DR SAVITHA SATHYAPRASAD

1.  ‘re-vision’

2. No mobiles……..plz ,,,,,
as it distracts and only 30
min time allotted
Questions will be asked as
a rapid fire

3. Definition of pediatric
dentistry??????

4. It is your first touch with patient
….the beginning of a long
bonding

5. Pediatric dentistry is an incredible
subject that includes all specialties
under one banner ---so we need to be
clear on diagnosis or else the growing
child will be messed up physically
,mentally ,emotionally and dentally.

6. to know what is normal
 what know what is abnormal
 to diagnose the child's disease
To assess the main hurdle ;the child and
maternal anxiety and to tailor-make behaviour
management strategy
 to diagnose the medical conditions
To plan treatment in a systematic way

7. The planned professional
conversation that enables the
patient to communicate
his/her symptoms, feelings
and fears to the clinician so
as to obtain an insight in to
the nature of patient’s illness
and his/her attitude to them
 Bricker

8. Data gathering;

9.  STATISTICS / Biographical Data
 CHIEF COMPLAINT
 HISTORY----- History of presenting illness
Medical history
Past dental history
Family history
 EXAMINATION------General examination
Extra oral examination
Intra oral examination
 DIAGNOSIS-----Provisional diagnosis
Investigations
Final diagnosis
 TREATMENT PLAN

10. Name & nick name
Patient registration number and date
Age and date of birth
Address/Phone
number
Class /School
Parents name
and
occupation
Gender
Name of his pet
Favourite cartoon
teacher, subject

11. Communication is the mainstay of
paediatric dentistry ad has to e very
well programmed as it is the
foundation for a building a relation
with child patient;

12.  To assess the growth spurt
 For calculation of drug dosage
 Exfoliation, Eruption and delay of dentition
 To plan endodontic treatment of young permanent teeth
 To understand the cognition and psychological limitations of age
 Chronological age v/s dental age v/s skeletal age and planning of
treatment of interceptive orthodontics
DIAGNOSIS

13. Very important to know the level of
psychological growth specially cognition ;to
plan the behaviour management; so the
stage of the level of cooperation can be
anticipated and child is not taxed.

14.  Diseases present in
children :
Early childhood caries
 Haemangioma
 Palatal cyst of newborn
 Fibrous dysplasia of the jaw
 Nursing bottle caries
 Juvenile periodontitis
 Eruption cyst
 Dentigerous cyst
 Pulp polyp
 Herpetic gingiva stomatitis
 Hand foot and mouth
 disease

15. Females :
 Dental caries
 Lichen planus
 MPDS
 Anaemia
 Sjogren’s
syndrome
 Juvenile
periodontitis
MALES
 Leukoplakia
 Herpes simplex
 Hodgkins
lymphoma
 Attrition
• Sex related diseases like
haemophilia, G6PD
deficiency
 (causes haemolytic
 anaemia)
• As an aid in treatment
planning
– Growth spurts in girls
are ahead of boys
 In trauma:
– Boys sustain more
 injuries than girls
– Ratio approx – 2:1

16.  Communication
 Record purpose
 To know certain endemic diseases
High fluoride content –
dental/skeletal fluorosis
Filariasis
 Is an excellent link to grow rapport
 To do parental counselling to use It as a
reinforce in child management
 To teach few things through apps like
diet and caries
 To teach the child oral hygiene
instructions
 To book appointments
PHONE NUMBER

17. • For communication
• Reflects the socioeconomic status
• (lower socioeconomic status are much more likely to develop chronic illness like heart
disease, COPD, etc.,)

18. Is the reason for the patient’s visit to the clinic
Should be recorded in patient’s own words and in a
chronological order of their appearance and severity
Helps to Understand patient’s underneath mental
status, anxiety, irritation or depression
This aids in diagnosis and treatment planning and
hence should be given utmost priority
In kids less than 5 years, parents should be questioned
Helps to categorically place child and parent under
different strata

23. ‘Pulp is a small tissue
with a big issue’

24. Why is dental pain
sooooo
painful??????

25. INTRAPULPAL PRESSURE
Normal pulp 10mm Hg
Reversible pulpitis 13mm Hg
Irreversible pulpitis 34.5mm Hg
Necrosis 36 mm hg

26.  It is covered by a non complaint chamber of hared enamel and dentine which does not
expand in due course of inflammation and infection and the pressure within causes
severe pain.

27. Why is pulpal diagnosis
important??????

28. How many of you believe…. it is not a
big deal to over diagnose a tooth with
just a deep caries as a irreversible
pulpitis?????

29. Each manifestation of pulp has a clear
indication of the pathology underneath
directing towards a clear treatment plan
it is clinicians judgement to do the most
conservative procedure like a ipc than an
aggressive pulpectomy if it is justified.

