Paediatric Dentistry at a Glance

121 Pages·2012·5.533 MB·English

by  Monty Duggal, Angus Cameron, Jack Toumba

Paediatric Dentistry at a Glance
Titles in the dentistry At a Glance series
Orthodontics at a Glance
Daljit S. Gill
978-1-4051-2788-2
Periodontology at a Glance
Valerie Clerehugh, Aradhna Tugnait, Robert J. Genco
978-1-4051-2383-9
Dental Materials at a Glance
J. A. von Fraunhofer
978-0-8138-1614-2
Oral Microbiology at a Glance
Richard J. Lamont, Howard F. Jenkinson
978-0-8138-2892-3
Implant Dentistry at a Glance
Jacques Malet, Francis Mora, Philippe Bouchard
978-1-4443-3744-0
Prosthodontics at a Glance
Irfan Ahmad
978-1-4051-7691-0
Paediatric Dentistry at a Glance
Monty Duggal, Angus Cameron, Jack Toumba
978-1-4443-3676-4
Paediatric Dentistry
at a Glance
Monty Duggal
BDS, MDS, FDS (Paeds), RCS (Eng), PhD
Professor and Head of Paediatric Dentistry
Department of Paediatric Dentistry
Leeds Dental Institute
Leeds
UK
Angus Cameron
BDS, MDSc, FDSRCS (Eng), FRACDS, FICD
Head of Department, Paediatric Dentistry and Orthodontics
Westmead Hospital
and
Clinical Associate Professor and Head, Paediatric Dentistry
The University of Sydney
NSW
Australia
Jack Toumba
BSc (Hons), BChD, MSc, FDS (Paeds), RCS (Eng), PhD
Professor of Paediatric and Preventive Dentistry
Department of Paediatric Dentistry
Leeds Dental Institute
Leeds
UK
A John Wiley & Sons, Ltd., Publication
This edition first published 2013
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Library of Congress Cataloging-in-Publication Data
Duggal, Monty S.
Paediatric dentistry at a glance / Monty Duggal, Angus Cameron, Jack Toumba.
p. ; cm. – (At a glance series)
Includes bibliographical references and index.
ISBN 978-1-4443-3676-4 (pbk. : alk. paper)
I. Cameron, Angus C. II. Toumba, Jack. III. Title. IV. Series: At a glance series (Oxford,
England)
[DNLM: 1. Dental Care for Children–Handbooks. 2. Child–Handbooks. 3. Tooth Diseases–
Handbooks. WU 49]

617.6'45–dc23
2012015790
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print
may not be available in electronic books.
Cover image: courtesy of the authors
Cover design by Meaden Creative
Set in 9/11.5 pt Times by Toppan Best-set Premedia Limited
1 2013
Contents
Treatment planning, growth and development Dento-alveolar trauma
 1 Planning treatment for children 6 27 Assessment of trauma in children 58
 2 Growth and development 8 28 Trauma to primary teeth 60
 3 Child cognitive and psychological development 10 29 Crown fractures in permanent teeth 62
30 Complicated crown and crown/root fractures 64
Strategies for management of the child patient 31 Non-vital immature teeth 66
 4 Behaviour management 12 32 Root fractures 68
 5 Aversive conditioning and management of phobia 14 33 Luxations and avulsion 70
 6 Local analgesia 16
 7 Conscious sedation 18 Paediatric oral medicine and pathology
 8 General anaesthesia 20 34 Diagnosis, biopsy and investigation of pathology in children 72
 9 Rubber dam 22 35 Differential diagnosis of pathology of the jaws 74
10 Dental radiography 24 36 Management of odontogenic infections in children 76
37 Ulcers and vesiculobullous lesions in children 78
Prevention of caries and erosion 38 Swellings and enlargements of the gingiva 80
11 Preventive care for children 26 39 Oral pathology in the newborn 82
12 Topical fluorides I 28
13 Topical fluorides II 30 Dental and oro-facial anomalies
14 Systemic fluoridation and fluoride toxicity 32 40 Premature loss of primary teeth 84
15 Cariology 34 41 Missing teeth and extra teeth 86
16 Caries risk assessment and detection 36 42 Disorders of tooth shape and size 88
17 Dental erosion 38 43 Enamel disorders 90
44 Disorders of dentine and eruptive defects 92
Restorative management in the primary
dentition Management of children with special needs
18 Early childhood caries 40 45 Physical and learning disabilities I 94
19 Strip crowns for primary incisors 42 46 Physical and learning disabilities II 96
20 Plastic restorations in primary molars 44 47 Bleeding disorders 98
21 Pulp therapy 46 48 Thalassaemia and other blood dyscrasias 100
22 Crowns for primary molars 48 49 Children with congenital heart defects 102
23 Management of extensive caries 50 50 Children with cancer 104
51 The diabetic child 106
Management of first permanent molars 52 Kidney and liver disease and organ transplantation 108
24 Preservation of the first permanent molar 52 53 Prescribing drugs for children 110
25 Molar incisor hypomineralisation 54
References 113
Space management Index 115
26 Space maintenance 56
Contents 5
1 Planning treatment for children
(a)
(a)
(a)
(b)
(b)
Figure 1.2 Bitewing radiographs showing extent
(b)
Figure 1.1 Intra-oral view showing the carious of caries.
