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PRE-CLINICAL PEDIATRIC DENTISTRY
DSV 342 The practical importance of pediatric dentistry
4
Updated:26/1/2012
Saturday 18/2/2012
1:00 pm-2:00 pm
Tuesday, November 11, 2014 1 OTHMAN AL-AJLOUNI
The practical importance of pediatric dentistry (Pinkham, Ch.1, Pg. 1)
• Historical perspective.
• Application of other disciplines.
• Challenges for pediatric dentistry in the 21th century.
• Child abuse and neglect, children of poverty.
• Informed consent and risk management technology.
• Heath care delivery strategies/payment strategies.
• Emergence of pediatric dentistry as a worldwide community.
Tuesday, November 11, 2014 2 OTHMAN AL-AJLOUNI
PRE-CLINICAL PEDIATRIC DENTISTRY
DSV 342 The practical importance of pediatric dentistry
(Pinkham, Ch.1, Pg. 1) Historical perspective. Application of other disciplines.
Challenges for pediatric dentistry in the 21th century. Child abuse and neglect, children of poverty. Informed consent
and risk management technology. Heath care delivery strategies/payment strategies. Emergence of pediatric
dentistry as a worldwide community.
Professor Othman Al-Ajlouni Salman Bin Abdul Aziz University
Saturday 28/1/2012 1:00 pm-2:00 pm
Tuesday, November 11, 2014 3 OTHMAN AL-AJLOUNI
Introduction and course requirements
• Course description,
• course objectives,
• text books,
• attendance,
• grading criteria,
• didactic and laboratory projects outline.
• introduction and course requirements
Tuesday, November 11, 2014 4 OTHMAN AL-AJLOUNI
Introduction and course requirements
Course description
• This is a two credit hour made up of didactic and laboratory technique as introduction to pediatric dentistry. The course holds in the second half of the third year.
• The primary goals of pediatric dentistry include the diagnosis and prevention of disease, the preservation of the natural dentition and the restoration of health, function and esthetic of stomatognathic system. The lectures will cover all these topics.
Tuesday, November 11, 2014 5 OTHMAN AL-AJLOUNI
Introduction and course requirements
Course description
• The primary function of the laboratory is the development of psychomotor skills of the dentist. The psychomotor skills must be highly developed in order to provide quality care of the children.
• Due to the high degree of skill required, disappointments and frustrations may occur during the process of learning and development. Some students, for example, will need to repeat various projects. However, the pre-clinical laboratory is the place where mistakes can occur without damage to the patient, and where skills can be developed to a high level of proficiency.
Tuesday, November 11, 2014 6 OTHMAN AL-AJLOUNI
Introduction and course requirements
Course description
• In order to maximize the benefits of each laboratory session, students will be expected to study the laboratory manual preparation for each project.
