Pediatric dentistry

case presentation

Personal historyPatient name : Ahmed Mohamed Abdalaziz Mohamed Age : 4years .Sex : maleBirth date :23 / 4 / 2011Phone : 01201633342Address : Alexandria . Alajamy Order among sibling : 1st Father occupation : teacher Mother occupation : housewife

chief complaint referred from other dental clinic for

construction of space maintainer for missing upper first primary molars .

Previous dental history ((Mother’s own words)(Mother’s own words)

Note : Child was breast feeding and

bottle feeding till 2 years there was repeated night feeding ( without cleaning the teeth) .

Discoloration and chipping of his teeth .

medical historyDoes child have: Yes no

Rheumatic fever √Diabetes√Kidney disorder√Heart disorders√Seizures√Hepatitis or AIDS√Bleeding problem√Breathing problems√

Asthma

medical history including:Q how often attacks occur(Triggering agents) ? Colds , changes in weather, dust ,strong smells.

Q how severe they have become(Frequency & severity of the attack)? Severity →moderate to severe Frequency → according to stimuli ( at night) Q Has child ever had been hospitalized? YesQ When the patient was hospitalized? Last time before 2 months

W

hat m

edicatio

n th

e patien

t takes? .

Aironyl Bronchodilator Syp 3mgTables 2.5 mg

VendexineAnti allergicanti-inflammatory

KokastBronchodilator tablets in a blister.Store below 30 ·C

Examination of head and neck and extremities

( N . O .S)

normalabnormalFacial swelling or asymmetry√

TMJ√

Eyes√

Nose√

Lymph nodes√

Fingers and nails√

Intra oral examination

normalabnormalLips√

Labial & buccal mucosa√

gingiva √

tongue√

palate√

(N . O .S)

Assessment of oral hygiene ( plaque index - Silness and Loe index)

ToothSurfacescore55Labial1

52Buccal2

64BuccalMissed

75Lingual1

72Lingual1

84Lingual1

Plaque index score : ( 1+ 2+1 +1 +1 ) I 5 = 1.2

Fair

Extra oral examination:

normalabnormalgait√

Hair√

Weight√

Stature√

Hands & finger nails√

(N . O .S)

Frontal facial profile

(( symmetrical ))

right

Lateral facial profile

( slight convex )

occlusion midline deviation to

word right side .Over jet:1mm Overbite :30%

No abnormal oral habit.

LeftRight

RELATION rightleftCUSPED

RELATION Class IIIClass I

Molars RELATION

Mesial step

Mesial step

Behavioral assessment

Un cooperative ..according to Frankl’s scale

and Wright’s modifications Rating 2 >>> (-ve)

Dental examinationDental Charting

4746454443424131323334353637

55

54535251

61

626364

65

85

84838281

71

727374

75

1716151413121121222324252627

class I

class v

class Iclass I

class IV

class Iclass I

class I

Dental examination

Investigation

X-rays( per apical )

InvestigationStudy cast

Calorie Range = 1200Calorie Range = 1200

sedentary …. Calorie level: 1200

Food groupRecommended amounts

Total diet consumed

Actual deficiency

Grain group4oz 4oz 0

Vegetable group1.5 cups 1cup- 0.5 cup

Fruit group1cup 1 cup0

Milk group2 cups2 cup 0

Meat and beans group

3oz 3oz0

Diet analysis

Food formDay of week( Sunday )sugar in solutionWith meal1

Bet meals1

Solid & retentive sugar food

With meal2

Bet meals1

Total number of exposure/day20 3 x

Total exposure X 20 min = time of exposure to acids60 min

Diet analysis. deficiency in vegetable group .

Offenders ( chocolate , chips ,sweets ,unnatural juice )

Substitutes ( nuts ,pop corn ,natural juice or milk with out sugar.

He is in a high risk group for sugar consumption (Occasional (2-3 daily) between meal exposure to sugar foods strongly associated with caries

Diagnosis

Problem List

Medically compromised patient ( Asthma ).

Sever early chidhood caries

Poor dietary habits.

- high caries risk .- Fair oral hygiene(1)

1st Visit:

1) Medical and dental history .2) Behavior Management3) Extra oral and Intra oral Examination.4) Preoperative Radiographs ,Photographs and study

cast.5) Intra oral per apical x ray .6) Diagnosis .7) Oral hygiene instruction. 8) Topical fluoride .

1(Medical Phase Systemic phase and

consultation

Ahamed with positive medical history ( Asthma) referred to (Dr.Adel Jarjes) for evaluation and consent.

Behavior Manageme

nt Techniques

3(Restorative Phase

5(Maintenance Phase

Recall after one week to check the appliances .Periodic follow up every 3 months for:Reinforcement of OHITopical fluoride application Follow up of restorations and ssc on #74 & #75.Detection & restoration of any carious lesionsAnticipatory guidance

1.Provide oral hygiene counseling for parents.

2.Provide dietary counseling related to oral health.

3.Provide age-appropriate injury prevention counseling for

orofacial trauma.

4.Provide counseling for non-nutritive oral habits (e.g.digit,

pacifiers).

