Mc: Donald and Avery Dentistry for the Child and Adolescent PDF
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3251 Riverport Lane Maryland Heights, Missouri 63043 DENTISTRY FOR THE CHILD AND ADOLESCENT, NINTH EDITION ISBN: 978-0-323-05724-0 Copyright © 2011, 2004, 2000, 1998, 1994, 1983, 1983, 1978, 1974, 1969 by Mosby, Inc., an affi liate of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: [email protected]. You may also com- plete your request on-line via the Elsevier website at http://www.elsevier.com/permissions. Notice Knowledge and best practice in this fi eld are constantly changing. As new research and expe- rience broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treat- ment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Authors assumes any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. The Publisher ISBN: 978-0-323-05724-0 Acquisitions Editor: John Dolan Developmental Editor: Joslyn Dumas Publishing Services Manager: Julie Eddy Senior Project Manager: Andrea Campbell Design Direction: Karen Pauls Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contributors Christopher Edward Belcher, MD Murray Dock, DDS, MSD, RPh Director Associate Professor of Clinical Pediatrics Pediatric Infectious Diseases University of Cincinnati, School of Medicine Infectious Diseases of Indiana Division of Pediatric Dentistry Indianapolis, Indiana Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio Ronald A. Bell, DDS, Med Professor of Pediatric Dentistry and Orthodontics Burton L. Edelstein, DDS, MPH College of Dental Medicine Professor of Dentistry and Health Policy Management Medical University of South Carolina Department of Community Health Charleston, South Carolina College of Dental Medicine Columbia University Medical Center Jeffrey D. Bennett, DMD New York, New York Professor and Chair Department of Oral Surgery and Hospital Dentistry Robert J. Feigal, DDS, PhD* Indiana University School of Dentistry Professor and Chair, Department of Preventive Indianapolis, Indiana Sciences Diplomate, American Board of Oral and Maxillofacial School of Dentistry, University of Minnesota Surgeons (ABOMS) Minneapolis, Minnesota Diplomate, National Dental Board of Anesthesiology Fellow, American Association of Oral and Maxillofacial Donald J. Ferguson, DMD, MSD Surgeons (AAOMS) Dean and Professor of Orthodontics Fellow, American Dental Society of Anesthesiology Nicolas and Asp College of Postgraduate Dentistry (ADSA) Dubai Healthcare City Dubai, United Arab Emirates David T. Brown, DDS, MS Chair and Professor Elie M. Ferneini, DMD, MD, MHS Department of Restorative Dentistry Oral and Maxillofacial Surgeon Indiana University School of Dentistry Clinical Instructor, University of Connecticut Indianapolis, Indiana Private Practice Greater Waterbury OMS David A. Bussard, DDS, MS Waterbury, Connecticut Associate Clinical Professor Department of Oral and Maxillofacial Surgery Charles J. Goodacre, DDS, MSD Indiana University School of Dentistry Professor and Dean Indiana Oral and Maxillofacial Surgery Associates School of Dentistry Indianapolis, Indiana Loma Linda University Loma Linda, California Judith R. Chin, DDS, MS Associate Professor Ann Page Griffi n, BA Department of Pediatric Dentistry Clinical Associate Professor Indiana University School of Dentistry Department of Family Medicine Indianapolis, Indiana East Carolina University School of Medicine Co-Chairman, Board Robert J. Cronin, Jr., DDS, MS Practicon, Inc. Professor and Director, Graduate Division Greenville, North Carolina Department of Prosthodontics The University of Texas Health Science Center at San Antonio Dental School *Deceased San Antonio, Texas v vi Contributors James K. Hartsfi eld, Jr., DMD, MS, MMSc, John T. Krull, DDS PhD, FACMG Assistant Professor Professor and E. Preston Hicks Endowed Chair in Department of Pediatric Dentistry Orthodontics and Oral Research Indiana University School of Dentistry University of Kentucky College of Dentistry Private Practice of Orthodontics Lexington, Kentucky Indianapolis, Indiana Roberta A. Hibbard, MD George E. Krull, DDS Professor of Pediatrics Private Practice of Pediatric Dentistry Indiana of University School of Medicine Clarkston, Michigan Indianapolis, Indiana Thomas H. Lapp, DDS, MS Randy A. Hock, MD, PhD, MMM Clinical Assistant Professor of Oral and Maxillofacial Presbyterian Blume Pediatric Hematology & Oncology Surgery Clinic Indiana University School of Dentistry Presbyterian Novant Medical Group Oral and Maxillofacial Surgeon Private Practice Charlotte, North Carolina Indianapolis, Indiana Donald V. Huebener, DDS, MS, MAEd Jasper