I. Pre-appointment considerations
A. Informing parents about
philosophy
1.
Brochures or information sheets from your practice
2. On
the phone through the Front Office Personnel
3. Sets
tone for entire relationship with person who decides to come
back
B. Establishing Rapport
1. Critical to
success of first visit and subsequent ones
2. Opportunity
to demonstrate behavior you prefer them to exhibit
3. Without
cooperation, adequate exam is already difficult
C. Medical History
1. Children
with significant histories will usually be more resistant
2. Some
medical situations require special care
D. Gross Evaluation of the child
1. Physical
condition
2.
Receptiveness or resistance
II. Oral Examination
A. Hygiene
1. Problem
areas give clues to source of caries activity
2. Helps
determine where to place emphasis on instruction
3. Age may
dictate which hygiene procedures to emphasize
B. Caries
C. Existing restorations
1. Indicate
whether child has been exposed before to dentistry
2. Shows the
trends in caries activity
D. Dental Development
1. Balance and
symmetry
a. Be aware of average tooth eruption sequences
b. Notice any areas that are not developed at a similar level
c. Look more deeply into causes for these descrepancies
2. Delays
a. Over-retained teeth
i. Mobility
ii. Extent of root resorption
b. Congenitally missing teeth
c. Fused or geminated teeth
3.
Disturbances
a. Ankylosis
b. Supernumerary teeth
c. Enamel dysplasias
E. Arch Form
1. Symmetry
2. Length
3. Molar
relationship
4. Inter-arch
relationships
a. Crossbites
b. Vertical problems
5. Intra-arch
relationships
a. Ectopic eruption
b. Early tooth loss with loss of space
F. Soft Tissue
G. Habits
1.
Finger-sucking
2. Bruxism
3. Mouth
breathing
III. Radiographs
A. Caries
B. Restorations
C. Apical pathology
1. When to
treat pulp versus extract
2. Second
primary molars are better root canal candidates than first
molars
D. Developmental disturbances
1.
Supernumerary teeth
2.
Congenitally missing teeth
3. Root
development
4. Ankylosis
IV. Early Orthodontic Referrals
A. Skeletal problems
1. Class II
and Class III relationships
a. Good to refer early for evaluation
b. Must determine which skeletal component is descrepant
2. Open bites
a. Is this a true skeletal problem?
b. Has this been caused by a habit?
B. Arch length deficiencies
1. Is this
congenital in nature?
2. What is the
molar relationship?
3. Has early
tooth loss and drifting created this problem?
C. Timing of referral
1. Dental
maturity-- want first permanent molars and lower incisors
erupted
2. Skeletal
problems lend themselves to early treatment during growth
D. Philosophies
1. Treat in
two phases
a. Correct skeletal problems early
b. Used fixed appliances to finish the case after permanent
teeth erupt
2. Functional
appliances
3. Wait until
child has all permanent teeth
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