30.  activity which induces the pain should
be taken in consideration.
 sudden / gradual
• Pain occurs without
being provoked
Induced
• Provocation causes
painful sensation
Triggered
• When evoked response
is out of proportion to
the stimulus
SPONTANEOUS

31. Mild
pain
• Controlled
by simple
analgesics
Moderate
pain
• Controlled
with narcotic
analgesics
Severe
pain
• Cannot
controlled
with
analgesics
• Require
elimination
of cause

32. –Pricking/piercing – acute irreversible
pulpitis
–Throbbing – furcal abscess
–LancinatingAching,Dull, boring,
gnawing – furcal abscess

33. • Pain of short duration & seperated by
wholly pain free periodIntermittent
• Pain of longer durationContinuous
• Two or more similar episodes of painRecurrent
• Characterized by regularly recurring episodePeriodic

34. Aggravating or relieving
factors- Hot/cold/sweet food,
eating, biting etc.
Pain aggravating to sweet
and cold food – reversible
pulpitis
Pain aggravating to hot food
and relieves to cold –
irreversible pulpitis
Nocturnaldiurnalpostural
variations- if pain on turning
the head , lying down – acute
irreversible pulpitis

37. PHYSIOLOGY OF PULPAL
PAIN
HYPERALGESIA –
spontaneous pain
decreased pain threshold (allodynia)
An increased response to painful stimuli
spontaneous pain - irreversible pulpitis or pulpal
necrosis

38.  Not a disease, but a symptom that last for a couple of seconds
 Causes a sharp, quick hypersensitive responses
 Momentary painful response to thermal change that subsides as
soon as the stimulus is removed
 Does not involve an unprovoked pain
REVERSIBLE PULPITIS

39. IRREVERSIBLE PULPITIS
The AAE has suggested dividing this classification
into the subcategories of
symptomatic irreversible pulpitis- acutely inflamed
asymptomatic irreversible pulpitis- chronically
inflamed
.

40. SYMPTOMATIC
IRREVERSIBLE PULPITIS
The sensitivity to temperature changes is more
intense and with a longer duration
 Rapid exposure of teeth in this category to dramatic
temperature changes (especially to heat stimuli) will
elicit heightened and prolonged episodes of pain
 even after the thermal stimulus has been removed.
may extend for minutes or even longer
usually dose not respond to pain killers the pain in
these cases may be sharp, lingering, spontaneous

41. With advanced irreversible pulpitis a thickening of
the periodontal ligament may become evident on
the radiograph,
by virtue of extensive pulp chamber and root canal
space calcification.
Typically, when symptomatic irreversible pulpitis
remains untreated, the pulp will eventually become
necrotic.

43. increases venous return from all tissues below the level of the heart
increasing cardiac output
transient increase in systemic blood pressure
stimulates baroreceptors
decrease sympathetic vasoconstriction to all vascular
beds
increases peripheral blood flow. Increased pulpal pressure

44. ASYMPTOMATIC
IRREVERSIBLE PULPITISPulp Necrosis after degeneration;due to death of the nerves and blood vessels
as a response to long standing irritation of toxins and inflammatory response
the tooth becomes nonvital and leads to infection
With pulp necrosis, the tooth will not respond to electric pulp tests or to cold
stimulation. However, if heat is applied for an extended period of time, the tooth
may respond to this stimulus. This response could possibly be related to
remnants of fluid or gases in the pulp canal space expanding and extending
into the periapical tissues.
 Pulpal necrosis may be partial or complete and it may not involve all of the
canals in a multirooted tooth.

45. After the pulp becomes necrotic, bacterial growth can be
sustained within the canal. When this infection the bacterial
toxins from this infection extends into the periodontal
ligament space, the tooth may become symptomatic to
percussion or exhibit spontaneous pain
Radiographic changes may occur, ranging from a thickening
of the periodontal ligament space
 appearance of a periapical radiolucent lesion.
The tooth may become hypersensitive to heat, even to the
warmth of the oral cavity, and is often relieved by

51. Provisional diagnosis

52. PAIN AGGREVATING WHILE HAVING
SWEET AND COLD FOOD
DEEP DENTINAL CARIES
STIMULATION OF A DELTA FIBERS
SHARP SHOOTING PAIN, EASILY LOCALIZABLE
WHICH DISAPPEARS ON REMOBAL OF STIMULI
DEEP DENTINAL CARIES WITH POSSIBLE
INVOLVEMENT OF PULP
SPONTANEOUS PAIN AGGREVATING ON
POSTURAL CHANGES AND NIGHT, PAIN
AGGREVATING TO HOT AND RELIEVING TO
COLD
STIMULATION OF DEEPER C FIBERS
DULL ACHING PAIN, DIFFICULT TO LOCALIZE
AND LINGERING IN NATURE

