So Little Room, So Much to See
(The Complete Pediatric Dental Examination)

  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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