1 special considerations for oral surgey in pediatric patients
TRANSCRIPT
SPECIAL CONSIDERATIONS FOR ORAL SURGEY IN PEDIATRIC PATIENTS
OBJECTIVES
• Background• Conditions that occur in pediatrics• Treatment
BACKGROUND
• Preoperative evaluation: – History of presenting complaint– Medical history– Dental history– Examination
• Behavioral management
Growth and Development
• Injuries may have adverse effect to growth• E.g. Injuries to the mandible:– Ankylosis• Limited mandibular functions• Restricted growth
• Surgery for acquired/congenital anomalies may tamper with growth.– Cleft Palate repairs cause palatal scarring resulting
in maxillary constriction
Maxillofacial Infections
• Vary according to age:– < 5 yrs Upper face infections: non-odontogenic – >5 yrs lower face infections : odontogenic
Treatment• Non-odontogenic infections: Broad spectrum
antibiotics and hydration• Odontogenic infections: Antibiotics, hydration,
drainage, treat underlying dental pblm
Impacted Teeth
Impacted Canines• 2nd most impacted tooth• Treatment is by extraction of the primary
canine (normal space and no incisor resorption)
• No improvement in canine position in a year, surgical and orthodontic treatment
Supernumerary Teeth
• Mesiodens • Most common supernumerary• Treatment– No surgery for non-erupting primary mesiodens
(damage to succedeneous tooth)– Mixed dentition extract the mesiodens ensure
2/3rd of root formation of incisor– Allow erupted primary mesiodens to shed
Mesiodens
Pediatric Oral Pathology
• Epstein’s pearls – Found in the median palatal raphe area– Due to trapped epithelial remnants along the line of fusion
of the palatal halves.• Dental lamina cysts,
– Found on the crests of the dental ridges, most commonly seen bilaterally in the region of the first primary molars.
– From remnants of the dental lamina. • They are both asymptomatic 1 mm to 3 mm nodules.
Smooth, whitish in appearance, and filled with keratin.
Epstein Pearl and Dental Lamina Cyst
Treatment:• Reassure parents •Disappear during the first 3 months of life.
• Congenital epulis of the newborn/ granular cell tumor / Neumann’s tumor, – Rare benign tumor seen only in newborns. – Protuberant mass arising from the gingival
mucosa. – Found on the anterior maxillary ridge.– Patients typically present with feeding and/or
respiratory problems.– Treatment: surgical excision.
Neumann’s tumor
• Eruption cyst (eruption hematoma)– Soft tissue cyst that results from a separation of
the dental follicle from the crown of an erupting tooth.
– Fluid accumulation occurs within this created fol-licular
– Most commonly found in the mandibular molar region.
– Color range from normal to blue-black or brown
Eruption Cyst
Difference from hemangiomas• Hemangiomas may undergo a rapid growth phase in the first year of life but then regress spontaneously.• Eruption cysts resolve with eruption of the tooth.
Natal and Neonatal Teeth
• Natal teeth: teeth present at birth• Neonatal teeth: erupt during the first 30 days
of life• Teeth most affected:mandibular primary
incisors.• In most cases they are part of the normal
complement of the dentition
• Treatment– Reassure parents– Preserve and maintain in a healthy condition unless excessively
mobile or causes feeding problems– Monitor Closely
Riga-Fede disease• Caused by the natal or neonatal tooth rubbing the ventral
surface of the tongue during feeding leading to ulceration. • Treatment :
– conservative :Create round, smooth incisal edges– If it does not correct: extraction is the treatment of choice to
avoid ‘failure to thrive’
Riga-Fede disease
REFERRENCES
• AAPD. Guideline on Pediatric Oral Surgery. Reference Manual. 2010. 34:6;264-271.
• AAOMS. Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgery. Journal of Oral and Maxillofacial Surgery. 2012.
• Cawson R.A. and Odell E.A. Essentials of OralPathology and Oral Medicine. 7th Edition. Churchill Livingston Publishers. 2002.
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