Treatment Planning in Pediatric Dentistry CONTENT. Children as individuals. Ⅰ.. Quality Care for Children

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1 Treatment Planning in Pediatric Dentistry 許修銘 93/04/ /5/4 2 CONTENT Ⅰ. Quality care for children Ⅱ. Philosophy of treatment planning Ⅲ. Diagnosis Ⅳ. Dental caries assessment Ⅴ. Dental charting Ⅵ. Radiographs Ⅶ. Choice of restoration Ⅷ. Local analgesia & rubber dam Ⅹ. Medical history & treatment planning 2004/5/4 3 Children as individuals Developed and designed to provide high-quality restorative care for each individual child s needs 2004/5/4 4 Ⅰ.. Quality Care for Children Children are future dental patients Promote positive dental experiences Ⅰ.. Quality Care for Children Whether children s teeth should be restored at all Cost of treatment Dental experience 2004/5/ /5/4 6

2 Ⅰ.. Quality Care for Children Good quality restorative care, as and when caries is diagnosed, would also obviate the need for extractions of primary teeth under general anaesthesia Ⅱ.. Philosophy of Tx Planning First Group no restorative care has been attempted in the past, but who now do need it Second Group already have had some restorations or perhaps attempted restorations 2004/5/ /5/4 8 Ⅱ.. Philosophy of Tx Planning First Group PDH(-) Step-by-step introduction Pain control (local analgesia) Rotary instruments Rubber dam Placing of restorations Ensure that they do not develop a fear of dentistry Ⅱ.. Philosophy of Tx Planning Second Group PDH(+) Treatment planning must take into account the degree of cooperation An amount of time allowed for behaviour modification The necessary information on the dental history & dental status of child 2004/5/ /5/4 10 Ⅱ.. Philosophy of Tx Planning Ideal approach for restoring children s teeth involves the practice of quadrant dentistry Ⅲ.. Diagnosis The dental problems of a child must be assessed before a treatment plan is designed This involves not only examining the teeth but also assessing the child s s behaviour 2004/5/ /5/4 12

3 Ⅲ.. Diagnosis In the waiting room: Child s s behaviour Relationship with parents or carers Any apprehension or difficult behaviour should be noted Ⅲ.. Diagnosis A history should be taken From the parents Including details of previous behaviour, restorations or attempted restoration These details should be recorded on a dental history form 2004/5/ /5/4 14 Ⅲ.. Diagnosis The first visit Simple examination of dentition an assessment of the extent of dental caries, oral hygiene, gingivitis & periodontal disease Examination of all oral tissue Oral hygiene Child s s behaviour 2004/5/ /5/4 16 Ⅳ.. Dental Caries Assessment Record all carious lesions Staining of pits and fissures Discolouration of the >1/3 pulp enamel therapy Condition of the marginal ridge (intact or broken) Note chronic or acute abscesses & draining sinuses Examine existing restorations 2004/5/4 17 Ⅳ.. Dental Caries Assessment Restore a large cavity in a primary tooth with a material that will not hold very long Leakage around the margins or breakdown of the margins leads to failure of the restoration 2004/5/4 18

4 Ⅳ.. Dental Caries Assessment Sufficient coronal dentine & enamel restored with strip crowns Ⅴ. Dental charting The condition of all teeth should be recorded on a suitable chart Accurate dental records for dental caries & restorations Drawing up a treatment plan Medico-legal requirements 2004/5/ /5/4 20 Ⅴ. Dental charting An intra-oral charting together with diagnostic quality radiographs and other diagnostic tests The success of the treatment will be dependent on parental enthusiasm and support Ⅴ. Dental charting All treatment is accepted by the parent or carer, & restorative work can be completed with cooperation of parent & child 2004/5/ /5/4 22 Ⅵ. Radiographs Clinical examination alone would mean that many early lesions will be missed It is not possible to diagnose early occlusal or proximal caries by clinical examination alone Ⅵ. Radiographs DIAGNOdent (KAVO) Bitewing radiography Orthopantomogram 2004/5/ /5/4 24

5 Alveolar bone structures Development of primary & secondary teeth Peri-apical or furcation pathology Other structures of maxilla & mandible Presence/absence of dental caries 2004/5/ /5/4 26 Ⅵ. Radiographs Radiographs should form routine part of dental examination & it is necessary to repeat radiographs for dental caries diagnosis at intervals 2004/5/ /5/ /5/ /5/4 30

6 Ⅶ. Choice of restoration Type of restoration used for a primary tooth will depend on: The tooth to be restored Past caries history Child cooperation Ⅶ. Choice of restoration Repeated restoration of primary tooth bad dental care Caries on at least 2 surfaces or marginal ridge has broken preformed metal crown (SSC) is the restoration of choice 2004/5/ /5/4 32 Ⅶ. Choice of restoration Amalgam: one-surface or small two-surface restoration Composite resin restorations & glass ionomer cements: Not survive beyond 48 months Technique-sensitive 2004/5/ /5/4 34 Ⅷ. Local Analgesia & Rubber dam Local analgesia should be routinely used in the restoration of primary teeth Choice flavour of topical analgesia Degree of participation Ⅷ. Local Analgesia & Rubber dam Rule of 10 Age of child+number of tooth (canine=3, 1st molar=4, 2nd molar=5) >10 mandibular block <10 infiltration For pulp therapy in mandibular, block analgesia should be used 2004/5/ /5/4 36

7 Ⅷ. Local Analgesia & Rubber dam Restoration of primary teeth should always, as far as possible, be carried out under rubber dam It is essential for pulp therapy, & highly desirable if quadrant dentistry is to be accomplished It is important to start restorative treatment with the easiest local analgesia, which will be an infiltration 2004/5/ /5/4 38 Maxillary left Maxillary right Mandibular left Mandibular right Maxillary incisors If primary mandibular incisors are involved then the caries rate is probably so high that a more radical approach is needed 2004/5/ /5/4 40 Ⅹ. Medical History & Tx Planning Hasty restoration of badly broken down teeth in mandible at a first visit ( ) Dress teeth with temporary restoration & plan the treatment in such a way as to introduce local analgesia in a controlled and simple manner so that child readily accepts the treatment Obviously a full medical history medical history should be completed for every child before dental care commences 2004/5/ /5/4 42

8 Ⅹ. Medical History & Tx Planning Bleeding disorders Extraction of teeth in a child with any form of bleeding disorder is contraindicated Pulpotomies or pulpectomies are mandatory as long as the tooth is restorable 2004/5/ /5/4 44 Ⅹ. Medical History & Tx Planning Heart conditions & immunosuppression At risk of infective endocariditis with heart disease Immunosuppression for any reason With shunts Pulp therapy should not be carried out Extracted with appropriate precautions 2004/5/4 45 ANC = Total WBCs x (segs( + bands) 2004/5/ /5/ /5/4 48

9 2004/5/ /5/4 50 KaVo DIAGNOdent. Thanks for Your Attention 655 nm diode laser Reads 2mm into the tooth Detects fluorescence in ANYTHING you aim it at 2004/5/4 52