Introduction to Pediatric Dentistry
Pediatric Dentistry is “the whole of Dentistry applied to children”
It is therefore multidisciplinary and as such, must be part of the activity of every practitioner regardless of their type of hospital or private practice. It can be considered by some as a “specialty” when it requires certain specific knowledge and the implementation of specific therapies, but should in no case be intended for the care of difficult children only. It begins with the eruption of the first temporary teeth and ends around the age of 15 when the apices of the second permanent molars are closed. Three main periods emerge with their clinical and pathological specificities:
a/ Temporary teeth, child from 0 to 6 years old:
- Early childhood caries
- Baby bottle syndromes
- Traumas
- Structural anomalies
b/ Mixed dentition, child aged 6 to 12:
- The first permanent molar
- Trauma
- Number and structure anomalies
c/ adolescent teeth, adolescent aged 12 to 15:
Pediatric Dentistry focuses on treating various oral and dental pathologies in children, taking into account growth phenomena in general and teething in particular, and prevention also plays a key role. Pediatric Dentistry prepares the oral and dental future of our future patients…
- Damage to the oral mucosa and periodontium
- Damage to the oral mucosa
Damage to the oral mucosa and periodontium in children constitutes a set of varied pathologies whose clinical picture and management present certain specificities compared to adults.
Epidemiological data on oral mucosal lesions in children are scarce and inconsistent; the most frequently encountered oral mucosal lesions were bites followed by aphthous stomatitis, herpetic infections and geographic tongue; children suffering from systemic diseases were more frequently affected.
- Periodontal damage
The prevalence of periodontal diseases in children is well known: it is relatively high for gingivitis and varies from 0.1 to 0.5% for aggressive periodontitis.
The periodontium is a major anatomical structure in the child’s oral cavity. During growth and dental eruption, it undergoes numerous physiological changes. In dentistry, it is important to understand the normality of this periodontium in order to detect alterations. This area of study will focus on identifying the various factors that modify the periodontium and scientific advances concerning the bacterial flora acquired by children and adolescents. The pathophysiology of gingivitis and periodontitis specific to children is described, and the differences with adults are highlighted. The periodontium can be an easily observable reflection of the child’s general health. In the presence of periodontal disease in the primary or mixed dentition, we propose a diagnostic and therapeutic approach.
- Prosthetic treatments:
In children, prosthetic treatments include either fixed prosthetic restorations using preformed crowns (major carious lesions, poor oral hygiene, structural anomalies, shape anomalies, agenesis, minor partial edentulism), or removable prosthetic restorations (agenesis, partial or total edentulism). The main objectives of these restorations are the maintenance of masticatory, aesthetic and phonetic functions as well as the maintenance of arch length and vertical occlusion dimension. Other objectives are to prevent possible psychological trauma due to tooth loss as well as the development of harmful habits.
However, they must take into account the child’s growth and allow the child to reach adulthood without major aesthetic, functional and periodontal problems.
They therefore evolve according to the child’s stage of growth, require regular monitoring and the maintenance of rigorous oral hygiene.
- Conservative dentistry
The preservation of temporary teeth until their normal loss date is a necessity. Let us briefly recall the foundations: firstly, a physiological necessity, because they constitute part of a whole whose overall integrity allows for the harmony of functions (mastication, phonation, swallowing) and the development of orofacial structures. Psychological and aesthetic necessities also exist in a fragile, developing subject.
However, this conservation will only be possible to the extent that the therapies are truly effective without the risk of acute or chronic infectious complications. The effectiveness
dentinopulpal therapy for temporary teeth requires precise knowledge of the specific conditions that govern them.
These dentinopulpal treatments are first conditioned by the morphological, histological and physiological characteristics of temporary teeth which result in significant differences in their pathologies and therapeutics compared to those of permanent teeth. Diagnosis of the stage of development of the pathology and particularly of the pulp involvement is particularly delicate.
- Pediatric endodontics:
Pediatric endodontics is a real challenge, the pulp diagnosis in the patient is uncertain, the clinical symptoms are not always correlated with the state of the pulp tissue: moreover; the age and behavior of the child can compromise the prognosis of the treatments.
When feasible, pulp treatments for temporary teeth aim to preserve the tooth(s) in the arch until they fall out; for permanent teeth, they aim to maintain root development and preserve function.
