Contents
Child assessment 1
What is paediatric dentistry? 1
Patient assessment 2
Defi nitive diagnosis 6
Assessment of disease risk 6
Treatment plan 7
Clinical conduct 7
2 Child management 9
Behaviour management 9
Referring for possible mental health evaluation and care 17
Pain management for children 19
Local anaesthesia 23
Sedation in paediatric dentistry 25
General anaesthesia 31
References and further reading 36
3 Dental caries 39
Factors infl uencing dental caries 39
The caries process 41
Caries detection 42
Preventing dental caries 43
Determining patients at risk of dental caries 45
Early childhood caries 49
References and further reading 51
4 Fluoride modalities 53
Introduction 53
New guidelines for use of fl uoride modalities 53
Mechanisms of action of fl uoride 54
Community water fl uoridation 54
Bottled and fi ltered waters 55
Home water fl uoridation 55
Dental fl uorosis 56
Contents
xvii
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xviii Handbook of Pediatric Dentistry
Topical fl uorides 59
Systemic fl uorides 64
Considerations in fl uoride therapy for infants and children 64
Recommended schedules for topical fl uoridation 65
Fluoride toxicity 66
References and further reading 69
Useful websites 69
5 Restorative paediatric dentistry 71
Primary teeth 71
Restorative materials 72
Restoration of primary anterior teeth 75
Restoration of primary posterior teeth 77
Minimal intervention dentistry 83
Management of occlusal caries in permanent teeth 85
New techniques for tooth preparation 89
Indications for the use of restorative materials in
paediatric dentistry 92
References and further reading 92
6 Pulp therapy for primary and immature
permanent teeth 95
Introduction 95
Clinical assessment and general considerations 96
Factors in treatment planning 100
Pulp capping 101
Pulpotomy 103
Pulpectomy 110
References and further reading 113
7 Trauma management 115
Introduction 115
Guidelines for management of dental injuries 115
Aetiology 115
Child abuse 117
History 118
Examination 119
Investigations 121
Other considerations in trauma management 122
Maxillofacial injuries 123
Sequelae of fractures of the jaws in children 128
Contents xix
Luxations in the primary dentition 129
Crown and root fractures of permanent incisors 136
Root fractures 142
Crown/root fractures 143
Luxations in the permanent dentition 145
Avulsion of permanent teeth 150
Complications in endodontic management of avulsed teeth 154
Autotransplantation 157
Bleaching of non-vital incisors 159
Soft-tissue injuries 161
Prevention 163
References and further reading 166
8 Paediatric oral medicine and pathology 169
Introduction 169
Orofacial infections 169
Ulcerative and vesiculobullous lesions 177
Pigmented, vascular and red lesions 187
Epulides and exophytic lesions 194
Gingival enlargements (overgrowth) 197
Premature exfoliation of primary teeth 199
Oral pathology in the newborn infant 208
Diseases of salivary glands 210
References and further reading 214
9 Dental anomalies 217
Introduction 217
Considerations in the management of dental anomalies 217
Dental anomalies at different stages of dental development 218
Formation of dental lamina 219
Disorders of proliferation 227
Abnormalities of morphology 236
Developmental defects of enamel 246
Molar–incisor hypomineralization 252
Amelogenesis imperfecta 254
Disorders of dentine 261
Dental effects of prematurity and low birth weight 267
Disorders of eruption 268
Loss of tooth structure 273
References and further reading 275
xx Handbook of Pediatric Dentistry
10 Medically compromised children 279
Introduction 279
Cardiology 279
Haematology 282
Red cell disorders 289
Immunodefi ciency 291
Acquired immunodefi ciency syndrome (AIDS)/HIV 293
Oncology 296
Nephrology 306
Gastroenterology 309
Endocrinology 312
Neurology 318
Respiratory disease 322
Other children with special needs 324
Oro-motor dysfunction in patients with
developmental disabilities 329
Genetics and dysmorphology 332
References and further reading 338
11 Orthodontic diagnosis and treatment in
the mixed dentition 341
Introduction 341
Orthodontic assessment 341
Orthodontic examination 343
Evaluation of crowding 346
Crowding and space management in the mixed dentition 347
Regaining space 350
Timed extraction of teeth to resolve intra-arch crowding 351
Spacing 352
Management of missing teeth 352
Orthodontic aspects of supernumerary teeth 354
Extraction of over-retained primary teeth 355
Ectopic eruption of permanent canines 356
Ectopic eruption of fi rst permanent molars 356
Extraction of fi rst permanent molars 357
Basic requirements of orthodontic appliances 359
Removable appliances 359
Treatment of anterior crossbites 362
Treatment of posterior crossbites 364
Habits: digit sucking 368
Contents xxi
Correction of developing Class II skeletal malocclusions 370
References and further reading 375
12 Management of cleft lip and palate 379
Introduction 379
The anatomy of the facial skeleton in cleft lip and palate 380
Current concepts of cleft management 384
Cleft management in the neonatal period 387
Cleft management in childhood 390
Cleft management in adolescence and early adulthood 393
Importance of dental care in overall management 394
References and further reading 398
13 Speech, language and swallowing 401
Introduction 401
Communication disorders 401
Structural anomalies and their relationship to speech
production and eating and drinking 405
Maxillofacial surgery and its relation to speech production 409
Referral to a speech pathologist 409
References and further reading 411
Appendices 413
Appendix A: Normal values in blood chemistry 413
Appendix B: Fluid and electrolyte balance 417
Appendix C: Management of anaphylaxis 422
Appendix D: Management of acute asthma 425
Appendix E: Antibiotic prophylaxis protocols for the
prevention of infective endocarditis 428
Appendix F: Vaccination schedules 432
Appendix G: Isolation and exclusion from school for
childhood infectious diseases 433
Appendix H: Somatic growth and maturity 434
Appendix I: Growth charts 438
Appendix J: Differential diagnosis of radiographic
pathology in children 444
Appendix K: Piaget’s four stages of intellectual development 446
Appendix L: Glasgow Coma Scale 447
Appendix M: Common drug usage in paediatric dentistry 448
Appendix N: Eruption dates of teeth 453
Appendix O: Construction of family pedigrees 456
xxii Handbook of Pediatric Dentistry
Appendix P: Calculating fl uoride values for dental products 457
Appendix Q: Bisphosphonate-related osteonecrosis of
the jaws 458
Appendix R: Charting form 460
Appendix S: Neurological observation chart 461
Index 463
