Syndromes in Pediatric Dentistry
Syndromes in Pediatric Dentistry
Syndromes in Pediatric Dentistry
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<strong>Pediatric</strong> <strong>Dentistry</strong><br />
Natalie J. Carr, DDS, MS<br />
July 14, 2013
Today’s program<br />
• Infant Oral Health Program<br />
– AAPD Guidel<strong>in</strong>es<br />
– What to review with parents<br />
– What to do dur<strong>in</strong>g the exam<br />
• Trauma<br />
– Primary teeth<br />
– Permanent teeth
AAPD Guidel<strong>in</strong>es- Dental Home<br />
• Parents and other care providers should<br />
help every child establish a dental home<br />
by 12 months of age.<br />
• Referral by the primary care physician<br />
– based on risk assessment<br />
– as early as 6 months of age<br />
– 6 months after the first tooth erupts<br />
– no later than 12 months of age
AAPD Guidel<strong>in</strong>es- Dental Home<br />
• Comprehensive oral health care<br />
– acute care<br />
– preventive services<br />
• Comprehensive assessment for oral diseases<br />
• Individualized preventive dental health program<br />
• Anticipatory guidance<br />
– growth and development<br />
• Plan for acute dental trauma<br />
• Dietary counsel<strong>in</strong>g<br />
– www.AAPD.org- Recommended Food Intake Patterns<br />
• Referrals to dental specialists when needed
AAPD Guidel<strong>in</strong>es:<br />
First Dental Visit<br />
• Record medical and dental history<br />
• Complete oral exam<br />
• Assess <strong>in</strong>fant risk for develop<strong>in</strong>g decay<br />
– Determ<strong>in</strong>e prevention plan<br />
– Interval for periodic reevaluation<br />
• Provide anticipatory guidance
AAPD Guidel<strong>in</strong>es:<br />
First Dental Visit<br />
• Provide anticipatory guidance<br />
– Dental and oral development<br />
– Fluoride status<br />
– Non-nutritive suck<strong>in</strong>g habits<br />
– Teeth<strong>in</strong>g<br />
– Injury prevention<br />
– Oral hygiene <strong>in</strong>struction<br />
– Effects of diet on dentition
Social class<br />
TIME<br />
Income<br />
Education<br />
BACTERIA<br />
SUBSTRATE<br />
CARIES<br />
TOOTH<br />
Behavior<br />
Knowledge
Smear vs. pea size
AAPD Fluoride<br />
Recommendations<br />
AGE < 0.3<br />
Birth –<br />
6 mo<br />
6 mo-<br />
3y<br />
ppm F<br />
0.3-0.6<br />
ppm F<br />
>0.6<br />
ppm F<br />
0 0 0<br />
0.25 mg 0 0<br />
3-6 y 0.50 mg 0.25 mg 0<br />
6-16 y 1.00 mg 0.50 mg 0
Development of Primary Teeth<br />
Initiation<br />
(weeks IU)<br />
Calcification<br />
(weeks IU)<br />
Eruption<br />
(months PP)<br />
Central 6 14 6-9<br />
Lateral 6 16 7-10<br />
Can<strong>in</strong>e 7 17 16-20<br />
1 st molar 6 15 12-16<br />
2 nd molar 8 19 23-30
Development of Permanent<br />
Teeth<br />
Initiation Calcification<br />
Crown<br />
Complete<br />
Eruption (yr)<br />
Lower Upper Lower Upper<br />
Central 5 mo (IU) 3-4 mo 3-4 mo 4-5 yr 6-7 7-8<br />
Lateral 5 mo (IU) 3-4 mo 10-12 mo 4-5 yr 7-8 8-9<br />
Can<strong>in</strong>e 5 mo (IU) 4-5 mo 4-5 mo 6-7 yr 9-11 11-12<br />
1 st Premolar 5 mo (IU) 1.7- 2 yr 1.5-1.7 yr 5-6 yr 10-12 10-11<br />
