PEDIATRIC CLINICAL EXAMINATION
1. INTRODUCTION:
Pediatric dental examination does not differ much from the examination performed in adults. In addition, the processes of physical and psychological maturation of the child must be taken into account.
Finally, the psychological approach is not the same for adults and the therapeutic relationship is threefold: practitioner – child – parents. The pediatric dental examination must be as methodical as the adult examination, but above all it must be the privileged moment to accustom the child to the environment of the dental office.
The first consultation is used to:
1. Collect the child’s contact details
2. Perform a brief dental examination
3. Answer parents’ questions and assess the child’s growth and development.
4. Inform parents about dental hygiene practices.
5. Teach the importance of nutrition and the cariogenic property of foods.
6. Show parents how to examine their child’s mouth themselves and explain the benefits of this examination.
This first consultation should be done from the age of 3 and on a regular basis.
The dental examination of children includes, as in adults, the anamnesis, the clinical examination and the radiographic examination. The diagnosis and the treatment plan and the prognosis are established at the end of this examination. Some cases require in addition to the initial examination clinical tests and laboratory examinations.
2. The physical and psychological approach to the child: the layout of the dental office is important. The waiting room and the treatment area must be designed to suit the child. The child must not only feel safe there but also be comfortable.
Very often, the success of the clinical approach is primarily due to the dentist’s ability to make himself understood. Effective communication is based on a few attentions, the use of vocabulary that the child understands is the most important.
3. Anamnesis : The ideal is to welcome the parents alone and gather as much data as possible on their child who will be questioned in turn during the consultation in a way that suits them.
The anamnesis consists of collecting various information on the child and the family, which are essential for establishing the file:
* General data:
These data include: name, first name, gender, date and place of birth; ethnic origin; address and telephone number of parents at home and at work; marital status and occupation of parents; languages spoken and written by the child; names and contact details of the family doctor and possibly the usual dentist.
Not only are these data very important from a forensic perspective, but they provide the first pieces of information that may be useful for diagnosis.
* The main reason for the consultation:
It is important for the practitioner to identify the reason for the consultation and to respond as far as possible to the parents’ expectations. Once this reason has been expressed, the examination continues according to the objectives listed above and according to the child’s degree of cooperation.
* Medical history:
Taking a medical history allows the dentist to know the patient’s current and past health status, to adapt the rules of asepsis and to screen for existing conditions.
Taking a medical history may provide information about the existence of a systemic illness that was not reported when the health questionnaire was completed.
* Dental history:
Dental history is reported by parents. Date of last appointment and attendance at dental appointments, if any, provide an indication of interest in dental health. How does the child respond to dental treatments and local anesthesia?
If treatment was provided under general anesthesia, conscious or unconscious sedation, the dentist will note the reasons why this solution was chosen.
* Diet: Since dietary habits vary greatly over the years in all individuals, monitoring diet should be part of the dental prevention program. Depending on the needs of each case, the analysis of diet should be repeated at intervals of 6 to 12 months and should be accompanied by appropriate recommendations. Despite a significant decrease (about 30%) in the prevalence of caries in the general population over the past ten years, the problem persists. It cannot be stopped without monitoring diet. The dentist has the responsibility to intervene in this area.
* Family, social and personal background: the family assessment allows us to know not only lifestyle habits and the importance given to dental health, but also congenital and family conditions that may have an impact on dental health.
In addition, the child’s academic progress indicates his psychological development and his favorite hobbies and sports denote his social development.
4. The clinical examination: the collection of information is done methodically:
a- Extra-oral examination:
The examination begins when the child enters the office. His attitude is noted (relationship with parents, passive or active attitude). The child’s physical appearance is observed (drooping shoulders, hunched back). His weight and height are assessed in relation to his civil age. If there is any doubt, the parents are asked for the exact values at the last health examination.
When the child is seated, we can observe his hands: presence of callus on a finger (sign of sucking), bitten nails (sign of anxiety).
