Match. Scheduling operative treatment The following are general rules of thumb • Small, simple restorations should be completed first • Maxillary teeth should be treated before mandibular teeth • Posterior teeth should be treated before anteriors • Quadrant dentistry should be practised • Endodontic treatment should follow completion of simple restorative treatment • Extractions should be the last items of operative care unless the patient … Surgical Treatment. Experience serves to improve all of these attributes. 3. 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. This site uses Akismet to reduce spam. Influences on children’s oral health: a conceptual model. 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 . Cote CJ, Wilson S, American Academy of Pediatrics, American Academy of Pediatric Dentistry. 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. She stated that she does not drink sugary drinks and always drinks bottled water without fluoride. Pediatric restorative dentistry involves the use of many materials. Fontana M, Gonzalez-Cabezas C. Evidence-based dentistry caries risk assessment and disease management. Effectively managing our youngest patients and assessing their caries risk get children on the path toward lifelong oral health. ISBN 9780721603124, 9780323079082 Benefits of Pediatric dentistry. Randall RC. She stated that she has had only a few small "cavities" in the past and that her teeth overall feel okay. Print Book & E-Book. (2014) Which of the following procedures would be the appropriate tx as recommended for a vital primary second molar with a large carious lesion that approaches that pulp radiographically? Your email address will not be published. Twetman S. Caries risk assessment in children: how accurate are we? It is the clinician’s responsibility to safely and effectively guide the child’s behavior during all pediatric procedures… Halasa-Rappel YA, Ng MW, Gaumer G, Banks DA. (2014) #1 During presentaiton of a tx plan, one should use visual aids and allow sufficient time for discussion and questions. Belmont Publications, Inc. presents Dimensions CE. After reading this course, the participant should be able to: Behavior management is a cornerstone of treatment planning in pediatric dentistry. Meyerhoefer CD, Panovska I, Manski RJ. In a pediatric population, behavioral guidance may limit the type of definitive treatment dental practitioners can offer their patients. (2013) Bitewing radiographs of a five-year-old child show interproximal carious lesions close to the dentinoenamel junction. Meyer BD, Lee JY, Thikkurissy S, Casamassimo PS, Vann WF, Jr. An algorithm-based approach for behavior and disease management in children. Safe and compassionate treatment that can improve the oral health trajectory of a child, not a tooth, is the ultimate goal. The orthodontic records will define the patient’s structural limitations (the position of the existing structure/walls). February 2020;18(2):30–33. The international caries detection and assessment system (ICDAS): an integrated system for measuring dental caries. Wright JT, Cutter GR, Dasanayake AP, Stiles HM, Caufield PW. anterior teeth may require the use of a. assuming all quadrants are equal in importance, greater importance in fxn and space maintenance. Pharmacologic management for pediatric dental patients in the 21st century. Chronic disease management strategies of early childhood caries: support from the medical and dental literature. Using evidence-based research, this book shows how risk assessment, prognosis, and expected treatment outcomes factor into the planning process. The child had severe asthma controlled with a daily steroid inhaler, as well as large tonsils obstructing nearly 75% of the oropharynx. Likewise, two children with similar health statuses and caries patterns may demonstrate markedly different rates of caries progression. What would be the recommended treatment for tooth #19 of case 2? In the second case, a family with a 4-year-old traveled more than an hour for a second opinion. Preformed metal crowns for decayed primary molar teeth. Time. The dental disease was confined to cervical lesions on the maxillary incisors, and the examination was completed with great difficulty due to the child’s inability to cooperate, which also prohibited radiographs. (2014) 34. Innes NP, Ricketts DN, Evans DJ. Diagnosis and Treatment Planning in Dentistry 3rd Edition provides a full-color guide to creating treatment plans based on a comprehensive patient assessment. 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. The crown can be digitally placed and the surgery planned for the most precise plan. From Dimensions of Dental Hygiene. Another way to conceptualize how disease and behavior management intersect is presented in Table 1. Caring for Children With Sensory Processing Disorders, Detecting Premalignant and Malignant White Lesions, CE Sponsored by Colgate: Digital Dentistry and the Quest to Improve Oral Health, Effects of a Plant-Based Diet on Oral Health. During medical/dental history interview, father of patient stated that he has not seen a dentist in several years and denied any major medical history or medication use. Presenters . 