5.Provide required treatment for any oral diseases or injuries.

6.Consult with the child’s physician as needed.

Cont>>..… 7. Complete caries risk assessment.

8. Provide topical fluoride treatments every 3 months or as

indicated by the individual patient’s needs.

9. Provide pit and fissure sealants for caries-susceptible

permanent molars, and anterior teeth.

10.Assessment and treatment of developing malocclusion

11.Provide required treatment and/or appropriate referral for any

oral diseases, habits, or injuries as indicated.

12.Assess speech and language development and provide

appropriate referral as indicated.

Nance space maintainer was inserted to maintain space for eruption of canine and premolars.

Check integrity of all restorations.Check any new lesions or any defect in

restoration.Check space maintainer appliances.Check occlusion development.

Nance SM will be removed after eruption of permanent first molars, canine and premolars.

Detect any abnormal sequence of eruption of all the permanent dentition..

Local anesthesia 1.8 ml mepvicain 2% with Vasoconstrictor (epinephrine 1/80000).

Cementation of SM & SSC by(( POLY CARBOXLATE CEMENT )).

Patient was cooperative in last two visits .

الطفل اسنان صحة على للمحافظة تعليمات

حافظات 1) مع كلها األسنان غسلالفوالذية والتركيبات المسافة

فضالت ترك وعدم جيدا بالفرشةاألسنان على األكل

سيستمر 2) المسافة لحافظ بالنسبةتظهر ان إلى الفم في وجوده

مكانها وتاخذ واألنياب الضواحكإزالته .. سيتم ذلك وبعد الصحيح

كل 3) دورية زيارة هناك تكون سوفالالصقة المادة لتفقد اشهر ثالثة

والتركيبات المسافات لحوافظتواجد من للتأكد وكذلك الفوالذية

األسنان على الالصقة الساداتمؤخرا ظهرت التى عاألسنان ووضعها

االسنان 4) على فلوريد طبقة وضعكل لمعدل 3وتكرراها uنظرا اشهر

الطفل . لدى العالى التسوس

Before after one week

After 3 month

After 6 month

Before after one week

after 3 monthsafter 6 months

Before

after 3 monthsafter 6 months

after 1 week

Before

after 3 monthsafter 6 months

after 1 week

Before

After 3 month

After one week

After 6 month

After 6 months

After 3 months

1st visit

Before

after

x ray

Problem List

Medically compromised patient ( Asthma ).

Sever early chidhood caries

Poor dietary habits.√Fair oral hygiene(1) √√

√

EARLY CHILDHOOD CARIES

Definition:It is diagnosed when there is one or more decayed (non cavitated or cavitated lesions), missing (due to caries) or filled tooth surface in any primary tooth in a child 71 months of age or younger.

Cont>>

The term severe ECC (S-ECC) refers to Any sign of smooth surface caries in children

younger than 3 years. One or more cavitated, missing (due to caries) or

filled smooth surface in primary maxillary anterior teeth in children 3-5 years.

DMF score > or = 4 at age 3.DMF score > or = 5 at age 4. DMF score > or = 6 at age 5.

Classification of respiratoy diseases

1 (Inflammatory lung disease

2) Obstructive lung diseases

- Chronic Obstructive

Pulmonary Disease

(COPD)

- Asthma

3-Restrictive lung diseases

4.Respiratory tract infections

- Upper respiratory

tract infection

-Lower respiratory tract

infection

5. tumors

6. Pleural cavity diseases

7. Pulmonary vascular

diseases

- ASTHMA

A dental procedure constitutes an acute irritant to the airways of the asthmatic child and may precipitate .an attack

Dental implications

-High caries rate

-Decreased salivary rate

increased prevalence of oropharyngeal candidiasis

-Increased level of gingivitis

-Orofacial abnormalities-:→High palatal vault

→Posterior crossbite→Greater overjet

→Increased facial height

Dental care before , during and after asthmatic pt treatment dentally-:

1) taking medications prior to the dental appointment. 2) If patients use a Medihaler they should bring it to their

appointment. 3) Position the child in upright or semi upright position.4) Avoid :

Barbiturates & narcotics → histamine release

-Aspirin compounds & non steroidal

anti--inflammatory drugs → wheezing

1) -Discontinue the treatment

2) If they have a Medihaler, they should utilize it(reverse the

bronchospasm) .

3) Reassure the patient & give 100% oxygen.

4) If no improvement, give 0,01 mg/kg epinephrine(1:1000)

subcutaneously ,(maximal dose, 0.5 mg).

If attack occurred during dental carecoughing, wheezing, chest tightness, and shortness of

breath-:

Cont>>>

If no relief has been afforded after two doses of epinephrine, emergency transport to the hospital should be arranged.

Early administration of a corticosteroid (hydrocortisone or dexamethasone) may also be helpful in severe attacks

Conclusion

Dentists should pay extra attention to the oral status of asthmatic patients, since they are more susceptible to caries and its progression. In this way, several painful and harmful complications and the huge economic expenses due to caries

could be reduced among persons with asthma.