Pediatric Dentistry 1st Year of Dentistry Prof. Kukletová Pedodontics Preventive dentistry Restorative dentistry Prosthetics Surgery Periodontics Adapted to the age 0 – 18 years Collaboration with orthodontics – diagnosis of anomalies Preventive dentistry Methods to prevent Dental caries Periodontal diseases Restorative dentistry (Operative dentistry) Caries therapy Esthetic dentistry Endodontics Endodontic surgery Materials Prosthetic dentistry Restoration of dentition Severely damaged teeth, missing teeth Fixed dentures –only crowns, no bridges Removable dentures – space-maintainers Materials Laboratory technology Oral surgery Surgical intervention in the mouth Tooth extraction Incision Surgical extraction Treatment of fractures, inflammations, tumors e.t.c. Periodontics Treatment of periodontal diseases Not so frequent as in adults Gingiva Periodontal membrane Bone Cement Orthodontics Diagnostics of anomalies Tooth position Intermaxillary relations The Primary Dentition There are 20 primary teeth 5 in each quadrant - two incisors - one canine - two molars no premolars Topography of the oral cavity The deciduous arch Topography of the oral cavity Points of contacts Topography of the oral cavity Numbering of teeth Congenitally missing teeth Oligodontia – Fig. 20 Missing groups of teeth 13, 23 25 35, 33 – 43, 45 Shape anomaly 12, 22, peg shaped teeth Hypodontia - Fig. 21 Missing teeth – individual, mostly of the same kind 35, 45 A. Enamel of primary molars is thinner, about 1mm thick throughout the entire crown. B. Greater thickness of dentine over the pulpal wall at the occlusial fossa of primary molars. C. Dental pulp proportionally larger, pulpal horns are higher, especially the mesial horns. D. Cervical ridge in primary teeth. E. Enamel rods slope occlusally (in permanent gingivally) F. Constricted neck (cervix) G. The roots of primary molars are longer and more slender in comparison with crown size. H. The roots of the primary molars flare out nearer the cervix than do those of the permanent teeth. Roots – root canals Maxillary teeth No of roots No of root canals incisors 1 1 canine 1 1 molars 3 3 In molars – one root palatally, two roots vestibularly in each root one canal Roots – root canals Mandibular teeth In molars – one root mesially, one root distally in each root two canals (in the distal root – one canal) No of roots No of root canals incisors 1 1 canine 1 1 molars 2 4 (3) Spatial relation between the permanent and primary dentitions Spatial relation between the permanent and primary dentitions Mixed dentition. Presence of the first permanent molars in the upper jaw, in the mandible, first permanent molars and the first permanent incisors are erupted. Endodontic trearmeent in the primary dentition is possible in case the root resorption has not started yet. (tooth 85) Age: 0-1 month, up1 year, 1-4 years Newborns, Succlings, Toddlers Caries shortly after eruption primarily inferior quality of enamel dummmy with honey circulary caries sweetened drinks in the night Pre-school age 2-6 years Complete primary dentition + l. permanent molars + lower permanent + lower incisors Caries in primary molars occlusal surfaces approximal surfaces 6 6 6 1 1 6 Early school age 6-12 years Caries in primary molars Caries in primary canines Risk of caries transfer to permanent molars — immature enamel Dental caries - primary dentition Caries depth 2 mm — molar a) car. pulp. proxima b) caries media a) 3 years b) 6 years diameter of the bur – 1 mm, depth - 0,5 mm in dentin Filling GIC, composite resin, compomer Occlusal caries Approximal caries caries in dentine – marginal ridge is not affected otherwise caries pulpae proxima or caries penetrans The filling should include extention for prevention retention resistency Neighbouring tooth has to be investigated isthmus - 1/3 of the intercuspal distance not less than 1,5 mm gingival wall 1 mm ClassIII. Access opening from the labial surface, the size of cavity is given by the caries extent  Access opening in primary maxillary canines may be from the palatatal surface, in mandibular canines from vestibular surface.  The dovetail is usually placed to the strong marginal ridge, not directly to the oral surface Fissure sealing Fig. 36 1. Prevention of caries development 2. Too narrow fissures are not suitable 3. suitable fissure 4. wall protects the cement Preventive restorations Fig. 38, 39 Glass ionomer Composite resin Sealant Removing isolated carious sites Conversing healthy pits and fissures Restoration-composite resin All pits and fissure areas-sealant Healthy dentition Decayed primary dentition, almost all the teeth are affected – Early childhood caries (ECC). Transfer of caries into the permanent dentition I. II. III. IV. Developmental stages of root of erupted teeth, root is growing continuously about 3 years, then it remains in so called rest period and later its resorption is started, and the tooth is finally shedded (fig.44, 45). Root filling Root filling materials for primary dentition – only in the rest stage requirements ◼ Resorption of the material – resorption of the root ◼ Inert to periodontium ◼ Inert to buds of permanent teeth ◼ Antiseptic properties ◼ Easy to applicate to the canals ◼ No shrinkage on setting ◼ Easy to remove when necessary ◼ Adherence to the walls ◼ X-ray opacity ◼ No discoloration of tooth structure No ideal material at the present time Materials used ◼ ZnO –eugenol cements ◼ Calcium hydroxide ◼ Iodophorm based materials Reconstruction of primary dentition in case of ECC. In primary dentition only removable dentures Reconstruction of primary dentition in case of ECC Reconstruction of primary dentition in case of ECC Space maintainer Space maintainers in primary dentition Permanent dentition in children Change from primary, to mixed and to permanent dentition, the age 6-12 years. Root is growing continuously, duration-3-4 years Dental pulp cavity is large with high horns, foramen apicale is large (see figs. 53 – 56). Continuous apposition of primary and secondary dentine is narrowing the dental pulp cavity with increasing age (Fig. 57). I. II. III. IV. Stages of the root development in permanent dentition are the same as in primary dentition, the development lasts 3-4 years. Teeth with incomplete root development Anatomical difference ◼ Larger dental pulp cavity both in crown and root ◼ Thinner dentine layer ◼ Root shorter ◼ Clinical crown lower Histological differences ◼ Lower degree of enamel mineralization ◼ Rich vascularization ◼ apex – shape of mesenchymal papila Biological properties ◼ favourable ◼ Rapid removal of noxes ◼ No blood stasis - wide apex ◼ Easy cell differentiation ◼ Rapid formation od tertiary dentine Tooth eruption - complete apex formation ( 3 years) Orthodontic anomalies Orthodontic anomalies should be diagnosed by pedodontists soon. Deep bite (Fig. 61) Mandibular progeny (Fig. 62) Supernumerary teeth (Fig. 63, 64) Anomal eruption (Fig. 65) Supernumerary teeth Vestibular eruption Diseases of periodontium Diseases of periodontium are not very frequent. Gingivitis accompanies infection diseases. Most frequently – bad habits (Fig. 67) Genetically conditioned diseases – fibromatosis gingivae (fig. 68). Oral mucous membrane diseases – lingua geographica (Fig. 69) 03.05.2020 Onemocnění sliznic dutiny ústní u dětí - přehled nejčastějších chorob 67 03.05.2020 Onemocnění sliznic dutiny ústní u dětí - přehled nejčastějších chorob 68 03.05.2020 Onemocnění sliznic dutiny ústní u dětí - přehled nejčastějších chorob 69 Injuries Crown fractures (Fig. 71) Injuries of periodontium (Fig. 72) Technique of taking X-ray in children (Fig. 73) Consequences of primary teeth injuries are given by the close relationship between the primary teeth and buds of permanent teeth (Figs. 74-76). Mouth guards are strongly recommended in contact sports.