Pediatric Dentistry I Forth Year

1. 1
Preventive measure
Preventive measure taken to prevent development of any condition or
impairment of dental health to the child so it focused on three
essential aspects:-
1. Caries control
2. Maintenance of periodontal integrity
3. Prevent the developing malocclusion
4. Preventive orthodontics requires a continuing long range
approach.
5. During primary dentition period child should be observed &
closely supervised for evidence of incipient problems of
abnormal symmetry or occlusion
6. Many unpredictable factors can affect the management of the
developing dental arch & minimize the overall success of any
treatment.
Preventive orthodontics
1. The dentist must aware of normal development of occlusion
during primary & mixed dentition.
2. know the development of dentition & sequence of eruption of
teeth
3. Accurate & periodic oral examination of child to diagnosis any
defect in the teeth or dental arch.
4. Examination of soft tissues like frenum, tongue, tonsils.
5. Early diagnosis of incipient caries by periodic cheek up using
bite wing film
6. Preservation of arch length by accurate restoration of proximal
contact areas using T band with wedge & good amalgam
restoration.
7. Detection of any speech defect.
8. Detection of breathing way of the patient.
9. Examination of the swallowing mechanism.
10.Detection of any beginning of oral habit.
11.Prevent early loss of primary dentition.

2. 2
12.Replacement of early loss of primary teeth by space
maintainers.
13. Detection of retained deciduous tooth.
14.Detection of congenital missing teeth.
15.Detection of jaw movement.
Eruption of primary teeth
Root
Completed
EruptionHard Tissue Formation
Begins
Tooth
Maxillary
1 ½ yr 7 ½ mo 4 mo in utero Central Incisor
2 yr 9 mo 4 ½ mo in utero Lateral Incisor
3 ¼ yr 18 mo 5 mo in utero Cuspid
2 ½ yr 14 mo 5 mo in utero First molar
3 yr 24 mo 6 mo in utero Second molar
Mandibular
1 ½ yr 6 mo 4 ½ mo in utero Central Incisor
1 ½ yr 7 mo 4 ½ mo in utero Lateral Incisor
3 ½ yr 16 mo 5 mo in utero Cuspid
2 ½ yr 12 mo 5 mo in utero First molar
3 yr 20 mo 6 mo in utero Second molar

3. 3
Causes of early tooth loss
1. Extraction resulting from caries
2. Trauma
3. Endocrine disorders
Diabetes
Hypophosphatasia
4. Immune disorders
Neutropenia
Neutophil defects
Interleukin 1 abnormalities
HIV infection
5. Miscellaneous
Ehlers Danlos syndrome type VIII
Eosinophilic granuloma
Causes of delayed tooth eruption
1. Endocrine disorders
• Hypothyroidism
• Calcium/phosphorus metabolism problems
• Hypopituitarism
2. Genetic disorders and bone disorders
Ectodermal dysplasias
• Down syndrome
• Cleidocranial dysplasia
• Gaucher disease
• Osteoporosis
3. Local factors
• Tooth in path of erupting tooth,
insufficient space, impacted teeth
• Dental infection
• Radiation therapy

4. 4
Chronology of the permanent dentition
Root CompletedEruptionHard Tissue Formation
Begins
Tooth
Maxillary
10 yr7-8 yr3-4 moCentral Incisor
11 yr8-9 yr10-12 moLateral Incisor
13-15 yr11-12 yr4-5 moCuspid
12-13 yr10-11 yr1 ½ - 1 ¾ yrFirst Bicuspid
12-14 yr10-12 yr2 – 2 ¼ yrSecond bicuspid
9-10 yr6-7 yrat birthFirst molar
14-16 yr12-13 yr2 ½ - 3 yrSecond molar
Mandibular
9 yr6-7 yr3-4 moCentral Incisor
10 yr7-8 yr3-4 moLateral Incisor
12-14 yr9-10 yr4-5 moCuspid
12-13 yr10-12 yr1 ¾ - 2 yrFirst Bicuspid
13-14 yr11-12 yr2 ¼ - 2 ½ yrSecond bicuspid
9-10 yr6-7 yrat birthFirst molar
14-15 yr11-13 yr2 ½ - 3 yrSecond molar

5. 5
Causes of delayed tooth eruption
1. Endocrine disorders
• Hypothyroidism
• Calcium/phosphorus metabolism problems
• Hypopituitarism
2. Genetic disorders and bone disorders
Ectodermal dysplasias
• Down syndrome
• Cleidocranial dysplasia
• Gaucher disease
• Osteoporosis
3. Local factors
• Tooth in path of erupting tooth,
insufficient space, impacted teeth
• Dental infection
• Radiation therapy
Normal transient developmental stages
1. The Ugly Ducking Stage
2. The Newly Erupted Lower Permanent Incisor
CARIES DETECTION METHODS
1. CLINICAL OBSERVATIONS
The oldest and most used method for the detection of caries is
visual by using probes combines to form the basic clinical
evaluation method. Today, clinicians are enhancing their vision
with magnification.
2. RADIOGRAPHIC DIAGNOSIS
Dental radiographs have been the one diagnostic tool which
dentists have used as their secret weapon.

