PSILENT
PRODUCTIONS
Dr. Gregory Psaltis
8733 Fernwood St. NE
Olympia, WA
98516
Phone and FAX:
(360) 413-5760
e-mail: drpsaltis@orcalink.com
Website: www.psaltis.info
Baby Steps
Infant and Preschool Care for the General Dentist
I. Initial comments about
infant and preschool care
A.
Dental Home should be established no later than
____________________
1. Recommendation grew out of Surgeon General C Everett L
Koop’s 2000 report,
which connected ______________________ with
________________________
2. Why start by this age of a child?
a.
Percentage of children who experience caries by age 5:
__________________
b.
Unique caries-risk factors for young children
i. Ongoing establishment of oral flora
ii.
Susceptibility of newly erupted teeth
iii. Development of dietary habits
c.
Age when high-risk dietary practices appear to be established:
______________
d.
Newly erupted teeth are at risk for caries because of
______________________
3. If you cannot/will not see children at 6-12 months
a.
Do NOT say, “We don’t see children until age _________.”
b.
Recommend an exam with a pediatric dentist
B.
Importance of infant oral health
1. Strep mutans colonies begin as soon as
__________________________
2. Appropriate fluoride regimens enhance caries
resistance
3. Caries risk assessment is a critical tool in
establishing ____________________
4. Injury prevention counseling can be provided
5.
Parents can be advised of importance of brushing and flossing
6. Immature enamel is not as mineralized or resistant to
bacteria
7. Physical transmission modes of MS can be explained to
parents
8. Physicians are now more aware of oral health
II. Infant Oral Health
A.
Establish a Dental Home
1. Is all-inclusive of all aspects of oral health among
all involved parties
2. Leads to heightened awareness of issues impacting
dental health of children
3. Modeled on the American Academy of Pediatrics
definition of a medical
home
4. Advantages of Dental Home:
a.
Cost-effective
b.
Higher quality of care
c.
More likely to provide ________________________________
d.
Creates time-critical opportunities to reduce risk of oral
diseases
5. Dental Home provides:
a.
Preventive services
b.
Comprehensive assessment of diseases and conditions
c.
Caries-risk assessment
d.
Anticipatory guidance for ____________________________
e. Plan for acute trauma
f.
Information about proper _____________________________
g.
Diet counseling
h.
Appropriate referrals
6. Establishing a Dental Home
a.
Eruption of first tooth or no late than 12 months
b.
Follows AAP policy of medical home
c.
Shown to be cost-effective
d.
Provides comprehensive oral health care
e.
Enables individualized preventive plans
B.
Oral Risk Assessment
1. One of the primary goals is to identify and minimize
causative factors
2. Emphasizes treatment of disease process rather than
the _______________
3. Helps patient understand disease process and
preventive steps
4. Customizes preventive program
5. Anticipates caries ____________________________
6 Specific risk associations
a. Sugar-caries relationship may not be as great as
previously thought
b. Evidence suggests night-time use of a bottle is a factor
c. Socioeconomics plays an _____________________ role
d. Lack of fluoride and regular brushing are both predictors
C.
Teething
1. Educate parents regarding expected time or arrival of
teeth
2. Delineate ___________________ from
____________________
3. Oral analgesics and chilled rings for pain are
recommended
4. Topical anesthetics are to be discouraged due to
________________________
D.
Oral hygiene
1. Implement upon eruption of ________________________
2. Use of soft toothbrush is recommended
3. Start flossing as soon as adjacent tooth surfaces
cannot be brushed
4. Toothbrushing is to be done _______ times daily
5. Discuss after-nursing cleaning
E.
Diet
1. High-sugar diets are usually established by 12 months
of age
2. Frequent night-feeding and/or ad-lib nursing
associated with ECC
3. Juices are not recommended for night-time feeding
4. Two other factors in increased caries rate are:
___________________________
and _______________________________
5. Diet Counselling relative to obesity
a.
Increased sugar consumption is also linked to obesity
b.
Prevalence of obesity has _______________ for 6-11 year olds in
past 25 years
c.
Prevalence of obesity has _______________ for 12-19 year olds in
past 25 years
d.
Obesity predisposes to Type 2 diabetes, heart disease,
respiratory, orthopedic and
liver problems
6. U.S. Department of Agriculture “Dietary Guidelines for
Americans,” 2007
a.
Eat a variety of foods
b.
Balance foods eaten with ____________________________
c.
Eat adequate calories to support normal growth up to a healthy
weight
d. Include
plenty of vegetables, fruits and _______________________
e.
Use sugar and salt in moderation
7. Human breast milk
a.
