E-Book, Englisch, Band 14, 100 Seiten
E-Book, Englisch, Band 14, 100 Seiten
Reihe: QuintEssentials of Dental Practice
ISBN: 978-1-85097-312-6
Verlag: Quintessence Publishing Co. Ltd.
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)
Autoren/Hrsg.
Weitere Infos & Material
Chapter 1 Paediatric Cariology: Management and Myth
Chapter 2 Diagnosis of Dental Caries
Chapter 3 Treatment Planning and Managing Toothache
Chapter 4 The Caries Prevention Tool Kit and How to Use It
Chapter 5 Intracoronal Restorations for Posterior Primary Teeth
Chapter 6 Preformed Crowns Are Easy
Chapter 7 Pulp Therapy in the Primary Dentition
Chapter 8 Avoiding Extraction of Carious Anterior Primary Teeth
Chapter 9 How to Cheat at Dental Dam
Index
Chapter 1
Paediatric Cariology: Management and Myth
Aim
This chapter aims to emphasise the importance of the management of caries in children in respect of their continued dental, emotional and educational development. In addition, various myths surrounding paediatric cariology will be discussed. Outcome
Upon reading this chapter, the practitioner should have gained an understanding of the importance of ensuring that children remain free of both acute and chronic dental pain and appreciate the contribution of the primary dentition, in particular, to overall health and development. The dental team should also be familiar with the chronology of the development of the dentition and appreciate how knowledge of this assists in determining the effect of common childhood illnesses upon the dental hard tissues. Introduction
Dental caries is one of the most prevalent of human diseases. This disease involves the mineralised tissues of the teeth, namely enamel, dentine and cementum, caused by the action of microorganisms on fermentable carbohydrates. It is characterised by demineralisation of the mineral portion of these tissues followed by the disintegration of their organic material. The disease can result in bacterial invasion and death of the pulp and the spread of infection into the periapical tissues, causing pain. In its early stages, however, the disease can be arrested since it is possible for remineralisation to occur. Over recent years there has been a decline in the prevalence of caries in the Western World. Possible reasons for this include the widespread use of fluoride (especially in toothpaste), changes in the diet, the increased use of antibiotics, and possible changes in the virulence of microorganisms. The decline in caries prevalence has been greatest on the smooth surfaces of teeth. The pit and fissured surfaces of the molar teeth now have the greatest disease susceptibility, although buccal and palatal pits and fissures remain caries prone. The decline in caries, however, has not been uniform but skewed. The Scottish Health Boards’ Dental Epidemiological Programme survey carried out in 1992/93 showed caries in 7% of 12-year-old children. Unfortunately, many dental practitioners do not see the value in restoring the primary dentition. This reinforces the view of many parents that primary teeth are expendable. We hope that this book will encourage dentists, dental therapists and hygienists to develop their skills to meet the challenge of treating the young child and promote a change in attitude in those who do not value the primary dentition (Fig 1-1). Fig 1-1 A visit to the dentist should be a pleasant experience. So Why Should We Restore the Primary Dentition?
It is becoming increasingly clear that dental health is intertwined with general health and development. Pain and infection have a detrimental effect on health. These are obvious in the child with acute pain, but chronic toothache also causes problems. A child with chronic dental pain cannot thrive and all carious teeth are likely to cause pain and sensitivity from time to time, resulting in: loss of sleep mood, behaviour changes and poor concentration uncomfortable eating, with subsequent loss of appetite and failure to meet developmental milestones: height, weight and head (brain) circumference. Therefore, the child with dental caries may not thrive physically, emotionally or intellectually, compared to the caries-free child (Figs 1-2 to 1-4). Where children are concerned, their medical, and particularly dental, well-being is of paramount importance. Even relatively simple dental problems can impact upon the medical or educational needs of children, especially on those already diagnosed with medical disorders or learning disabilities. Fig 1-2 Young child with carious upper incisors and an abscess on tooth 51. Fig 1-3 Caries-free child with (a) primary teeth and (b) permanent teeth. Fig 1-4 Child who has had multiple teeth extracted (a) intra-oral view and (b) extra-oral view. The dental practitioner should aim to motivate the patient and their family by demonstrating that teeth are not disposable and restore primary dentition because it helps: restore form restore aesthetics restore function (mastication and speech) maintain space for the permanent teeth (Fig 1-5) acclimatisation avoid pain and sepsis – avoid damage to the permanent teeth avoid extraction, particularly under general anaesthesia avoid sepsis and surgical intervention in the medically compromised child. Fig 1-5 Primary teeth act as a natural space maintainer for the permanent teeth. The Chronology of the Development of the Dentition
The development of the primary and permanent dentitions is affected by: genetic factors nutrition somatic growth and development. There is little variation reported between different races in the timing of eruption of the primary dentition. Racial variation, however, can be seen in the eruption of the permanent dentition – for example, Asian children complete their dental development faster that their Caucasian peers. Therefore, care must be applied when dentists seek to compare an individual child to the “normal” eruption times (Table 1-1). Table 1-1 Eruption dates of primary teeth and secondary teeth Primary Teeth Eruption Time (Months) Central incisor 6 Lateral incisor 9 Canine 18 First molar 12 Second molar 24 Calcification commences 4–6 months in-utero Root formation complete 12–18 months after eruption Secondary Teeth Eruption Time (Years) Calcification Starts (Years) Central incisors 7 0.3 Lateral incisors 8 0.3/1* Canine 9 /12* 0.3 First premolar 10 2 Second premolar 11 2 First molar 6 Birth Second molar 12 3 Third molar 16–24 8–14 *lower/upper Root formation complete 2–3 years after eruption Studies in Peru, on malnourished children, have shown that infants were delayed in the eruption of their primary teeth. This link between nutrition, dental development and general growth can also be seen in premature and low birthweight babies. These babies will “catch-up” on their dental development once their nutrition and medical problem has been rectified and somatic growth will “catch up” with the normal milestones for length, weight and head circumference. A nutritionist often investigates children who fail to meet their normal developmental milestones. Such children may be placed on dietary supplements: these are generally carbohydrate-rich and so oral hygiene and fluoride therapy are of paramount importance. Other children are referred for dental care to manage dental pain, which may be deterring adequate food intake. The dental team plays a key role in infant growth and development. Childhood Fever and Caries Susceptibility
Common childhood illnesses can affect the coincidental dental hard-tissue formation. This can result in hypomineralisation and discolouration. As soon as this is diagnosed, the dental team should be alerted to the fact that the child will have a high caries risk and consequently needs personalised, enhanced preventive management. Teeth affected by childhood fevers have increased susceptibility to dental caries due to: altered tooth morphology enamel porosity difficulties in maintaining good oral hygiene due to sensitivity. An example of this is molar incisor hypomineralisation (MIH), in which the permanent incisors and first permanent molars are affected (and possibly also the tips of the canines). The affected teeth appear to be prone to post-eruptive enamel loss. Examples of the common childhood illnesses that can cause enamel defects are: chickenpox measles middle ear infections fevers caused by respiratory or urinary tract infections other fevers that cause skin rashes (remember that enamel and skin share a common ectodermal origin). Myths
Calcium Deficiency
The...