6. 6
Dentin caries in molar tooth
The new direction of caries detection
It has taken a path towards three basic areas:-
 Electrical resistance,
 Light illumination and
 Digital imaging.
 Another useful, older diagnostic tool, risk assessment.
1. Electrical resistance measurements:-
Such as a.c. impedance spectroscopy, electrical conductance
measurements (ECMs), electrical resistance monitors;
2. Light illumination:-
Such as laser fluorescence, stereomicroscopy, fiberoptic
transillumination;
3. Strip mutans test for risk measurement, and
4. Ultrasonic imaging.
Caries prevention has also been applied in the form of:
* Use of oral hygiene
* Use of fluoride
* Pit and fissure sealants
* Diet counseling
* Prevention of extension
Examination of the breathing for the patient is done by holding a
mirror in front of both nostrils. In nasal breathers the mirror will cloud

7. 7
with condensed moisture during expiration. Oronasal or mouth
breather the alar muscles of external nares of a patient do not change
their size or shape. There is a characteristic of adenoid face which
there is long face, lips are a part and anterior teeth are protruded
between the two lips.
Examination of the swallowing of the child must be performed. In
normal swallowing the tongue touch the palate papillae of anterior
teeth & dorm surface of the tongue in contact with the palate and lips
are tightly closed together. While abnormal swallowing teeth are
separated, tongue thrust forward between upper & lower anterior
teeth, dorm surface of the tongue away from the palate and lips are
separated.
Examination for retained or ankylosed primary molar must be done
by periapical & clinical examination. It is important to observe the
eruption of these permanent teeth. Occasionally they will erupt out of
position if the primary tooth is retained. To prevent the mal-
positioning of the permanent tooth it might be necessary to remove
the retained primary tooth.
Prevention of premature loss of primary teeth is very important factor
to prevent development of malocclusion.
The general factors which influence the development of
malocclusion in the presence of premature loss : -
1. Abnormal oral musculature
E.g. high tongue position coupled with strong mentalis
muscle will damage the occlusion after tooth loss leading to collapse
of lower dental arch & distal drifting of anterior segment.
2. The presence of abnormal oral habit
Thumb or finger sucking provides abnormal forces on dental
arch leading to collapse after tooth loss.
3. Existence of malocclusion

8. 8
Arch length inadequacies as in class II D I become more severe
after mandibular molar loss.
4. Stage of developing dentition
More space loss occurs if a tooth actively erupting adjacent to
space left after premature tooth loss.
Prevention of crowding of teeth
1. Crowding takes place when there is not sufficient space for the
teeth. Since the premature loss of primary teeth results in
crowding, it is important for the primary teeth to remain in
position until the permanent teeth replace them.
2. Here are some preventive measures and considerations relating
to crowding:
• A regular routine of tooth cleaning, together with a low
sugar diet will help to keep the primary teeth healthy,
until they are ready to be replaced.
• Regular visits to the dentist from the age of 2 or 3 will
ensure that problems are detected and treated in time.
• If a primary tooth is lost before the permanent tooth is
ready to replace it, a space maintainer can keep the space
open for the permanent tooth
• Mean the procedure taken to intercept a malocclusion that is
develop or lessen its severity in such away as to facilitate future
orthodontic treatment. Or
• It is a science & art of orthodontics employed to recognize &
eliminate potential irregularities and malposition in developing
dentofacial complex. The measure of interceptive are:-
• Cross-bites
• Anterior diastema
• Ankyloglossia
• Anterior crowding (Serial extraction)
• Space regaining

9. 9
• Ectopic eruption
• Treatment of oral habit
Conditions cause orthodontic problems are
1. Crowding
 Teeth affected by crowding are difficult to clean and are
prone to decay.
 Crowding may prevent other teeth from erupting, causing
them to become impacted.
 Crowding spoils the appearance of the mouth and smile.
2. A mismatch of tooth and jaw size
• Teeth can be too big or too small for the size of the jaws.
• This can be a congenital or inherited problem.
3. Upper and lower jaws out of proportion to each other
• The lower jaw may be too large or too small for the upper
jaw, and vice versa.
• This can also be a congenital or inherited problem.
4. Missing or extra teeth
• This is not uncommon and can be an inherited problem.
5. Premature loss of teeth caused by:
• Injuries.
• Tooth decay.
6. Breathing problems
• When adenoids or tonsils obstruct normal nasal breathing,
this can affect the teeth and jaws.
7. Thumb sucking or dummy sucking
• This can and often does affect the development of the jaw
and the position of the teeth.
8. Hypotonic muscles
 Lip exercises with a piece of card-board to improve the lip
seal. The cardboard should be held loosely in horizontal
position with the lips.
9. Ectopic eruption of the first molar

10. 10
 Using ligature wire to guide the permanent first molar to erupt
in its normal position. Or extraction of the deciduous second
molar & guiding the first permanent molar to erupt in normal
position.
The general factors which influence the development of
malocclusion in the presence of premature loss :
1. Abnormal oral musculature
E.g. high tongue position coupled with strong mentalis
muscle will damage the occlusion after tooth loss leading to collapse
of lower dental arch & distal drifting of anterior segment.
2. The presence of abnormal oral habit
Thumb or finger sucking provide abnormal forces on dental arch
leading to collapse after tooth loss.
3. Existence of malocclusion
Arch length inadequacies as in class II D I become more severe
after mandibular molar loss.
4. Stage of developing dentition
More space loss occurs if a tooth actively erupting adjacent to
space left after premature tooth loss.
General effects of premature loss:-
1. Mesial drift distal to extracted tooth.
2. Distal drift mesial to extracted tooth.
3. Midline shift.
4. Delayed or accelerated eruption of permanent tooth.
5. Falling of anterior segment toward the affected side with increase
in over bite.
6. Development of thrusting habit.
7. Loss of tooth without immediate replacement considered one of
etiology of malocclusion.

11. 11
Corrective orthodontic
• It is measurement taken to correct the already develop
malocclusion.
• It performed at late mixed dentition and early permanent teeth.
• The variables that can affect the outcome of treatment may
include:-
1. The chronologic or emotional age of the patient.
2. The intensity, frequency & duration of oral habits
3. Parental interest, support & compliance.
4. Variation in facial growth
5. Accuracy of the clinician’s diagnosis & appropriateness of care.