Uniquely superior in nutrition and, by itself, is
____________________
b.
In combination with other carbohydrates is
_______________________
c.
Frequent night-bottle and adlib nursing are associated with,
but not consistently
linked to ECC
e. Studies reveal that breastfeeding may be protective
against ______________
8. Other interesting articles
a.
Enzyme-inhibitory properties are associates with polyphenols.
Two foods are:
__________________________ and
________________________________
b.
Parents’ behaviors influence their children’s ____________ and
_____________
F.
Fluoride
1. Optimal exposure is important to all infants and
children with teeth
2. Well documented as _____________ and
___________________________
3. Individualize the plan for each patient
4. Amount of fluoridated toothpaste is dependent upon the
child’s _____________
5. Fluoride ingestion
a.
Water fluoridation shows ______ reduction in caries without
significant fluorosis
b.
Review all sources of fluoride (water, beverages, prepared foods
and toothpaste)
6. Mechanisms of action
a.
Enamel remineralization
b.
Altering bacterial metabolism
7. Varnishes prevent or reverse enamel demineralization
8. Toothpaste amounts
a.
A “smear” for the under-2-year old will provide approximately
______ mg
b.
A “pea-sized” amount for 2-5 year olds provides approximately
______ mg
c.
Ingested toothpaste was greater if a child uses fruit-flavored
dentifrice
9. Supplementation (assuming less than 0.3 ppm F in
child’s diet)
a.
Birth to 6 months= none
b.
6 months to 3 years= .25 mg F (.55 mg NaF)
c.
3 years to 6 years= .5 mg F (1.1 mg NaF)
d.
6 years to 16 years= 1 mg F (2.2 mg NaF)
G.
Injury prevention
1. Most common trauma occurs due to __________________
2. Emphasize need for car seats
3. Toothbrushes and pacifiers an be problems when
children are running
4. Electrical cords are potential problems
5. Trauma can have negative psychological and esthetic
effect on children
6. Greatest incidence of trauma occurs at _____________
years of age
7. Causes of dental trauma
a.
Falls
b.
Traffic accidents
c.
Violence
d.
Sports
H.
Non-nutritive habits
1. Can contribute to negative changes in occlusion and
facial development
2. Early visits provides opportunity to encourage parents
help them stop
3. Types of habits
a.
Finger sucking
b.
Pacifier usage
c.
Nail biting
d.
Tongue thrusting
III Coaching the parents
A.
Etiology and prevention of ECC
1. Explain roles of nursing and/or bottle feeding
2. Discuss night-time feeding
3. Educate them to avoid
____________________________________
B.
Comprehensive oral exam during preganancy
1. Very important for the mothers
2. Get active caries treated
3. Keeping Strep Mutans down decrease chances of ECC
C.
Oral hygiene instructions
1. Use fluoridated toothpaste
2. Floss regularly
3. Reduce levels of _________________________________
D.
Diet
1. Explain cariogenicity of foods and beverages
2. Discuss role of ____________________ of consumption of
these foods
3. Educate them about the process of demineralization
4. There is a relationship between maternal oral health
and children’s caries rate
5. Parents’ smoking (not exactly diet) increased their
children’s school absenteeism
E.
Fluoride
1. Encourage use of fluoridated toothpaste
2. Recommend rinsing with an OTC fluoride rinse
___________________
3. Help them understand remineralization
4. Kids have tremendous BS detectors in case you try to
fake it
F.
Xylitol chewing gum
1. Chewing with xylitol gum 2-3 times daily reduces
mother-child MS transfer
2. Children’s caries rate can possibly be reduced in this
same way
IV.
ECC- Early Childhood
Caries
A.
Previously—bottle syndrome, nursing caries, baby bottle tooth
decay
B.
Definition of ECC
1. ______________ or more decayed, missing or filled
primary tooth
2. Child is under the age of ___________
C.
Definition of SEVERE ECC
1. Any sign of smooth surface caries in a child younger
than __________
2. One of more DMF smooth surface in primary maxillary
anteriors in ages ________
3. DMF scores of >4 (age _________), >5 (age
_________) or >6 (age _________)
V. Child development
A.
One year olds
1. Learn by conditioning, when two stimuli are paired
together
2. _________________ behavior is likely to occur again
3. Fear of strangers is very common
4. They startle easily
B.
Two year olds
1. Language skills begin to develop
2. They will exert their ___________, testing their
__________________________
3. Role model observation is primary instructor for their
own behaviors
4. Discipline should not be _____________________
5. Tantrums are normal and should best be left
_____________________________
C. Three
year olds
1. Increased ______________________ behavior demonstrated
2. A unique identity begins to emerge
3. Fear of strangers is replaced by greater capacity for
_______________________
4. New situations are less likely to have a negative
effect
5. They can understand ___________________________
D.
