A child’s behavior can complicate decision making in pediatric dentistry. After reading this course, the participant should be able to: Behavior management is a cornerstone of treatment planning in pediatric dentistry. However, a broader medical and dental risk assessment for the pediatric patient should remind clinicians to individualize treatment plans based on the child’s and family’s social context, health behaviors and disease severity. Another way to conceptualize how disease and behavior management intersect is presented in Table 1. How useful are current caries risk assessment tools in informing the oral health care decision-making process? What should the dentist recommend for this patient? Randomized clinical trial of 12% and 38% silver diamine fluoride treatment. Managing ECC traditionally includes surgical care via a combination of restorative, endodontic, and surgical treatment, as indicated by clinical guidelines. She stated that her daughter does not floss regularly because when she flosses her teeth it "makes her gums bleed." Disease management of early childhood caries: ECC collaborative project. For a poorly cooperative child, moderate sedation and/or general anesthesia are reasonable options for children with moderate to severe treatment needs. Treatment(s) of choice for this patient include: (2013) Statement #1: In cases where minimal procedures are required in mandibular quadrants, administer bilateral blocks in young children. Clinical examination of case 2 also revealed dark staining associated with no radiographic carious lesions on the occlusal or interproximal surfaces of tooth #14. radiograph of a deep carious lesion that approaches, but has not penetrated the pulp should be planned for a, implied the completion of all required procedures in one fourth of the mouth, restoration of max. Preformed metal crowns for primary and permanent molar teeth: review of the literature. Disney JA, Abernathy JR, Graves RC, Mauriello SM, Bohannan HM, Zack DD. Pharmacologic behavior management introduces a new level of risk, which can be managed by appropriately trained providers paying careful attention to preoperative assessment, emergency preparedness, intraoperative monitoring, and post-operative evaluation.2,3 In light of new approaches to risk assessment, changing disease patterns, and the emphasis on nonsurgical management in pediatric dentistry, the amount of information influencing clinical decisions is greater than ever. Gori GB. In case of adults the amount of research being carried out is extensive, however, the treatment planning and execution of implant placement in children and adolescents is still in its infancy. From Dimensions of Dental Hygiene. Pediatric Dentistry: Infancy through Adolescence Expert Consult 6th Edition provides comprehensive coverage of oral care for infants children teenagers and medically compromised pediatric patients. Wright JT, Cutter GR, Dasanayake AP, Stiles HM, Caufield PW. Digital treatment planning enhances the diagnostics of implantology by assisting the dentist alone or partnered with a trained laboratory technician to account for anatomical limitations and restorative goals. Chicago, Ill.: American Academy of Pediatric Dentistry; 1991:57-9. Innes NP, Evans DJ, Stirrups DR. (2014) Case 2: KS is a 9-year-old female patient who presented to the dental office to have her teeth cleaned. Fisher-Owens SA, Gansky SA, Platt LJ, et al. 35. Chronic disease management strategies of early childhood caries: support from the medical and dental literature. Fontana M, Gonzalez-Cabezas C. Evidence-based dentistry caries risk assessment and disease management. Registration confirmation will be emailed to you. Time. American Academy of Pediatric Dentistry. Bader JD, Shugars DA. 8:30 AM to 4:00 PM. ADA CERP does not approve or endorse individual activities or instructors, nor does it imply acceptance of credit hours by boards of dentistry. 7:00 to 8:30 PM Central Time, Presentation. Beau D. Meyer, DDS, MPH, is an assistant professor and predoctoral program director in pediatric dentistry at the X-rays and disease screenings are also commonly used, depending on the … An eight year-old male patient has deep fissures but no apparent carious lesions on his posterior teeth. Belmont Publications, Inc. is designated as an Approved PACE Program Provider by the Academy of General Dentistry. Benefits of Pediatric dentistry. Early childhood caries (ECC) is an age-defined diagnosis of caries in the primary dentition in children younger than 6.4 Even though its incidence and associated disparities have decreased,5 ECC still conveys considerable public health and financial burden for many families.6,7 Severe cases often require general anesthesia, with costs approaching $25,000 or more.6 Due to the complexity of the disease and factors affecting its presence (or absence), prevention is rarely as simple as practicing good oral hygiene or having frequent fluoride exposure. Likewise, two children with similar health statuses and caries patterns may demonstrate markedly different rates of caries progression. Pediatric Dentistry MCQs - Child Behavior Management # The main areas of concern