53. PAIN ON MASTICATION AND
CLENCHING OF TEETH
PRESENCE OF SWELLING

54. Reversible pulpitis Irreversible pulpitis
Pain with stimulus (cold or sweet) and subsides on
removal of stimulus
Pain continues after removal of stimulus
Quick, sharp , hypersensitive response Spontaneous pain
No pain at night Pain at night
No pain on lying down Pain on lying down
Stimulation of A delta fibres Stimulation of C fibres

56. PARENTAL HISTORY
Pedodotic treatment triangle

57. Maternal attitude
( Bayley and Schaefer)
Behaviour of child
Over protective •Shy ,submissive , anxious
• Cooperative patient
Over indulgent •Aggressive ,demanding ,display temper tantrum
•Usually not anxious, demands dentists attention
Under affectionate •Usually well behaved, may be unable to cooperate, shy ,
may cry
•Often respond to surrogate who will give emotional
support and needed affection.
Rejecting •Aggressive ,overactive ,disobedient
•He will usually resort to any behaviour to gain attention
Authoritarian Dawdling and evasive

59.  Hemifacial microsomia
 Ectodermal dysplasia
 Enamel hypoplasia
 Cleft lip / cleft palate
 Down syndrome
EFFECTS OF CONSANGUINEOUS MARRIAGES ON ORAL AND CRANIOFACIAL STRUCTURES: A STUDY
ON DENTAL PATIENTS IN NORTH INDIA , Annals and Essences of Dentistry – Dec. 2010

60. Oral cavity is a
insuperable part of
body ;thanks to the
anatomy so we get a
privilege to be called
as doctors

61.  CNS
 CVS
 Hematopoietic and lymphatic
system
 Respiratory system
 GI system
 Endocrine system
 Genitourinary system
 Skin
 Extremities
 Allergies
 Medications or treatment taken
 Hospitalization
MEDICAL HISTORY

62. cvs

63. Irrespective of the type, they share certain clinical characteristics and
oral manifestations which includes,
Cyanotic gingivitis & stomatitis Glossitis

64. Delayed tooth eruption
Increased caries activity
INCREASED STRUCTURAL DEFECTS OF
ENAMEL
Intrinsic dyschromia
(medication and/or
blood byproduct deposition.

65. CARDIA
C
PACEMAK
ERS
principally usedfor atrio-
ventricular defects and
sympotamatic sinus node
disease in children

66. RENAL DISEASES

67. • Soft tissue findings include :
Metastatic calcifications (altered CaPo4 metabolism)
Noted in maxillary sinus and around the oral cavity
Chronic marginal gingivitis Uremic gingivostomatitis
Uremic stomatitis,whitish-
gray pseudomembrane
on the tongue.
White keratotic lesion which
mimics leukoplakia.

68. •
Uremic osteodystrophy of bones
Loss of lamina duraGround glass appearance Large bony lesions
Retarted growth resulting in malocclusion
Hypoplasia – characteristic
Incremental defect
Tetracycline
staining

69.  Blood investigation –
BLEEDING
DISORDERS
parameter Normal value Moderate risk High risk
INR 1-1.5 >1.5
PT 12-18 sec 18-27 sec >30 sec
a - PTT 22- 28 sec 50 – 55 sec >55 sec

70. Procedure Decision recommended Reason
Pulpally involved teeth Endodontic therapy Lowers bleeding
LA administration *Infiltration preferred over block
* PDL and intrapulpal useful
Accidental pricking of bv results in hematoma
No bleeding risk
Number of appointments Reduced to 2 , consecutive days
highly appropriate
Factor VII infusion need not be repeated
Treatment mode Split mouth technique – one
quadrant in one appt. Or full
mouth treatment under GA
Decreases frequency of factor VII infusion.
Minor surgical procedures. Electrocautery or laser preferred No risk of bleeding

71.  .
Complete blood
count with platelet
count
< 20,000-
prophylatic platelet
transfusion before
treatment
ANC- <1000/cubic
mm- elective
dental treatment
should be delayed.
Pulp therapy and
RCT
contraindicated.
Donot prescribe
aspirin related
analgesics.

73. • Hypopituitarism
The craniofacial manifestations include
Circumoral paraesthesia,
Spasm of the facial muscles,
Hypodontia
Oral
candidiasis
thickened lamina dura
Enamel hypoplasia
Delayed /
arrested tooth eruption

74. •
•
•
•
A familial X-linked dominant disease in which there are adequate
parathyroid hormone levels but inadequate response to
parathyroid hormone.
Boys are more severely affected than girls.
• Treatment focuses on maintaining serum calcium through
medication, diet supplementation and vitamin D therapy.
Hypoplastic enamel and pitting
Delayed eruption of teeth
Incomplete closure of
apical area of teeth

76. Inherited autosomal recessive disease It
produces dentin defects in both
the primary and the permanent
dentition.
Enlarged pulp-chambers and extension
of the pulp horns into
the cusp tips also appear.

