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Uploaded byJacey Mitchell
PPTX, PDF148 views

Pediatric Dental Assessments

Here are the key points about gingival diseases in childhood from the article: - Gingivitis is the most common gingival disease seen in children. It is caused by bacterial plaque accumulation. - Signs of gingivitis include redness, swelling, bleeding on probing. It is usually not painful. - Gingivitis is reversible with proper plaque control. Treatment involves oral hygiene instruction and plaque removal. - Necrotizing ulcerative gingivitis (NUG) is less common in children than adults. It presents as painful, bleeding ulcers and necrosis of the gingiva. It is associated with stress and poor oral hygiene. Treatment involves scaling, antibiotics

Education◦
COMPONENTS OF THE DENTAL EXAM • MEDICAL HISTORY • BEHAVIORAL ASSESSMENT AND GENERAL APPRAISAL • EXTRA-ORAL EXAM: HEAD, NECK, FACE, HANDS • INTRA-ORAL EXAM • CARIES RISK ASSESSMENT (CRA) • RADIOGRAPHIC EXAMINATION
GENERAL APPRAISAL • THE CLASSIC AREAS OF THIS APPRAISAL INCLUDE GAIT, STATURE, AND PRESENCE OF GROSS SIGNS AND SYMPTOMS OF DISEASE. THE NORMAL 3- TO 6-YEAR- OLD IS AMBULATORY, WELL COORDINATED IN BASIC TASKS, ENGAGING, AND PHYSICALLY HEALTHY IN APPEARANCE. TABLE 18-2 LISTS PHYSICAL AND BEHAVIORAL MILESTONES FOR THE 3- TO 6-YEAR-OLD CHILD. THE GENERAL APPRAISAL OF THE CHILD IS BEST ACCOMPLISHED IN THE WAITING ROOM OR SIMILAR NONTHREATENING ENVIRONMENT. THIS APPRAISAL SHOULD BE FOLLOWED BY CLARIFICATION OF ANY ABNORMAL FINDINGS AND DISCUSSION OF POTENTIAL BEHAVIOR PROBLEMS WITH THE PARENT. HEIGHT AND WEIGHT RECORDED TO MONITOR DEVELOPMENT.
MEDICAL HISTORY CONSIDERATIONS General Health Common Findings Allergies Probably related to food and other environmental allergens; may have allergy to medications such as antibiotics Asthma May be reported; triggering factors usually known; medications also well known; impact of dental intervention usually not known Bleeding Parent may suggest excessive bruising without real problem Blood Transfusion May have been performed at birth Childhood Infections Immunizations will have occurred, or there is a clear history of having had a specific illness such as measles or chickenpox Development Poor parental knowledge for normal child development Heart Functional murmur may exist, or parent may have been told of a murmur Hypertension Usually unknown, unless child has a chronic problem Illnesses Probable history of upper respiratory infections Jaundice Possible at birth Medications Probably has taken acetaminophen as necessary; may have received amoxicillin or other antibiotic Surgical Procedures Possible tonsillectomy or adenoidectomy; possible ear tubes Seizures Possibly febrile; may be on seizure medication for only one seizure
DENTAL HISTORY CONSIDERATIONS Dental Health Common Findings Bottle Use Probably considered not to contribute to decay Developmental/Eruption Knowledge may be limited to eruption dates of first teeth, unless consistently very early or late Fluoride May know water status; possible vitamin with fluoride supplementation Habits (thumb sucking) Will be well known to parent if present Home Care Usually confined to tooth brushing; may be largely left to child Previous Care Possible none Reaction to Care (behavior) Likely poor or tentative Trauma to Teeth and Chin Possible, usually left untreated unless serious; commonly upper teeth and chin
