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PRE-CLINICAL PEDIATRIC DENTISTRY

DSV 342 The practical importance of pediatric dentistry

4

Updated:26/1/2012

Saturday 18/2/2012

1:00 pm-2:00 pm

Tuesday, November 11, 2014 1 OTHMAN AL-AJLOUNI

The practical importance of pediatric dentistry (Pinkham, Ch.1, Pg. 1)

• Historical perspective.

• Application of other disciplines.

• Challenges for pediatric dentistry in the 21th century.

• Child abuse and neglect, children of poverty.

• Informed consent and risk management technology.

• Heath care delivery strategies/payment strategies.

• Emergence of pediatric dentistry as a worldwide community.


PRE-CLINICAL PEDIATRIC DENTISTRY

DSV 342 The practical importance of pediatric dentistry

(Pinkham, Ch.1, Pg. 1) Historical perspective. Application of other disciplines.

Challenges for pediatric dentistry in the 21th century. Child abuse and neglect, children of poverty. Informed consent

and risk management technology. Heath care delivery strategies/payment strategies. Emergence of pediatric

dentistry as a worldwide community.

Professor Othman Al-Ajlouni Salman Bin Abdul Aziz University

Saturday 28/1/2012 1:00 pm-2:00 pm


Introduction and course requirements

• Course description,

• course objectives,

• text books,

• attendance,

• grading criteria,

• didactic and laboratory projects outline.

• introduction and course requirements



Course description

• This is a two credit hour made up of didactic and laboratory technique as introduction to pediatric dentistry. The course holds in the second half of the third year.

• The primary goals of pediatric dentistry include the diagnosis and prevention of disease, the preservation of the natural dentition and the restoration of health, function and esthetic of stomatognathic system. The lectures will cover all these topics.



Course description

• The primary function of the laboratory is the development of psychomotor skills of the dentist. The psychomotor skills must be highly developed in order to provide quality care of the children.

• Due to the high degree of skill required, disappointments and frustrations may occur during the process of learning and development. Some students, for example, will need to repeat various projects. However, the pre-clinical laboratory is the place where mistakes can occur without damage to the patient, and where skills can be developed to a high level of proficiency.



Course description

• In order to maximize the benefits of each laboratory session, students will be expected to study the laboratory manual preparation for each project.


Pediatric Dentistry Training Module

Training and Calibration Guidelines

for The College of Dentistry, Salman Bin Abdul Aziz University

Updated : 16/1/2o12

Preclinical Exercises

Preclinical Pediatric Dentistry Preclinical Exercises

The following procedures shall be carried out by students in the Phantom Head Laboratory on ivories or natural teeth:

• Occlusal cavity for amalgam on #54

• Occlusal cavity for amalgam on #84

• Occlusal-lingual (OL) #55

• Mesio-occlusal (MO) #65

• Mesio-occlusal (MO) #85

• Disto-occlusal (DO) #74

• Rubber dam isolation Demonstration


• Rubber dam isolation Demonstration • Forming and placing T-band matrix • Amalgam restoration: condensing, carving, burnishing and

finishing • Fluoride gel application Demonstration • Fissure sealant (permanent molar) Extracted tooth • Preventive resin restoration Natural permanent

molar/premolar • Stainless steel crown preparation #75 or #85 and #64 • Pulpotomy (primary molar) Extracted natural tooth • Composite crown (anterior strip) #52 or #62 • Extraction technique in children Demonstration • Space maintainer Demonstration (band

selection and adaptation)


• #J – OL/L amalgam

• #S – Do and #T MO amalgam

• Adaption of a T-band for class II preparation

• #K – SSC, #L – DO composite

• #A – SSC, #B – pulpotomy and SSC

• #F – strip crown

• #E – SSC


#J (55) OL/L amalgam


#S(84) DO and #T (85) MO amalgam


Adaption of T Band for Class II restorations


#J OL/L

amalgam #S DO and #T MO

amalgam

Adaption of T Band for Class II

restorations


#K(75) SSC, #L(74) DO Composite


#F Strip Crown


#A SSC, #B Pulpotomy/SSC


#E SSC

Incisal/Lingual reduction for 1 mm clearance

Interproximal reduction to allow for close adaption

Similar to strip crown without a groove


#K SSC, #L DO

Composite #A SSC, #B

Pulpotomy/SSC

#F Strip Crown

#E SSC

Incisal/Lingual reduction

for 1 mm clearance

Interproximal reduction to

allow for close adaption

Similar to strip crown

without a groove

Daily Clinical

Protocols

Daily Clinical Protocols

• Students expected to arrive on time in the Pediatric clinic.