2 nd Premolar 10 mo (PP) 2.2-2.5 yr 2-2.2 yr 6-7 yr 11-12 10-12<br />
1 st Molar 20 wk (IU) Birth Birth 2.5-3 yr 6-7 6-7<br />
2 nd Molar 12 mo(PP) 2.5–3 yr 2.5-3 yr 7-8 yr 11-13 12-13<br />
3 rd Molar 5 yr (PP) 8 yr 9 yr 12-16 yr 17-25 17-25
Knee to Knee exam
Enamel Hypoplasia
Hypoplasia<br />
• Caused by failure of the apposition and<br />
prote<strong>in</strong> matrix formation or an alteration<br />
<strong>in</strong> the m<strong>in</strong>eralization of the matrix<br />
• Treatment<br />
– Sealant<br />
– Composite<br />
– Sta<strong>in</strong>less steel crown<br />
– Glass Ionomer if partially erupted
Hypoplasia
Hypoplasia<br />
• Treatment challenges<br />
– Exquisitely sensitive<br />
• Nitrous Oxide<br />
• Septoca<strong>in</strong>e (and Lidoca<strong>in</strong>e)<br />
– Composite bond to affected area
AAPD.ORG<br />
Assessment of Acute Traumatic Injuries
Trauma<br />
• Avulsed Primary – Do not re-implanted<br />
• Avulsed Permanent – can re-implant<br />
– Open apex<br />
– Closed apex<br />
• Lateral Luxation-<br />
– Primary-<br />
• passive reposition<strong>in</strong>g or extraction<br />
– Permanent- Reposition and spl<strong>in</strong>t 10 days
AAPD.ORG<br />
Decision Trees for Management of an<br />
Avulsed Permanent Tooth
Local Anesthesia<br />
• 2% Lidoca<strong>in</strong>e with 1:100,000 epi<br />
– Maximum dosage: 2mg/lb<br />
– One carpule: 1.8 ml = 36mg<br />
• 4 % Artica<strong>in</strong>e with 1:100,000 epi<br />
– Maximum dose is 3.2 mg/ lb<br />
– One carpule: 1.7 ml = 68mg<br />
– Approved for 4 years and older
Age <strong>in</strong> years lbs kgs 2% Lidoca<strong>in</strong>e with epi<br />
1:100,000 Maximum Dose<br />
mg<br />
carpules<br />
1 22 10 44 1 1/8<br />
2 27 12 54 1 1/2<br />
3 32 15 64 1 3/4<br />
4 36 16 72 2<br />
5 40 18 80 2 1/8<br />
6 46 21 92 2 1/2<br />
7 52 24 104 2 3/4<br />
8 58 26 116 3 1/8<br />
9 64 29 128 3 1/2<br />
10 70 32 140 3 3/4<br />
11 79 36 158 4 1/4<br />
12 88 40 176 4 3/4<br />
13 99 45 198 5 1/2<br />
14 108 49 216 6<br />
15 116 53 232 6 1/4<br />
Adult female 123 56 246 6 3/4<br />
Adult male 154 70 308 8
Useful Websites<br />
• www.aapd.org<br />
• www.ada.org<br />
• www.epocrates.com<br />
• www.emedic<strong>in</strong>e.com<br />
• www.pubmed.com<br />
• www.scholar.google.com<br />
• www.translate.google.com/
OPTIMALLY FLUORIDATED WATER IN FLORIDA – 2008<br />
County<br />
ALACHUA<br />
BAKER<br />
BAY<br />
BRADFORD<br />
BREVARD<br />
BROWARD<br />
CALHOUN<br />
CITRUS<br />
CLAY<br />
COLLIER<br />
COLUMBIA<br />
DADE<br />
DESOTO<br />
DUVAL<br />
ESCAMBIA<br />
FRANKLIN<br />
GADSDEN<br />
GLADES<br />
GULF<br />
HARDEE<br />
HENDRY<br />
Escambia<br />
77%<br />
Communities<br />
Alachua<br />
Ga<strong>in</strong>esville<br />
High Spr<strong>in</strong>gs<br />
MacClenny<br />
Callaway<br />
Cedar Grove<br />
Panama City<br />
Panama City Beach<br />
Parker<br />
Spr<strong>in</strong>gfield<br />
Southport<br />
Mexico Beach<br />
Starke<br />
Lawtey <br />
Cocoa<br />
Cocoa Beach<br />
Indialantic<br />
Indian Harbour Beach<br />
Melbourne<br />