COMMON GENETIC CONDITIONS Noonan syndrome Down syndrome William’s syndrome Fragile X syndrome Treacher-Collins syndrome Osteogenesis imperfecta
GENETIC DISORDERS AFFECTING TOOTH DEVELOPMENT • VAN DER WOUDE- LOWER LIP PITS; CLEFT LIP/PALATE; CLEFT UVULA; HYPODONTIA • AMELOGENESIS IMPERFECTA- ENAMEL DEFECTS THAT AFFECT BOTH DENTITIONS; APPEARANCE IS YELLOW-BROWN TO ORANGE DEPENDING ON SUBTYPE; TEETH ARE SENSITIVE, SUSCEPTIBLE TO WEAR, AND MAY ALSO HAVE TAURODONTISM IN MOLARS • DENTINOGENESIS IMPERFECTA- BOTH PRIMARY AND PERMANENT TEETH ARE AFFECTED; TEETH ARE BLUE-GRAY OR BROWN; SUSCEPTIBLE TO EXTREME WEAR; PULPAL OBLITERATION AND DENTAL ABSCESSES • HYPOPHOSPHATASIA- PREMATURE LOSS OF TEETH DUE TO LACK OF CEMENTUM; CRANIOSYNOSTOSIS • ECTODERMAL DYSPLASIA- FULL LIPS; SMALL NOSE; HYPODONTIA; CONICAL OR MALFORMED TEETH; DEFICIENT ALVEOLAR RIDGE • CLEIDOCRANIAL DYSPLASIA- FRONTAL BOSSING; BRACHYCEPHALY; LATE CLOSURE OF FONTANELLES; HYPERTELORISM(INCREASED DISTANCE BETWEEN THE EYES); DELAYED ERUPTION OF PERMANENT TEETH; SUPERNUMERARY TEETH; IMPACTED TEETH
EXTRA-ORAL EXAM • be aware of thickness or amount for ectodermal dysplasiaHair • look for abuse, dermatitisScalp • malformed ears as in Treacher collins syndrome, hearing loss Ears • Position of eyes including upward or downward slanting of fissures, stellate pattern in iris is for William’s syndrome Eyes • misshapen=ectodermal dysplasia, asthma, allergies, cleftsNose •Many children of this age have swollen nodes, but the nodes are usually movable and confined to the lower face and jaws and are indicative of minor infection. Swollen nodes in the neck and clavicular region are more rare and may indicate more serious ailments. Lymph nodes: • increased size=goiter, tumorThyroid: • through visualization, should have absence of lesions, poor closure lip incompetence, clefting, asymmetry/bell’s palsy or cranial nerve damage, ulceration or herpes infection Lip: • edema or cellulitis=renal disorder, redness=allergies? Dryness or dehydration=ectodermal dysplasia, ulcerations=abuse? Skin: • scars=trauma?Chin:
PEDO EXAM: EXTRAORAL PALPATION
EXTRA-ORAL EXAM: FACIAL PROFILE A: Class I skeletal relationship is characterized by a well-balanced profile in the anteroposterior dimension. These relationships can be judged by mentally connecting the points of the bridge of the nose, the base of the upper lip (maxilla), and the soft tissue chin (mandible). This line should be slightly convex. B: Class II skeletal relationship is characterized by a truly convex profile. C: Class III skeletal relationship is characterized by a straight or concave profile.
INTRAORAL EXAM Palate •Clefting •Ulcerations •Herpes •Petechiae= abuse Pharynx •Normal vs enlarged tonsils Tongue •Redness = glossitis •Ulcerations •Herpes •Trauma •Limited movement= cerebral palsy or ankylosis Floor of mouth •Swelling •Mucocele •Aphthous ulcers •Abuse Buccal mucosa •Ulcerations •Cheek Biting •Swelling= salivary gland infection •Mumps Teeth •Absence/delayed •Supernumerary teeth •Cleidocranial dysplasia •Microdontia •Macrodontia •Fusion •Abnormal color •Amelogenesis imperfecta •Caries •Mobility •Maxillary lateral incisor is the most common missing tooth in primary dentition
INTRAORAL FINDINGS: DESCRIBE EACH PHOTO
GINGIVAL CONDITIONS • PLEASE REVIEW THE ARTICLE “GINGIVAL DISEASES IN CHILDHOOD”