Restorative Dentistry for the Pediatric Patient Abstract

Restorative Dentistry
for the Pediatric
Patient
Steven P. Hackmyer, D.D.S.
Kevin J. Donly, D.D.S., M.S.
Introduction
In April, 2002, the American Academy of Pediatric
Dentistry (AAPD) sponsored a Pediatric Restorative
Dentistry Consensus Conference (1). The purpose of
Abstract
The American Academy of
Pediatric Dentistry sponsored
the Pediatric Restorative Dentistry Consensus Conference in
2002. This paper will review the
consensus statements that were
issued as a result of the conference. Since the conference there
have been advances in procedures, materials, and techniques
the conference was to bring together experts in eight
that need to be considered in
recognized areas (risk assessment, sealants, glass
terms of some of the consensus
ionomer cements, amalgam, dentin/enamel adhe-
statements. The introduction
sives, resin-based composites, stainless steel crowns,
of the First Dental Home, in-
and anterior restorations) to provide literature re-
terim therapeutic restoration and
views to aid in the development of evidence-based,
scientifically supported position papers supporting
pediatric restorative techniques and approaches.
The purpose of this paper is to revisit those findings
and recommendations in terms of current pediatric
restorative techniques.
nanotechnology are examples
of some of the materials and
techniques that are now part of
everyday pediatric dentistry. This
paper will discuss the updates
as it relates to each of the 2002
consensus statements.
Key worDS: Pediatric,
restorative dentistry, risk assessment, sealants, amalgam, resinbased composite, glass ionomer
Hackmyer
Donly
Dr. Hackmyer is a clinical associate professor, Department of Developmental Dentistry, University of
Texas Health Science Center at San Antonio Dental School, San Antonio, Texas.
Dr. Donly is a professor and chair, Department of Developmental Dentistry, University of Texas
Health Science Center at San Antonio Dental School, San Antonio, Texas.
cement, stainless steel crowns,
bonding adhesives
Tex Dent J;127(11):1165–1171.
Corresponding Author: Steven Hackmyer, D.D.S., Clinical Associate Professor, Department of
Developmental Dentistry, University of Texas Health Science Center at San Antonio Dental School,
7703 Floyd Curl Drive, San Antonio, Texas 78229-3900; Phone: (210) 567-3535; Fax: (210) 567-3526;
E-mail: [email protected]
Texas Dental Journal l www.tda.org l November 2010
1165
Masters
OF
Alternative to Pulpotomy
Indirect Pulp Therapy: An
Abstract
Aesthetic excellence
in Primary Teeth
N. Sue Seale, D.D.S., M.S.D.
Introduction
Preservation of the primary teeth is of paramount importance in maintaining the integrity of the dental arch and supporting normal
growth and development of the face of the
child. The tooth is the best space maintainer
and best contributes to normal function and
growth. Therefore, the primary tooth with a
large carious lesion approximating the pulp
presents the challenge of managing the lesion
with the intent of maintaining the tooth until normal exfoliation. To meet this challenge,
several pulp therapy techniques have been advocated. Among the earliest recommendations
was indirect pulp therapy (IPT), then called indirect pulp capping. As far back as the 1950’s,
IPT was recommended for primary teeth with
large carious lesions in which complete caries
removal would expose the pulp (1-8).
JW MARRIott
San Antonio hill Country
ReSoRt & SpA
Seale
Dr. N. Sue Seale, Department of Pediatric Dentistry, Baylor College of Dentistry – Texas
A&M Health Science Center, Dallas, Texas.
Correspondence
to: N. Sue Seale, D.D.S., M.S.D., 3302 Gaston Avenue, Dallas, Texas
22 Dental
CE Hours
75246; Phone: (214) 828-8241; Fax: (214) 874-4562; E-mail: [email protected]
Approved
For
The author has no declared financial interests. This article has been peer reviewed.
Preservation of the primary teeth until
their normal exfoliation is essential for
normal oral function and facial growth
of the child. To that end, treatment of
primary teeth with large carious lesions approximating the pulp should be
aimed at preserving the tooth. Currently, the pulpotomy is the most frequently
used pulp treatment for cariously
involved primary teeth. The purpose
of this manuscript is to describe the
use of an alternative to the pulpotomy,
indirect pulp therapy (IPT), for the treatment of vital, primary teeth with carious involvement approaching the pulp.
Accurate diagnosis of the vitality status
of the pulp is critical to the success of
IPT and involves careful radiographic
and clinical assessment of the teeth to
be sure they are healthy or at worst,
reversibly inflamed. The indications for
IPT are the same as for pulpotomy. The
technique involves one appointment,
requires that some carious dentin be
left to avoid pulp exposure and requires
the placement of a biologically sealing base and sealing final restoration.
Teeth treated with IPT have success
rates at least as good as those treated
with pulpotomies, and IPT offers an
acceptable alternative to pulpotomy
as a treatment for vital, asymptomatic,
cariously involved primary teeth.
Key worDS:
Indirect pulp therapy,
Register
primary teeth, pulp therapy
at
www.asdatoday.com
Tex Dent J 2010;127(11): 1175-1183.
or call 1-888-988-ASDA
for more information
Texas Dental Journal l www.tda.org l November 2010
1175
Infant Oral Exam and
First Dental Home
Abstract
Kavitha Viswanathan, D.D.S., M.S., Ph.D.
