Donetsk National Medical University named after M. Gorky Pediatric Dentistry Department icon

Donetsk National Medical University named after M. Gorky Pediatric Dentistry Department




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Ministry of Public Health of Ukraine




Donetsk National Medical University named after M. Gorky

Pediatric Dentistry Department




MODULE 1.


THERAPEUTIC PEDIATRIC DENTISTRY

(CLINICAL ODONTHOLOGY)


Methodical guidelines

to self-directed preparation for practices

in therapeutic pediatric dentistry

for students of 4th term of dentistry faculty


Donetsk 2012


УДК 616.314-08-053.2(075.8)


Chizhevsky I.V., Ermakova I.D., Zabyshniy A.A., Redko A.A.


Module 1. Pediatric Dentistry (Clinical Odontology) (methodical guidelines to self-directed preparation for practices in Pediatric Dentistry for students of 4th term of dentistry faculty of Donetsk National Medical University named after M. Gorky). Methodical guidelines match the working program in Therapeutic Pediatric Dentistry for specialty 7.110106 – Dentistry. – Donetsk, 2012. – p.


Methodical guidelines are worked out in accordance with standarts, provided in

National Medical University named after M. Gorky, and realize the system of programmed and aimed ruling of quality of preparing specialists. Methodical guidelines allow students recognize their aims during preparation for the practical classes, assess level of their knowledge with the help of tests solving. There are a list of basic theoretical issues and recommended literature in the methodical guidelines. All that gives the possibility to use theoretical knowledge in practical activity and forms professional skills. Methodical guidelines are about all topics of practical classes, that are held on the Pediatric Dentistry Department of Donetsk National Medical University named after M. Gorky in accordance with the working program.


Reviewers:

  1. Pedorets A. –D.Sc. (medicine), professor, chief-head of Therapeutic Dentistry Department of Donetsk National Medical University named after M. Gorky.



  1. Kosareva L. – Ph.D. (medicine), head of methodological commission in dentistry disciplines of Donetsk National Medical University named after M. Gorky.



  1. Gontar E. – Ph.D. (medicine), Methodist of educational and methodological cabinet in dentistry disciplines of Donetsk National Medical University named after M. Gorky.



Approved by Scientific Council of Donetsk National Medical University named after M. Gorky. (Protocol №6 from 30 of August, 2012).

MODULE no. 1

^ THERAPEUTIC PEDIATRIC DENTISTRY

(CLINICAL ODONTHOLOGY)


MODULAR AIMS

To be able:

  1. Interpret the basic developmental periods of primary and permanent teeth, their periods of eruptions.

  2. Analyze the need for basic clinical and additional examination methods; carry out the pediatric dental examination.

  3. Interpret the results of basic clinical and additional examinational methods for making the diagnosis of dental diseases in children.

  4. Analyze the recent findings about etiology and pathogenesis of dental caries and dental developmental defects in children.

  5. Interpret the classifications of dental caries and its complications.

  6. Interpret the classifications of dental developmental defects, depending on the time of the occurrence, currents, localizationю

  7. Evaluate and analyze the caries prevalence and experience in age-related aspect, also identify the factors that affect these rates.

  8. Interpret the clinical features of different forms dental caries, its complications and developmental defects

  9. Make the clinical and differential diagnosis of dental caries, its complications and dental developmental defects

  10. Make the treatment plan, analyze the different indications to select the methods of caries treatment.

  11. Identify and avoid the mistakes and complications in caries treatment, pulp and endodontic therapy, and treatment of dental developmental defects in children.