L. Lewis, DDS, MS Professor, Plastic and Reconstructive Surgery Clinical Assistant Professor Department of Surgery, School of Medicine Department of Pediatric Dentistry Washington University, St. Louis, Missouri University of Tennessee College of Dentistry Professor, Pediatric Dentistry Memphis, Tennessee School of Dental Medicine Clinical Professor, Department of Surgery Chief of the Division of Dentistry Southern Illinois University Clinical Assistant Professor Alton, Illinois Department of Family Medicine School of Medicine, East Carolina University Christopher V. Hughes, DMD, PhD Private Practice of Pediatric Dentistry Associate Professor and Chair Greenville, North Carolina Department of Pediatric Dentistry Henry M. Goldman School of Dental Medicine James L. McDonald, Jr., PhD Boston University Emeritus Professor of Oral Biology Boston, Massachusetts Indiana University School of Dentistry Indianapolis, Indiana Charles E. Hutton, DDS Emeritus Professor of Oral and Maxillofacial Surgery John S. McDonald, DDS, MS, FACD Indiana University School of Dentistry Volunteer Professor Indianapolis, Indiana Departments of Surgery and Anesthesia Volunteer Associate Professor Vanchit John, DDS, MSD, MDS, BDS Department of Pediatrics Chairperson, Associate Professor and Director Division of Pediatric Dentistry Department of Predoctoral Periodontics College of Medicine, University of Cincinnati Indiana University School of Dentistry Cincinnati, Ohio Indianapolis, Indiana Private Practice of Oral and Maxillofacial Pathology/Head and Neck Pain Cincinnati, Ohio James E. Jones, DMD, MSD, EdD, PhD Professor and Chair Dale A. Miles, BA, DDS, MS, FRCD(C), Dip. Department of Pediatric Dentistry ABOM, Dip. ABOMR Indiana University School of Dentistry Adjunct Professor James Whitcomb Riley Hospital for Children University of Texas Health Science Center at San Indianapolis, Indiana Antonio San Antonio, Texas Joan E. Kowolik, BDS, LDS, RCS Adjunct Professor Associate Professor of Pediatric Dentistry Arizona School of Dentistry and Oral Health Department of Pediatric Dentistry Mesa, Arizona Indiana University School of Dentistry CEO, Digital Radiographic Solutions Indianapolis, Indiana Fountain Hills, Arizona Contributors vii B. Keith Moore, PhD Jenny I. Stigers, DMD Professor Emeritus Associate Professor Indiana University School of Dentistry University of Kentucky College of Dentistry Division of Dental Materials Lexington, Kentucky Department of Restorative Dentistry Indianapolis, Indiana George K. Stookey, MSD, PhD Distinguished Professor Emeritus of Preventive Edwin T. Parks, DMD, MS and Community Dentistry Professor of Diagnostic Sciences Indiana University School of Dentistry Indiana University School of Dentistry Indianapolis, Indiana Indianapolis, Indiana James A. Weddell, DDS, MSD Laura Romito, DDS, MS Associate Professor of Pediatric Dentistry Associate Professor of Oral Biology Indiana University School of Dentistry Indiana University School of Dentistry James Whitcomb Riley Hospital for Children Indianapolis, Indiana Indianapolis, Indiana Alan Michael Sadove, MD Gerald Z. Wright, DDS, MSD, FRCD(C), Private Practice of Esthetic Surgery Dip. Amer. Brd Meridian Plastic Surgeons and Medical Skin Professor Emeritus Care University of Western Ontario Indianapolis, Indiana London, Ontario, Canada Secretary General International Association of Paediatric Dentistry Brian J. Sanders, DDS, MS Professor of Pediatric Dentistry Director, Riley Dental Clinic Karen M. Yoder, MSD, PhD Director, Advanced Education Program in Pediatric Professor and Director Dentistry Division of Community Dentistry Indianapolis, Indiana Department of Preventative and Community Dentistry Indiana University School of Dentistry Indianapolis, Indiana Amy D. Shapiro, MD Co-Medical Director and Pediatric Hematologist Indiana Hemophilia and Thrombosis Center Indianapolis, Indiana Preface The ninth edition of Dentistry for the Child and Adolescent • Chapter 6, in addition to discussing the increasing link presents current diagnostic and treatment recommenda- between dental disease and genetics, includes an inter- tions based on research, clinical experience, and current esting discussion regarding the link between tooth literature. The newest edition follows the same basic agenesis and the diagnosis of cancer. structure and format of the previous eight editions. The • Chapter 8 contains substantial new information re- contributors who joined us in the preparation of this lat- garding childhood oral pathologies. est revision express a coordinated philosophy and the • Two new authors have contributed to the rewriting of approach