Paediatric Dentistry

Notes

Paediatric Dentistry

Natal teeth - teeth present at birth

Neonatal teeth - teeth erupt within a month of birth

Permanent incisors develop slightly behind the roots of primary incisors, larger. Extra space is gained from :

• spacing of primary incisors
• permanent incisors more proclined
• ↑ inter-canine width

Preformed Metal Crowns (PMC) uses :

• 2 surface (or more) cavities in first primary molars
• More than 2 surface cavities in second primary molars
• Following pulp therapy in primary molars
• Failure of plastic restorative technique
• Initial restoration in amelogenesis imperfecta, dentigenesis imperfecta, severe enamel hypoplasia

Pulp Therapy

Indirect pulp capping - carious dentine without pulp exposure

Direct pulp capping - asymptomatic exposure, < 1 mm, < 24 hr

Coronal pulpotomy - traumatic injuries, pulp exposed, > 1 mm, > 24 hr

Partial coronal (Cvek) pulpotomy - removal of superficial (2 - 3 mm), calcium hydroxide place, induce calcific bridge. maintain vital coronal and radicular pulp, allow normal crown and root maturation

Full coronal pulpotomy - coronal pulp removed, calcium hydroxide placed over healthy radicular pulp stump

Pulpectomy - marked pulpitis, non-vital, pulpotomy has failed

Traumatic Injuries

Concussion = tooth traumatized but not loosened

Subluxation - tooth loosened in socket but not displaced

Extrusion = tooth displaced in occlusal direction

Intrusion = tooth displaced apically into socket

Lateral displacement = tooth pushed laterally, buccally or palatally

Avulsion = tooth totally displaced form socket

Abnormalities of Tooth Number

Supplemental teeth - duplication of teeth

Supernumerary teeth - conical / tuberculate

Hypodontia - upper lateral incisors / premolars / lower central incisors

Abnormalities of Tooth Position

Impacted first permanent molars - crowding

Abnormal position of crypts - lower second premolar

Ectopic upper canines - palatally or in line of arch, palpable by 9 y/o

Transposition - upper canine and first premolar, lower canine and lateral incisor

Abnormalities of Tooth Structure

Enamel

Enamel hypoplasia - ↓ thickness, deficient structure

Enamel hypomineralization - normal structure, not fully mineralized

(Local) infection, trauma, irradiation, idiopathic

(General) rubella, syphilis, childhood infections, excess exposure to fluoride

(Hereditary) amelogenesis imperfecta → X-linked

Dentine

Dentinogenesis imperfecta - ↓ number of wide irregular tubule, loss of scalloping at ADJ, opalescent bluish appearance

Cementum

Hypercementosis - Paget's disease

Hypocementosis - hypophosphatasia

Non-accidental Injury (NAI)

• Bruising in babies and children who are not independently mobile
• Bruises not overlying bony prominence e.g. cheeks, ears
• Multiple bruises in clusters
• Multiple bruises of uniform shape
• Bruises that carry an imprint of an implement
• Injuries sustained no consistent with history provided by parents
• Delayed presentation
• Lack of concern
• Frenal tears in child < 1 y/o
• Withdrawn / frightened child