upper (a) and lower (b) primary molars. Figure 1.3 Intra-oral view showing upper (a) and
lower (b) arches at the end of treatment.
Table 1.1 Step-by-step plan of the proposed treatment where prevention is
carried out alongside restorative care.
Visit Treatment Preventative
One Examination and treatment Oral hygiene instructions
plan Use of adult tooth paste
Correspondence with Diet sheet was given
(a) (b)
paediatrician
Figure 1.4 Postoperative radiographs of the treated case. Two Full mouth prophylaxis Reinforce oral hygiene
55 – Fissure sealant instructions
65 – Fissure sealant Collect diet sheet
75 – Fissure sealant Duraphat™ (22 600 ppm F)
85 – Fissure sealant Plaque score
Temporisation of 54 and 64
Three 64 – Composite restoration Reinforce oral hygiene measures
Diet counselling
Duraphat™ (22 600 ppm F)
Four 54 – Stainless steel crown Reinforce diet advice
Plaque score
(a) (b)
Duraphat™ (22 600 ppm F)
Figure 1.5 Follow-up visit revealed that first permanent molars had erupted Five 74 – Composite restoration Reinforce oral hygiene measures
and these were fissure sealed.
Paediatric Dentistry at a Glance, First Edition. Monty Duggal, Angus Cameron and Jack Toumba. © 2013 John Wiley & Sons Ltd. Published 2013 by Blackwell Publishing Ltd.
6  Chapter 1  Planning treatment for children
General philosophy of the authors Diagnosis should be specific. For example, a diagnosis “dental caries”
Dentists who treat children are in a unique position not only to provide in itself is incomplete as it does not specify the reason the child has
dental treatment when required, but to influence the future behaviour, dental caries. The root cause of the problem cannot be addressed
attitudes to oral health and attitude towards dentistry in general. Chil- unless a specific diagnosis is made.
dren deserve the highest quality care and highest quality restorative
dentistry should be provided to them, supplemented with rigorous pre- Formulating treatment plan
vention. Prevention of dental caries in children should be a priority An example of a treated case and the step-by-step treatment plan is
but sadly nearly half of 5-year-olds, even in developed countries, still shown is Figs. 1.1–1.5 and Table 1.1 respectively. When managing
develop dental caries. A non-interventionist approach, as has been caries in children this should relate to:
advocated in some countries such as the UK, or poor restorative • prognosis of the affected teeth;
patchwork dentistry, is doomed to failure and only leads to pain, infec- • child’s behaviour and likely acceptance of the treatment.
tion and suffering in children, requiring more invasive interventions.