8:30 AM to 4:00 PM. According to the parents, despite the completion of a stainless steel crown on the primary molar, the sedation visit proved a negative experience. What would be the recommended treatment for tooth #14? PULPOTOMY and a SSC. Disease management of early childhood caries: ECC collaborative project. Statement #1: During presentation of a treatment plan, you should use visual aids and allow sufficient time for discussion and questions. 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. 2. 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. Kristine Fu Shue, DMD, is currently practicing pediatric dentistry along California's Central Coast. AmericAn AcAdemy of pediAtric dentistry cLinicAL GUideLines 213 Purpose The American Academy of Pediatric Dentistry (AAPD) recog-nizes the importance of managing the developing dentition and occlusion and its effect on the well-being of infants, children, and adolescents. Which of the following is not important to develop a diagnosis? Mother of the child stated that she eats very healthfully and mostly organic foods. 3. (2013) Which of the following statements is true regarding the development of a treatment plan? 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. Accept 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. About Us. Pediatric Dentistry MCQs - Child Behavior Management # The main areas of concern in diagnosis and treatment planning for the child are: A. Divaris K. Predicting dental caries outcomes in children: a “risky” concept. Belmont Publications, Inc. is designated as an Approved PACE Program Provider by the Academy of General Dentistry. One of the most widely used conceptual models for defining and diagnosing ECC illustrates its multiple levels of influence.8 Genetic predisposition, the oral microbiome, and individual health behaviors may be specific to a particular child, but the surrounding environment—including family and social supports, access to quality foods, or access to health care—also has a major influence on ECC and oral health disparities. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. This is why I believe that the orthodontist’s role in treatment planning is akin to the architect from our construction analogy. Impact of dental treatment on the incidence of dental caries in children and adults. Created by. Presenters . However, the path to treatment differed significantly. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Individualized or population risks: what is the argument? An eight year-old male patient has deep fissures but no apparent carious lesions on his posterior teeth. For small pit and fissure lesions, strong evidence supports almost all restorative materials.17 However, for interproximal lesions, the evidence is more variable. Pediatr Dent 2014;36(special issue):230-41. Featherstone JD, Chaffee BW. Spell. STUDY. Radiographs revealed no interproximal radiolucencies. Patient drinks fluoridated water and brushes once/day before breakfast. Diagnosis and Treatment Planning; Schedule . Beau D. Meyer, DDS, MPH, is an assistant professor and predoctoral program director in pediatric dentistry at the always assume the worst plan for the more extensive tx plan. Randomized clinical trial of 12% and 38% silver diamine fluoride treatment. 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. Though rare, these behavior guidance techniques can pose potentially life-altering risks. For example, a particular child in a dental office may be warm and outgoing one day, and anxious and fearful the next. On their own, dental restorations fail to arrest the caries process, especially for children with severe ECC.27,28 Following restoration, the plaque biofilm recolonizes and can reinitiate the caries process if no behavior change takes place.29 These findings emphasize the importance of diagnosing and treating ECC at the patient level, rather than focusing exclusively on tooth-level interventions. X-rays and disease screenings are also commonly used, depending on the … 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. Test. When managing the behavior of a pediatric patient, there is a need for knowledge, understanding, trust, and expertise. Jacy Stauffer, DMD, is a Diplomate of the American Board of Pediatric Dentistry and a Fellow of the American Academy of Pediatric Dentistry. He can be reached at: [email protected]. Ismail AI, Sohn W, Tellez M, et al. If cavities are detected, dental fillings, stainless steel crowns, or extractions will be recommended, depending on the severity of the decay. Lee H, Milgrom P, Huebner CE, et al. 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. Chicago, Ill.: American Academy of Pediatric Dentistry; 1991:57-9. Comparative effectiveness of visual/​tactile and simplified screening examinations in caries risk assessment. 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 … 8:30 to 9:00 PM Central Time, Question and Answer Session. 