^ MODULAR CONTENT

  1. DENTAL CARIES: CLINICAL DIAGNOSIS AND TREATMENT

    1. Some features of pediatric dental examination.

    2. Dental caries of temporary and permanent teeth in children. Some clinical and diagnostic features

    3. The treatment of dental caries for temporary and permanent teeth in children

2. ^ PULPITIS AND PERIODONTITIS IN CHILDREN: CLINICAL DIAGNOSIS AND TREATMENT

    1. Clinical and diagnostic features of pulp pathosis of temporary and permanent teeth in children

    2. Pulp treatment in primary teeth

    3. Pulp treatment in permanent teeth. Some features of pulp therapy in immature permanent teeth. Mistakes and complications while pulp treatment

    4. Clinical and diagnostic features of apical periodontitis in temporary and permanent teeth in children.

    5. The treatment of apical periodontitis in primary teeth. The choice of the treatment method.

    6. The treatment of apical periodontitis in permanent teeth. Some features in endodontic therapy for immature permanent teeth. Mistakes and complications while treatment of the apical periodontitis

3. ^ DENTAL DEVELOPMENTAL DEFECTS AND TRAUMATIC INJURIES OF TEETH: CLINICAL DIAGNOSIS AND TREATMENT

    1. Dental developmental defects. Some abnormalities of tooth eruption. Clinical diagnosis and treatment.

    2. Traumatic injuries to the teeth in childhood. Clinical diagnosis and treatment.

^ SOME FEATURES OF PEDIATRIC DENTAL EXAMINATION


Importance of the Subject: Due to dental diseases, especially caries and some periodontal diseases, being very common in children, appropriate treatment plan and therapeutic approaches should be applied in each particular case. Occurrence of dental abnormalities that common in childhood and timely making of diagnosis will make it possible to develop a suitable treatment plan to be performed to avoid any relevant complications in future. Treatment of a child can be performed with much success, provided that a psychological and pharmacological preparation for dental intervention has been made.


^ Aims of the practice:

Key Goal: to develop skills in performing the pediatric dental examination in different ages and identifying the anatomical, physiological, and radiological features of the chewing system, depending on the age.


^ The specific objectives

The pre-practice level skills

To be able:

1.To perform the pediatric dental examination in different ages

1. To perform dental examination of adults, and to notate the dental charting (as explained in the Propaedeutic Dentistry course).

2.To assess the different developmental periods for primary and permanent teeth to fit the age

2. To interpret the anatomy and times of initiation, mineralization, teething and root resorption of temporary, and permanent teeth (as explained in the Propaedeutic Dentistry course)

3.To determine the developmental periods for primary and permanent teeth in children

3.To interpret the developmental periods for primary and permanent teeth (as explained in Histology, Propaedeutic Dentistry)

4.To identify they age-related radiological features of primary and permanent teeth on the radiographs; to determine the stage of root development and resorption

4. To interpret the anatomical features and radiological pathological signs of dental diseases in adults (as explained in Radiology, Propaedeutic Dentistry)


^ Identification and supporting of the pre-practice skill-knowledge level

Questions for Self-Assessment of Prerequisite Knowledge and Skills


Q1. A 30-year-old patient complains of a prolonged pain in the tooth 36 caused by thermal stimulation. Carious cavity is in a contact with a pulp cavity.What method should be used to diagnose the disease?

  1. Pulp probing

  2. Carious cavity probing

  3. Enamel-to-dentin border probing

  4. Response to a percussion stimulus

  5. Examination of the condition of gums


Q2. 50-year-old patient complains of pain in the 44th tooth while eating. The chronic fibrous pulpitis has been diagnosed. Endodontic treatment is prescribed. How many roots and root canals are there in the 44th tooth?

  1. 1 canal and 1 root

  2. 1 canal and 2 roots

  3. 2 canals and 2 roots

  4. 2canals and 3 roots

  5. 3 canals and 3 roots


Q3. 24-year-old woman, on the 4th month of pregnancy, asks a dentist, which teeth have already initiated in the fetus?

  1. Temporary (deciduous) incisors and canines

  2. Temporary (deciduous) incisors and molars

  3. Temporary (deciduous) incisor, canines, and molars

  4. All temporary (deciduous) teeth and permanent (second) molars

  5. All temporary (deciduous) teeth and permanent (second) incisors


Q4. A 20-year-old woman complains of the destruction of tooth 11. Objective examination reveals a deep carious cavity on the medial surface of tooth 11, which communicates with the pulp chamber. There is not pain caused by the pulp probing. The none-well-demarked area of the bone destruction is around the root apex on the radiograph. What disease should be diagnosed on the basis of the X-ray?