These are traumatic and expensive and negatively influence the child’s Restore or extract
future behaviour and attitudes to dentistry. Good restorative and pre- • Extent of caries. Are the teeth restorable?
ventive care obviates the need for extraction of primary teeth under • Impact that either option will have not only on developing dentition
general anaesthesia, a practice which should have only a small place but child’s long-term well-being.
in the dental care of young children. In addition, in a developing child, • When all primary molars are involved, give consideration to restor-
the dentist has the task of monitoring the dentition, diagnosis and ing the second and extraction of the first primary molars.
management of anomalies as well as having a knowledge of medical Each treatment plan should be tailor-made for the child. For some
conditions and the provision of safe restorative care for children. children, comprehensive restorative care using one of the behavioural
approaches is appropriate. For others extraction of some primary teeth
Philosophy of treatment planning and restoration of the others with local analgesia (LA) or general
• Gain the trust and cooperation of the child. anaesthesia (GA) is more appropriate.
• Make an accurate diagnosis and devise a treatment plan appropriate
to the child’s need. Management strategy – LA, LA with sedation or GA?
• Comprehensive preventive care. Most children are amenable to behaviour guidance. However, when
• Deliver care in a manner the child finds acceptable. planning treatment, the child’s well-being, and also the impact that
• Use materials and techniques which provide effective and long- multiple visits of invasive treatment under local analgesia might have
lasting results. on the child’s future behaviour and attitude towards dental treatment
should be considered. Access to good GA facilities is essential.
History
This should include medical history, social history, history of the
Preventive strategy
present complaint and the past dental history. What were the
Depending on the caries risk, a preventive strategy is devised.
“likes” and “dislikes” of the child at previous dental visits? In addition,
parents’ assessment of the previous and expected child’s behaviour
Choice of materials
is useful.
This depends on tooth to be restored, past caries history and coopera-
tion of the child. An important consideration in children is that the
Examination
tooth should only need restoring once. In very young children where
• A good examination using tell–show–do, including charting for
a restoration is required to last 4–5 years, due consideration should be
teeth present and caries, including areas of early decalcification.
given to the use of stainless steel crowns.
• Any missing teeth.
• Gingival health. Developmental anomalies
• Developmental defects.
Formulate a short-, medium- and long-term plan.
• Tooth surface loss.
• Initial occlusal assessment. Medical history and treatment planning
• Liaise with medical practitioner.
Radiographs and other investigations
• Understand the impact of the medical condition on the provision of
Appropriate radiographs such as bitewings or OPG (Chapter 10) or treatment.
any other special tests such as pulp sensibility tests. In the following chapters all the aspects that play a role in the manage-
ment of children’s oral and dental health are discussed.
Diagnosis
In children the diagnosis needs to encompass two aspects:
• diagnosis of the dental/oral condition;
• the child’s behaviour and the behavioural approach likely to succeed
in provision of the treatment.
Planning treatment for children  Chapter 1  7
2 Growth and development
Table 2.1 Growth period. Lowrey’s classification (1973).
Growth period Chronological age
Prenatal Conception to birth (40 weeks)
Infancy Birth to 2 years
Early childhood (preschool) 3–6 years
Toddlers – second and third year
Play stage – 4–6 years
Late childhood (prepubertal) 7–12 years
Puberty age range for girls 10–14 years, puberty
age range for boys 12–16 years
Adolescence 13–20 years
Table 2.2 Disturbances in prenatal development.
Genetic disturbances Environmental disturbances
Chromosomal: Down syndrome, chromosome 18 Medication: thalidomide
Polygenic (several genes), e.g. cleft lip/palate Maternal infections: rubella, toxoplasmosis
Monogenic (single gene), e.g. enzyme deficiencies, X-ray radiation
amelogenesis imperfecta, chondrodysplasia, some Anorexia
craniofacial syndromes Maternal malnutrition
Maternal alcoholism
Table 2.3 Disturbances in postnatal development.