in diagnosis and treatment planning for the child are: A. (2014) What would be the recommended treatment for this patient's first permanent molars in case 1? Learn the principles of case selection, informed consent, treatment planning, and a clinical protocol for SDF. (2014) 33. After considering the risks and benefits of surgical vs nonsurgical disease management, and general anesthesia vs conventional behavior management, the family elected nonsurgical treatment with SDF (Figure 2). When managing the behavior of a pediatric patient, there is a need for knowledge, understanding, trust, and expertise. Understanding dentists’ restorative treatment decisions. Enable regular cleaning of teeth; Right care during the teething period. First, ECC risk factors at the population level (ie, groups) fail to translate to the individual level (ie, a single person).15 For example, it is not uncommon to find patients who follow excellent preventive regimens, yet still experience disease. Presenters . (2014) 34. Kristine Fu Shue, DMD, is currently practicing pediatric dentistry along California's Central Coast. When complete-mouth restorations are planned, the strategic use of dental implants and smaller units (short-span fixed dental prostheses), either tooth- or implant-supported, as well as natural tooth abutments with good prognoses for long-span FDPs, is recommended to minimize the risk of failure of the entire restoration. Aside from amalgam, strong clinical trial evidence is missing for most materials used to restore interproximal lesions in the primary dentition.17 Composite resin and stainless steel crowns have been shown to have high success rates in retrospective studies,22,23 but few clinical trials validate these findings in the primary dentition.24–26 Regardless of material choice, the goal of restorative dentistry is to eliminate disease and restore form, function, and esthetics. Oral diagnosis and treatment planning is of utmost importance in pediatric dentistry. After discussing the risks and benefits of nonsurgical vs surgical disease management, and conventional vs pharmacologic behavior management, the parents’ preferred treatment under general anesthesia. INTRODUCTION • Successful dental care for children is best achieved after thorough examination, thoughtful diagnosis and formulation of a proper treatment plan. Get the right treatment from our professionals today. Treatment planning strategies are presented to help with balancing the ideal with the practical, with emphasis placed on the central role of the patient — whose needs should drive the treatment planning process. Pharmacologic management for pediatric dental patients in the 21st century. These timely algorithms serve as important discussion points with families, especially when considering the growth in treatment alternatives. ISBN 9780721603124, 9780323079082 Heintze SD, Rousson V. Clinical effectiveness of direct class II restorations—a meta-analysis. Guideline on restorative dentistry. Click here for our refund/cancellation policy. Dimensions of Dental Hygiene - Dental Hygienist Magazine, Reevaluation After Scaling and Root Planing. (2007) After examining the first permanent molar of a seven year old child, you found: (2005) Which ofthe following arc the Appropriate steps in the determination of treatment priorities. Bitewing radiographs reveal no occlusal or interproximal posterior lesions. STUDY. Many pre-cooperative and highly anxious or fearful children require more advanced or invasive methods of behavior management, including pharmacological techniques, such as procedural sedation and general anesthesia.1. Although intraoral and conventional radiographic procedures have been used extensively since decades, there two-dimensional representation has raised many questions. With the emergence of ECC-CDM as the contemporary caries management framework and emphasis on advanced behavior management in pediatric dentistry,34,35 clinicians must make a more global assessment of the child’s and family’s overall status and oral health needs when developing treatment recommendations. Clinical examination revealed fair oral hygiene and enamel demineralization associated with a radiographic carious lesion on the occlusal surface of tooth #19. Print Book & E-Book. Behavior Guidance for the pediatric dental Patient. More important, the model recognizes the time dynamic to the caries process, which complicates risk assessment and prognosis, as these will change as the balance of protective and risk factors ebbs and flows with time.8. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Featherstone JD, Chaffee BW. In a pediatric population, behavioral guidance may limit the type of definitive treatment dental practitioners can offer their patients. Diagnosis and Treatment Planning; Schedule . cases where minimal procedures are required in several quadrants consider: reason for half mouth tx vs complete arch tx, avoid administration of bilateral mandibular blocks in young children, Clinical observation shows no carious lesions, Tx options: none or pit and fissure sealants, Clinical observation shows no carious lesions but x-ray shows lesions into dentin, clinical observation shows no carious lesions but deep staining is present, clinical observation shows white spot lesion (surface demineralization), Tx plan: apply fluoride varnish or pit and fissure sealant, Clinical observation shows cavitated lesion, Oral hygiene: instructions, supervision, flossing, (2014) #1 Assuming all quadrants are equal in importance, tx the anterior quandrant first. For small pit and fissure lesions, strong evidence supports almost all restorative materials.17 However, for interproximal lesions, the evidence is more variable. Diagnosis and Treatment Planning in Dentistry 3rd Edition provides a full-color guide to creating treatment plans based on a comprehensive patient assessment. (2007) A defect in tooth enamel matrix formation that results in less quantity of enamel than normal is . According to the parents, despite the completion of a stainless steel crown on the primary molar, the sedation visit proved a negative experience. Discuss modern strategies for disease and behavior management in pediatric dentistry. This manuscript describes intraoral and extraoral radiography techniques that can be applied in every day pediatric dentistry. This website uses cookies to improve your experience. Now in full color, this text uses a unique age-specific organization to discuss all aspects of pediatric dentistry from infancy through adolescence. Meyer BD, Chen JW, Lee JY. Birpou E, Agouropoulos A, Twetman S, Kavvadia K. Validation of different cariogram settings and factor combinations in preschool children from areas with high caries risk. Pediatric Dentistry: Infancy through Adolescence Expert Consult, 6th Edition provides comprehensive coverage of oral care for infants, children, teenagers, and medically compromised pediatric patients. Once a carious primary tooth is to be restored after assessing disease progression, the type of restorative material must be chosen based on caries risk, lesion location and size, moisture control, clinical longevity needed, and, increasingly, esthetics. When planning treatment for pediatric dental patients, each patient and restorative material to be used should be evaluated on an individual basis, in order to provide appropriate care within each material's limitations. Make your appointment now. In instances of access-to-care problems, concerns about compliance or follow-up with treatment, or heightened parental preferences, more invasive options such as this may be warranted. Pediatric restorative dentistry involves the use of many materials. Guidelines for pediatric restorative dentistry 1991. The pediatric dentist, or any dentist who treats children, must have expertise in managing pediatric patients as well as in discussing with parents the need for any recommended treatment and the behavioral techniques that will be used to provide the treatment. Presenters . Explain the dynamic nature of the caries process, and the variables that affect the intersection between disease and behavior management in pediatric oral health care. Save my name, email, and website in this browser for the next time I comment. Atieh M. Stainless steel crown versus modified open-sandwich restorations for primary molars: a 2-year randomized clinical trial. American Academy of Pediatric Dentistry. Effect of conventional dental restorative treatment on bacteria in saliva. Safe and compassionate treatment that can improve the oral health trajectory of a child, not a tooth, is the ultimate goal. Divaris K. Precision dentistry in early childhood: the central role of genomics. The emergence of patient safety as a critical component of treatment planning dictates that nonsurgical caries-management tech… What would be the recommended treatment for tooth #14? This distinction is important. The child had severe asthma controlled with a daily steroid inhaler, as well as large tonsils obstructing nearly 75% of the oropharynx. By understanding the dynamic caries process and focusing on patient-level treatment, oral health professionals can leverage caries regression or arrest when planning pediatric therapy. University of North Carolina at Chapel Hill Adams School of Dentistry. A child’s level of cooperation and ability to follow instructions from the dental team directly influence how well a restorative or surgical procedure can be performed and even what materials can be used. Policy on Early Childhood Caries (ECC):classifications, consequences, and preventive strategies. In both instances, a comprehensive, informed-consent process occurred to outline multiple combinations of disease and behavior management alternatives, based on health risk, caries risk, disease extent and severity, and family context. (2014) Case 1: Ten year-old male patient presented in the pediatric dental clinic as a new patient. Individualized or population risks: what is the argument? Learn how your comment data is processed. In effect, the authors present decision-making guideposts for clinicians who navigate these issues on a daily basis. We'll assume you're ok with this, but you can opt-out if you wish. planning for the Pedo pt. Nine months after the procedure, the family decided to pursue a more