  1. Chronic fibrous pulpitis

  2. Chronic gangrenous pulpitis

  3. Chronic fibrous periodontitis

  4. Chronic granulomatous periodontitis

  5. Chronic granulating periodontitis


Q5. An 11-year-old child has his tooth 55 extracted because of a teething. The distal root of tooth 55 is resorpted completely, and about one-third of the medial root. Which type of root resorption takes place in this case?

  1. Pathological and equal

  2. Pathological and unequal

  3. Physiological and equal

  4. Physiological and unequal

  5. Mainly in the area of root bifurcation



Answer Keys

Q1- 1

Q2- 1

Q3- 3

Q4- 5

Q5- 4


Sources of Information

  1. Mosby’s dental dictionary / Edited by T. Zwemer, M.J. Fehrenbach, M. Emmons, M. A. Tiedemann. Mosby, 2004.- 763pp.

  2. L. Mitchell, D.A. Mitchell Oxford Handbook of Clinical Dentistry. Third edition. Oxford University press, 2003. – p. 2-25


Further literature:

  1. Dental Hygiene. Theory and practice. M.L. Darby, M.M. Walsh. 2nd edition, 2011. – 1219 pp.

  2. Dental pulse. Satheesh Kumar K., Swapna M., Venugopal T.,- Medical Publishers, volume II, 2009. – 910 pp



Studying content associated with the specific objectives


  1. Dental examination of children at the dentist.

  2. Terms of odontogenesis of the deciduous and permanent teeth

  3. Developmental periods of the primary and permanent teeth

  4. Radiographic features of deciduous and permanent teeth.

  5. Stages of root development and types of root resorption.



Case-Study Questions

Sources of Information


  1. Paediatric Dentistry / Edited by Richard R. Welbury. Second edition. Oxford, 2001. – p. 39-50.

  2. I. R. Pinkham, P.S. Casamassimo, H.W. Fields, D.I. McTigue, A.I. Novak Pediatric Dentistry. Infancy through Adolescence Fourth Edition. Saunderes, 2005. – p. 375-381, 577-580.

  3. Pediatric Therapeutic Dentistry / Edited by prof. L.A. Khomenko - Kiev, ′Book-plus′, 2012. – 5-11

  4. Handbook of Pediatric Dentistry /Edited by A.C. Cameron, R.P. Widmer. Third edition. Mosby Elsevier, 2009. – p. 1-36

Further literature:

  1. Mosby’s dental dictionary / Edited by T. Zwemer, M.J. Fehrenbach, M. Emmons, M. A. Tiedemann. Mosby, 2004. - 763pp.

  2. L. Mitchell, D.A. Mitchell Oxford Handbook of Clinical Dentistry. Third edition. Oxford University press, 2003. – p. 58-65; 76-77


Some test-questions to check for specific objectives


Q1. 7.5-year-old boy fell down and got the dental trauma of his upper frontal teeth. Objective examination: 1/3 of the crown in 11 and 12 teeth is absent. Teeth cavities are open. Probing is grossly painful, percussion is painless. Mucous membrane in the area of 11 and 12 teeth is hyperemic. What additional investigation should be used?

  1. Visual examination

  2. Thermometry

  3. Radiography

  4. EPT

  5. Tactile probing


Q2. Parents of a 2 and half-year-old boy came to a clinic of pediatric dentistry complaining of a prolonged pain in a tooth on the right maxilla in their child. Eruption is physiological. A deep carious cavity in tooth 84 is observed. Acute purulent diffuse pulpitis has been diagnosed. Endodontic treatment is planning. Which developmental period of tooth 84 takes place in this case?