Preschoolers
1. Ability to reason grows considerably
2. Child becomes able to think with mental imagery or
symbols
3. They can group objects and use more complex thoughts
4. Value system develops and ________________________ is
shown
VI.
Behavior
Management of the Young Patient
A.
The
three
C’s are the critical elements of success
B.
Confident
1.
Be
in charge
2.
Children
can
“smell _________________”
3.
Remain
positive
4.
C-B-A
a.
If you can C__________________ of
something
b.
Then you B__________________ in it
c.
You will A__________________ it
C.
Calm
1.
Keep
voice
quite
2.
Look
at
child (at eye level) when speaking
3.
Do
not show ______________________________
4.
Nasal
breathing
is a way to calm yourself down
D.
Child-friendly
1.
Smile
and
engage the child
2.
Show-tell-do
3.
Terminology
a.
Descriptive
terms
b.
Avoid
____________________
labels
c.
Child-friendly
words
d.
Understandable
VII.
Behavior
Management of the Parents
A.
What we often expect is problems
B.
Parent guidelines
1. Do not over-prepare
2. Use our terminology
3. Be an ________________________ only
4. Leave when asked
5. Do not make promises
VIII. Treatment Planning
A.
Must
consider age of patient for length of visit
1. Young children need shorter, earlier appointments
2. Older children (6+) can handle longer, later
appointments
B.
Number of visits
1. Always try for 1 or 2 visits, with a maximum of 4
2. Consolidate treatments during each visit
C.
Prioritizing
1. Posteriors should always be treated first
a. Longevity of teeth
b. Chew food during child's growth
c. Less traumatic for treatment
d. Often NOT
the parents' preference
2. Anteriors should be saved for last
a. Function for speech and smiling are secondary to
mastication
b. More difficult to treat comfortably
c. Incentive for parents to continue with treatment of
posteriors
3. Referral of abscessed teeth
a. Let oral surgeon complete care with general anesthetic
b. Have exodontia done out of your practice
D.
Sequencing of treatment
1. Generally start with mandibular arch first, if
possible
2. Try to relieve pain at first visit
3. Save short, simple quadrant for last, as that memory
will be held
IX. Local anesthesia
A. Infiltrations vs. Blocks
B. Needles
1. 27
ga. short
2. 30
ga. short
3. 30
ga. extra short
C. Septocaine 4%
1. Especially
effective
for _________________________
2. NOT
recommended for children under __________ years of age
3. NOT
recommended
for mandibular blocks
4. Effective
for
hard-to-get-numb patients
5. Maximum
dose
is _________mg per pound
D. Lidocaine 2%
1. For
children
under 3 years of age
2. Exclusively
for
______________________________
3. Can
be used for infiltrations, too
4. Maximum
dose
is ___________mg per pound
E. Topical Anesthetic
1. Caine
sticks
2. Can
give
to kids for soft-tissue extractions at home
F. Safety techniques
1. Assistant
hands
of child’s forehead and child’s hands
2. Mouth
prop
G. Terminology
H. Management
X. Rubber Dam
A.
Advantages
1. No tongues to lips to fight
2. Maintains a _______________________
3. Easier access
4. Segregates work in child’s mind to “the other side”
B.
Currently consider the standard of care
C.
Useful clamps
1. 8A for primary molars
2. 14A for partially erupted permanent molars
3. 3 for fully erupted permanent molars
XI. Stainless Steel Crowns
Preparation and Placement
A.
Prep
occlusal surface first with ___________________
1. Reduce only
about _______________—remove occlusal anatomy
2. Reduces
hemorrhage by avoiding gingiva
2. Gives better
idea of crown size
B.
Prep axial walls with 1170 thin tapered fissure bur
1. Minimal reduction,
but break proximal contacts
2. Use wedges to
_________________________________
3. Place
counter-bevels and modify prep to the shape of the SS crown
C.
Select crown size
1. Should fit
snugly, but must go all the way down
2. Check for
crown length- if tissue blanches, trim crown
3. General rule
is tissue should not blanch more than 1mm
D.
Shape crown
1. Contouring
pliers to basic curvature
2. Crimping
pliers to engage undercuts of prep
3. With
pre-crimped crowns, these steps are not necessary
E.
Cement crown
1. RelyX Luting
Plus cement
2. ZnPO4 is OK
XII. Sedation
A. Special requirements
1. Training
2. Monitoring
3. Licensure and
___________________________
4. Total focus
B. Do not use sedation without being
fully _____________________