pediatric dentistry update.final

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Acknowledgements

PEDIATRIC DENTISTRY UPDATE

By DR/Ali Abdel Fattah pedodontist

THE DENTAL HOME

THE DENTAL HOME WAS

ESTABLISHED AS “AAPD POLICY IN

2003, AND IS BASED ON THE SAME

CONCEPT AS THE AMERICAN

ACADEMY OF PEDIATRICS POLICY

STATEMENT DEFINING THE MEDICAL

HOME IN 1992.

THE DENTAL HOME

The dental home is the ‘ongoing relationship

between the dentist and the patient, inclusive

of all aspects of oral health care delivered in a

comprehensive, continuously accessible,

coordinated, and family-centered way.

Establishment of a dental home begins no

later than 12 months of age and includes

referral to dental specialists when

appropriate (AAPD def,)

The Dental Home Provides…

a. Comprehensive oral health care including

“acute care” and preventive services

in accordance with AAPD periodicity

schedules.

b. Comprehensive assessment for oral

diseases and conditions.

The Dental Home Provides…

c. “Individualized “ preventive dental health program based upon a caries-risk assessment and a periodontal disease risk assessment.

d. Anticipatory guidance about growth

and development issues,

(ie, teething, digit or pacifier habits).

The Dental Home Provides…

e. Plan for acute dental trauma.

f. Information about proper care of the

child’s teeth and gingivae. This would

include prevention, diagnosis, and

treatment of disease of the supporting

and surrounding tissues and the

“maintenance of health, function,

and esthetics of those structures

and tissues.”

Why Brush Teeth in”{ Day Care Centers}” ?

• Develop good habits

• Children may not brush at home

• Children learn basic hygiene principals

H2O X X

Tips for Preventing Decay

It’s not the bottle, it’s the beverage

MINIMALLY INVASIVE TECHNIQUES

Minimally invasive techniques today utilize microscope , imaging systems , lasers, air abrasion Prevention protocols can keep the patient disease free indefinitely

Historical Development of Dentistry

- Extraction;

- Surgical approach (“drilling and filling”):

after G.V. Black;

- Medical approach – Minimal Intervention.

Minimal Intervention Dentistry

- Modern approach to the treatment of

tooth decay

- Based on “Medical Model” of caries

management

The Intervention approach Minimal

A medical model;

Caries treated as a biological

infection

Surgical techniques are {minor}

and stress retention of tooth tissue.

Details of the MI approach

- (1) Reduces cariogenic bacteria;

- (2) Uses preventive measures;

- (3) Early lesions remineralised;

- (4) Minimal surgery on cavities;

- (5) Repair of defective restorations.

(1) Cariogenic bacteria

Caries is a bacterial disease;

Depends on dietary sucrose;

Driven by frequency of eating;

{ Modified by saliva }

(2) Preventive measures

• Topical fluoride

• Fissure sealants

• Patient education on oral hygiene

(3) Remineralisation

• Requires management by non-intervention

{medical model}

• Enhanced by fluoride ion in saliva.

(4) Minimal surgery

Requires adhesive materials (glass-ionomers,

adhesive composite systems);

Possibly without drilling (ART technique).

(5) Repair of materials

• To prevent cavity extension;

• Not “botch job”, but appropriate.

The challenge for materials

Adhesion– Occurs naturally for glass-ionomers; problematic for

composites.

Fluoride-release;

• Release of other mineralising ions

( PO4, Ca2+ )

Repairable.

Conclusions

• Minimal Intervention dentistry is the future:

– Advocated by FDI;

– Cost effective;

– Less trauma for the patient.

• A biological approach, not a mechanical one.

• Makes significant demands on materials.

Caries Stabilization

Interim therapeutic restorations (ITRs)

Resin and glass ionomer sealants

Regular recharging of ITRs and sealants

with fluoride

Fluoride varnish applications

Twice daily brushing with fluoride toothpaste

Why Caries Stabilization?

Poor Dental Access for 0-5 year olds

Only 10% of 0-2 year olds are seen

yearly in the dental clinic.

Only 25% of 3-5 year olds are seen

yearly in the dental clinic.

Policy Statement

Download AAPD policy on ITRs.

Indications for ITRs

No pulpal involvement

1 or 2 surface lesions

Reduce fear

Defer treatment

Provide care at schools

Contraindications for ITRs

Necrotic pulp

Irreversible pulpitis

3 or more surfaces

affected by decay

Fluoride Varnish

“every- every”

Factors for Success

1. Proper diagnosis

2. Adequate restoration

3. Appropriate excavation

4. Margin quality

POLYMER BUR

Smart bur 2 is self – limiting

caries removal bur for use in

a slow –speed hand piece

operating at up to 4000 rpm

Research demonstrates that

the polymer bur is truly dentin

safe & will not cut sound

healthy dentine

NU SIMLE SIGNATURE ARE ST ST CROWNS

WITH TOOTH COLORED COATING

NU SMILE ZR OFFERS SUPERIOR DURABILITY

AND EASY PLACEMENT COMPERED TO

COMPOSITE RESTORATIONS & STRIP CROWNS

NU SMILE & NU SMILE ZR

AIR ABRASION

This technique uses a stream of

purified aluminium oxide

particles that are forced under

pressure through a fine –focused

nozzle onto the tooth surface

AIR ABRASION

This technique uses a stream of

purified aluminium oxide

particles that are forced under

pressure through a fine –focused

nozzle onto the tooth surface

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POLISY STATMENT

ITR may be used to restore & prevent

dental caries in young pat ,

uncooperative pat , pat with special

health care needs & situations in which

traditional cavity prep, &/or placement

of traditional dental restorations are

not feasible .

Indications for interim therapeutic restorations (ITRs), and glass ionomer sealants

Appropriate technique for placing ITRs and GI

sealants

Variables that influence the success of ITRs and GI sealants

Behavioral management when working with young children

Oral health messages for parents and caregivers of

young children

Strategies for follow-up and coding

Objectives

I R T UTILIZES SIMILAR TECHINQUES Like

A R T BUT HAS DIFFERENT THERAPEUTIC

GOALS

( ART: REMOVAL OF CARIES USING HAND OR

SLOW SPEED ROTARY INSTRUMENT & THEN

RESTORE THEM WITH AN ADHESIVE

RESTORATIVE MATERIAL e.g G I CEMENT )

THE USE OF ITR HAS BEEN SHOWN to

REDUCE “THE LEVES OF CARIOGENIC