  1. Pre-natal and intra-jaw period of development

  2. Period of eruption

  3. Period of growth and root development

  4. Period of root stabilization

  5. Period of root resorption


Q3. Parents of 1,5-year-old boy came to a clinic of pediatric dentistry with complaints that the teething has not started yet. What age all the deciduous teeth are most likely to appear at?

  1. At the 5 years

  2. At the 4 years

  3. At the 3,5 years

  4. At the 2,5 years

  5. At the 1,5 year


Q4. The periapical radiograph of the upper jaw shows that the root length of tooth 21 fits the age of the child. Dentine walls of roots become thinner, diverging in apex direction and spout is formed. The root canal takes the form of funnel and joints with the growth zone. Define the approximate age of the child, and the stage of the roots development.

  1. 10 years old, incomplete root apex

  2. 7 years old, stage of unclosed root apex

  3. 9 years old, stage of unclosed root apex

  4. 8 years old, incomplete root (blunderbuss apex)

  5. 6 years old, incomplete root apex


Q5. A 6.5-year-old boy complains of destruction of a tooth on the left mandibula. Objective examination reveals a deep carious cavity in the tooth 74. Probing and percussion are painless, and gum in the area of tooth 74 is hyperemic. The tentative diagnosis is chronic periodontitis of tooth 74. The periapical radiograph shows the bone destruction in the bifurcation, and around the root apices. The half of the root length is resorpted. Which type of root resorption is the most likely to be?

  1. Physiological, mainly in the bifurcation region

  2. Physiological, equal (uniform)

  3. Physiological, unequal (uneven)

  4. Pathological, premature

  5. Pathological, delayed



Answer Keys


Q1: C

Q2: C

Q3: D

Q4: D

Q5: D


The short methodical guidelines for practice: ′Some features of pediatric dental examination′


The teacher checks pre-practice knowledge level using some test-questions at the beginning. After that, the teacher shows the basic and additional dental examinations at the patients and models. Then the students study and interpret the dental radiographs and others examinations. Having acquired the theoretical material, students acquire practical skills on their own. The practical skills are developed first on models and then on patients under the supervision of a teacher. The teacher should assess the student practical skills. Then, the teacher controls the student knowledge using the test questions. Wrap-up and evaluation of students are carried out at the end of the practice.


^ A TOPIC SUMMARY OF PRACTICE: PEDIATRIC DENTAL EXAMINATION


Social history:

Name (first name, second name, nickname); age, address, school, parental occupation).


Developmental and Medical history:

It allows the dentist to assess the patient’s dental growth. Eruption of the first tooth provides information as to the child’s future dental development. If a child a “late bloomer” it will not be surprising that the child will have a slower dental developmental pattern.

  • This part includes: prenatal – pregnancy complication

      • perinatal – premature or low-birth weight; birth complication

      • postnatal – hospitalizations, medications, allergies (medications, anesthetics, food), immunizations up to date, disability, chronic illness

      • developmental milestones within correct time-span – speech, motor skills, socialization

      • First baby tooth – how old was the baby when the first tooth appeared?

      • Any current medical treatment or problems – anemia, asthma, excessive bleeding from cut or extractions, cardiac problems, diabetes, eye disorders, frequent ear infections, immune-system disorders (HIV), kidney or liver problems, malignancies or leukemia, psychiatric care/ emotional problems rheumatic fever, sinus problems, thyroid disorders, tonsillitis, ulcer or colitis


Dental history:

History of fluoride intake, dental trauma, oral hygiene habits, oral or dental symptoms and presenting complaints, current infant-oral-health

  • Fluoride supplements

  • Water supply fluorinated

  • Tooth pastes use

  • Texture of toothbrush

  • Frequency of brushing

  • Dental floss

  • Bad breath

  • Mouth breathing

  • Oral habits: thumb sucking, fingernail biting, cheek-biting, pacifier

  • Grinding

  • Traumatic injury to the mouth or teeth

  • Teeth sensitivity to cold, hot, sweets, pressure

  • Swelling or lumps in the mouth

  • Frequent blisters on the lips or mouth

  • Pain around the teeth or ear


Feeding history:

Information such as whether the child is breast- or bottle-fed, frequency and duration of feedings, nighttime feedings, contents of bottle and pacifier use, solid food, snacking frequency, content, feeding problems.