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. Provider ID 317924. Learn the principles of case selection, informed consent, treatment planning, and a clinical protocol for SDF. (2014) Case 2: KS is a 9-year-old female patient who presented to the dental office to have her teeth cleaned. Knowing and understanding the techniques and being aware of their limitations are paramount in making the right decision to obtain the best diagnostic image in every individual case. Learn. 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. Sheiham A. Fung MHT, Duangthip D, Wong MC, Lo EC, Chu CH. Terms in this set (43) questionable diagnosis. Oral diagnosis and treatment planning is of utmost importance in pediatric dentistry. This manuscript describes intraoral and extraoral radiography techniques that can be applied in every day pediatric dentistry. 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. Innes NP, Evans DJ, Stirrups DR. Dr. Fu graduated from the University of Pennsylvania School of Dental Medicine in 2017, where her clinical honors focus was Medically Complex Patients. (2007) A defect in tooth enamel matrix formation that results in less quantity of enamel than normal is . Using evidence-based research this book shows how risk assessment prognosis and expected treatment outcomes factor into the planning process. Rather than offer another algorithm that tries to quantify and organize decision-making factors, this table poses a framework that allows clinicians to individualize treatment plans based on a particular child’s or family’s circumstances. It is also an excellent opportunity for the dentist to establish a relationship with the child and his/her parent. Managing ECC traditionally includes surgical care via a combination of restorative, endodontic, and surgical treatment, as indicated by clinical guidelines. A child’s behavior can complicate decision making in pediatric dentistry. 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). Clinical examination revealed fair oral hygiene and enamel demineralization associated with a radiographic carious lesion on the occlusal surface of tooth #19. In: American Academy of Pediatric Dentistry Reference Manual 1991-1992. (2013) In order to develop an organized and sequenced method of comprehensive care for a child, the clinician must gather information and make a diagnosis. 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. Atieh M. Stainless steel crown versus modified open-sandwich restorations for primary molars: a 2-year randomized clinical trial. Despite the availability of multiple caries risk assessment tools for pediatric patients, caries risk assessment remains an inexact science that is difficult to validate.9–13 Recently, Divaris14 identified deficiencies of the current models of caries risk assessment, calling into question two main issues: risk being a population parameter assigned to individuals, and the level at which ECC is diagnosed. Bruen BK, Steinmetz E, Bysshe T, Glassman P, Ku L. Potentially preventable dental care in operating rooms for children enrolled in Medicaid. What would be the two most important factors when designing KS's intervention plan for caries? Get the right treatment from our professionals today. Belmont Publications, Inc. is an ADA CERP-Recognized Provider. An additional component of the ECC-CDM framework—and perhaps more important than any intervention the oral health professional provides—is actively engaging the child/parent/family from diagnosis through self-management and treatment. 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. However, as currently defined, ECC is a person-level disease requiring person-level treatment. This child had no medical conditions or risk factors that would alter treatment recommendations. Taking a comprehensive case history is an essential prelude to clinical examination, diagnosis, and treatment planning. Reconnecting Practicing Hygienists with the Nation's Leading Educators and Researchers. Purchase Pediatric Dentistry - 4th Edition. Prevents decay in children from dental issues. Early childhood caries chronic disease management (ECC-CDM) takes advantage of this idea and embodies a paradigm shift driving dental interventions toward minimally invasive, nonsurgical treatments to control the disease before restoring form and function.30,31 Many treatments would fit under this nonsurgical umbrella, including active surveillance, silver diamine fluoride (SDF), glass ionomer restorations as interim therapeutic restorations, Hall Technique crowns, and frequent use of fluoride varnish.21,32 Often, nonsurgical treatments are provided for caries control in uncooperative children, those with complex medical histories, or in cases of severe disease in order to control the disease while allowing the child to age in a developmental way to a point where conventional surgical treatment can be safely rendered.21,30,31. As a second opinion, the clinical team discussed a wider variety of behavior and disease management options. Clinical examination of case 2 also revealed dark staining associated with no radiographic carious lesions on the occlusal or interproximal surfaces of tooth #14. 