Cameron Angus C. - Paediatric Dentistry at a Glance

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Paediatric Dentistry at a Glance

Monty Duggal, Angus Cameron, Jack Toumba

978-1-4443-3676-4

This edition first published 2013

2013 by John Wiley & Sons Ltd.

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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 ChildrenHandbooks. 2. ChildHandbooks. 3. Tooth Diseases

Handbooks. WU 49]

617.6'45dc23

2012015790

A catalogue record for this book is available from the British Library.

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Cover image: courtesy of the authors

Cover design by Meaden Creative

Planning Treatment for Children

Dentists who treat children are in a unique position not only to provide dental treatment when required, but to influence the future behaviour, attitudes to oral health and attitude towards dentistry in general. Children deserve the highest quality care and highest quality restorative dentistry should be provided to them, supplemented with rigorous prevention. Prevention of dental caries in children should be a priority but sadly nearly half of 5-year-olds, even in developed countries, still develop dental caries. A non-interventionist approach, as has been advocated in some countries such as the UK, or poor restorative patchwork dentistry, is doomed to failure and only leads to pain, infection and suffering in children, requiring more invasive interventions. These are traumatic and expensive and negatively influence the childs future behaviour and attitudes to dentistry. Good restorative and preventive care obviates the need for extraction of primary teeth under general anaesthesia, a practice which should have only a small place in the dental care of young children. In addition, in a developing child, the dentist has the task of monitoring the dentition, diagnosis and management of anomalies as well as having a knowledge of medical conditions and the provision of safe restorative care for children.

• Gain the trust and cooperation of the child.
• Make an accurate diagnosis and devise a treatment plan appropriate to the childs need.
• Comprehensive preventive care.
• Deliver care in a manner the child finds acceptable.
• Use materials and techniques which provide effective and long-lasting results.

This should include medical history, social history, history of the present complaint and the past dental history. What were the likes and dislikes of the child at previous dental visits? In addition, parents assessment of the previous and expected childs behaviour is useful.

• A good examination using tellshowdo, including charting for teeth present and caries, including areas of early decalcification.
• Any missing teeth.
• Gingival health.
• Developmental defects.
• Tooth surface loss.
• Initial occlusal assessment.

Appropriate radiographs such as bitewings or OPG (Chapter 10) or any other special tests such as pulp sensibility tests.

In children the diagnosis needs to encompass two aspects:

• diagnosis of the dental/oral condition;
• the childs behaviour and the behavioural approach likely to succeed in provision of the treatment.

Diagnosis should be specific. For example, a diagnosis dental caries in itself is incomplete as it does not specify the reason the child has dental caries. The root cause of the problem cannot be addressed unless a specific diagnosis is made.

An example of a treated case and the step-by-step treatment plan is shown is respectively. When managing caries in children this should relate to:

• prognosis of the affected teeth;
• childs behaviour and likely acceptance of the treatment.

Intra-oral view showing the carious upper (a) and lower (b) primary molars.

Bitewing radiographs showing extent of caries.

Intra-oral view showing upper (a) and lower (b) arches at the end of treatment.

Postoperative radiographs of the treated case.