77. THYROID DISEASES
Oral manifestations include :
• Hypothyroidism:
 Macroglossia & poor periodontal health
 Pronounced lips, altered tooth morphology
 Delayed tooth eruption with malocclusion
 Long-term effect : impaction of mandibular
2ndmolar.
• Hyperthyroidism:
 Early loss of primary teeth with subsequent rapid eruption of permanent
teeth(young children)
 Lymphoid tissue hyperplasia- tonsillar & oropharynx (Grave’s disease)
 Burning mouth syndrome, Sjogren′s syndrome
 Maxillary & mandibular osteoporosis
 In Graves disease, thyroid may be enlarged
or noticeably palpable. in a supine position
in the dental chair.
ShaluChandna, ManishBathla etal.Oral mani f es t at i ons ofthyroid disorders and i
t s management .IndianJournalofEndocrinology andMetabolism, Vol. 15,2011,

78. Ten-year-old child suffering from
hypothyroidism with delayed
eruption and exfoliation
Anterior open bite
Eight-year-old child
suffering from
hyperthyroidism with
early eruption of
premolars and
second molars
Macroglossia observed in
child with congenital
hypothyroidism

79. More severe periodontal disease
Xerostomia
angular chelitis
Burning tongue - associated with candidiasis Multiple abscess

80. Comprehensive
medical history
along with screening
test essential.
Dental procedure –
short , stress free,
atraumatic
Early morning appt,
normal breakfast
Conscious sedation
preferred
LA –excess
adrenaline –
increase blood
glucose level
Prophylactic
antibiotics before
surgical procedures
Fixed or removable
applince- depends
on periodontal
health.
Nonvital tooth with
evidence of
infection- extraction
Pulp capping and
pulpotomy-
questionable

82. Oral manifestations include,
Soft tissue lacerations
of the tongue or
buccal mucosa
Facial fractures
Trauma to the teeth
Recurrent apthous like ulceration

83. GINGIVAL
HYPERPLASIA
Cervical lymphadenopathy

84. A condition in which a
person's airways become
inflamed, narrow and swell
and produce extra mucus,
which makes it difficult to
breathe.

85. Semi-supine / upright position may be better for treatment in such patients.
Avoid use of rubber dam in severe diseases

87. Sickle cell Anemia
VIT D Resistent Rickets
Herpes zoster
DISEASES CAUSING
SPONTANEOUS PULPAL
DEGENERATION

88. Nutritional diseases
Stress
Corticosteriod Theray
DISEASES WHICH
REDUCES PULPAL
HEALING AND REPAIR

89. Condition of mother during pregnancy???
 Disease
 Trauma
 Medications
 Food and habits
 Radiation
 Anomalies scan
 Gene testing

90.  Cytomegalovirus infections- microcephly, hydrocephaly , mental
retardation
 HSV – microcephaly, micropthalmia , mental retardation
 Rubella – congenital heart disease, defeness, microphalmia,
cleft lip and palate
 Treponema pallidum- Hutchinsons teeth and bones , mental
retardation, congenital deafness.
DISEASES IN MOTHER

91. • Term of delivery: Full term/ premature
• Type: Normal / Forceps / Caesarian
• Forceps delivery ---- injury to TMJ ---
retarded growth of mandible
• Intracranial hemorrhage
Cyanosis at birth : congenital heart defect
Rh incompatibility : erythroblastosis fetalis.

92. Rh incompatibility - may result in
the condition termed as
‘erythroblastosis fetalis’.
Rh hump on the tooth and
the characteristic blue – green
discoloration.
ABO incompatibility
Hemolytic anemia when mother is
Blood Type 0 and the infant is
Blood Type A or B, with A being
more antigenic.