• All patients are scheduled by the Pediatric clinic assistant and students are not assigned pediatric patients to their family of patients.

• The students should thoroughly review the chart prior to treatment.

• The faculty hold seminars and discuss Tx planning, behavior management, charting and Tx sequencing among other topics.

Daily Clinical Protocols Examination:

• Medical and dental Hx.

• Evaluation of hard and soft tissues.

• Radiographs are based upon individual need and taken only when a diagnostic yield is expected.

• Caries Risk Assessment.

• Occlusal analysis and need for orthodontic assessment.

• Other specialty consultations are requested, if needed.


Tx Plan Formulation:

• “Worst first” approach

• Quadrant dentistry/arch dentistry

• Selective non-invasive procedures introduce the patient to the dental environment

• Caries Risk assessment and Preventive follow-up


Behavior Management:

• Tell, Show, Do

• Positive Reinforcement/Ignoring Negative

• Nitrous Oxide

• Voice control

• Modeling

• Distraction

• Papoose board used as needed – parents may or may not be in the operatory during procedures


Materials:

• Local Anesthetics – Lido 2% with epi (max single dose 4.4 mg/kg/2mg/lb [300 mg], septo 4% w/ epi

• Amalgams – Dispersalloy

• Composites – Dyract, Esthet-X micro hybrid and composite, Clinpro Sealant

• Matrix and Wedging – T bands, Palodent matrix, Tofflemier matrix bands

Daily Clinical Protocols Stainless Steel Crowns:

• Occlusal reduction, interproximal and B/L reduction to allow for proper adaption of the crown

• 1 – 1.5 mm of occlusal clearance and no cervical ledge to prevent seating

• Use 6888-012 flame diamond and 909-040 wheel diamond, 330 and 169L

• Adapt 3M Ion primary molar crowns

• Crimping pliers/Howe pliers for contouring

• Cement with glass ionomer luting cement


Pulp Therapy for Primary/Immature Permanent Teeth:

• Protective base – Fuji GI liner

• Indirect pulp cap

• Direct pulp cap (permanent only) MTA or CaOH


Pulpotomy Primary:

• Access pulp chamber – 330 or 169 carbides

• Remove pulp tissue - #4 or #6 round burs

• Formocresol or Ferric sulfate to fix tissue

• IRM or Tempit in pulp chamber

• Condense wet cotton pellet or amalgam condenser

• Pulpectomy Primary – 30+ Vitapex, ZOE


Space Maintainers:

• Band and Loop

• Lower lingual holding arch

• Transpalatal arch/Nance appliance


Pediatric Burs:

• 331/2, 34, 35SS, 330, 556SS, 556, 169, 169L

• #2, #4, #6, #8 round

• 6358-023 football diamond, 6888-012 pointed tapered diamond, 909-040 wheel diamond, 6858-014 pointed taper diamond, 7901 flame carbide, 7408 football carbide

Assessment

of

Student

Performance

Pediatric Dentistry Clinical Requirements

Essential Experiences = EE

• 100 Procedures to include at least 1 space main.

• 1 Pulpotomy

• 1 SSC

Competency Assessments = CA

• 1 Pediatric Class II composite or amalgam

• 2 Case-based Tx plans – 1 comprehensive exam and 1 dental emergency exam

Faculty Assessment of Student Performance

• Faculty should consult the Clinical Procedure Guide Book (CPGB) for the clinical technical criteria for assessing each clinical procedure. Link to CPGB:

G:\Dental\CPAF's_CLINICAL GUIIDEBOOK

• On site faculty should utilize electronic CPAFs for pediatric assessment. Electronic CPAF can be accessed at:

https://asd.icedentalsystems.com/

• External site faculty should utilize the daily CPAF. Link:

G:\Dental\CPAF's_CLINICAL GUIIDEBOOK\CPAFS Versions 4.07

• Hard copy CPAF for pediatrics is also available. Link:

G:\Dental\CPAF's_CLINICAL GUIIDEBOOK\CPAFS Versions 4.07

D1351 Sealant

D1351 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1

Procedure and Surface Preparation

Appropriate sealant product selected. Tooth surface clean and free from debris

Failure to review Med and Dent Hx. Failure to clean surfaces in preparation for sealant

Inappropriate understanding of what is involved and how procedure is done

Isolation Tooth is adequately isolated to prevent contamination

Loss of isolation No isolation

Etch/rinse/isolate Tooth etched appropriately & rinsed

Incomplete etch or contamination of site

No etch

Sealant placement/cure Appropriate amount of sealant applied and allowed to cure for appropriate amount of time

Inappropriate amount, too much, too little, requiring adjustment through further care

Inability to complete procedure

Sealant adhered Sealant checked for complete adherence. Tooth restored to ideal occlusion w/o assistance

Incomplete retention of sealant material

No retention of sealant material

D2150 CL II Amalgam


Outline Form and Extension

Outline does not weaken the tooth, no demineralization

Over prepared or extended when caries and anatomy does not dictate

Grossly over prepared or extended OR Preparation of wrong tooth

Proximal & gingival extension is optimal

Optimal treatment of fissures

Oblique ridge of upper second primary or permanent molar nor transverse ridge of lower are not crossed unless undermined by caries

Proximal cavosurface angles at 90 degrees

D2150 CL II Amalgam


Internal Form Proximal walls are convergent occlusally

Over prepared or deeper than necessary

Pulpal exposure when none should have occurred

Portions of the prep that extend into the buccal and lingual grooves should slightly diverge

Pulpal floor, 1mm, free of defects, uniform depth, internal line angle slightly rounded, axio-pulpal line angle is rounded, gingival floor 1 – 1.5 mm wide – M-D

Retention features (grooves) ideally placed, if necessary

No fragile or unsupported enamel

D2150 CL II Amalgam


Operative Environment Rubber dam is optimal, preparation is dry

Poorly adapted dam Failure to use dam

Adjacent tooth contact is not damaged

Amalgam material is handled in a safe manner

Matrix band and wedge used appropriately

Anatomical Form Restores harmonious form of existing tooth

Proximal contour returns proper shape and position

Optimal contact will allow lightly waxed floss to pass with proper resistance

D2150 CL II Amalgam


Margins No excess or deficiency at any margin

Excessive or deficient margin that can be improved without new restoration

Excessive or deficient margin that requires new restoration

Finish, Function & Damage

Smooth surface, no pits, voids or irregularities

Damage to adjacent tooth which is noted but is managed with minimal involvement

Damage to adjacent tooth causing loss of tooth structure and necessitating a restoration

Examples of CL II Amalgam Preps

Proximal walls are convergent

occlusally,

portions of the prep extend into buccal

and lingual grooves,

pulpal floor is flat and uniform depth,

gingival floor is 1 – 1.5 mm wide

mesiodistally.

Acceptable

Examples of CL II Amalgam Preps Assuming a small

interproximal lesion, just

inside the DEJ. The size

and axial depth of the box

would rate this Improvable.

If there was a pulpal

exposure, it would be

Unacceptable


course objectives

Upon completion of this course, the student should be able to:

1. Understand the basic morphologic application of cavity preparation in primary teeth.

2. Gain the knowledge of matrix systems, amalgam and composite resin manipulation, stainless steel crown restoration as related to primary teeth.

3. Understand the technique and indications for pulpotomy.



course objectives

4. Utilize the sealant system as a preventive measure against caries.

5. Predict possible crowding problems and to utilize the space maintainer as a preventive measure against malocclusion.

6. Acquire such psychomotor skills as to be able to treat a child by carrying of simple procedures in the clinic without any inhibitions.



Recommended Textbooks

• Every student is required to purchase the Recommended Textbooks.

• Lectures will be given from these books,

• students are required to read the assigned chapters for every lecture.

• The lecture may not cover everything.