Melbourne Beach<br />
Merritt Island<br />
Mims<br />
Palm Bay<br />
Port Malabar<br />
Port St. John<br />
Rockledge<br />
Satellite Beach<br />
Suntree Viera<br />
Titusville<br />
West Melbourne<br />
County un<strong>in</strong>corporated areas<br />
All communities<br />
County un<strong>in</strong>corporated areas<br />
Blountstown <br />
Inverness<br />
Crystal River<br />
Golden Terrace<br />
Green Cove Spr<strong>in</strong>gs<br />
Immokalee<br />
Golden Gate<br />
Naples<br />
County un<strong>in</strong>corporated areas<br />
Lake City<br />
County un<strong>in</strong>corporated areas<br />
All communities, except<br />
Florida City<br />
County un<strong>in</strong>corporated areas<br />
Arcadia <br />
Entire County natural optimal <br />
fluoride except Baldw<strong>in</strong><br />
County un<strong>in</strong>corporated areas<br />
Pensacola<br />
County un<strong>in</strong>corporated areas<br />
Apalachicola <br />
County un<strong>in</strong>corporated areas<br />
Qu<strong>in</strong>cy<br />
Lake Port <br />
Port St. Joe <br />
Port St. Joe Beach <br />
Wewahitchka <br />
County un<strong>in</strong>corporated areas <br />
Wauchula <br />
Zolfo Spr<strong>in</strong>gs <br />
Clewiston<br />
LaBelle<br />
South Shores<br />
Santa Rosa<br />
51% Okaloosa<br />
County<br />
81% Walton<br />
0%<br />
Communities<br />
Holmes<br />
0%<br />
Wash<strong>in</strong>gton<br />
0%<br />
Bay<br />
88%<br />
Jackson<br />
0%<br />
Calhoun<br />
30%<br />
Gulf<br />
100%<br />
HERNANDO Brooksville<br />
HIGHLANDS Avon Park<br />
Sebr<strong>in</strong>g<br />
HILLSBOROUGH Hershel Heights<br />
Oak Estates<br />
Tampa<br />
Temple Terrace<br />
County un<strong>in</strong>corporated areas<br />
INDIAN RIVER Vero Beach<br />
County un<strong>in</strong>corporated areas<br />
JEFFERSON Monticello<br />
LAKE<br />
Eustis<br />
Tavares<br />
Umatilla<br />
LEE<br />
Ft. Myers<br />
County un<strong>in</strong>corporated areas<br />
LEON<br />
Tallahassee<br />
MADSION Madison<br />
MANATEE Anna Maria<br />
Bradenton<br />
Holmes Beach<br />
Long Boat Key<br />
Palmetto<br />
Sunny Shores<br />
County un<strong>in</strong>corporated areas<br />
MARION Ocala<br />
MONROE All communities<br />
NASSAU Fernand<strong>in</strong>a Beach <br />
Amelia Island<br />
OKALOOSA Crestview<br />
Niceville<br />
Dest<strong>in</strong> <br />
Fort Walton Beach <br />
Mary Ester <br />
Seashore <br />
Shalimar <br />
County un<strong>in</strong>corporated areas <br />
ORANGE Apopka<br />
Crescent Heights<br />
Eatonville<br />
Maitland<br />
Ocoee<br />
Orlando<br />
W<strong>in</strong>ter Park<br />
OSCEOLA Kissimmee<br />
St. Cloud<br />
PALM BEACH Belle Glade<br />
Boynton Beach<br />
Delray Beach<br />
Pahokee<br />
Well<strong>in</strong>gton<br />
West Palm Beach<br />
PASCO<br />
New Port Richey<br />
County un<strong>in</strong>corporated areas<br />
PINELLAS Belleair<br />
Clearwater<br />
Duned<strong>in</strong><br />
St. Petersburg<br />
County un<strong>in</strong>corporated areas<br />
Liberty<br />
0%<br />
Frankl<strong>in</strong><br />
19%<br />
Gadsden<br />