to the most modern concepts of dentistry for Chapter 10, this most important chapter regarding the child and adolescent. The information contained dental caries, and Chapter 12, on nutritional consider- herein is relevant to the contemporary science and prac- ations for the pediatric dental patient. tice of pediatric dentistry. This textbook is designed to • Chapters 13, 20, and 21 have new authors added to help undergraduate dental students and postdoctoral pe- the list of contributors, which has provided enhanced diatric dental students provide effi cient and superior insight to these chapter topics. comprehensive oral health care to infants, children, teen- • Chapter 20 in particular has several new cases regard- agers, and medically compromised patients. It also pro- ing trauma to the dentition. vides experienced dentists with reference information • Chapter 27, about the management of the developing regarding new developments and techniques. occlusion, has undergone a signifi cant rewrite, with This ninth edition represents a signifi cant revision, many new cases added to illustrate the basic principles with three main areas of enhancement. Perhaps most involved. notable is the addition of color illustrations throughout • Chapters 29 and 30, both about practice management the textbook, which signifi cantly enhance the esthetic and community oral health, were signifi cantly revised. quality of the material. In addition, the book is con- In addition, a new author was added to chapter 30, nected with Elsevier’s Evolve website, which will provide providing signifi cant revisions and enhancements re- advantages for both students and faculty of pediatric garding access to dental care for children. dentistry in utilizing the information from the text, as • Finally, Chapter 31 is a revision of a pediatric oral sur- well as providing additional features. Finally, multiple gery chapter from several editions ago that has re- signifi cant areas of improvement in individual chapters turned at the request of our readers. were accomplished during this revision. Specifi c notable chapter improvements include: Again, thanks to our author contributors for all of their • Chapter 3 underwent a signifi cant rewrite with the ad- dedication and work on this ninth edition! dition of a new author and provides our contemporary knowledge of nonpharmacologic behavioral guidance. Ralph E. McDonald • Chapter 5 has been enhanced in the digital radiogra- David R. Avery phy section with material regarding three-dimensional Jeffrey A. Dean cone-beam computed tomography, an exciting new area in dental diagnostics. ix Acknowledgments A textbook can be planned and written only with the Editor; Joslyn Dumas, Associate Developmental Editor; supportive interest, encouragement, and tangible contri- and Andrea Campbell, Senior Project Manager. butions of many people. Therefore, it is a privilege to ac- The faculties of pediatric dentistry and other disci- knowledge the assistance of others in the preparation of plines at Indiana University have contributed substan- this text. First of all, we would like to thank the many tially to this work in many ways. We truly appreciate authors and co-authors who have made this ninth edi- their willingness to share information relevant to scien- tion possible. Donna Bumgardner provided manuscript tifi c accuracy of the manuscripts. In particular, we grate- preparation and valuable editorial assistance. Mark fully acknowledge Drs. Michael Baumgartner, John Dirlam, Kyla Jones, Terry Wilson, and Tim Centers pro- Emhardt, Margherita Fontana, Gopal Krishna, Dongmei vided assistance with new illustrations. Our excellent li- Liu, Charles Palenik, Phillip Pate, Jeffrey Platt, Paul brary staff was eager to help in any way possible, and the Walker, and Susan Zunt. Many pediatric dentistry post- assistance of Janice Cox, Barbara Gushrowski, Keli doctoral students and auxiliary staff have also assisted in Schmidt, Mike Delporte, and Sue Hutchinson is much numerous ways. The encouragement and support of all appreciated. We also gratefully acknowledge the profes- members of our families sustained our resolve to com- sional staff at Elsevier who has provided valuable assis- plete this task when it seemed that it would not get done. tance and superb guidance in the publication of this We extend our heartfelt thanks to all who played a role in ninth edition; special thanks to John Dolan, Executive helping us bring this project to a successful conclusion. xi 1 CHAPTER Examination of the Mouth and Other Relevant Structures ▲ Ralph E. McDonald, David R. Avery, and Jeffrey A. Dean