Clinical examination in Pediatric Dentistry

Clinical examination in Pediatric Dentistry

Introduction

• Welcoming and caring for a child who is coming to the dental office for the first time is not an easy task. Not all practitioners are comfortable with children. In addition, my three-way communication between the child, their companion and the practitioner can be difficult. 
• The first appointment is a must for every child and therefore every future adult patient. This consultation proves to be crucial for the development of future attitudes and behaviors in the dental office, particularly during subsequent sessions. It will also shape the patient’s opinion on the dental world.
• Anxiety, fear or even a phobia can arise from a problem that occurred during the first appointment. The first consultation cannot compromise anything but can compromise everything. 

1. The objectives of the first consultation

• The child’s consultation provides medical care, because the dentist must, to the extent of his abilities and skills:

• Detect systemic pathologies with oral-dental repercussions such as diabetes;
• Detect growth and development disorders.
• Advise and guide in the case of genetic anomalies.

• The consultation has a psychological aspect: 
• By observing the patient in the waiting room, showing empathy and assessing the pain or its feeling by the little patient, by respecting and making oneself respected.

2. Means of examining the child

• Armed with sufficient psychological and technical knowledge, the practitioner is in the best conditions to receive and care for his young patients. There are, however, commonly accepted elements that can facilitate the first contact and consequently reduce the risks of psychological blockages and/or refusal of care. 

2.1 Premises and instruments

• The child’s very first contact with the dental environment occurs when he enters the practice. He receives his first sensations and forms his first impressions, even before entering the treatment room and meeting the dental surgeon. 

2. The reception

• The reception is the first part of the office visited by the patient.
• This space is the transition zone between the “outside” and the waiting room. It must be peaceful and welcoming to relax and reassure him. 

2.3 The Waiting Room It must be:

• visually pleasing, have the most sober, familiar and soothing decor possible.
• Cleaned regularly; the level of cleanliness is a good indicator of the hygiene rigor of the rest of the office. 
• The furniture, the decor, the accessories must contribute to making us forget inactivity and impatience, by capturing attention and arousing interest to reduce the stress and aggressiveness that can arise from waiting.
• Reserve a space for children, children’s furniture (coffee table, small chairs)
• Recent magazines adapted to different ages 

  2.4 The Treatment Room

For children, everything in the space dedicated to the interview must evoke play.

• Show drawings, photos of their heroes 
• Clean and tidy (avoid leaving instruments that could cause fear on display)

2.5 Instruments

There are now fun dental accessories that can help demystify the dental office and are more effective on young children.

•  Decorated cups 
• Colorful mask
• Drawing bib
• Sunglasses for children to protect them from the glare of the surgical light. 

3. Clinical examination of the child

The first consultation is a space for meeting and discovery, it is the ideal place to assess the risk of illness and therefore to disseminate preventive concepts. 

 The practitioner: 

 ● builds a relationship of trust;

 ● Through non-invasive methods, helps the child and their parents identify problems and become aware of the risks; 

● teach them to control them; 

● defines the most appropriate curative and preventive treatment plan for his patient while fully assuming his role as caregiver: therapist and health educator. 

3.1 Questioning children

It is done in the presence of the parents, and depending on their age, the child will be asked to answer certain questions.

A. The basics

– Name

– First name

– Date of birth (civil age)

– School level

– Address

– Phone number

– Who is sending the child to us?

– Name of the pediatrician, the attending physician and their contact details.

The social environment greatly influences the child’s behavior.

– Reason for consultation: The parents’ request is not always that of the child.

B. General Medical History  

In addition to the information collected from the parents, the child’s health and vaccination record should also be consulted. We will look for: 

Hereditary antecedents 

• They can explain certain chronic conditions, dental anomalies such as amelogenesis imperfecta (structural abnormality) or hereditary ones such as genotypic mandibular prognathism , hemostasis conditions such as hemophilia. Sickle cell disease is often due to consanguineous marriage . 

C. Personal background  

• Must be subject to careful questioning. These include:

– early childhood conditions

– nutritional and vitamin deficiencies

– trauma

– medical history concerning “major systems”:

• cardiovascular, pulmonary, renal, endocrine, blood, neurological.

– ongoing treatments must be known precisely.

D. Oral and dental history  

We will note in the child:

– Dental care habits

– Hygiene habits and motivations

– Oral habits

• This first phase of the interview will allow, among other things, to identify the personality of the parents and especially of the child.

4. Clinical examination proper 

4.1. Exo-oral examination  

• The inspection :

• head and face
• integuments
• Palpation

External palpation of the face and neck will allow us to find certain anomalies necessary for oral-dental diagnosis. 