Introduction
Early Childhood Caries (ECC), also known as ‘baby bottle caries’ or ‘nursing bottle decay’ is a severe form of childhood dental
caries that is chronic, rampant and infectious in young children
under 6, most commonly seen in poor and minority populations
(1, 2 ). ECC (Figure 1) is defined as “the presence of one or more
decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschoolage child between birth and 71 months of age (3).” ECC usually
affects maxillary primary incisors but when severe, can progress
to involve primary molars and cuspids. ECC, like caries has a
multi-factorial etiology but its high prevalence in poor minority
children is attributed to improper feeding practices, familial socioeconomic background, lack of parental education and dental
knowledge, and lack of access to dental care (1). ECC is a disease that, when severe, can affect growth, cause pain and infection and have lasting detrimental effects on the quality of life of
patients and parents. Even though ECC is preventable through
parental education, early and regular checkups, topical fluoride
treatments, appropriate diet control and proper oral hygiene
practices, it is still the most common chronic childhood disease
in America. The prevalence of ECC is alarming — 40 percent of
children are affected by the time they reach kindergarten; 70
percent of these carious lesions are found in approximately 20
percent of our nation’s children (4). Approximately, 51 million
school hours are lost due to dental-related illness (5, 6).
The purpose of this
article is to familiarize
general practitioners
with the components of
a dental home including
an infant oral exam, and
to the First Dental Home
initiative, which is unique
to the State of Texas.
This article encourages
the general practitioners
to actively participate in
providing care for young
children under the age
of 3. Components of an
infant oral examination
are described here with
emphasis on knee-toknee or lap exam, caries
risk assessment, preventive treatment, ageappropriate anticipatory
guidance, and parent
education. The First Dental Home is uniquely designed to help pediatric
clients 6 months through
35 months of age to
establish a dental home.
The objectives, goal and
components of FDH are
discussed in detail.
Key worDS:
Viswanathan
Dr. Viswanathan is an assistant professor, Department of Pediatric Dentistry, Baylor College of Dentistry –
Texas A&M Health Science Center, Dallas Texas.
Requests for reprints should be sent to Kavitha Viswanathan, D.D.S., M.S., Ph.D., Assistant Professor,
Pediatric Dentistry, Baylor College of Dentistry, #207, 3302 Gaston Ave., Dallas, Texas 75246, USA;
Phone: (214) 828-8317; Fax: (214) 874-4562; E-mail: [email protected]
dental home, Texas
Health Steps, knee-toknee exam, prevention,
early childhood caries
Tex Dent J 2010;
127(11): 1195-1205.
Texas Dental Journal l www.tda.org l November 2010
1195
Comprehensive Oral Rehabilitation
with General Anesthesia and
Prosthetic Care in the Primary
Dentition: A Case Report
Gisela M Velasquez, D.D.S., M.S.; Sanford J. Fenton, D.D.S., M.D.S.;
Laura Camacho-Castro, C.D., D.M.D.; Bhavini S. Acharya, B.D.S., M.P.H.;
Aaron Sheinfeld, D.D.S., D.M.D.
Abstract
This case report
describes the oral
rehabilitation of a 5year-old male referred
by a general dentist to
a pediatric dentist due
to acute psychological
Introduction
Pediatric dentists seldom consider removable prosthesis in
children after loss of multiple primary teeth due to dental
caries or trauma because it is often thought unrealistic to
expect a child to be compliant with this type of treatment
(1). However, it is important to consider not only esthetics
but also the psychological and emotional development of
the child as an individual (2, 3). General anesthesia is one
of the many procedures that pediatric dentists use to treat
patients with extensive dental caries associated with psychological or emotional maturity or physical or mental disabilities where there is no expectation of behavior improvement over time (4, 5).
The following case report describes the prosthetic rehabilitation of a 5-year-old male whose pre-treatment behavior
might have discouraged a practitioner from considering a removable prosthesis. However, not only was the patient compliant with treatment, he was very happy with the results.
stress to dental treatment and extensive
dental caries. The
patient’s dental restorations and extractions
were completed under
general anesthesia.
Maxillary and mandibular prostheses were
completed in the outpatient clinical setting.
The treatment plan
for this child provided
options to improve appearance, self-image
and oral function.
Key worDS:
Dr. Gisela M. Velasquez is an assistant professor, Department of Pediatric Dentistry, University of Texas at Houston Dental Branch, Houston, Texas.
Dr. Sanford J. Fenton is a professor and chair, Department of Pediatric Dentistry, University of Texas at Houston
Dental Branch, Houston, Texas.
Dr. Laura Camacho-Castro is a clinical assistant professor, Department of Pediatric Dentistry, Tuft University
School of Dental Medicine, Boston, Massachusetts.
Dr. Bhavini S. Acharya is an assistant professor, Department of Pediatric Dentistry, University of Texas at Houston
Dental Branch, Houston, Texas.
Dr. Aaron Sheinfeld is a prosthodontist, private office, Boca Raton, Florida.
General anesthesia,
pediatric, primary
dentition, removable
prosthesis
Tex Dent J 2010;
127(11): 1187-1192.
Texas Dental Journal l www.tda.org l November 2010
1187