CHAPTER OUTLINE INITIAL PARENTAL CONTACT WITH RADIOGRAPHIC EXAMINATION SUICIDAL TENDENCIES IN CHILDREN THE DENTAL OFFICE EARLY EXAMINATION AND ADOLESCENTS THE DIAGNOSTIC METHOD INFANT DENTAL CARE INFECTION CONTROL IN THE DENTAL PRELIMINARY MEDICAL AND DENTAL DETECTION OF SUBSTANCE ABUSE OFFICE HISTORY Etiologic Factors in Substance Biofi lm CLINICAL EXAMINATION Abuse EMERGENCY DENTAL TREATMENT TEMPOROMANDIBULAR EVALUATION Specifi c Substances and Frequency UNIFORM DENTAL RECORDING of Use A dentist is traditionally taught to perform a com- health and even general health are related to the correc- plete oral examination of the patient and to de- tion of oral defects. velop a treatment plan from the examination fi ndings. The dentist then makes a case presenta- INITIAL PARENTAL CONTACT tion to the patient or parents, outlining the recommended WITH THE DENTAL OFFICE course of treatment. This process should include the devel- opment and presentation of a prevention plan that out- The parent usually makes the fi rst contact with the dental lines an ongoing comprehensive oral health care program offi ce by telephone. This initial conversation between the for the patient and establishment of the “dental home.” parent and the offi ce receptionist is very important. It The plan should include recommendations designed provides the fi rst opportunity to attend to the parent’s to correct existing oral problems (or halt their progres- concerns by pleasantly and concisely responding to ques- sion) and to prevent anticipated future problems. It is tions and by offering an offi ce appointment. The recep- essential to obtain all relevant patient and family infor- tionist must have a warm, friendly voice and the ability mation, to secure parental consent, and to perform a to communicate clearly. The receptionist’s responses complete examination before embarking on this com- should assure the parent that the well-being of the child prehensive oral health care program for the pediatric is the chief concern. patient. Anticipatory guidance is the term often used to The information recorded by the receptionist during describe the discussion and implementation of such a this conversation constitutes the initial dental record plan with the patient and/or parents. The American for the patient. Filling out a patient information form is Academy of Pediatric Dentistry has published guidelines a convenient method of collecting the necessary initial concerning the periodicity of examination, preventive information (see Fig. 29-3). Additional discussion of dental services, and oral treatment for children as sum- the initial communication with parents is presented in marized in Table 1-1. Chapter 29. Each pediatric patient should be given an opportu- nity to receive complete dental care. The dentist should THE DIAGNOSTIC METHOD not attempt to decide what the child, parents, or third- party agent will accept or can afford. If parents reject a Before making a diagnosis and developing a treatment portion or all of the recommendations, the dentist has plan, the dentist must collect and evaluate the facts as- at least fulfi lled the obligation of educating the child sociated with the patient’s or parents’ chief concern and the parents about the importance of the recom- and any other identifi ed problems that may be un- mended procedures. Parents of even moderate income known to the patient or parents. Some pathognomonic usually fi nd the means to have oral health care com- signs may lead to an almost immediate diagnosis. For pleted if the dentist explains that the child’s future oral example, obvious gingival swelling and drainage may 1 2 Chapter 1 ■ Examination of the Mouth and Other Relevant Structures Table 1-1 Recommendations for Preventive Pediatric Oral Health Care Because each child is unique, these recommendations are designed for the care of children who have no contributing medical conditions and are developing normally. These recommendations will need to be modifi ed for children with special health care needs or if disease or trauma manifests variations from normal. The American Academy of Pediatric Dentistry (AAPD) emphasizes the importance of very early professional intervention and the continuity of care based on the individualized needs of the child. Refer to the text of this guideline for supporting information and references. AGE 6–12 mo 12–24 mo 2–6 yr 6–12 yr 12+ yr Clinical oral examination1,2 • • • • • Assess oral growth and development3 • • • • • Caries-risk assessment4 • • • • • Radiographic assessment5 • • • • • Prophylaxis and topical fl uoride4,5 • • • • • Fluoride supplementation6,7 • • • • • Anticipatory guidance counseling8 • • • • • Oral hygiene counseling9 Parent Parent Patient/ Patient/ Patient parent parent Dietary counseling10 • • • • • Injury prevention counseling11 • • • • • Counseling for nonnutritive habits12 • • • • • Counseling for speech/language development • • • • • Substance abuse counseling • • Counseling for intraoral/perioral piercing • • Assessment and treatment of developing malocclusion • • • Assessment for pit and fi ssure sealants13 • • • Assessment and/or removal of third molars • Transition to adult dental care • 1First examination at the eruption of the fi rst tooth and no later than 12 months. Repeat every 6 months or as indicated by child’s risk status/ susceptibility to disease. 2Includes assessment of pathology and injuries. 3By clinical examination. 4Must be repeated regularly and frequently to maximize effectiveness. 5Timing, selection, and frequency determined by child’s history, clinical fi ndings, and susceptibility to oral disease. 6Consider when systemic fl uoride exposure is suboptimal. 7Up to at least 16 years. 8Appropriate discussion and counseling should be an integral part of each visit for care. 9Initially, responsibility of parent; as child develops, jointly with parent; then, when indicated, only child. 10At every appointment; initially discuss appropriate feeding practices, then the role of refi ned carbohydrates and frequency of snacking in caries development and childhood obesity. 11Initially play objects, pacifi ers, cars seats; then when learning to walk, sports and routine playing, including the importance of mouthguards. 12At fi rst, discuss the need for additional sucking; digits vs. pacifi ers; then the need to wean from the habit before malocclusion or skeletal dysplasia occurs. For school-aged children and adolescent patients, counsel regarding any existing habits such as fi ngernail biting, clenching, or bruxism. 13For caries-susceptible primary molars, permanent molars, premolars, and anterior teeth with deep pits and fi ssures; placed as soon as possible after eruption. be associated with a single, badly carious primary mo- be postponed until more urgent conditions are resolved. lar. Although the collection and evaluation of these For example, a patient with necrotizing ulcerative gin- associated facts are performed rapidly, they provide a givitis or a newly fractured crown needs immediate diagnosis only for a single problem area. On the other treatment, but the treatment will likely be only pallia- hand, a comprehensive diagnosis of all of the patient’s tive, and further diagnostic and treatment procedures problems or potential problems may sometimes need to will be required later. Chapter 1 ■ Examination of the Mouth and Other Relevant Structures 3 The importance of thoroughly collecting and evaluat- A notation should be made if a young child was hos- ing the facts concerning a patient’s condition cannot be pitalized previously for general anesthetic and surgical overemphasized. A thorough examination of the pediat- procedures. Shaw reported that hospitalization and a gen- ric dental patient includes assessment of: eral anesthetic procedure can be a traumatic psychologi- • General growth and health cal experience for a preschool child and may sensitize the • Chief complaint, such as pain youngster to procedures that will be encountered later in • Extraoral soft tissue and temporomandibular joint a dental offi ce.3 If the dentist is aware that a child was evaluation previously hospitalized or the child fears strangers in • Intraoral soft tissue clinic attire, the necessary time and procedures can be • Oral hygiene and periodontal health planned to help the child overcome the fear and accept • Intraoral hard tissue dental treatment. • Developing occlusion Occasionally, when the parents report signifi cant dis- • Caries risk orders, it is best for the dentist to conduct the medical • Behavior and dental history interview. When the parents meet Additional diagnostic aids are often also required, such with the dentist privately, they are more likely to discuss as radiographs, study models, photographs, pulp tests, the child’s problems openly and there is less chance for and, infrequently, laboratory tests.1 misunderstandings regarding the nature of the disorders. In certain unusual cases, all of these diagnostic aids In addition, the dentist’s personal involvement at this may be necessary to arrive at a comprehensive diagnosis. early time strengthens the confi dence of the parents. Certainly no oral diagnosis can be complete unless the When there is indication of an acute or chronic