Introduction

Nermin Khalaf

Ghazala Alghali

1 - 5 - 2015

1

pg. 1

Pediatric Dentistry

In this lecture we are going to go through the topics we will take this semester and then a small introduction about our course . We all know that children need special management in clinical treatment different than the one we use with adults . In our first clinic we discussed how we are going to deal with a child , how to communicate , examine and take history … etc . We always need to be patient when dealing with a child patient and try to manage his behavior (This should be our Prime aim ) . Always be relaxed and never anxious specially when the patient is not cooperative , because this is a normal attitude for children , so you have to interact with the child reaction to the dental clinic , specially with the children who are visiting the dental clinic for the first time because it’s a new environment for them . And those who had a previous bad experience in dental clinics before are a little bit difficult to interact with or manage ,so you have to be carful and take it slow . Deal with your case as it should be and Ask your supervisor !

INSTRUCTIONS :

Please remember the following; your mark will be reduced if they are breached:

1. Wear gown(CLOSED & CLEAN) , shoes covering whole foot, glasses, mask and gloves for EVERY procedure. 2. Seating patient in supine position for dental treatment EXCEPT for fluoride gel application (seat in upright position) and seating for dentist must be in 12:00 o'clock position. WHY ?because your patient might be/become uncooperative due to painful procedure and suddenly move or leave the chair so its easier to control him when you are sitting . 3. Use of rubber dam unless decided impossible by demonstrator.(If it’s not available use cotton roll isolation) 4. Needles: never show needle to patient, re-cap appropriately, place in kit

pg. 2

cover after finished . 5. Bench: divide into clean and dirty areas, placement of kit 3 cover in dirty area. 6. No touching drawers and handles or anything with dirty gloves. 7. Disinfection of impressions: wash with water and clean with disinfectant on bench then, in NaOCL solution for 10 min . 8. Document everything in the patients chart. 9. Prepare everything you need before starting any procedure.( instruments, gauze, cotton rolls…etc) DO NOT reach to the drawer with dirty gloves suddenly. 10. Cases/ discussions will be available for whoever doesn’t havea patient and will be considered as a bonus if requirements are finished . 11.Wash hands IMMEDIATELY after taking off your gloves , clean your clinic and put everything in its place clean & sterile .

Contents :

Now lets start our first lecture …

pg. 3

Prevention I

Prevention is the most important job for us as a dentist and if we cant prevent these diseases then we are doing nothing to our patients .so its important to know that our aim is to prevent disease rather than treating them .

Aspects of Prevention of caries :

• Oral Hygiene Instructions . • Diet advice . • Fluoride . • Fissuresealants . • Chemotherapeuticagents .(ex. mouthwashes) • Vaccines .(stillunderresearch) • Recalls:Regularcheck-up.

Oral Hygiene Instructions (OHI):

OHI is maintained by a lot of means :

1.Tooth brush: Manual or Powered. (the most important one)

2.Tooth paste .

3.Mouth washes . (spically for the elderly)

4.Dental Floss.

5.and there’s some other not common methods that can be used with children .

pg. 4

Tooth brushes :

-studies shows no difference between the manual and powered tooth brushes the only thing that the powered one is indicated for the handicapped patients specially the physically handicapped. Otherwise you can use both and they have the same effect if you use it in a correct way .

Types of tooth brush is determined according to :

- Size: Small which can accommodate the child mouth opening , medium and large sizes for the adult uses.

- bristles: soft, medium & hard. (the doctor recommended us to read more about it so check out this link I think it’s helpful : http://www.midtowndentalspecialists.com/types-of-toothbrush-bristles-to-know-for-better-dental-hygiene/ )

- Handles: small or large according to the ages.

- Technique: which technique is suitable for children to use ?

- Frequency: for how long he/she should clean his mouth?, how many times per day ?

We always have to Motivate ,Educate patients and theirparents and Demonstrate things in front of them so they can do it in the proper way use models or mirrors , and after you give him the week program demonstration for tooth brushing, next visit you can Assess the oral hygiene and he/she have to show you how he/she cleaned his/her teeth to make sure that he/she learned it , because if it’s done wrong there will be accumulation of food and plaque formation and therefore tooth decay .

pg. 5

Infant:

Before teeth erupt, caregivers should wash the gums and tongue with a wet washcloth/gauze after feedings or use a special instrument that looks like a fingertip which is available in the pharmacies .