93.  Post Natal
 Feeding history-
Duration , Weaning?
 Natal or neonatal teeth?
 Vaccinations
 DPT
 BCG
 OPV
 Tetanus
 MMR
• Milestones of development
• Habits
• Childhood diseases

94. DEVELOPMENTAL
MILESTONES

95.  Child’s first dental visit?
 Any unfavourable dental
experience?
 How much satisfied was the
previous treatment?
 Does your child complain of
tooth ache ?
 Has your child suffered any
injury to teeth?
 Did he have any fluoride
treatment done before?
 Source of drinking water?
 Place of residing for the last

97. INFANT FORMULA
PRESENCE OF SUGAR IN THE
FORMULATIONS
KEEPING FOOD FOR LONG
TIME

98.  Compared to cow milk, breast milk has low mineral content but high
lactose content favouring caries.
 High calcium and casein levels in cows milk also helps in reducing caries
by remineralisation.
• Breast feeding greater than 7 times daily
after 12 months of age is associated with
increased risk of ECC.
AAPD GUIDELINES 2013

99. ANY MEDICATION
LATEX
HISTORY OF ALLERGIC
REACTIONS

100. Do make a note of previous
unpleasant dental episode so you can
frame strategies to modify that phobia

101.  Acrodynia
 Cherubism
 Cyclic neutropenia
 Hypophosphasesia
 Histocytosis X
 Juvenile diabetes
 Papillon LeFevre syndrome
 Progeria

102. Frequency
Intensity
Duration

104. Each child is different; there is no one size
fits all, so important to clearly and
categorically understand child's nature

105. Definitely negative-
refuse treatment,
cries forcefully
Negative- reluctant
to accept treatment,
display evidence of
slight negativism.
Positive- accepts
treatment, if bad
experience during
treatment becomes
uncooperative
Definitely positive –
good rapport with
dentist and accepts
treatment

106. CO-OPERATIVE TENSECO-OPERATIVE OUTWARDLYAPPREHENSIVE
FEARFUL
STUBBORN
HYPERMOTIVE
EMOTIONALLY IMMATURE HANDICAPPED
LAMPSHIRE’S CLASSIFICATION

107.  To decide on the behavior management
mainly desensitization is usefull

110.  Cooperative behaviour:
Cooperative behaviour-
Lacking Cooperative
behaviour- young child ,
disabled child
Potentially Cooperative
behaviour- has potential
to cooperate, because
of inherent fear child
doesn’t cooperate

111.  Un Cooperative behaviour
Uncontrolled
behaviour- preschool
children at their first
dental visit, refuses
to cooperate.
Obstinate behaviour-
spoilt and stubborn
child
Timid behaviour- shy
but cooperative
Tense Cooperative
behaviour- do not
resist treatment, but
tensed at mind
Whining behaviour-
allows for procedure
,but complains
throughout
treatment.
Stoic behaviour-
cooperative and
accepts treatment
without any facial
expression

112. Fearful –resist
entering room , cries
, accepts treatment
with a state of fear
Timid – enters
cautiously , do not
look at the staff when
talked to.
Spoiled- enters
clinics with arrogent
and proud behaviour,
neglects treatment ,
gives orders.
Aggressive- screams
,does not open
mouth, neglects
treatment
Adopted-
combination of
spoiled and fearful.
Handicapped- all
children with physical
and mental
handicapping
condition.
Cooperative-
cooperate with
treatment

114. 0-1 year 1- 2 years
2- 6 years 6-12 years

115. So empathy is the main ethics

116. Oral hygiene history
– Method of cleaning teeth
– Who brushes the teeth
– Type of brush
– Method of brushing
– No. of times of brushing
– Other oral hygiene aids used like
flossing, rinses
– How often it is changed
– Fluoridated/non fluoridated tooth
pastes

117. It includes recording of the following :
Veg/non-veg/mixed diet
No. of meals/day
Cariogenic snacks/day
Does your child eat everything you prepare
Does your child constantly snack on food
Favourite foods
Other food habits

118. DETERMINE THE ADEQUACY OF DIET:
Dental health diet score = Food score+ nutrient score
- sweet score

119. Milk 3 *8
Meat 2 *12
Fruits & Vegetables 1 *6
Vitamin c 1 *6
Others 2 *6
Breads and cereals 4 *6
FOOD RDA NO OF SERVINGS

120. 72- 96 = excellent
64 – 72 = adequate
56 – 64 = barely adequate
 < 56 = not adequate
Score 60-100 is acceptable, and diet counseling is given only at patient request. If 56 or
less ,then dietary counseling is both recommended and indicated as a part of preventive
program.

121. Day Meat group Milk group Veg/fruit
group
Bread
cereal
Detergent Sugar equivalents
1 - 2 x (8) 1 banana x 5 2 chapatis
Rice x 6
- Biscuits -5
Tofee-2
2 - 2 x (8) 2 slice melon
x 5
One cup rice
x 6
- Biscuits-5
Chocolate-2
3 Fish 1 x 12 2 x (8) Carrot half
Pulses x 5
One cup rice
x 6
- Icecream – 1
Tofee- 1
4 - 2 x (8) Mix veg x 5 Chpatis
1 cup rice x 6
- Biscuits – 4
Chips
5 Eggs 1x 12 2 x (8) Banana 1
Mango 2
slice x 5
3 bread
slices
2 chapatis x
6
Peanuts Chocolate – 1
Biscuits- 6
6
7
-
Chicken 1 x
12
2 x (8) -
apples x 5
1 cup rice
Noodles x 6
Chapatis
Rice x 6
- Chocolate-2
Biscuits- 6
Biscuits - 2

