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ЗмістTherapeutic pediatric dentistry
Pulpitis and periodontitis in children: clinical diagnosis and treatment
Dental developmental defects and traumatic injuries of teeth: clinical diagnosis and treatment
Some features of pediatric dental examination
Aims of the practice
The specific objectives
Identification and supporting of the pre-practice skill-knowledge level
A topic summary of practice
Oral hygiene index by Seelnes-Low
Childhood can be classified as
The chronology of the development of the primary dentition
The chronology of the development of the permanent dentition
Stages of root and periodontal development may be seen on periapical radiograph
Complete root and periodontium development
Tooth charting in primary dentition
Ministry of Public Health of Ukraine
Donetsk National Medical University named after M. Gorky
Pediatric Dentistry Department
THERAPEUTIC PEDIATRIC DENTISTRY
to self-directed preparation for practices
in therapeutic pediatric dentistry
for students of 4th term of dentistry faculty
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.
Approved by Scientific Council of Donetsk National Medical University named after M. Gorky. (Protocol №6 from 30 of August, 2012).
MODULE no. 1
To be able:
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.
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.
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?
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?
Q3. 24-year-old woman, on the 4th month of pregnancy, asks a dentist, which teeth have already initiated in the fetus?
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?
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?
Sources of Information
Studying content associated with the specific objectives
Sources of Information
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?
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?
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?
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.
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?
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.
^ PEDIATRIC DENTAL EXAMINATION
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.
History of fluoride intake, dental trauma, oral hygiene habits, oral or dental symptoms and presenting complaints, current infant-oral-health
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.
See Algorithm in Pediatric Dental Examination for more detailed studying in Clinical Examination.
Algorithm in Pediatric Dental Examination
1. History taking:
2. Extraoral examination:
3. Intraoral examination:
4. Make notations and fill out the dental charting.
Algorithm for assessment of oral hygiene
Green-Vermillion′s Index Simplex
Coloring of the facial surfaces 16, 11, 26, 31 teeth and lingual surfaces 36, 46 teeth.
(in order to coloring area of distribution on the teeth surfaces)
Sum of marks
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
amount of teeth
^ 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.
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
^ (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)
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
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
Tooth charting in permanent dentition
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