systemic diagnostician has evaluated the facts obtained by medical disease or anomaly, the dentist should consult the child’s and dental history taking, inspection, palpation, explora- physician to learn the status of the condition, the long- tion (if teeth are present), and often imaging (e.g., radio- range prognosis, and the current drug therapy. graphs). For a more thorough review of evaluation of the Current illnesses or histories of signifi cant disorders dental patient, refer to the chapter by Glick, Greenberg, signal the need for special attention during the medical and Ship in Burket’s Oral Medicine.2 and dental history interview. In addition to consulting the child’s physician, the dentist may decide to record PRELIMINARY MEDICAL AND DENTAL additional data concerning the child’s current physical condition, such as blood pressure, body temperature, HISTORY heart sounds, height and weight, pulse, and respiration. It is important for the dentist to be familiar with the Before treatment is initiated, certain laboratory tests may medical and dental history of the pediatric patient. Fa- be indicated and special precautions may be necessary. A milial history may also be relevant to the patient’s oral decision to provide treatment in a hospital and possibly condition and may provide important diagnostic infor- under general anesthesia may be appropriate. mation in some hereditary disorders. Before the dentist The dentist and the staff must also be alert to identify examines the child, the dental assistant can obtain suffi - potentially communicable infectious conditions that cient information to provide the dentist with knowledge threaten the health of the patient and others. Knowledge of the child’s general health and can alert the dentist to of the current recommended childhood immunization the need for obtaining additional information from the schedule is helpful. It is advisable to postpone nonemer- parent or the child’s physician. The form illustrated in gency dental care for a patient exhibiting signs or symp- Fig. 1-1 can be completed by the parent. However, it is toms of acute infectious disease until the patient recov- more effective for the dental assistant to ask the questions ers. Further discussions of management of dental patients informally and then to present the fi ndings to the dentist with special medical, physical, or behavioral problems are and offer personal observations and a summary of the presented in Chapters 2, 3, 14, 15, 23, 24, and 28. case. The questions included on the form will also pro- The pertinent facts of the medical history can be trans- vide information about any previous dental treatment. ferred to the oral examination record (Fig. 1-2) for easy Information regarding the child’s social and psycho- reference by the dentist. A brief summary of important logical development is important. Accurate information medical information serves as a convenient reminder to refl ecting a child’s learning, behavioral, or communica- the dentist and the staff, because they refer to this chart tion problems is sometimes diffi cult to obtain initially, at each treatment visit. especially when the parents are aware of their child’s de- The patient’s dental history should also be summa- velopmental disorder but are reluctant to discuss it. Be- rized on the examination chart. This should include a havior problems in the dental offi ce are often related to record of previous care in the dentist’s offi ce and the the child’s inability to communicate with the dentist and facts related by the patient and the parent regarding pre- to follow instructions. This inability may be attributable vious care in another offi ce. Information concerning the to a learning disorder. An indication of learning disorders patient’s current oral hygiene habits and previous and can usually be obtained by the dental assistant when ask- current fl uoride exposure helps the dentist develop an ing questions about the child’s learning process; for ex- effective dental disease prevention program. For exam- ample, asking a young school-aged child how he or she is ple, if the family drinks well water, a sample may be sent doing in school is a good lead question. The questions to a water analysis laboratory to determine the fl uoride should be age-appropriate for the child. concentration. 4 Chapter 1 ■ Examination of the Mouth and Other Relevant Structures Figure 1-1 Form used in completing the preliminary medical and dental history. (Printed with permission from Indiana University–University Pediatric Dentistry Associates.)
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