18%<br />
County<br />
POLK<br />
Wakulla<br />
3%<br />
PUTNAM<br />
ST. JOHNS<br />
ST. LUCIE<br />
SANTA ROSA<br />
SARASOTA<br />
SEMINOLE<br />
SUWANNEE<br />
TAYLOR<br />
VOLUSIA<br />
80%<br />
60%<br />
40%<br />
20%<br />
0%<br />
Leon<br />
66%<br />
Jefferson<br />
0%<br />
Communities<br />
Taylor<br />
45%<br />
Madison<br />
34%<br />
Hamilton<br />
0%<br />
Suwannee<br />
18%<br />
Lafayette<br />
0%<br />
Dixie<br />
0%<br />
Auburndale<br />
Bartow<br />
Ha<strong>in</strong>es City<br />
Lake Alfred<br />
Lakeland<br />
W<strong>in</strong>ter Haven<br />
Crescent City<br />
Palatka<br />
Hast<strong>in</strong>gs <br />
Palm Valley <br />
Ponte Vedra <br />
Inlet Beach <br />
North At. August<strong>in</strong>e Beach <br />
County un<strong>in</strong>corporated areas<br />
Ft. Pierce<br />
Port St. Lucie<br />
County Un<strong>in</strong>corporated areas<br />
Milton<br />
Navarre <br />
Navarre Beach <br />
Sarasota <br />
Siesta Key<br />
County un<strong>in</strong>corporated areas <br />
Altamonte Spr<strong>in</strong>gs<br />
Lake Mary<br />
Longwood<br />
Oviedo<br />
Sanford<br />
County un<strong>in</strong>corporated areas<br />
Live Oak<br />
Perry<br />
Daytona Beach<br />
Daytona Beach Shores<br />
South Daytona<br />
Deland<br />
Holly Hill<br />
New Smyrna Beach<br />
Ormond Beach<br />
Ponce Inlet<br />
Port Orange<br />
Columbia<br />
25%<br />
Gilchrist<br />
0%<br />
Levy<br />
0%<br />
P<strong>in</strong>ellas<br />
97%<br />
Baker<br />
20%<br />
Union<br />
0%<br />
Alachua<br />
70%<br />
Citrus<br />
10%<br />
Hernando<br />
8%<br />
Pasco<br />
9%<br />
Bradford<br />
24%<br />
Marion<br />
20%<br />
Sumter<br />
0%<br />
Hillsborough<br />
86%<br />
Manatee<br />
92%<br />
Percent of Population on Community<br />
Water Systems Receiv<strong>in</strong>g Fluoridated<br />
Water by 5 Year Intervals<br />
33%<br />
47%<br />
57%<br />
64% 68%<br />
Sarasota<br />
59%<br />
77%<br />
1980 1985 1990 1995 2000 2005<br />
Nassau<br />
54%<br />
Clay<br />
6%<br />
Duval<br />
93%<br />
Putnam<br />
25%<br />
Lake<br />
18%<br />
St. Johns<br />
34%<br />
Polk<br />
51%<br />
Hardee<br />
23%<br />
DeSoto<br />
24%<br />
Charlotte<br />
0%<br />
Lee<br />
55%<br />
Flagler<br />
0%<br />
Volusia<br />
65%<br />
Sem<strong>in</strong>ole<br />
68%<br />
Orange<br />
76%<br />
Osceola<br />
82%<br />
Highlands<br />
56%<br />
Glades<br />
11%<br />
Collier<br />
74%<br />
Hendry<br />
56%<br />
Brevard<br />
97%<br />
Okeechobee<br />
0%<br />
Monroe<br />
99%<br />
Indian River<br />
83%<br />
Lake<br />
Okeechobee<br />
70.9% of Florida’s Population<br />
Receives Optimally Fluoridated<br />
Water<br />
St. Lucie<br />
75%<br />
Mart<strong>in</strong><br />
12%<br />
Palm Beach<br />
60%<br />
Broward<br />
99%<br />
Dade<br />
99%<br />
-----------------------------<br />
78.7% of Florida’s Population<br />
Served by Community Water<br />
Systems Receives Optimally<br />
Fluoridated Water<br />
Percent by County<br />
<br />
0%<br />
1-20%<br />
21-40%<br />
41-60%<br />
61-80%<br />
81-100%<br />
Natural<br />
Fluoride<br />
04/09