Tuesday, November 11, 2014 7 OTHMAN AL-AJLOUNI
Pediatric Dentistry Training Module
Training and Calibration Guidelines
for The College of Dentistry, Salman Bin Abdul Aziz University
Updated : 16/1/2o12
Preclinical Exercises
Preclinical Pediatric Dentistry Preclinical Exercises
The following procedures shall be carried out by students in the Phantom Head Laboratory on ivories or natural teeth:
• Occlusal cavity for amalgam on #54
• Occlusal cavity for amalgam on #84
• Occlusal-lingual (OL) #55
• Mesio-occlusal (MO) #65
• Mesio-occlusal (MO) #85
• Disto-occlusal (DO) #74
• Rubber dam isolation Demonstration
Preclinical Pediatric Dentistry Preclinical Exercises
• Rubber dam isolation Demonstration • Forming and placing T-band matrix • Amalgam restoration: condensing, carving, burnishing and
finishing • Fluoride gel application Demonstration • Fissure sealant (permanent molar) Extracted tooth • Preventive resin restoration Natural permanent
molar/premolar • Stainless steel crown preparation #75 or #85 and #64 • Pulpotomy (primary molar) Extracted natural tooth • Composite crown (anterior strip) #52 or #62 • Extraction technique in children Demonstration • Space maintainer Demonstration (band
selection and adaptation)
Preclinical Pediatric Dentistry Preclinical Exercises
• #J – OL/L amalgam
• #S – Do and #T MO amalgam
• Adaption of a T-band for class II preparation
• #K – SSC, #L – DO composite
• #A – SSC, #B – pulpotomy and SSC
• #F – strip crown
• #E – SSC
Preclinical Exercises
#J (55) OL/L amalgam
Preclinical Exercises
#S(84) DO and #T (85) MO amalgam
Preclinical Exercises
Adaption of T Band for Class II restorations
Preclinical Exercises
Adaption of T Band for Class II restorations
Preclinical Exercises
#J OL/L
amalgam #S DO and #T MO
amalgam
Adaption of T Band for Class II
restorations
Preclinical Exercises
#K(75) SSC, #L(74) DO Composite
Preclinical Exercises
#F Strip Crown
Preclinical Exercises
#A SSC, #B Pulpotomy/SSC
Preclinical Exercises
#E SSC
Incisal/Lingual reduction for 1 mm clearance
Interproximal reduction to allow for close adaption
Similar to strip crown without a groove
Preclinical Exercises
#K SSC, #L DO
Composite #A SSC, #B
Pulpotomy/SSC
#F Strip Crown
#E SSC
Incisal/Lingual reduction
for 1 mm clearance
Interproximal reduction to
allow for close adaption
Similar to strip crown
without a groove
Preclinical Exercises
#K SSC, #L DO
Composite #A SSC, #B
Pulpotomy/SSC
#F Strip Crown
#E SSC
Incisal/Lingual reduction
for 1 mm clearance
Interproximal reduction to
allow for close adaption
Similar to strip crown
without a groove
Daily Clinical
Protocols
Daily Clinical Protocols
• Students expected to arrive on time in the Pediatric clinic.
• All patients are scheduled by the Pediatric clinic assistant and students are not assigned pediatric patients to their family of patients.
• The students should thoroughly review the chart prior to treatment.
• The faculty hold seminars and discuss Tx planning, behavior management, charting and Tx sequencing among other topics.
Daily Clinical Protocols Examination:
• Medical and dental Hx.
• Evaluation of hard and soft tissues.
• Radiographs are based upon individual need and taken only when a diagnostic yield is expected.
• Caries Risk Assessment.
• Occlusal analysis and need for orthodontic assessment.
• Other specialty consultations are requested, if needed.
Daily Clinical Protocols
Tx Plan Formulation:
• “Worst first” approach
• Quadrant dentistry/arch dentistry
• Selective non-invasive procedures introduce the patient to the dental environment
• Caries Risk assessment and Preventive follow-up
Daily Clinical Protocols
Behavior Management:
• Tell, Show, Do
• Positive Reinforcement/Ignoring Negative
• Nitrous Oxide
• Voice control
• Modeling
• Distraction
• Papoose board used as needed – parents may or may not be in the operatory during procedures
Daily Clinical Protocols
Materials:
• Local Anesthetics – Lido 2% with epi (max single dose 4.4 mg/kg/2mg/lb [300 mg], septo 4% w/ epi
• Amalgams – Dispersalloy
• Composites – Dyract, Esthet-X micro hybrid and composite, Clinpro Sealant
