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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

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