- Restorative dentistry
Restorative dentistry is the final stage when carious cavity lesions have passed the remineralization stage. It is always done to the detriment of dental tissues, which is why it is essential to respect the concepts of dentistry to a minimum in order to preserve them as much as possible and to restore them using biocompatible or even bioactive materials.
Pediatric restorative dentistry aims to reconstruct the temporary tooth in its anatomical integrity so that it can fulfill its roles:
- Functional (chewing, swallowing, speaking)
- From eruption guide
- Space maintainer
- Growth (organization of inter-arcade relationships)
- Aesthetic
- Preventive and interceptive orthopedics
Preventive and interceptive orthopedics are of interest to young children. Prevention, which is the act of getting ahead of things, cannot really be applied to orthodontics for congenital and hereditary anomalies. However, for acquired anomalies, it is possible to act quickly by eliminating the responsible cause(s). It would therefore be more appropriate to use the term “interception.”
Interceptive orthopedics treats, corrects or simply improves evolving dysmorphias, the functional causes of these dysmorphias, and prevents the worsening of skeletal and dental anomalies.
It is implemented between the ages of 8 and 11 and acts on the disturbed function, on maxillofacial growth and on the harmonious development of the dental arches. Its objectives are limited; it never claims to establish a perfect occlusion.
The advantage of this therapeutic design is to reduce the duration and cost of treatment and to bring a benefit on the one hand to the individual, and on the other hand to the community.
- Pediatric surgery
Dental extractions in children may seem like a simple procedure. However, for young patients, it is often the most dreaded procedure.
Surgical procedures are performed under local or locoregional anesthesia which may be combined with sedation techniques.
Avulsion is often caused by caries and its infectious complications, but also by trauma or orthodontic indications.
Oral surgery procedures do not present any notable differences from those performed on adults. The surgical protocol must obey precise principles and take into account certain factors, such as the morphology of temporary teeth and the position of successive germs.
- Prevention:
Preventing dental caries is one of the major goals in dentistry. Implemented early, it becomes the most effective tool for avoiding and controlling the development of carious lesions. Depending on the point at which it occurs in the progression of carious disease, three stages are distinguished.
- Primary prevention
It aims to prevent the onset of the disease by eliminating risk factors.
- Hygiene :
Oral hygiene is the primary checkpoint for caries. Learning it from a young age is essential. Visualizing dental plaque using color markers is an essential teaching tool for oral hygiene. An individualized care program is established, including twice-daily brushing, the possible use of mouthwash (containing chlorhexidine), dental floss, and fluoride products if necessary.
- Food:
It plays a role in the formation of teeth before they erupt. Malnutrition affects the development of the salivary glands, resulting in a lesser and lower-quality saliva flow. However, saliva plays a mechanical cleansing role through its flow, eliminating carbohydrates and acids from dental plaque.
9.1.3 .Fluorine:
The use of fluoride in the prevention and control of caries has proven its effectiveness for many years.
- Secondary prevention: Elimination of factors that promote the retention and formation of dental plaque;
A thorough clinical examination. The earlier the diagnosis, the more non-invasive remineralization therapeutic measures can be implemented. New techniques have been developed to complement the visual clinical examination, such as quantitative light fluorescence measurements, electrical conductance measurements, and DIAGNOdent.
- Screening:
Screening is essential; it helps identify risk factors that can contribute to the disease and the development of new lesions. Interviewing and clinical examinations, combined with screening tests, will lead to the selection of appropriate preventive and interceptive treatment alternatives.
9.4 Half-yearly checks and prophylaxis:
Dental plaque is the main etiological factor in caries. Although it can be removed by twice-daily brushing, most patients lack the motivation or dexterity to maintain proper hygiene over a long period of time. Regular checkups and professional prophylactic cleaning are therefore imperative.
The American Academy of Pediatric Dentistry recommends regular checkups including:
- Teaching oral hygiene techniques;
- Descaling followed by careful polishing;
10. Conclusion
Pediatric dentistry is a particular discipline of the nine official teaching disciplines, it is the only one not to be centered on a field of competence (like prosthetics or periodontology ) but on an individual: the child who goes through stages of growth, evolution and maturation.
Introduction to Pediatric Dentistry
Untreated cavities can cause painful abscesses.
Untreated cavities can cause painful abscesses.
Dental veneers camouflage imperfections such as stains or spaces.
Misaligned teeth can cause digestive problems.
Dental implants restore chewing function and smile aesthetics.
Fluoride mouthwashes strengthen enamel and prevent cavities.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush protects enamel and sensitive gums.