• Matrix and Wedging – T bands, Palodent matrix, Tofflemier matrix bands
Daily Clinical Protocols Stainless Steel Crowns:
• Occlusal reduction, interproximal and B/L reduction to allow for proper adaption of the crown
• 1 – 1.5 mm of occlusal clearance and no cervical ledge to prevent seating
• Use 6888-012 flame diamond and 909-040 wheel diamond, 330 and 169L
• Adapt 3M Ion primary molar crowns
• Crimping pliers/Howe pliers for contouring
• Cement with glass ionomer luting cement
Daily Clinical Protocols
Pulp Therapy for Primary/Immature Permanent Teeth:
• Protective base – Fuji GI liner
• Indirect pulp cap
• Direct pulp cap (permanent only) MTA or CaOH
Daily Clinical Protocols
Pulpotomy Primary:
• Access pulp chamber – 330 or 169 carbides
• Remove pulp tissue - #4 or #6 round burs
• Formocresol or Ferric sulfate to fix tissue
• IRM or Tempit in pulp chamber
• Condense wet cotton pellet or amalgam condenser
• Pulpectomy Primary – 30+ Vitapex, ZOE
Daily Clinical Protocols
Space Maintainers:
• Band and Loop
• Lower lingual holding arch
• Transpalatal arch/Nance appliance
Daily Clinical Protocols
Pediatric Burs:
• 331/2, 34, 35SS, 330, 556SS, 556, 169, 169L
• #2, #4, #6, #8 round
• 6358-023 football diamond, 6888-012 pointed tapered diamond, 909-040 wheel diamond, 6858-014 pointed taper diamond, 7901 flame carbide, 7408 football carbide
Assessment
of
Student
Performance
Pediatric Dentistry Clinical Requirements
Essential Experiences = EE
• 100 Procedures to include at least 1 space main.
• 1 Pulpotomy
• 1 SSC
Competency Assessments = CA
• 1 Pediatric Class II composite or amalgam
• 2 Case-based Tx plans – 1 comprehensive exam and 1 dental emergency exam
Faculty Assessment of Student Performance
• Faculty should consult the Clinical Procedure Guide Book (CPGB) for the clinical technical criteria for assessing each clinical procedure. Link to CPGB:
G:\Dental\CPAF's_CLINICAL GUIIDEBOOK
• On site faculty should utilize electronic CPAFs for pediatric assessment. Electronic CPAF can be accessed at:
https://asd.icedentalsystems.com/
• External site faculty should utilize the daily CPAF. Link:
G:\Dental\CPAF's_CLINICAL GUIIDEBOOK\CPAFS Versions 4.07
• Hard copy CPAF for pediatrics is also available. Link:
G:\Dental\CPAF's_CLINICAL GUIIDEBOOK\CPAFS Versions 4.07
D1351 Sealant
D1351 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1
Procedure and Surface Preparation
Appropriate sealant product selected. Tooth surface clean and free from debris
Failure to review Med and Dent Hx. Failure to clean surfaces in preparation for sealant
Inappropriate understanding of what is involved and how procedure is done
Isolation Tooth is adequately isolated to prevent contamination
Loss of isolation No isolation
Etch/rinse/isolate Tooth etched appropriately & rinsed
Incomplete etch or contamination of site
No etch
Sealant placement/cure Appropriate amount of sealant applied and allowed to cure for appropriate amount of time
Inappropriate amount, too much, too little, requiring adjustment through further care
Inability to complete procedure
Sealant adhered Sealant checked for complete adherence. Tooth restored to ideal occlusion w/o assistance
Incomplete retention of sealant material
No retention of sealant material
D2150 CL II Amalgam
D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1
Outline Form and Extension
Outline does not weaken the tooth, no demineralization
Over prepared or extended when caries and anatomy does not dictate
Grossly over prepared or extended OR Preparation of wrong tooth
Proximal & gingival extension is optimal
Optimal treatment of fissures
Oblique ridge of upper second primary or permanent molar nor transverse ridge of lower are not crossed unless undermined by caries
Proximal cavosurface angles at 90 degrees
D2150 CL II Amalgam
D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1
Internal Form Proximal walls are convergent occlusally
Over prepared or deeper than necessary
Pulpal exposure when none should have occurred
