Illustrated Pediatric Dentistry - Part 4

Dental treatment has been associated with pain by adults and children alike. The fear associated with the perceived pain causes a lot of anxiety and is a common cause for patients to show avoidance towards basic dental care. A painless experience during dental treatment allows children to look forward to future dental appointments and allows the dentist to establish a good rapport with the child. Various agents are available for the administration of local anesthesia with lignocaine being the most common agent. As children have unique physiology and anatomic variations, the techniques for local anesthesia require minor modifications. Advances in local anesthesia materials and techniques have provided the dental surgeon to accomplish the goal of true painless dentistry. 

Surgical procedures in children are often required for alleviation of pain, or removal of pathologic or aberrant entities from the oral cavity. The general principles for surgical management are relevant in children as well. Due to behavioural and cooperation problems in children the minor surgical procedures should be planned well, taking into consideration all aspects. Extraction of primary teeth must be commonly done due to extensive dental caries. Minor surgeries like cyst enucleations, frenctomies, mucoceles etc. require proper planning and execution for successful results. The advent of dental implants has opened new vistas in rehabilitation of adult patients. However, the use of implants in pediatric dentistry has not been extensively used due to the growth and developmental changes in chidren. There is a limited scope for implants in dentistry hence it has been covered. If used judiciously implants can be an important addition to the field of work of pediatric dentists.

Managing a child for dental treatment is one of the most challenging tasks for both anaesthesiologists & pediatric dentists alike. The goal is to provide safe, painless, anxiety-free, prompt & appropriate treatment in the minimum number of sessions. To achieve this, children need to be given Monitored Anaesthesia Care (MAC), Sedation, Anxiolysis or sometimes complete general anaesthesia (GA) by appropriately trained specialists in day-care & ambulatory services settings with better advances in anaesthesia, dentistry, pharmacology, monitoring devices, better understanding of paediatric airway anatomy & physiology, paediatric dental anaesthesia has become safe over the last few years. This chapter overviews the various aspects of Pediatric dental anaesthesia & sedation and highlights the significance of specialised infrastructure, personnel, & protocols.

Children are in a state of delicate physiologic equilibrium and, unlike adults, are more susceptible to medications and their adverse effects. Medicines used for children should be carefully selected, and the minimum dose required should be administered. Possible adverse reaction in multidrug therapy is also essential. The pediatric dentist must also consider any other drug the child may be taking while prescribing drugs and understanding children’s presenting signs and symptoms.

Significant oral problems are associated with many medical disorders. Close cooperation and consultation between the dentist and the child’s physician are essential to render optimum medical care. Prevention of oral disease is the primary consideration for these children. Medically compromised children can be challenging to treat and affect dental care [30]. To treat medically compromised patients safely, it is essential to Obtain a relevant and thorough medical history and understand the possible implications of the illness on dental treatment and the potential importance of the condition on treatment planning and the caries risk associated with the medical condition. With advances in medical treatment, significantly more children survive longer with more complex medical needs, and these children will present to the general dentist for dental treatment.

Patients with a spread of medical conditions, some unknown to them, ask for dental treatment. Usually, this can often be mixed with the intake of a posh variety of medicines. Dental management aims to produce safe and effective treatment while not causative a medical crisis. Consequently, dental treatment might be changed to keep with the patient's medical constraints, and occasionally, MD consultation can be required. Information of the medical standing of patients obtained through correct medical history-taking is key to safe patient management. The health profile of a country's population is additionally relevant for the supply of oral health care. However, there's a scarceness of data regarding the medical standing of patients seen. This chapter throws lightweight on the consecutive management of dental patients with medical emergencies with this read. 

Orofacial clefts are one of the most common head and neck birth defects worldwide, affecting children of all socioeconomic and cultural backgrounds. Orofacial clefts refer to a cleft lip and palate, a complex trait caused by multiple genetic and environmental factors. Children with orofacial clefts commonly have various issues, such as learning difficulties, speech and language disorders, middle ear abnormalities, psychosocial problems, and dental abnormalities. Due to the complex nature of a cleft lip/palate, the treatment involves interdisciplinary teams, including plastic surgeons, pediatric dentists, maxillofacial surgeons, orthodontists, and speech therapists. Dental and orthodontic procedures are required at an early age (9 months to one year of age) to aid normal facial and dental development and prepare the patient for surgery later. The main treatment goals in cleft lip and palate cases are to maintain the natural anatomical form of the lips and palate to ensure everyday speech without hypernasality. An additional goal is to ensure normal psychosocial development. 

A medical emergency is a serious concern in the dental office. It may lead to a life and death situation, and prompt early response has a profound effect on the morbidity and mortality of the patient. A dental surgeon is expected to be a first responder in any medical emergency until appropriate medical help arrives. The office staff should be adequately trained and assigned proper individual roles in an emergency to ensure a smooth and efficient response. They should have basic knowledge of resuscitation and drugs used in emergencies. The dental clinic should be equipped with a basic armamentarium and drugs cart.

Children are innocent victims of HIV infection. Children who are HIV positive, either through mother-to-child transmission or following sexual abuse, are often not revealed what could happen to them. They will undoubtedly be worried when they experience symptoms. It has been estimated that 90% of people with HIV infection present at least one oral indication at some time during the disease. The presence of oral lesions may be an early diagnostic indicator of HIV/AIDS. Early recognition, diagnosis and treatment of HIV associated oral lesions in children can reduce morbidity and improve the quality of life of children who have HIV/AIDS. 