At the facial level, we look at the symmetry of the face, the eyeballs (protrusion or not), the presence of dark circles or not, the shape of the nose (pinched, flared), the shape of the lips (thick or thin), prominent cheekbones or not. An aquiline nose, with poorly developed nostrils, may reveal respiratory insufficiency. At rest, we look to see if the mouth remains open (gaping lip).
b- Intra-oral examination
In a first approach, the teeth are counted. Any anomaly in number and shape is noted. The most advanced caries are detected. A systematic oral examination must be carried out:
— examination of the mucous membranes: bites, spots, mouth ulcers, etc.;
— examination of the gums: gingival inflammation, presence of plaque, periodontal problem (gingival recession, epulis, etc.);
— shape of the palate: deep or not, ogival, etc.;
— insertion of the labial and lingual frenulum;
— assessment of lingual shape and volume.
This initial information is noted on an examination sheet.
The intra-arch examination will allow the identification of various possible anomalies:
— the presence or absence of diastemas;
— the absence of a tooth either due to agenesis or premature extraction;
— misaligned teeth;
— supernumerary teeth;
— eruption delays.
The inter-arch examination will reveal occlusion anomalies in the
Three senses of space (transverse, vertical and sagittal):
— the presence of inverted dental articulation in both the posterior and anterior sectors;
— the presence of an anterior and lateral gap or, conversely, an incisor overbite;
— the presence of an anteroposterior shift.
PEDIATRIC CLINICAL EXAMINATION
c- Functional examination:
A brief functional examination must be systematic during each first consultation. Screening for an abnormality in a masticatory praxis (sucking-swallowing, chewing, breathing) will prevent the growth of the skeletal and alveolo-dental systems from taking the wrong direction. These functional disorders will result in different types of malocclusions ranging from simple ectopia of a tooth to significant dysmorphosis. During this first consultation, the examination is brief but it will need to be deepened during subsequent sessions.
5. additional examinations:
a- Radiological examination:
The dentist should limit the exposure of young subjects to diagnostic radiation. Indeed, routine radiographs should be avoided. The use of radiographs is justified in many situations, such as developmental assessment, developmental anomalies, caries, pulp diseases, trauma, eruption problems, infections, etc. On the other hand, in children with generalized interdental spaces, especially if the history and clinical examination are negative, radiographs for the diagnosis of caries are not indicated.
In children aged 5 to 6 years, a panoramic image and retrocoronal images allow a good oral-dental assessment.
b- biological examinations: These examinations are rarer in the context of a practice in the dental office. However, investigations concerning the blood formula may prove necessary, in the context of heavy treatments, in children whose health is fragile.
c- medical examinations:
Through health professionals, other types of examinations or information are sometimes essential for our different therapies.
Which health professionals can help us and why?
— Pediatricians and general practitioners: they provide all useful information on the high frequency of early childhood illnesses and on the general growth of the child.
— Ear, nose and throat doctors: in the event of breathing difficulties (mouth breather) highlighted by difficult treatment sessions and associated clinical signs (open lip, nasal respiratory deficiency), a complete ENT assessment is requested.
— Speech therapists and facial physiotherapists: they will intervene as part of a functional assessment.
— Psychologists: they intervene in cases of refusal of care characterized by a phobia of care, particularly in older children. The most common area is that of “finger suckers”.
PEDIATRIC CLINICAL EXAMINATION
6. Diagnosis and treatment plan:
The practitioner is then able to make a diagnosis, but must remain vigilant in order to offer treatment suited to his patient.
First, the treatment plan must meet the expectations of the child and his parents. The emergency remains the priority act and will be included as such in our treatment plan without any other consideration.
Then the treatment plan will be built based on a number of parameters:
– caries assessment with determination of the type of caries lesion (site and stage of development);
– determination of individual caries risk;
-cooperation of the child and parents during sessions and follow-up of care;
– special request from parents and child to be taken into account, if there are no contraindications
-treatment sessions per hemi-arcade whenever possible
– posterior sectors first, then anterior sectors.
PEDIATRIC CLINICAL EXAMINATION
Sensitive teeth react to hot, cold or sweet.
Sensitive teeth react to hot, cold or sweet.
Ceramic crowns perfectly imitate the appearance of natural teeth.
Regular dental care reduces the risk of serious problems.
Impacted teeth can cause pain and require intervention.
Antiseptic mouthwashes help reduce plaque.
Fractured teeth can be repaired with modern techniques.
A balanced diet promotes healthy teeth and gums.