Portions of the prep that extend into the buccal and lingual grooves should slightly diverge
Pulpal floor, 1mm, free of defects, uniform depth, internal line angle slightly rounded, axio-pulpal line angle is rounded, gingival floor 1 – 1.5 mm wide – M-D
Retention features (grooves) ideally placed, if necessary
No fragile or unsupported enamel
D2150 CL II Amalgam
D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1
Operative Environment Rubber dam is optimal, preparation is dry
Poorly adapted dam Failure to use dam
Adjacent tooth contact is not damaged
Amalgam material is handled in a safe manner
Matrix band and wedge used appropriately
Anatomical Form Restores harmonious form of existing tooth
Proximal contour returns proper shape and position
Optimal contact will allow lightly waxed floss to pass with proper resistance
D2150 CL II Amalgam
D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1
Margins No excess or deficiency at any margin
Excessive or deficient margin that can be improved without new restoration
Excessive or deficient margin that requires new restoration
Finish, Function & Damage
Smooth surface, no pits, voids or irregularities
Damage to adjacent tooth which is noted but is managed with minimal involvement
Damage to adjacent tooth causing loss of tooth structure and necessitating a restoration
Examples of CL II Amalgam Preps
Proximal walls are convergent
occlusally,
portions of the prep extend into buccal
and lingual grooves,
pulpal floor is flat and uniform depth,
gingival floor is 1 – 1.5 mm wide
mesiodistally.
Acceptable
Examples of CL II Amalgam Preps Assuming a small
interproximal lesion, just
inside the DEJ. The size
and axial depth of the box
would rate this Improvable.
If there was a pulpal
exposure, it would be
Unacceptable
Introduction and course requirements
course objectives
Upon completion of this course, the student should be able to:
1. Understand the basic morphologic application of cavity preparation in primary teeth.
2. Gain the knowledge of matrix systems, amalgam and composite resin manipulation, stainless steel crown restoration as related to primary teeth.
3. Understand the technique and indications for pulpotomy.
Tuesday, November 11, 2014 45 OTHMAN AL-AJLOUNI
Introduction and course requirements
course objectives
4. Utilize the sealant system as a preventive measure against caries.
5. Predict possible crowding problems and to utilize the space maintainer as a preventive measure against malocclusion.
6. Acquire such psychomotor skills as to be able to treat a child by carrying of simple procedures in the clinic without any inhibitions.
Tuesday, November 11, 2014 46 OTHMAN AL-AJLOUNI
Introduction and course requirements
Recommended Textbooks
• Every student is required to purchase the Recommended Textbooks.
• Lectures will be given from these books,
• students are required to read the assigned chapters for every lecture.
• The lecture may not cover everything.
• Examination will be from the lectures and respective chapters in the textbooks.
Tuesday, November 11, 2014 47 OTHMAN AL-AJLOUNI
Introduction and course requirements
attendance
• Students MUST attend all lectures and laboratory exercises, and be ON TIME.
• Student who fails to attend a lecture/lab., he must report to COURSE DIRECTOR the reason behind his absence.
• Any student who fails to attend 75% of lectures/laboratory exercises will not be allowed to sit for the FINAL EXAMINATION.
• No excuse whatsoever.
Tuesday, November 11, 2014 48 OTHMAN AL-AJLOUNI
Introduction and course requirements
Grading criteria
• Didactic – 40%.
• Laboratory – 60%.
• Student MUST pass both parts individually to pass the course.
• If a student passes the didactic but fails the laboratory part, or vice versa, he will not pass the course.
Tuesday, November 11, 2014 49 OTHMAN AL-AJLOUNI
Introduction and course requirements
Grading criteria
I. Didactic – 40%
The evaluation for the lecture part will be as the following:
I. I. Mid-Term Exam [Essay or/and short note questions
or/and MCQs] 15%.
I. II. Final Exam [MCQs or/and Essay or/and short note]
25%.