124. Sweet Group Score
 Sweetened liquid – 5
 Sweetened solid – 10
 Slowly dissolving – 15
Sweet Score Inference
5/<5 = excellent
10 = good
15/>15 – watch out

126.  Prefered positions:
• Parental presence is
mandatory for clinical
examination of infants
• Dental chair is not always
necessary for examination

127.  Dental arches- edentulous/ tooth
bulges
 Frenula- high placement on
alveolus
 Palate- prominent median raphe /
rugae
 Gingiva – pink hydrated

128. Riga Fede disease
Neonatal teeth

129. Bhon’s nodules and epstein pearls

130. Eruption cyst
Congenital epulis

131. – Assessment of general appearance should start before the child is seated in
the dental chair
– It includes
1. Child’s stature/ built
2. Weight
3. Height
4. Gait
5. Speech
6. Vital signs

132. William Sheldon's-1940
 Endomorph
 Mesomorph
 Ectomorph

134.  Aphasia
 Delayed speech
 Sluttering speech
 Cluttering speech
Significance:
-For Management of child in the dental chair
-To know if any systemic diseases associated
Aphasia-CNS disorders
Sluttering speech – parrot like speech
(Autism)

135.  Pulse
 Normal pulse rate is 60-80beeats/min
 Average pulse is 72 beats/min
 Physiologic increase in infants, afterexertion.
 Pathologic increase in fever, cardiopulmonarydisea
 Temperature
 normal temp is 98.6 degree F or 37 degreecelsius.
 Measured by thermometer.
 Respiratoryrate
 Adult rate–16-24 breaths perminute
 Observe
 Feel for chestmovement
 Auscultate

136.  Blood pressure
 Systolic- 110-140 mm Hg
 Diastolic-60-90 mm of Hg
 Measured by Sphygmomanometer.

137.  Includes examination of
 Head
 Face
 Hair
 Eyes
 Ears
 Nose
 Lips
 Lymph Nodes
 TMJ
 Swallow

138. Cephalic index =maximum skull width ( transverse dimension)
(CI) Maximum skull length (Anteroposterior dimension)
Cephalic index
Mesocephalic 75-79.9
Brachycephalic 80 – 84.9
Dolichocephalic <74.9

140.  abnormal intrauterine pressure,
 cranial nerve paralysis,
 fibrous dysplasia,
 familial developmental disturbances.
 Infections
 Trauma
 Hemifacial atrophy
 Hemifacial hypertrophy
 Unilateral condylar hypoplasia
 TMJ disorders

142. ANGLE’S CLASS 2
MALOCCLUSION
VTO

143. PSEUDOCLASS III
WITH OCCLUSAL
PREMATURITY

144.  Upper facial height:
 45% of the total facial height
 Lower facial height:
 55% of the total facial height

145. Increased :
• Skeletal open bite
• Long face
syndrome
Lowered :
• Growing
children
• Skeletal deep
bite
• Class II div 2

147. • Angle formed between
lower border of nose to the
upper lip(90-110degree)
Increased: Retrusive
maxilla
Decreased : Proclined
maxilla

148. Seen between lower lip
and mentalis muscle
• Normal - class I
occlusion
• Deep - class II div 1
occlusion
• Shallow -bimaxillary
protrusion

149. Chin prominence
is related to
mandibular
position
• Recessive chin-
class II molar
relation
• Prognathic chin-
class III molar
relation
• Normal position-class
I occlusion

150. Pigmentations
Skin of face – primary or secondary skin lesions (ulcerations ,
scars)
Edema / cellulitis- renal disorder
Redness/ allergic response
Dryness/ dehydration, ectodermal dysplasia
Ulceration , infectious disease.

151. bruising – child abuse
cafe- au-lait spots
PIGMENTATION

152. ANGIONEUROTIC OEDEMA
SYSTEMIC LUPUS ERYTHEMATOSIS

153. • Symmetry
• Interincisal opening
• Mandibular movement---Observe path of closure for
 deviations,Range of motion(also in lateral movements)
• Palpation of the joint
– Pretragus palpation
– Intra-auricular palpation
• Auscultation of the joint
– Clicking
– Crepitus

154. MOUTH OPENING
• Adults:
–Males- 50 – 60 mm
–Females- 45 – 55 mm
• Children:
– 35-45 mm
–Lateral movements- 8 – 12 mm