Extraoral examination:

  • Evaluate head and neck for abnormalities (skin color and hydration, size, shape and symmetry)

  • Orthodontic facial type

  • Lymph nodes (cervical, submandibular, occipital)

  • Eyes, ears, TMJ, lips and mouth

  • Facial bruising - rule out child abuse

  • Speech and language assessment

Intraoral examination:

  • Evaluate the soft tissues ( vestibulum, labial and lingual frenum attachments, any mucosal pathosis)

  • Oropharynx and tonsils

  • Periodontal status and oral hygiene level

  • Dentition (molar relationship, overjet/bite midline, cross-bite, crowding/spacing, hypo/hyperdontia, hypoplastic/hypocalcified enamel)

  • Current dental status (tooth numbering- how does it fit to age? Tooth decay and presenting of caries-risk factors)


See Algorithm in Pediatric Dental Examination for more detailed studying in Clinical Examination.


Algorithm in Pediatric Dental Examination

1. History taking:

  • social- name, address, date of birth, school;

  • medical- medically compromised or none, identify where and why child is/was treated for any medical conditions, operations, medications, allergies;

  • dental- previous experiences( prevention, restorations, extractions), oral hygiene and dietary habits, complaints or reason for attendance( routine or emergency, presence of pain, any particular concerns)

2. Extraoral examination:

  • general appearance, skin colour and hydration (bruises/scars, laceration, swellings); face symmetry and proportions, lip vermillion (colour, scaling, crusting, bleeding) and lip closure- complete normal (without tension), complete abnormal (with tension), incomplete lip closure.

  • recognition of the main functions- breathing (normally is nasal, abnormal- mouth or mixed), swallowing (infantile or somatic type), speaking and pronunciation;

  • palpation of the lymph nodes- palpate the submandibular lymph nodes (enlarged or none);

  • temporomandibular joint- opening, deviation, discomfort

3. Intraoral examination:

  • vestibulum depth (deep- more than 10mm, moderate- within 5-10mm., or small- less 5mm);

  • labial frenum attachments (normally- frenum should be offset by 3-5mm from the gingival margin or abnormal attachment is shorter);

  • tongue and lingual frenum attachment (normally- the upper end of lingual frenum is spaced 1/3part from the tip of the tongue and lower end attaches to the mouth floor behind Wharton’s ducts), dorsal tongue and lingual papillae;

  • oral mucosa- cheeks, palate, oropharynx and tonsils (swelling, redness, ulceration or any other lesions);

  • periodontal condition (gingival inflammation, bleeding, pocketing);

  • chart the teeth present and absent, determine primary and permanent teeth, examine each tooth in turn for caries and for restorations present; try to make differential diagnosis especially between caries, pulpitis and chronic apical periodontitis;

  • oral surgery: grossly decayed teeth (roots), chronic apical periodontitis (draining parulis- sinus tracts or fistulae), identify the indications for tooth extraction; abnormal frenal attachments- remember recommended terms for surgical correction (frenotomy, frenectomy, or frenoplasty);

  • occlusion: identify misaligned teeth, areas of crowding, defects and relationship between the dental arches, especially “key of occlusions”- relationship of first permanent molars;

  • make the clinical diagnosis taking in account dental, surgical orthodontic problems, periodontal diseases, and oral pathology.

4. Make notations and fill out the dental charting.

Algorithm for assessment of oral hygiene

Green-Vermillion′s Index Simplex


  1. Stage


Coloring of the facial surfaces 16, 11, 26, 31 teeth and lingual surfaces 36, 46 teeth.


