PEDODONTICS MIDTERMS

INTRAORAL EXAMINATION Examination of the oral cavity The breath of the healthy child is usually pleasant and

even sweet BAD BREATH or HALITOSIS may be caused by local or

systemic factorso LOCAL

Poor oral hygiene Presence of blood in the mouth Presence of strong smelling

volatile foodo SYSTEMIC

Dehydration Sinusitis Hypertrophy of upper alimentary

tract Typhoid fever Other enteric infections and GI

disturbances ACIDOSIS usually produces and odor of acetone on

the breatho Condition of the oral mucosa is an indicator

of the general health of the childo Presence of inflammation, pallor, and

ulcerations

SOFT TISSUES LIPS & CHEEKS

o Gateway to the oral cavityo The most common lesions seen in the labial

and buccal mucosa of children are those associated with HSV

o Addison’s disease and Intestinal Polyposis may cause a pathologic brownish…

TONGUEo Pathologic enlargement of the tongue may

be due to cretinism or mongolism or may be associated with a cyst or neoplasm

o Desquamation of the surface papillae associated with avitamonoses, anemias, or stress disorders

o Abnormally short lingual frenum may prevent the tip of the tongue from coming forward and result to speech difficulty

o Tongue habits should be observed for possible association with malocclusion

o Dryness of tongue may be due to dehydration for mouth breathers

o RANULA or MUCOUS RETENTION CYST …

SALIVARY GLANDSo Epidemic parotitis or Mumps is

characterized by a tender, painful, unilateral or bilateral swelling of the salivary glands

HARD & SOFT PALATEo Scars may be caused by trauma or surgical

repair of developmental anomalieso Color changes may be caused by

neoplasms, infectious or systemic diseases, trauma or chemical agents

TONSILS GINGIVA

o Periodontal pocketing is rare in the primary dentition unless there is an associated medical condition

o If generally the oral hygiene is good, with few plaque…

TEETHo Oral cleanlinesso Teeth present/number of teeth

Partial anodontia Supernumerary teeth

(Mesiodens)o PRIMARY

Crowns are completely formed and start to erupt: 6 months

Start of tooth formation: 6 weeks intrauterine life

Completion of roots: 2 years Formation of roots start at 1

yearo PERMANENT

Crowns form: 3 years Roots form: 3 years

o Size of teeth Macrodontia Microdontia

o Mobility Exfoliating primary tooth Abscess Periodontitis

o Color of the teeth Extrinsic stains can be caused by

chemogenic bacteria which may invade deposits of materia alba and calculus, causing an array of colors on children’s teeth

Generalized discoloration of the enamel and dentin is due to intrinsic factors such as:

Blood dyscrasias Amelogenesis

imperfecta

Dentinogenesis imperfecta

Internal resorption Drugs – tetracycline

Non-vital tooth Caries

o Structure/malformation Hypoplasia Hypomineralization Dilacerations Dwarfed tooth Geminated tooth Fused tooth Nothced tooth – syphilis Peg-shaped tooth

Due to hereditary, systemic or developmental disturbances

OCCLUSION/OCCLUSAL ASSESSMENTo Permanent first molars and canines

Molar and canine relationshipso incisors

overjet overbite

o position crowding spacing drifting

MORPHOLOGY OF THE PRIMARY TEETH 1 hour chair time at the most for pedo patients Primary has flared roots Primary may fracture easily at the neck portion

GENERAL MORPHOLOGIC CONSIDERATIONS IN THE PRIMARY DENTITION

CROWN1. Shorter crown2. Occlusal table is narrower3. More constricted cervical area4. Enamel and dentin layers are thinner5. Enamel rods in gingival 3rd extend slightly

occlusal direction from DEJ6. Contact areas are broad and flat7. Mineral content is nearly the same8. Color is more lighter9. oral hygiene is not yet developed in

children that is why they are more prone to acute caries

PULP1. Larger pulp2. pulp horn is closer to outer surface3. mesial pulp horns are closer to outer

surface

4. mandibular has larger pulp chamber than maxillary

5. form of pulp chamber follows the surface of the crown

6. usually has pulp horns under each cusps7. histologically, there are very little

differences from permanent ROOT

1. Narrower M-D of anterior roots2. Posteriors are longer and more slender3. More flare as it approach the apex

INFLUENCES OF PRIMARY TOOTH MORPHOLOGY Progress of caries and it is necessary to restore

incipient lesions in primary teeth because of the ff. factors:

