___________________________________ DCA06DT Dental Treatment of Pediatric and Adolescent Patients
by bacteria that can initiate the carious process. Consultation with a dentist or pedodontist can determine the best protocol by which this is accomplished. These teeth are extracted if the mobility presents a risk of aspiration, but this is rare. The chronology of the eruption of the 20 deciduous teeth will vary widely among children. The mandibular central incisors are usually the first teeth to erupt at 6 to 10 months of age. The maxillary and mandibular second molars complete the sequence and usually appear at 23 to 33 months of age [2]. The lateral incisors, canines, and first molars erupt in the intervening interval. Genetics, systemic illness, and develop- mental problems are among the many factors that can delay the eruption of the deciduous teeth. Unlike their permanent counterparts, deciduous teeth have no premolars. The permanent premolars replace the first and second deciduous molars and are the only permanent teeth to have less length in a mesial-to-distal (anterior-to-posterior) dimension than their deciduous predecessors. The permanent molars are the only permanent teeth that do not replace a pre- existing deciduous tooth. The eruption sequence of permanent teeth can also vary. The mandibular central incisors and the mandibular and maxillary first molars are the first permanent teeth to erupt, usually at 6 to 7 years of age. The maxillary and mandibular second molars erupt between 12 and 13 years of age. The third molars are unpredictable but may appear at 17 to 21 years of age, the last teeth to fully erupt during adolescence [3]. Many genetic and physiologic factors can accelerate or extend these eruption patterns. Teething pain can cause infants and toddlers to drool, become restless and irritable, and even develop a low-grade fever, with treatment designed to palliate symptoms. Caution should be exercised if over-the-counter topical anesthetic preparations are used, as even small doses of these drugs can be toxic to infants and toddlers if swallowed. Similarly, the use of any analgesic medication should be minimized to reflect the limited abil- ity of the infant or toddler to metabolize these substances. Consultation with a pedodontist or pediatrician is advisable to determine a dosing schedule that is efficacious and safe.
INTRODUCTION The goal of achieving and maintaining optimal oral health is one that should begin during childhood, continue during adolescence, and extend into the adult years. Teeth are essential throughout life for mastication, phonation, cosmetics, and support for the tissues that compose the facial form. Dental treatment of pediatric and adolescent dental patients must take into consideration their unique anatomical, physiologic, psychologic, maturational, and emotional differences and needs. This course will highlight these differences and options for preventive dentistry appropriate for this patient population, including a proactive means by which the risk of early child- hood caries can be reduced. The need to adjust the dosage and/or frequency of administration of medications used in conjunction with dental treatment of pediatric and adolescent patients will be discussed. Oral lesions associated with com- mon childhood diseases will be identified, as local outbreaks of infectious disease such as the measles and chickenpox still occur. The factors that are integral to the restoration of carious teeth and the oral and perioral signs of child abuse/domestic violence are discussed. Clinicians should consider the extent of their training with pediatric and adolescent patients before they are treated. If the complexity of the case, behavioral con- cerns, or patient management is beyond the clinician’s ability, referral to a pedodontist should be made. ERUPTION SEQUENCE The first complete set of teeth to erupt in the oral cavity have been called deciduous, primary, baby, or milk teeth. The eruption of a tooth is a developmental process during which a tooth moves from its position within the alveolar bone through the overlying mucosa into the oral cavity until it achieves a fully erupted position, where it will attain occlusion against an opposing tooth. Most teeth follow this process, although some teeth, most often the third molars (“wisdom teeth”), become impacted as they encounter bony or other anatomical obstructions and never fully erupt. Surgical removal is usu- ally required to relieve pain and to prevent pathology to the adjacent structures. Infants are usually born completely edentulous (without teeth), but there are rare exceptions. Natal teeth are those that are pres- ent at birth, and neonatal teeth erupt within 30 days of birth [1]. These usually occur in the anterior mandible, particularly the early eruption of the mandibular deciduous incisors. Natal and neonatal teeth exhibit minimal root formation and may have a variable range of mobility. This can cause complications during breastfeeding, and sharp edges of the exposed teeth can even traumatize the oral mucosa of the infant. Although these are deciduous teeth, they must be cleaned gently with plain cot- ton gauze or a cotton swab, as they are subject to colonization
ANATOMY AND MORPHOLOGY OF DECIDUOUS TEETH
The 20 deciduous teeth have pronounced differences in the anatomy of their crowns and roots and in the structure and amounts of enamel, dentin, and pulp chamber compared to those of the permanent teeth. These morphologic differences reflect the teeth’s design to function for a limited period of time and to be aligned into maxillary and mandibular arches of small dimensions. These differences will also influence the progression of the carious process and the manner in which carious deciduous teeth are restored.
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