esthetic option for the child’s central incisors, so esthetic bonding was completed to remove the black stain from the SDF and restore a natural shade (Figure 3). It may be easy to justify restorative treatment choices for a specific tooth based on caries extent or a preferred method of behavior management. Cote CJ, Wilson S, American Academy of Pediatrics, American Academy of Pediatric Dentistry. Diet was classified as cariogenic. When assigning risk, an oral health professional’s subjective assessment, intuition, and local context often serve as risk assessment tools.16 Without local context, however, such subjectivity renders the interpretation of caries risk across providers and other interested parties meaningless.14 In addition, clinical training frequently emphasizes diagnosis and treatment planning at the tooth and surface level (ie, individual teeth and tooth surfaces). 8:30 to 9:00 PM Central Time, Question and Answer Session. PULPOTOMY and a SSC. Gravity. Sheiham A. Generally speaking, information is best gathered by way of a relaxed conversation with the child and his/her parent in which the dentist assumes the role of an interested … Oral medical problems Learn how to restore cavities in a quick, effective, and painless way using Glass Ionomer Cement and SDF, known as Silver Modified Atraumatic Restorative Treatment (SMART). (2013) Bitewing radiographs of a five-year-old child show interproximal carious lesions close to the dentinoenamel junction. Treatment planning is a critical aspect of clinical education in the dental school curriculum. It is the clinician’s responsibility to safely and effectively guide the child’s behavior during all pediatric procedures… While various algorithms summarize the evidence and case selection criteria for different treatment strategies,21,35 this paper outlines a framework that considers context beyond the individual lesion or isolated observation of the child’s behavior. Projections of dental care use through 2026: preventive care to increase while treatment will decline. Flashcards. However, as currently defined, ECC is a person-level disease requiring person-level treatment. The dental disease was limited to one primary molar and maxillary central incisors, and the child demonstrated a high level of dental anxiety during the examination. Randall RC. Created by. Test. For example, a particular child in a dental office may be warm and outgoing one day, and anxious and fearful the next. As a second opinion, the clinical team discussed a wider variety of behavior and disease management options. Taking a comprehensive case history is an essential prelude to clinical examination, diagnosis, and treatment planning. In the second case, a family with a 4-year-old traveled more than an hour for a second opinion. Mother of the child stated that she eats very healthfully and mostly organic foods. 2. Provider ID 317924. always assume the worst plan for the more extensive tx plan. The orthodontist can review the lateral cephalogram, panoramic images, and possibly a CBCT to describe the positions of the maxillary and mandibular incisors so that certain … Dye BA, Mitnik GL, Iafolla TJ, Vargas CM. This site uses Akismet to reduce spam. TREATMENT PLANNING IN PEDIATRIC DENTISTRY Monday, 23/11/2015 11:00 am-12:00 pm TREATMENT PLANNING OBJECTIVES • Discuss development of a proper and adequate TP to include: Ideal treatment and Alternative plans and approaches • Discuss the importance of timing and sequencing of treatment . PLAY. New chapters cover patient diagnosis and team-based treatment planning and a new Evolve … Management includes the recognition, diagno-sis, and appropriate treatment of dentofacial abnormalities. Ethics rounds: death after pediatric dental anesthesia: an avoidable tragedy? The international caries detection and assessment system (ICDAS): an integrated system for measuring dental caries. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/cerp. The current term of approval extends from 7/1/2016-6/30/2019. He can be reached at: [email protected]. Using evidence-based research, this book shows how risk assessment, prognosis, and expected treatment outcomes factor into the planning process. Canares G, Hsu KL, Dhar V, Katechia B. Evidence-based care pathways for management of early childhood caries. Belmont Publications, Inc. is an ADA CERP-Recognized Provider. Parents also need to be educated about the causes of dental caries and other or… Match. B ehavior management is a cornerstone of treatment planning in pediatric dentistry. Conventional communication techniques should be employed at all times and might include demonstration via the tell-show-do approach, setting clear expectations for the child at each visit, and positive reinforcement.1 While these techniques work well for most children, when a child’s behavior or ability to cooperate is less than ideal, oral health professionals must adapt their treatment to account for behavior management. It is also an excellent opportunity for the dentist to establish a relationship with the child and his/her parent.

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treatment planning in pediatric dentistry