You can used normal saline which is available in pharmacies or you can prepare it at home with very minimum amount of salt .

With eruption of the first tooth , begin brushing with soft-bristled , small-

head brush . Its important to start cleaning the teeth as soon as they erupt to control

any caries formation from the beginning . Smear layer of tooth children tooth pastes . The most important time to brush is at night, after the last feeding. Parents should brush the child’s teeth at least twice a day (morning and

night) by 1 year of age. Children should not be allowed to consume any sugary liquids such as

milk or juice after brushing at night (water only). And as for the newly born babies with different patterns of eating and

sleeping , it’s important to always wash the ridges of the infant with water after feeding him at the middle of the night .

Children: Use small, soft, multi-tufted nylon bristles, according to the age

..previously they used other types of bristles with different shapes but

pg. 6

nowadays they only use nylon ones … you have to use small size of toothbrush until the age of 5 to accomdate the child mouth size and prevent any damage to the gingiva .

Notice the technique of brushing with the blisters of the brush in a 45

degree angle with the teeth to make sure it reaches all the gingival tissue surrounding the teeth using gentle forces to prevent unnecessary bleeding .

Tooth brushing should be performed or assisted by the parent until the child is 7-9 years of age; Still they don’t have the dexterity to clean the teethproperly.

Tooth brushing should be supervised thereafter until the child can do an adequate job of brushing alone. Caregivers should position themselves behind the child.

All the surfaces of every tooth should be brushed. Caregivers should lift the lip to brush the top gum line, pull down the lip

to brush the bottom gum line, and brush the top of all the molars. brush teeth twice a day . The number of brushing is at least after meals

and before going to bed.(Simmons et.al 1983) Electric types have no clear advantages over manual types(Owen,1972) The techniques of brushing is not critical as long as the child regularly

cleans the teeth. Children usually miss cleaning the lingual surfaces and the side of handedness. The child should taught the method most comfortable to him usually horizontal technique, (Mac Gregor 1978)

always keep in mind that sometimes the child is so young that he/she can’t understand you so you have to explain everything( type of

pg. 7

toothbrush , type & amount of toothpaste ,technique ) to the caregiver to help the child brush his teeth in the correct way .

TheAAPDrecommendsusingonlysoft-bristled toothbrushes. Also, remember to throw out a toothbrush after 3 months or sooner if the bristles are fraying due to using hot water or chewing . Frayed bristles can harm the gums and are not as effective in cleaning teeth.

Diet Advice : The main cariogenic cause according to the etiology of the dental caries .

pg. 8

Aim of the diet plan : • Limitation of sugar and sweet intake .

• Rational: Identifying the cariogenic foods in the diet with emphasis on the frequency of consumption and retentiveness of the food, making appropriate substitutes and providing follow-up evaluation for reinforcement.(Nizel 1972b)

Always keep in mind that our concern is the frequency rather than the quantity , but that doesn’t mean that quantity isn’t important .

there is a lot of food charts lately so you should rely on the one that is suitable for the patient you are treating , for example if he has certain diseases like DM or allergies . there is also different ones according to certain communities , different age groups … etc .

Counseling should include information to parent on role of sugar in caries process in form of printed or verbal information, keeping a dietary and assessment of the child’s diet and implementing realistic achievable changes.

Make sure you explain everything to the child and his caregiver in a language that they understand .

pg. 9

Advice should focus on:

Reducing the frequency of cariogenic food and drinks intake. Confining cariogenic food to mealtimes, Substituting cariogenic snacks with anti-cariogenic snacks such as:

eggs, cheese (cheddar, mozzarella)

Peanuts and walnuts, other fats and proteins. (Tinanoff 1995)

Diet sheet Form

You have to select 3 different days and write down whatever he is eating during these days .( breakfast , lunch , dinner , and between meals )

pg. 10

thissecond page is for you to assist the patient and give him instructions on what to avoide or what to eat .

-slides are included , the doctor stopped at slide number 25 .. -please forgive us for any mistakes and let us know if you find any .

Best of luck “Don’t say you don’t have enough time .. You have exactly the same number of

hours per day that were given to Helen Keller, Pasteur, Mother Teresa, Leonardo da

Vinci, Thomas Jefferson, and Albert Einstein “

“The difference between ordinary and extraordinary is that little extra”

So use your time wisely and be Extraordinary !

Your college : Nermin Khalaf .

Reviewed by :YahyaMasalha .