155. Lymphatic
drainage
of teeth
Maxillary
teeth
Mandibular
posteriors
Deep cervical
lymph nodes
Mandibular
anteriors
Submental
lymphnodes
Submandibular
lymph nodes

158. SOFT TISSUE EXAMINATION
1. Breath
2. Lips and buccal mucosa
3. Saliva
4. Gingiva
5. Tongue and sublingual area
6. Palate
7. Teeth

159. Compound nevus on the vermillion
border of maxillary lip
MUCOCEL
HERPIS LABIALIS

160. MUCOSA – LABIAL + BUCCAL +
VESTIBULE
 Check for:
 Ulcerations
 Swellings
 Growths
 Pigmentation
 Texture
 lesions

161. Fordyces granules
leukoedemaLinea alba
Mucocele

162. Fibroma Keratotic Patch
Lichen planus Major Apthous Ulcer

163.  Check for:
 High labial frenae
 TongueTie
 High labial frenae may cause Midline
diastema when attached highly - to
incisal papilla
 Blanch test confirms

164.  Dorsum
Check for...
– Volume
– Colour
– Swelling and ulcer
– Mobility
– Tongue
thrusting
on
swallowing
 Variations in size
 Macroglossia
 Micoglossia
 Range of movements

165. Coated tongue
Apthous ulcer on tongue tip
Coated tongue

166. Benign migratory glossitis
Median rhomboid glossitis

167.  FLOOR OF MOUTH

168.  Floor of mouth
 Swelling – mucocele, sialolith
 Ulceration- aphthous , abuse

169. FREE TONGUE
16 mm
Kotlow's classification
Class I: Mild ankyloglossia:
12 to 16 mm,
Class II: Moderate ankyloglossia:
8 to 11 mm,
Class III: Severe ankyloglossia:
3 to 7 mm,
Class IV: Complete ankyloglossia:
Less than 3 mm.

170.  Hard Palate
 Clefts
 Fistulae (syphiliticgumma)
 Inflammation
 Swellings
 Pigmentations
 Ulcerations
 Hyperkeratinization
 Soft Palate

171. Erythematous candidiasis

173. ANUG
Herpetic gingivostomatitis

174. Mandibular tori
Fibromatosis gingiva

175. Pericoronitis

176. Primary examination technique
for evaluating teeth include:
Visual inspection
Transillumination
Probing
Palpation
Percussion

177.  STAGES OF DENTITION
VISUAL INSPECTION

179.  Syndromes associated:
 Aperts syndrome
 Cleidocranial dysplasia
 Gardner syndrome
 Downs syndrome
 Struge weber syndrome

180. HYPODONTIA :
 Ectodermal dysplasia
 Chondroectodermal
dysplasia
 Achondroplasia

181. Microdontia- hemifacial microsomia
- downs syndrome( peg laterals)
- chondroectodermal displasia
- Ectodermal displasia

182.  Macrodontia
 – hemifacial hypertrophy
- fusion
- gemination

183. DENS IN DENTE- OEHLERS CLASSIFICATION
Dens invaginatus. Part 1: classification, prevalence and aetiologyInternational
Endodontic Journal 2008

186.  Amelogenisis imperfecta
 Enamel hypoplasia
 Dentinogenisis imperfecta
 Dentine displasia
 Regional odontodisplasia

192.  Dental caries

195.  PROBING

197. Inspection of the offending tooth
and surrounding structures

199. Examination of the exposed pulp for size .type of
bleeding and any pus discharge and the type of
surrounding dentin is sound or carious

205. If large carious lesion –
check for percussion
sensitivity
Pain on lateral
percussion – apical
periodontitis
Done by tapping the tooth
lightly with a mirror
handle

210.  Radiograph provide information about hard tissue
Helpful in detecting
 Caries
 Periapical pathology
 Bony structures of face , jaw and dental anomalies

211. PERIAPICAL RADIOGRAPH

212. CHRONIC IRREVERSIBLE PULPITIS

221. BITE WING

222. OCCLUSAL RADIOGRAPHY

224.  Fibro Optic Transilluminator.
 Digital Fibro Optic Transilluminator.
 DIAGNOdent -

225.  Pulp testing is often referred to as vitality testing.
 It assess the integrity of the nerve supply in the pulp while it is
the blood supply that maintains the pulp health.
PULP VITALITY TESTS

226.  Testing should never be limited just to tooth in question.
 Surrounding and contralateral tooth should be tested
Various types of pulp tests
 Thermal test
 cold test
 heat test
 Electric pulp testing
 Test cavity
 Anesthesia
 Bite test

227. COLD TEST

229. ELECTRICAL VITALITY TESTS

230.  Exaggerated brief
 Pulp is vital but inflamed.
 Pulpits may be reversible.
 Exaggerated, Prolonged - Pulp is vital and inflamed.
 Pulpitis likely to be irreversible.
 Negative response
 Pulp is non vital necrotic or root canals are sclerosed.