Tuesday, November 11, 2014 50 OTHMAN AL-AJLOUNI
Introduction and course requirements
Grading criteria
II. Laboratory – 60%.
The evaluation for the laboratory part will be as the following:
I. II. Weekly projects/Cleaning the cubicle/Behavior 25%
II. II. Quizzes 5%
III. II. Midterm Exam [specific lab procedure] 10%
IV.II. Final Exam [specific lab procedure/spot Exam] 20%
Tuesday, November 11, 2014 51 OTHMAN AL-AJLOUNI
Introduction and course requirements
didactic outline
1. The practical importance of pediatric dentistry
2. Development and morphology of the primary teeth
3. Dental caries in the child and adolescent
4. Restorative Dentistry for the primary Dentition:
• I: posterior restorations
• II: anterior restorations
• III: stainless steel crowns Tuesday, November 11, 2014 52 OTHMAN AL-AJLOUNI
Introduction and course requirements
didactic outline
5. Pulp therapy for the primary dentition
6. Local anesthesia
7. The use of rubber dam in pediatric restorative dentistry
8. Prevention of dental diseases
9. Eruption and development of primary dentition
10. Dental materials in pediatric dentistry
11. Space maintenance in the primary dentition
12. Oral habits
13. Examination of the child patient Tuesday, November 11, 2014 53 OTHMAN AL-AJLOUNI
Introduction and course requirements
laboratory projects outline
The following procedures shall be carried out by students in the Phantom
Head Laboratory on ivories or natural teeth:
1. Occlusal cavity for amalgam on #54
2. Occlusal cavity for amalgam on #84
3. Occlusal-lingual (OL) #55
4. Mesio-occlusal (MO) #65
5. Mesio-occlusal (MO) #85
6. Disto-occlusal (DO) #74
7. Rubber dam isolation Demonstration
8. Forming and placing T-band matrix
9. Amalgam restoration: condensing, carving, burnishing and finishing Tuesday, November 11, 2014 54 OTHMAN AL-AJLOUNI
Introduction and course requirements
laboratory projects outline
10. Fluoride gel application Demonstration
11. Fissure sealant (permanent molar) Extracted tooth
12. Preventive resin restoration Natural permanent molar/premolar
13. Stainless steel crown preparation #75 or #85 and #64
14. Pulpotomy (primary molar) Extracted natural tooth
15. Composite crown (anterior strip) #52 or #62
16. Extraction technique in children Demonstration
17. Space maintainer Demonstration (band selection and
adaptation)
Tuesday, November 11, 2014 55 OTHMAN AL-AJLOUNI
Introduction and course requirements
References:
1. McDonald RE, Avery DR, Dean JA. Dentistry for the child and adolescent, 8th Ed. New York, NY, 2005, Mosby.
2. Pinkham JR, Casamassimo PS, Mc Tigue DJ, Fields HW, Nowak AJ. Pediatric dentistry , infancy through adolescence, 4th ED. Philadelphia PA: WS Saunders Company; 2005.
3. Raymond L. Braham and Merle E. Morris. Textbook of Pediatric Dentistry, 2nd Ed. Baltimore. London. Loss Angeles. Sydney,1985, Williams & Wilkins.
4. R. S. Andlaw, W.P. Rock. A Manual of Pediatric Dentistry, Churchill Livingstone,1998.
Tuesday, November 11, 2014 56 OTHMAN AL-AJLOUNI
Introduction and course requirements
5. Angus C Cameron and Richard P Widmer. Handbook of Pediatric Dentistry.
3rd Ed, 2008, Elsevier Limited.
6. Welbury ,R.R..(2001) Paediatric Dentistry . 2nd edition. Oxford University
Press, London.
7. Related Articles will be distributed.
8. Main internet resources:
9. American Academy of Pediatric Dentistry Policies and Guidelines
10. www.aapd.org
Tuesday, November 11, 2014 57 OTHMAN AL-AJLOUNI