Primary Secondary
Skeletal dysplasias – 100 disorders where genetic damage or Malnutrition: if prolonged and severe. Poverty and poor nutrition. Emotional and physical
defect to skeletal system abuse
Chromosomal aberrations/disorders, e.g. Down syndrome, Systemic and metabolic disorders, e.g. coeliac disease, cystic fibrosis, chronic renal
Turner’s syndrome disease
Congenital errors of metabolism, e.g. mucopolysaccharidoses Deprivation dwarfism (psychosocial growth retardation), caused by disturbances in
(genetic conditioned failures in the intercellular substance in emotional contact between child, parents and environment
the connective tissues), Hunter syndrome, Hurler syndrome Endocrine disorders: growth, sex or thyroid hormone deficiency, hypothyroidism
Miscellaneous syndromes. Unknown aetiology but seen at birth Constitutional growth delay and puberty (normal variant): children with delayed skeletal
Genetic short stature (familial) maturity. They tend to have delayed growth and sexual maturation but their final
height will be normal
Paediatric Dentistry at a Glance, First Edition. Monty Duggal, Angus Cameron and Jack Toumba. © 2013 John Wiley & Sons Ltd. Published 2013 by Blackwell Publishing Ltd.
8  Chapter 2  Growth and development
Development of the nasomaxillary  • Chronological age.
complex • Neurological age.
• Grows downwards and forwards relative to the cranial base and • Morphological age.
greatest during pubertal growth spurt. • Skeletal age.
• Areas near sutures found at maxilla and cranial base have bone • Mental age.
deposition as brain grows and soft tissue of face forms. • Secondary sex characteristics.
• During pubertal growth spurt, facial skeleton growth starts and is • Dental age.
almost completed at age 15.5 years in girls and later in boys.
Methods of monitoring somatic growth
Mandibular growth • Length/height.
• Greatest during pubertal growth spurt. • Weight.
• Growth of mandible coordinates with growth of maxilla and cranial • Head circumference.
base in forward and downward direction (translation of the mandible). • Behavioural milestones.
• Bony deposition at ramus and in condyles allows mandible to grow • Dental age.
downwards and forward. Height and weight are usually monitored using standard growth charts.
• Mandibular condylar cartilage (reactive growth site) is involved in For height the most common one used is height velocity chart and for
bone formation with cartilage proliferation and its replacement by weight the BMI-for-age chart.
bone.
Dental age – why is it important?
Tooth development Dental age correlates well with chronological age. It is important for
Teeth start to form very early on, around the 5th week of the embryo. dentists to have a knowledge of growth and development, especially
The dental lamina gives rise to epithelial buds that then differentiate of the dentition, for the following reasons:
into the tooth germ, within which reside the cells for the development • tooth eruption sequence is important – if any problems with the
of the various tooth structures. The odontoblasts form dentine and occlusion occur, it is important to check whether the eruption sequence
ameloblasts form the enamel. The epithelial structure known as the is correct, especially in cases where teeth might be developmentally
root sheath of Hertwig arises from an apical migration of the epithelial absent;
cells at the cervical loop of the enamel organ and is responsible for • tooth emergence dates are used in orthodontics for timing of
the development of the roots of the teeth. treatment;
• timing of fluoride supplements (systemic fluoride) depends on the
Tooth eruption dental age (prevention advice);
Eruption times for the primary teeth (in months) • stages of development are important when considering loss of the
Lower central incisor: 7–8 permanent first molars;
Upper incisors: 10–11 • stage of apical development in incisors is important in cases of
Upper lateral: 11 trauma to monitor pulp healing.
Lower lateral: 13 It is also important for paediatric dentists to understand the difference
First primary molars: 16 in growth between males and females to help in the management of
Canines: 19 the developing dentition and provision of interceptive orthodontic
Second primary molars: 27–29 care:
• growth in height between boys and girls is almost parallel up to age
Eruption times permanent dentition (in years) 10 years;
First molar and lower central incisor: 6 • in girls, age 11–13 years, female oestrogens causes rapid growth and
Upper central and lower lateral incisors: 7 bony epiphyses uniting at age 14–16 years;
Upper lateral incisor: 8 • in boys, testosterone causes later prolonged growth (age 13–17
Lower canines and first premolars: 10 years).
Upper canine and second premolars: 11 Disturbances in prenatal and postnatal development are shown in
Second molars: 12 Tables 2.2 and 2.3.
Third molars: 16 onwards
Methods of assessing growth
The growth periods as described by Lowrey (1973) are shown in
Table 2.1.
Growth and development  Chapter 2  9