Approaches for managing dental caries have changed dramatically in recent years, evolving from froadichtional treatments to a preventive approach. Modern management approaches aim to prevent the disease, manage the caries risk, and detect caries lesions as early as possible. Also, various breakthroughs have been made in restorative materials to improve their biocompatibility and bonding with tooth structure. With nanotechnology, knowledge of materials, and developments in biomaterials, the prod the action of the best quality dental restorative materials is rising. Local anaesthesia is the standard and the backbone for controlling pain. The introduction of newer techniques of regional anaesthesia and delivery devices assist dentists in providing enhanced pain relief with reduced pain from injection and fewer adverse reactions. The chapter below highlights the various advancements in sterilisation, diagnostic aids, preventive strategies, restorative materials and techniques and tissue engineering.

Carious lesions can range from early, non-detectable mineral loss, restricted to enamel, through to lesions that extend into dentine without any surface cavitation, to cavitated lesions, which destroy the tooth tissue and can be visible as cavities in the teeth. Cavitated caries lesions generally are non-cleansable and thus active; therefore, these lesions most commonly need to be restored. Selective removal of carious tissues is guided by the depth of the lesion, pulpal health, and choice of dental material. Fluoride is the cornerstone of the non-invasive management of non-cavitated caries lesions. Still, its ability to promote net remineralisation is limited by the availability of calcium and phosphate ions. Ideal remineralisation material should diffuse or deliver calcium and phosphate into the subsurface lesion or boost the remineralisation properties of saliva and oral reservoirs without increasing the risk of calculus formation. These options are often no longer feasible for carious lesions where the tooth tissue surface has become cavitated, as the biofilm is sheltered and cannot be easily removed or manipulated. In such situations, invasive (restorative) options are required. With the advent of adhesive restorations and facilitated by the described changing understanding of the pathogenesis of caries and carious lesions, a paradigm shift in restorative dentistry occurred. In asymptomatic, vital teeth with deep lesions, conservative carious tissue removal strategy,s that reduce tissue loss and pulp exposure risk must be balanced against removing adequate tissue to maximise restoration longevity. In two stages, the most recent inspiration for stepwise carious removal originates from the knowhow on Intra lesion changes in deep carious lesions. Natural enamel and dentin are still the best “dental materials” in existence; therefore, minimally invasive procedures that conserve a more significant part of the wild, healthy tooth structure must be considered desirable. Ultraconservative dentistry represents a significant step forward for the dentist, the profession, and especially the patient. A changing understanding of the disease of dental caries has initiated a paradigm shift in the management of carious lesions. Instead of merely removing the symptoms of the carious lesion, any treatment aims to manage the disease. 

In recent years, the desire of Dental Clinicians and patients to use lasers for the treatment of Dental conditions has increased. Knowledge of laser functions and biological features of oral tissues is crucial for understanding the effect of dental lasers. Choosing a suitable dental laser for different tissues effectively reduces tissue damage. Other types of lasers are used in dentistry, which effectively treats lesions by providing innovative and minimally invasive treatments that also have biostimulation, anti-inflammatory, and analgesic effects. Among lasers, erbium lasers, being less invasive and having caries removal properties, have been optimally considered in pediatric dentistry. Lasers in children can also have efficient antiseptic effects on vital and non-vital pulp therapies of primary teeth. One of the most common oral problems in children is dental trauma. Laser-based therapies can significantly reduce pain and surgical problems. Laser therapy is a suitable and valuable treatment strategy in children despite surgery problems and provides practical health solutions. Findings have shown that different lasers, based on their wavelength, can cause incisions on the soft and hard tissues of the mouth and teeth in the form of various mechanisms such as vaporisation or ablation, and these effects vary according to the wavelength used; however, choosing an infrared laser allows the dentist to better interact with specific targets such as gums, mucous membranes, and mouth injuries. This chapter examines the critical effects of lasers in pediatric dentistry. 

Genetics is the study of genes at all levels from molecules to populations. Common dental diseases such as dental caries, periodontal disease and malocclusion are influenced by environmental factors. However, even in these diseases, the genetic aspects that influence the degree of susceptibility should not be overlooked. Dental practitioners would find value in understanding the genetic contribution to caries risk as they would be able to explain to patients that some forms of decay are more strongly associated with inherited risk and these patients could be monitored more closely and provided with more aggressive preventive programs.

Humans are host to oral microbiomes in a positive relationship which is a critical determinant for regulating oral symbiosis. When the balanced condition is transformed into an acidic environment, the percentage. mutans streptococci and Lactobacillus species increase. However, to be beneficial in the oral cavity, probiotics must first aggregate and attach to the oral tissue, creating a protective barrier to prevent the colonisation of the pathogenic microorganisms. The growth and activity of probiotics are enhanced by nondigestive oligosaccharides, namely, prebiotics, which cannot be digested by the host but enhance the beneficial effects of probiotics by selectively stimulating the growth and activities of the probiotics.

Pediatric Dental Clinic should be colourful and pleasantly full of colours and lights. Pediatric patients should like the ambit of the environment. So, the setup of a Pediatric dental clinic should consider the interests and likes of pediatric patients. The clinic should have designated areas for the clinical work of patients. There should be a separate clinical area, waiting area, and play area. 

Child abuse and neglect are synonymous with the current term “Child maltreatment”, a multifactorial problem affecting the health and well-being of large numbers of children worldwide. “Child Abuse and Neglect” has been discussed from public health and a professional perspective, focusing on global problems. It narrates the consequences of being exposed to this form of brutality on the minds and bodies of the child, their detection and measures being taken to prevent these types of violence. Also, the extent of the problems, the risk factors, the consequences of child abuse, and what is being done to avoid child abuse and neglect have also been discussed.