DCA06DT Dental Treatment of Pediatric and Adolescent Patients _ __________________________________
An alternative to fluoride for enamel protection and tooth remineralization is calcium hydroxyapatite, a calcium and phosphorus (phosphate) mineral of which 70% to 80% of tooth and bone are composed. Topical preparations containing hydroxyapatite have been shown to be as or more effective for remineralization, treating tooth hypersensitivity, and reversing carious lesions than fluoride and do not have the detriments of toxicity or fluorosis [84]. Other effects of hydroxyapatite are absorption of oral pathogens and protection against stains and biofilm attachment. The most effective type of hydroxyapatite for topical use is the nanocrystal form (nanohydroxyapatite), which is readily available as toothpastes and rinses. Calcium hydroxyapatite is available as a nutritional supplement and is also included in some dental gels and varnishes. DENTAL EXAMINATIONS AND PROPHYLAXIS APPOINTMENTS As noted, children and adolescents are entirely dependent upon their parents or caregivers for access to dental care, and issues with transportation and financial stress may arise. However, regularly scheduled dental examinations can provide a means for oral hygiene instruction for children and their parents and can allow for identification of carious lesions early, when they can be restored by conservative and less expensive means. Beyond the cost-effectiveness of preventive pediatric dentistry, this approach reduces the suffering and morbidity associated with advanced dental problems. Dental insurance coverage and family income may impact access to care. Families in need of financial assistance may be eligible for dental coverage under the Medicaid program. Unfortunately, the low reimbursement fee schedule for den- tal procedures precludes many general dentists and dental specialists from accepting patients under this program. The dental divisions of county health departments may provide another low-cost source of dental treatment for pediatric and adolescent patients. Some county and state dental societies also provide periodic pro bono services to those in need. Access to adequate dental care is essential for the appropriate development of children’s oral and general health and for their ability to develop and maintain a healthy sense of self-esteem, making this a public health issue.
MEDICATION USE IN PEDIATRIC AND ADOLESCENT DENTAL PATIENTS Local anesthetics, analgesics, and antibiotics are used most often before, during, and after the dental treatment of pediatric and adolescent patients. As with any patient, a thorough medi- cal history must be obtained and discussed with the patient and his or her parent or guardian prior to using any medica- tion. Some states require written parental/guardian consent for any medication use in minor children. Medications used for dental purposes should be carefully selected and used to ensure they do not interact adversely with those prescribed to treat a systemic disease. If there are any medical issues that would cause a concern with a proposed dental treatment or the medications used, consultation with the patient’s pediatrician or another physician is recommended. Dental professionals who rarely treat or prescribe medications to pediatric and adolescent patients may give little thought to the profound differences in their ability to metabolize and excrete medications compared with adults. The dosage and frequency of administration may require significant adjust- ments. History of an adverse reaction to any medication should be discussed with the parent or guardian, as should the presence of pre-existing illness and other medication use. Age and weight should be considered before a medication is recommended or prescribed. For example, a child who is 3 years of age and weighs 30 pounds is often categorized gener- ally as “pediatric,” as is an adolescent who is 17 years of age and weighs 200 pounds. But their ability to absorb, distribute, metabolize, and excrete medications will be vastly different. Given these issues, it is not possible to recommend a single dose of any analgesic, antibiotic, or local anesthetic for all pediatric patients. Consultation with a pediatrician is neces- sary if there is any concern about the type, dose, or frequency of administration of a given medication. ANALGESICS Carious involvement of the pulp, localized infections, and trauma to the teeth or surrounding structures may all lead to the use of analgesics for pediatric patients. Acetaminophen is the most frequently used analgesic in this population for mild- to-moderate pain [33]. It is preferred over aspirin, which causes irritation to the gastric mucosa and may cause Reye syndrome. Acetaminophen has analgesic and antipyretic (fever-reducing) capabilities. It blocks the production of prostaglandins in the central nervous system and the generation of pain impulses peripherally [34]. Some younger children and adolescents may have difficulty swallowing tablets or capsules, and acetamino- phen is available as a chewable tablet, elixir, or liquid.
The U.S. Preventive Services Task Force recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. (https://jamanetwork.com/journals/jama/
fullarticle/2786823. Last accessed January 16, 2026.) Strength of Recommendation : B (There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.)
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