Enamel is much thinner Thus, dental caries is more active

in primary teeth Dentin is proportionally thinner

INDICATIONS FOR USE OF MATERIALS IN PEDIATRIC DENTISTRY PRIMARY

CLASS I GIC, Am, Co

CLASS II GIC, Am, Co

Gross carious breakdown or restoration after pulp therpy

SSC PERMANENT

Occlusal Table Fissure sealant

Occlusal enamel caries Fissure sealant

Occlusal caries with minimal involvement of dentin

PRR (Preventive Resin Restoration)

CLASS I Co

CLASS II Am

CLASS III Co

CLASS IV GIC, Co

CLASS V Co

PREVENTIVE RESIN RESTORATIONS Most conservative approach toward confined, incipient

occlusal caries in young permanent teeth whereby restoration occurs with a minimum of tooth

preparation while ensuring the prevention of future caries formation through sealant placement

PRR preserves sound tooth structure by incorporating a conservative composite resin restoration with sealant application

Counterpart in adult/permanent: SPOT FILLING PROPHYLACTIC ODONTOTOMY – remove defect part

of tooth to prevent decay

3 TYPES OF PRR1. TYPE A

Comprises suspicious pits and fissures where caries removal is limited to enamel

Unfilled sealant2. TYPE B

Is indicated where the exploratory removal of caries has included dentin to a slight extent

Diluted composite resin (flowable)3. TYPE C

Characterized by the need for greater exploratory preparation in dentin

With local anesthesia and liner placed in the exposed dentin

Filled composite resin

PIT AND FISSURE SEALANT (preventive) Application and mechanical bonding of resin material

to an acid-etched enamel surface, thereby sealing existing pits and fissures from the oral environment

This mechanism prevents bacteria from colonizing in the pits and fissures and nutrients from reaching the bacteria already present

Indications:o Be dependable on recall appointmentso Be aged 6 – 15 yearso Be motivated and effective in caries controlo Have low caries activityo Caries-free permanent teeth with steep

cuspal inclineso

STAINLESS STEEL CROWNS (restorative) Are preformed extracoronal restorations Indications:

o Primary or permanent teeth with extensive carious lesions

o Primary teeth with three carious surfaceso Primary or permanent teeth with enamel or

dentin defectso Hypoplastic enamel, amelogenesis

imperfecta, or dentinogenesis imperfectao Fractured teeth

o Primary molars that have undergone pulp therapy

o Teeth used as abutments for space maintainers

ARMAMENTARIUM FOR SSC Stainless steel crowns numbered 2 – 7 Pliers

o Johnson 114o Crimping pliers or Adams plierso Crown cutting scissors

Reduce 1 – 1.5mm on the cuspal area Slice through Do not create a ledge Measure the tooth before reduction Crowns are placed lingual first so that the filling will

flow at the buccal for easier removal of excess material

CROWNS Are often times associated with an adult dentition for

restoration of a tooth that needs full crown coverage Casted crowns are better fitting that preformed crowns A restoration that covers a tooth to restore it to

normal shape and size It helps in strengthening and improving the

appearance of the tooth A crown is necessary when the tooth is totally broken

down where fillings can’t restore tooth’s function and anatomy

The crown should represent the natural tooth The color of the crown should match with the teeth

adjacent to it The dimension of the crown – MD width should be in

proportion The crown should restore the function and esthetics of

the tooth it represents and should help in maintaining adequate arch length

Should be biocompatible with the surrounding structures should be economical

INDICATIONS: A primary tooth with more than two surfaces

destroyed due to caries A tooth which has undergone pulp therapy Moderate caries involvement in… After traumatic dental fracture involving significant