• Examination will be from the lectures and respective chapters in the textbooks.



attendance

• Students MUST attend all lectures and laboratory exercises, and be ON TIME.

• Student who fails to attend a lecture/lab., he must report to COURSE DIRECTOR the reason behind his absence.

• Any student who fails to attend 75% of lectures/laboratory exercises will not be allowed to sit for the FINAL EXAMINATION.

• No excuse whatsoever.



Grading criteria

• Didactic – 40%.

• Laboratory – 60%.

• Student MUST pass both parts individually to pass the course.

• If a student passes the didactic but fails the laboratory part, or vice versa, he will not pass the course.



Grading criteria

I. Didactic – 40%

The evaluation for the lecture part will be as the following:

I. I. Mid-Term Exam [Essay or/and short note questions

or/and MCQs] 15%.

I. II. Final Exam [MCQs or/and Essay or/and short note]

25%.



Grading criteria

II. Laboratory – 60%.

The evaluation for the laboratory part will be as the following:

I. II. Weekly projects/Cleaning the cubicle/Behavior 25%

II. II. Quizzes 5%

III. II. Midterm Exam [specific lab procedure] 10%

IV.II. Final Exam [specific lab procedure/spot Exam] 20%



didactic outline

1. The practical importance of pediatric dentistry

2. Development and morphology of the primary teeth

3. Dental caries in the child and adolescent

4. Restorative Dentistry for the primary Dentition:

• I: posterior restorations

• II: anterior restorations

• III: stainless steel crowns Tuesday, November 11, 2014 52 OTHMAN AL-AJLOUNI


didactic outline

5. Pulp therapy for the primary dentition

6. Local anesthesia

7. The use of rubber dam in pediatric restorative dentistry

8. Prevention of dental diseases

9. Eruption and development of primary dentition

10. Dental materials in pediatric dentistry

11. Space maintenance in the primary dentition

12. Oral habits

13. Examination of the child patient Tuesday, November 11, 2014 53 OTHMAN AL-AJLOUNI


laboratory projects outline

The following procedures shall be carried out by students in the Phantom

Head Laboratory on ivories or natural teeth:

1. Occlusal cavity for amalgam on #54

2. Occlusal cavity for amalgam on #84

3. Occlusal-lingual (OL) #55

4. Mesio-occlusal (MO) #65

5. Mesio-occlusal (MO) #85

6. Disto-occlusal (DO) #74

7. Rubber dam isolation Demonstration

8. Forming and placing T-band matrix

9. Amalgam restoration: condensing, carving, burnishing and finishing Tuesday, November 11, 2014 54 OTHMAN AL-AJLOUNI


laboratory projects outline

10. Fluoride gel application Demonstration

11. Fissure sealant (permanent molar) Extracted tooth

12. Preventive resin restoration Natural permanent molar/premolar

13. Stainless steel crown preparation #75 or #85 and #64

14. Pulpotomy (primary molar) Extracted natural tooth

15. Composite crown (anterior strip) #52 or #62

16. Extraction technique in children Demonstration

17. Space maintainer Demonstration (band selection and

adaptation)



References:

1. McDonald RE, Avery DR, Dean JA. Dentistry for the child and adolescent, 8th Ed. New York, NY, 2005, Mosby.

2. Pinkham JR, Casamassimo PS, Mc Tigue DJ, Fields HW, Nowak AJ. Pediatric dentistry , infancy through adolescence, 4th ED. Philadelphia PA: WS Saunders Company; 2005.

3. Raymond L. Braham and Merle E. Morris. Textbook of Pediatric Dentistry, 2nd Ed. Baltimore. London. Loss Angeles. Sydney,1985, Williams & Wilkins.

4. R. S. Andlaw, W.P. Rock. A Manual of Pediatric Dentistry, Churchill Livingstone,1998.



5. Angus C Cameron and Richard P Widmer. Handbook of Pediatric Dentistry.

3rd Ed, 2008, Elsevier Limited.

6. Welbury ,R.R..(2001) Paediatric Dentistry . 2nd edition. Oxford University

Press, London.

7. Related Articles will be distributed.

8. Main internet resources:

9. American Academy of Pediatric Dentistry Policies and Guidelines

10. www.aapd.org


http://www.aapd.org/





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