  1. Stage


Guideline Assessment:

(in order to coloring area of distribution on the teeth surfaces)





  1. Stage


Sum of marks

HI=

6 (teeth)


4 Stage



Index Assessment




Assess

0,06

Low

Good

0,7 – 1,6

Moderate

Satisfactory

1,7 – 2,5

High

Not Satisfactory

more 2,6

Very High

Bad


^ Oral hygiene index by Seelnes-Low


0 – no dental plaque on the point of explorer


1 – dental plaque unvisible but can find out using explorer


2 – visible dental plaque


3 – too much visible dental plaque covers smooth surfaces, interproximal spaces.


Sum of the marks

HI =

amount of teeth


^ Cariogenic situation is a result of joint action of some caries-risk factors, which can lead to the misbalance between demineralization and remineralization sidewise the demineralization, if this condition is existing for a long time, weather the compensatory mechanisms are inadequate (low caries resistance), or badly depleted (high activity of risk-factors)

Clinical appearance – focal enamel demineralization or white spot lesions.


^ CARIES-RISK FACTORS

LOCAL

SYSTEMIC

1. Dental plaque

2. Salivary disorders (amount or flow of saliva, thickness, Ph, low buffering capacity)

3. Gingivitis

4. Occlusal abnormalities

5. Abnormal frenum attachment

6. Early eruption of the teeth (immature enamel)

7. Enamel hypoplasia

8. Chewing dysfunctions

9. Soft food and increased frequency of sugars or snacks intake


1. Abnormalities during pregnancy

2. Malnutrition

3. Low concentration of fluoride in water supply

4. Gender predilection

5. Vitamin and mineral deficiency

6. Systemic (somatic) diseases

7. Immunocompromised children

8. Systemically administered drugs (tetracyclines)

9. Ecologic factors



Tests, which indicate cariogenic situation


Fedorov-Volodkina HI is more than 3, and Green-Vermillion HI is more 2 may indicate the person at high caries risk

Plaque-test is using of disclosing solution for identifying plaque on the tooth surfaces

Dentocult SM to identify the density of mutans streptococci

Class0 – from0 to 103

Class1 – from104 to 105

Class2 – from105 to 106

Class3 – from106 and more

Dentocult LB –amount of lactobacilli in the saliva

1-degree –up to 103

2-degree –up to 104

3-degree –up to 105

4-degree –up to 106

Caries-risk factor is bacterial density and amount more 104

^ Saliva viscosity(thickness) –high viscosity indicates a slow-flowing saliva, it’s considered as caries-risk factor meaning more than 1,46

Low ph < 6,2

Flow speed of saliva is determined according the formula: 0,78*age (years)+5,6 = amount of saliva, which should be secreted while 15min. Decreasing activity of salivary glands is cariogenic factor. Also, the greater protein content in saliva, the higher caries resistance

CRT – time of the change in color of a paper disc with acid-basic indicator on the tooth surface from yellow to purple, after applying diluted acid. In caries resistant persons, CRT is 63,09+4,19sec. If CRT<10sec. – low resistance to caries

Clinical speed of enamel remineralization – for normal caries resistance it takes not more 3 days

TER – the greater than 40%, the low caries resistance


Test of enamel resistance (TER)


Equipment:

  1. micropipette

  2. clock

  3. 1% dilution of hydrochloric acid

  4. 1% dilution of methylene blue

  5. Tenth-measured scales




  1. Remove the dental plaque from tooth surface and dry. Isolate from saliva.



2. The one drop of hydrochloric acid dilution is placed on the vestibular surface of the central incisor (the drop is 2mm in diameter) for a 5sec.



3. Wash off the acid and dry the tooth surface



4. Methylene blue dilution is placed on the etched site of enamel



5. Remove the methylene blue dilution with cotton wool pellets



6. Assess the intensity of coloring according the 10-measured scale


Assessment:

1-3 – high enamel resistance and tolerance for caries (structural and functional)

4-5 – moderate enamel resistance and caries resistance

6-7 – low enamel resistance and high caries risk

8-10 – extremely low resistance and maximum caries risk


^ Childhood can be classified as:

  1. Breast-fed period (0-1year), and can be subdivided further into new-birth period (within 2weeks or 1month): sucking is the predominant function. This stimulates jaw growth (especially lower jaw that is posterior to its normal position – physiologic retrognathy). Swallowing is infantile. Dental developmental pattern is important for us (eruption of all primary incisors from 6mnth to 1y.)

