
2) Preventive care
3) Restorative care:
- Ideally, from the simplest to the hardest ( e.g. class I prior to class II).
- Upper before the lower because you need infiltration for the upper and an I.D for the lower.
* These cases if we have the right to choose but Pain control has the priority.
4) Surgical care
5) Orthodontic treatment
6) Review and recall


1. Pain management :
-Has the priority and has a long term treatment planning.
- in case of trauma we carry out the immediate treatment and then we fill a class IV
-we take measurements of space maintainers before extractions to prevent space loss.

2. Preventive care :
-advice should be realistic to each individual case.
-it’s the most important aspect of treatment planning to young patient.
-prevention includes: Dietary advice/ Fluoride supplement/ Oral hygiene/ Fluoride application.
- Prevention advice should be reinforced REGULARLY.


3. Restorative care:

-Obtain co-operation of the child.
-Not all the teeth are restorable  X-ray
-Starts with the easiest procedures if possible maxillary arch before the lower, lager restorations later but always always we depend on the cause of pain.
- we can also temporize in case of multiple carious teeth, we try to apply zinc oxide eugenol or glass ionomer cement and later on we can fill each one individually in this way we relief symptoms on the child.

4. Surgical treatment :
-extractions for space maintainers
- has a long term ??

5. Orthodontic treatment:
- refer to the orthodontic
- Whether the space maintainer is indicated or not.

6. Review and Recall:
What is the difference between Review and recall?
Review: attendance for further appointment for treatment
Recall: plan an precipitated return for the patient who last seen at good oral health, and it’s ideally should be once a year to reinforce the preventive messages, and if there’s any initial caries we treat them before progression.
So 6 months is a convenient attending for continuity of care, we may lessen the 6 months period esp. in immunocomprimised patients or patients who have high caries risk.


Variations in recall frequencies:
1) Mild abnormalities in the dental arch
2) Sequence of the eruption is not normal
3) Active oral disease
4) Specific oral diseases such as periodontal diseases esp. on medically immuno-comprimised patients.

 But always we go for the aims of pediatric dentistry:
- The child reaches adulthood in a good oral health
- Child develops a positive attitude toward dental care




THE END
DONE BY: Thana’a AL-Hadeed
DR. Suha Abu Ghazaleh
1st pediatric lecture






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Shadi Jarrar
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