 ● If there is a deformation  

● Cervical lymph nodes 

● The salivary glands  

● The thyroid body 

● The musculature 

● Muscle sensitivity 

● ATM

4.2. Examination at mouth opening

The child is asked to open and then close his mouth. We appreciate:

 ● the degree of mouth opening which will be measured between the incisal edges; 

● the way in which the mouth closes: whether it is normal or whether it is done in two stages with or without mandibular lateral deviation

• It will be noted whether or not the complete opening causes pain in the temporo-maxillary joints.

4.3 Open mouth examination

Examination – Treatment Plan (Treatment Plan, Instructions)

             ● Oral hygiene 

● The appearance of the mucous membranes

   ● Study of salivary secretion 

● Condition of the mucous membranes 

● Muscle mobility 

● The state of the periodontium

● Dental arches 

● Dental condition 

  ● Functions

4.4. Dental examination  

4.4.1 the dental formula 

The teeth must be counted to see if there are any extra or missing teeth.

• We will thus establish the dental formula and judge the precocity or delay of eruptions. Then the examination is done tooth by tooth (caries, existing care, dysplasia, dyschromia, care to be reviewed, to be completed, etc.), frame by frame. We will note the type of dentition (temporary, mixed, permanent) . 

Clinical examination in Pediatric Dentistry

4.4.2 Determination of RCI (individual caries risk)

Clinical examination in Pediatric Dentistry

4.4.3 Examination of the causal tooth:  

This is why the patient came for consultation

1. Subjective or functional signs: 

These are all the abnormal sensations present in the past that the patient associates with the current illness, it should be noted:

The type of symptom: spontaneous or provoked pain, by which stimuli? Do certain medications have it to weigh? 

Locate the symptoms: localized or radiated, precise or vague 

Onset of symptoms: when the symphyses were first perceived 

Clinical progress: this step must specify the circumstances of appearance: the beginning and end of each painful episode 

Periodicity: Do the symptoms occur regularly? 

The frequency of each symptom 

Duration: how long ago did the symptoms begin?

2. Objective signs: 

• inspection of the causal tooth  : situation, position, morphology, shade 
• palpation  : allows the nature (fluctuating or hard) of existing swellings to be determined 
• percussion  : it is performed by gently tapping the tooth using the handle of a mirror in vertical and transverse directions. It demonstrates the presence or absence of inflammation at the level of the desmodont.
• mobility  : with the index finger of both hands, alternately applying forces to the Lingual and Vestiular sides.
• Pulp sensitivity tests: 

 It is based on the triggering of pain in a specific condition at the level of the diseased tooth and the neighboring teeth serving as witnesses. 

• Thermal tests  : the teeth must be subjected to a wide temperature variation by heating and cooling them. 
• Electrical tests  : 

An electric current is passed through the teeth, the intensity of which can be varied, the pulp tester or the vitality scanner. 

• Dentin milling test (cavity test): reserved for cases of doubt about the previous tests. 

3. Additional examinations 

   They include X-ray examinations and biological analyses .

1. X-ray examinations 

Basic elements for any observation, diagnosis and therapeutic decision, in pedodontics they are the essential complements to the clinical examination and must make it possible to establish a complete oral-dental assessment.

Intraoral techniques 

• Retro-alveolar clichés 

They are essential whenever there is pulp involvement and are the essential elements of diagnosis and therapeutic decision. They provide the most precise images of teeth and periodontal tissues. They allow us to specify:

– the volume of cavities and their location in relation to the pulp. 

– root anatomy and changes caused by resorption;

• Bite-Wing 

They allow the detection of early proximal caries, occlusal caries and their depth, caries recurrence under fillings, proximal adjustments of fillings and preformed pedodontic caps.

Exo-buccal shots 

They are almost always essential: orthopantomogram 

Panoramic image providing an overall view of the teeth on the arch  and the germs.

Clinical examination in Pediatric Dentistry

2. Biological examination

It is necessary to consider:

● Normal physiological data: 

• Height and weight development 
• Heart rate and respiratory rate
• Blood pressure 
•  Hemoglobin level
•  Nervous system
• Hepatic immaturity   
• Exploration of hemostasis 

•  Bleeding time 
•  Capillary resistance (lace, suction cup)
•  Clot retraction (thromboplastin)
•  Kaolin Cephalin Time
•  QUICK time
•  Thrombin level 

  Baby teeth need to be taken care of to prevent future problems.
Periodontal disease can cause teeth to loosen.
Removable dentures restore chewing function.
In-office fluoride strengthens tooth enamel.
Yellowed teeth can be treated with professional whitening.
Dental abscesses often require antibiotic treatment.
An electric toothbrush cleans more effectively than a manual toothbrush.
 

Clinical examination in Pediatric Dentistry