  2. Early childhood or crèche period (1-3years): complete formation of the primary dentition up to 2,5-3y. Sucking dies down, chewing is established, swallowing should become somatic type.

  3. Pre-school period (3-6years): further growth of the both jaws (maxillae and mandible), and due to this process spacing should be formed (diastema is normal for this age). This period is preceded by permanent dentition formation.

  4. Young school period (6-9years): further jaw growth, eruption of the permanent incisors (first group of eruption).

  5. Older school period (9-12years): jaw growth continues eruption of the permanent premolars and molars (second group of eruption).

  6. Adolescence period (12-16years): further formation of periodontium and bone structures.

^ The chronology of the development of the primary dentition

Tooth

Initiation

(intrauterine period/weeks)

Mineralization begins (intrauterine period/months)

Times of eruption (months after birth)

Complete root development (years of life)

Resorption begins (years of life)

I

Between 6-8 weeks of the intrauterine period

4,5

6-8

2

5

II

4,5

8-12

2

6

III

4,5

16-20

5

8

IV

7,5

12-16

4

7

V

7,5

20-30

4

7-8


^ The chronology of the development of the permanent dentition

Tooth

Initiation


Mineralization begins

Times of eruption (years of life)

Complete root development (years of life)

1

8th month of intrauterine period

6th month of life

6-7

10

2

9th month of life

7-8

10

3

6th month of life

10-11

13

4

2 years of life

2,5 years

9-10

12

5

3 years of life

3,5 years

11-12

13

6

5th month of intrauterine period

8th month of intrauterine period

5-6

9-10

7

3 years of life

3,5 years

12-13

15

8

5 years of life

8 years

17-19

19,5-21


^ Stages of root and periodontal development may be seen on periapical radiograph:


  1. Incomplete root development or ′blunderbuss′ apex is the stage of continuous root growth and increasing the root into the length. The root walls look like two bright strips, which become thinner and diverging in the direction of growth zone, and spout is formed. The root canal takes the form of funnel and joints together with growth zone. This growth zone is seen as well-demarcated area of radiolucency.




  1. Incomplete root apex is characterized by: the root is normal length; dentine walls are parallel and become thinner in apex direction. The diameter of root canal at the pulp floor is the same as at the apex. Periodontal ligament space has the same thickness throughout and confluents with the growth zone at the apex.




  1. Opened (unclosed) root apex: the root walls are gradually converging, but not completely closed. The root apex is clearly seen on the radiograph (it can′t be determined at the stage of complete root development). The root canal is still wide, its diameter at the apex is narrower than in the root cervix. Periodontal space is well-defined throughout and enlarged to the apex.




  1. ^ Immature periodontium is characterized by the expansion of periodontal space, especially at the apex. This extension may exist in the area of the central incisors at the age 7-11 years; lateral incisors and first permanent molars – 8-11 years; canines – 11-16 years; premolars – 13-17 years.




  1. ^ Complete root and periodontium development


Tooth charting in permanent dentition


8 7 6 5 4 3 2 1

1 2 3 4 5 6 7 8

8 7 6 5 4 3 2 1

1 2 3 4 5 6 7 8


^ Tooth charting in primary dentition


V IV III II I

I II III IV V

V IV III II I

I II III IV V


^ Recommended World Health Organization (WHO) for permanent dentition


18 17 16 15 14 13 12 11

21 22 23 24 25 26 27 28

48 47 46 45 44 43 42 41

31 32 33 34 35 36 37 38


^ Recommended WHO for primary dentition


55 54 53 52 51

61 62 63 64 65

85 84 83 82 81

71 72 73 74 75



^ Graph of logical structure to the subject ′Some features of pediatric dental examination′


  1   2   3   4   5   6   7   8   9

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