231.  UNRELIABLE IN DECIDUOUS TEETH AND IMMATURE
PERMANENT TEETH BECAUSE
 RELATIONSHIP BETWEEN ODONTOBLASTS AND NERVE FIBERS OF
THE PULP HAS YET TO DEVELOP
 LACK OF DEVELOPMENT OF RASCHKOW PLEXUS
 IN DECIDUOUS TEETH, NERVE FIBERS ARE THE LAST TO DEVELOP
AND FIRST TO DEGENERATE
Dr. Grossman in 1940, stated that the electric pulp tester is not delicate enough to
differentiate diseases of the pulp although it does give a gross indication of the vitality or
non-vitality of the pulp.
Gopakumar R, Gopakumar M. Diagnostic aids in pediatric dentistry. International journal of clinical pediatric dentistry.
2011 Jan;4(1):1.

232.  Increase in the threshold for pain due to systemic medication narcotic analgesics etc.
 Extensive calcifications in the pulp Teeth with extensive restorations and a pulp
protecting base.
 Recently traumatized teeth.
 Recently erupted teeth with incomplete root formation.
 Patients with an unusually high pain threshold.
 Defect in the EPT that is used.

233.  Accidental contact of the electrode with a large metal restoration in the tooth. It may
conduct that electric impulse to the attachment apparatus.
 The pulp cavity containing fluid, i.e., in case of moist gangrenous pulp in a root canal.
 In case of multi rooted teeth with partially necrotic pulp with some nerve fibers still vital
in one or more of the root canals.
 Inadvertent spreading of the conducting medium on to the marginal gingiva.
 Over anxious patient may give an exaggerated response.

235. PULSE OXIMETRY
It depends on the absorbance characteristics of haemoglobin in
the red and infra-red range. Oxygenated hemoglobin and
deoxygenated hemoglobin are different in color and therefore
absorb different amounts of red and infrared light.

237. EMERGENC
Y PHASE

238.  Referral to physician
MEDICAL
PHASE

239. SYSTEMIC PHASE
 Premedication
 Antibiotic Prophylaxis
 Managing anticoagulants
 Adrenal/Thyroid insuffiency cases

240. REGIMEN FOR DENTAL PROCEDURE
situation Agent Adults children
oral Amoxicillin 2g 50 mg /kg
IV/IM Ampicillin
Cefazolin or Ceftriaxone
2g
1 gm
50 mg /kg
50 mg /kg
Allergic to Penicillin or Ampicillin
Oral Cephalexin
or
Clindamycin
or
Azithromycin or Clarithromycin
2g
600 mg
500 mg
50 mg /kg
20 mg/kg
15 mg/kg
IV/IM Cefazolin or Ceftriaxone
or
Clindamycin
1 gm
600 mg
50 mg /kg
20 mg /kg
AAPD guidelines

241. PREPARATOR
Y PHASE
(Preventive and
interceptive phase)

242. ORDER RESTORATI
ON CLASS
MATERIALS SURGIC
AL
DATE
OF
COMPLETIO
N
Pulp protection Restoration

243.  INDICATIONS:
 Patients requiring full mouth
rehabilitation.
 Uncomplicated vital teeth.
 Patients in whom sedation is required.
 Fractured anterior or bicuspid teeth
where esthetics is the concern.
 Teeth with accidental/mechanical pulp
exposure.
 Non vital teeth with sinus tract
 Medically compromised patients who
require antibiotic prophylaxsis
 Physically compromised patients who
cannot come to dental clinics frequently
 CONTRAINDICATIONS
 Patients having severe pain on
percussion suffering from acute apical
periodontitis.
 Teeth with anatomic anomalies for e.g.
calcified and curved canals.
 Acute alveolar abscess cases with pus
discharge.
 Patients who are unable to keep mouth
open for long duration for e.g. TMJ
disorders.
 Teeth with limited access.

244. OLIET'S CRITERIA FOR
CASE SELECTION
Oliet's criteria for case selection include
1. Positive patient acceptance,
2. Sufficient available time to complete the procedure properly,
3. Absence of acute symptoms requiring drainage via the canal and
of persistent continuous flow of exudate or blood, and
4. Absence of anatomical obstacles (calcified canals, fine tortuous
canals, bifurcated or accessory canals) and procedural difficulties
(ledge formation, blockage, perforations, inadequate fills).
Oliet S: Single-visit endodontics: a clinical study, J Endod 9:147,1983.

246. Final diagnosis is ;like a jigsaw
puzzle …..we come to a final
diagnosis by bringing together all
the collected information's of chief
compliant, signs and symptoms.