The Latest and Greatest in Pediatric Dentistry

The newest techniques, materials and concepts

I.               Pulp Therapy

A.    Latest research on primary pulp treatment

i.               Diagnosis is no longer based on radiographs

ii.              Pulp exposure (clinicially) is now basis for treatment

B.    History of medicaments for pulp therapy

i.               Formocresol

ii.              Ferric sulfate

iii.             Calcium silicate (MTA and Biodentine)

C.   Technique when pulpotomy is indicated

i.               Clean out coronal pulp with slow speed round bur

ii.              Obtain hemostasis (pressure, or Retrax pellets)

iii.             Fill with calcium silicate cement (NeoPUDDY)

iv.            Full coverage crown

II.             Local Anesthetic

A.    Topical anesthetic

i.               Caine tips

ii.              Convenient and not messy

B.    Treating teeth without any local anesthesia

i.               SOLEA laser unit

a.    Overwhelms pain receptors to prevent sensations

b.    Can be used on primary and permanent teeth

c.     Very expensive unit

ii.              Synapse dental pain reducer

a.    Smaller, hand-held unit

b.    Effective for primary restorations

C.   SOAN intraosseous syringe

i.               No numb lips, works quickly, can use less anesthetic

ii.              Expensive to start, learning curve, need excellent patient

D.   Onset

i.               Very simple system

ii.              Can use existing syrings

iii.             Rapid onset of anesthesia—saves waiting time

iv.            Excellent for working with children

E.    Blocks vs infiltrations

i.               Infiltrations are indicated for:

a.    Class I and Class II restorations

b.    Single root extractions

c.     Good patient

ii.              Blocks are indicated for:

a.    Full coverage crowns

b.    Pulpotomies

c.     Multi-root extractions

d.    Nervous patients

F.    Anesthetic agents

i.               Septocaine

a.    Infiltrations

b.    Patients over the age of 3

c.     Difficult to numb patients (often teenagers for second molars)

d.    Maximum dose: 3.2mg/pound

ii.              Lidocaine

a.    Mandibular blocks

b.    Children under the age of 3

c.     Infiltrations

d.    Maximum dose: 2mg/pound

III.            Minimally invasive procedures (also called Atraumatic care)

A.    Fundamental component of patient care—Amer Acad Pediatric Dentistry

B.    Intervention is to slow, stop or reverse incipient lesions

C.   Complete removal of caries no longer necessary—preserve tooth vitality

D.   SDF (Silver Diamine Fluoride) is a RETARDING agent, not ARRESTING

i.               Components are antibacterial and anticaries

ii.              Indications

a.    Medically compromised patients

b.    Patients at extreme risk

c.     Non-candidates for conventional care

d.    Stablization until final care is possible

e.    Minimal access-to-care populations

iii.             Cautions

a.    Possiblity of recurrent caries has been shown

b.    Need for regular followup to monitor areas treate

IV.           Full coverage restorations

A.    Hall crowns

i.               Technique

a.    Minimal to no prepping

b.    Often no need for local anesthetic

c.     Select crown that seems about right

d.    Have patient bite it into place with cement already in it

ii.              Results

B.    Esthetic crowns

V.             Dealing with “Dr. Google” parents

A.    Parent wants no x-rays

i.               AAPD guidelines require MINIMUM of every 24 months

ii.              70% of primary tooth caries are interproximal caries

iii.             Multiple asymptomatic developmental anomalies

a.    Supernumerary teeth

b.    Odontomas

c.     Congenitally missing teeth

d.    Impacted and ectopic teeth

e.    Over-retained teeth and cysts

f.      Dens en dente (sometimes symptomatic)

iv.            Recommendation: discharge the patient

B.    Parent wants no crowns- only fillings

i.               Longevity of crowns is far greater that fillings

ii.              Cost of re-care

iii.             Number of appointments for re-care

iv.            Recommendation: do a crown or discharge the patient

C.   Parent wants no fluoride

i.               Effectiveness and safety are well established

ii.              Cost is minimal

iii.             Recommendation: leave it up to parents

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