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,)

Early Childhood Caries_4.mp4

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 The AAPD recognizes ITR

as a beneficial provisional technique in contemporary pediatric restorative dentistry.

ITR may be used to restore and prevent caries in young patients, uncooperative patients, patients with special needs and situations in which traditional cavity preparation and restorations are not feasible.

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 diagnosis2. Adequate restoration3. Appropriate excavation4. Margin quality

POLYMER BURSmart 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

NuSmile Pediatric Crowns.mp4

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

Quiet Comfort, also called Air Abrasion. - YouTube.mp4

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

Pediatrics Air Abrasion.mp4

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