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. Gravity. Increasingly, clinical and nonclinical data and risk assessments are driving the profession toward precision dentistry.36 Two similar cases treated differently—but achieving similar clinical endpoints—were presented to illustrate various treatment approaches for navigating the intersection of disease and behavior management. Fuks AB, Araujo FB, Osorio LB, Hadani PE, Pinto AS. Parents also need to be educated about the causes of dental caries and other or… 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). Bitewing radiographs reveal no occlusal or interproximal posterior lesions. radiograph of a deep carious lesion that approaches, but has not penetrated the pulp should be planned for a . Edelstein BL, Ng MW. She stated that her daughter does not floss regularly because when she flosses her teeth it "makes her gums bleed." 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. Effect of conventional dental restorative treatment on bacteria in saliva. List various approaches to caries risk assessment and treatment planning when caring for this patient population. New chapters cover patient diagnosis and team-based treatment planning and a new Evolve … Canares G, Hsu KL, Dhar V, Katechia B. Evidence-based care pathways for management of early childhood caries. This team-based approach provides more information to influence treatment decisions concerning the child’s ability to medically tolerate the procedure and determine the appropriate venue for care. 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. How useful are current caries risk assessment tools in informing the oral health care decision-making process? The formal continuing education programs of this program provider are accepted by the AGD for Fellowship/Mastership and membership maintenance credit. Each age-specific section covers the physical, cognitive, emotional, and social changes that children experience, as well as the epidemiology of dental disease at that age. Bader JD, Shugars DA. Behavioral Management in Pediatric Patients, Perspectives on the Midlevel Practitioner, Esther Wilkins Lifetime Achievement Award. In effect, the authors present decision-making guideposts for clinicians who navigate these issues on a daily basis. Displaying treatment planning in pediatric dentistry PowerPoint Presentations Primary Discipline of Vacant Positions, 2004‒05 to 2010‒11 PPT Presentation Summary : … Dimensions of Dental Hygiene - Dental Hygienist Magazine, Reevaluation After Scaling and Root Planing. The end product of restorative treatment was the same for both children, and both children and parents were satisfied with the care they received. Pediatric Dentistry: Infancy through Adolescence Expert Consult, 6th Edition provides comprehensive coverage of oral care for infants, children, teenagers, and medically compromised pediatric patients. Not all solutions are tolerated by all patients, but decision aids and frameworks exist to help providers find safe venues and alternatives for pediatric therapy. Guideline on restorative dentistry. Do you want to know more about robotics in dentistry? 25. 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. Read More. 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 … Clinical examination revealed generalized white spot carious lesions on the occlusal surfaces of the first permanent molars and poor oral hygiene. We'll assume you're ok with this, but you can opt-out if you wish. Ng MW, Ramos-Gomez F, Lieberman M, et al. Berkowitz RJ, Amante A, Kopycka-Kedzierawski DT, Billings RJ, Feng C. Dental caries recurrence following clinical treatment for severe early childhood caries. Save my name, email, and website in this browser for the next time I comment. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at 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. The previous dentist provided options of dental treatment under general anesthesia or conscious sedation, and the family opted to pursue conscious sedation out of concerns for risk and cost. Fisher-Owens SA, Gansky SA, Platt LJ, et al. The following cases illustrate the decision-making framework presented in Table 1. (2014) Which of the following is the correct tx sequence step for a pediatric pt? Discuss modern strategies for disease and behavior management in pediatric dentistry. American Academy of Pediatric Dentistry. The current term of approval extends from 7/1/2016-6/30/2019. Time. Recently, different authors published clinical decision-making aids to use when planning pediatric dental treatment.21,35 While one focuses on disease management and the other on behavior management, both attempt to bridge this intersection by reviewing the evidence and selection criteria for various treatment strategies. • Discuss the significance of the following: • Emergency Care: … 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). 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. Make your appointment now. Adopting such an approach supports compassionate and effective care that will frame the dental experience in a positive way for children and their families.