portion of the crown

CONTRAINDICATIONS: Primary teeth in which conservative amalgam

restorations can be placed Teeth to be exfoliated within a brief period Retainer for space maintainers appliance

o The preformed crown should be considered as a means of restoring a primary tooth, not

as a means of fabricating a space management appliance

CLASSIFICATION OF PREFORMED CROWNS According to Form and Contour

o Untrimmed, uncontoured, uncrimped crowns

o Precontoured and untrimmed crownso Pretrimmed, precontoured, precrimped

crowns According to Materials used

o Stainless steel crownso Nickel chromium crowno Polycarbonate crowno Pedo strip crown

SSC STEPS:1. The occlusion of the patient is noted2. Anesthetize the tooth to be prepared3. Placement of the rubber dam is essential4. Removal of decay

For pulpotomy, instead of using ZOE for sealing, use Calcium Hydroxide for the apices to close (APEXOGENESIS)

TOOTH PREPARATION1. Occlusal reduction2. Proximal reduction3. Selection and seating of the crowns (measure M-D

width first)4. Adaptation of the crown (check the occlusion; do

crimping)5. Cementation of the crown

PROPERLY SEATED CROWNS Correspond to marginal ridge height of the adjacent

tooth Does not rotate on tooth Adapts closely to the tooth in cervical 3rd

No blanching of gingival tissueso Crown normally extends 1mm into the

gingival sulcus Adjacent proximal contact must be maintained Occlusal relationship must be established

o A thumb must always be kept over the occlusal surface of the crown during removal

ADAPTATION OF THE CROWN Adjustment the crown is required Crown should adapt to the walls of the tooth on Bu, Li,

M, D Sudden forceful jerks on sharp dislodging movements

must be avoided

CEMENTATION Adapt first on Li then Bu

o For easier removal of cement excess

OBJECTIVES FOR ANTERIOR Restoring esthetics Preventing psychological trauma Restoring function Maintaining occlusion Prevents fracture

INDICATIONS Primary anteriors with severe caries A tooth which has undergone pulp therapy Moderate caries involvement in… After traumatic dental fracture involving significant

portion of the crown

POLYCARBONATE CROWNS Provisional crowns, acrylic crowns

Polycarbonate Crown Strip – off CrownAdvantages:

Improved esthetics Helps in phonation

Advantages: More esthetic

crown Improved retention Better wear

resistantDisadvantages:

Difficult to place Poor retention Prone to excessive

wear Brittle, high

incidence of fracture

Limited shade selection

Uncrimpable margin

Disadvantages:

POLYCARBONATE CROWN PREP1. Caries removal2. Administration of local anesthesia3. Selection of crown size4. Placement of rubber dam5. Shoulderless prep of tooth6. Adaptation of crown7. Roughening of interior surface of crown8. Cementation9. Finishing of margin

STIP – OFF TECHNIQUE1. Crown selection and prep2. Tooth prep3. Crown placement

SELECTION OF STRIP – OFF CROWN Select the appropriate celluloid crown size from the

MD measurement (in mm) at the tooth’s incisal edge Trim off excess cervical collar and tab with curved

scissors Punch holes in the incisal edge of the crown Reduce interproximal surfaces with a tapered diamond

abrasive, produce knife edged cervical margin Reduce the incisal edge by approximately 1mm Round all line angles Place cervical undercut Remove caries with spoon shaped excavator

CROWN PLACEMENT Trial fitting Acid etching Bonding Pack crown with resin Position the filled crown over the prepared tooth Polymerize Remove crown by stripping or slicing it on the lingual

surface with a sharp scaler Finishing

STRIP OFF CROWN Quick and simple method for restoration of primary Parents and children are often delighted with the

improvements that can be achieved without resorting to extraction

-Rosette Go 012211