GOOD MORNING

TREATMENT RECOMMENDATIONS AND

INFORMED CONSENT :

- The treatment plan includes information regarding :

• Nature of the procedures/materials to be used

• Number of appointments/time frame needed for care
• Behaviour guidance techniques
• Fee for proposed procedures
-The dentist should educate parents
on the need, benefits, risks,
alternatives for recommended
treatment & expectation if no
intervention is provided.

- Parent should have opportunity to ask

questions and have their concerns
satisfied prior to giving informed
consent.

- Documentation should include that

parent appeared to understand and
accepted the proposed procedures.

- Any special restrictions of the parent

should be documented.
 EMERGENCY TREATMENT
• Needed in cases of emergencies like trauma, avulsion, pain &
swellings – abscess.

• Includes surgical extractions, emergency root canal opening,

replantation of the avulsed tooth, splinting, abscess drainage
and temporary relief from pain by medication.
 PLANNED TREATMENT
A.PREVENTIVE PHASE

• ORAL HYGIENE COUNSELLING – AAPD Guidelines

- Parents adviced that if an infant falls asleep while feeding,

teeth should be cleaned before placing the child in bed.

- Toothbrushing of all dentate children performed twice

daily with a fluoridated toothpaste and a soft toothbrush.

- Parents should use a ‘smear’ of toothpaste to brush the

teeth of a child less than 2 years & perform or assist with
their child’s toothbrushing.
- For the 2-5 years old child, parents
should dispense a ‘pea-size’ amount of
toothpaste & assist toothbrushing.

- Children should be taught to never

swallow the toothpaste.

- Dental flossing should be initiated

when adjacent tooth surfaces cannot
be cleansed by a toothbrush.

- Brushing should be supervised and

assisted until age 8.

- A small, circular scrubbing motion is

recommended for children.
DIET COUNSELLING :

AAPD Guidelines

• Infants not be put to sleep with a bottle containing

fermentable carbohydrates.

• At-will breast-feeding avoided after the first primary tooth

begins to erupt and other dietary carbohydrates are given.

• Parents encouraged to have infants drink from a cup as they

approach their first birthday.
• Infants should be weaned from the bottle at 12 to 14
months of age.

• Repetitive consumption of any liquid containing fermentable

carbohydrates from a bottle or training cup should be
avoided.

• Between-meal snacks and prolonged exposures to foods and

juice or other beverages containing fermentable
carbohydrates should be avoided.
OTHER PREVENTIVE TREATMENTS:
• Counselling for stoppage of habits before malocclusion or
skeletal dysplasias occur

• Removal of supra & sub gingival calculus

• Pit & fissure sealants

• Topical fluoride application – 1.23% APF gel (every 3 – 6

months)
B) RESTORATIVE PHASE:

GIC – GLASS IONOMER CEMENT favorable to use in

children:

• Chemical bonding to both enamel and dentin

• Thermal expansion similar to that of tooth structure

• Biocompatibility

• Uptake and release of fluoride

• Decreased moisture sensitivity when compared to resins

DENTAL AMALGAM is recommended for:

• Class I restorations in primary and permanent teeth

• Class II restorations in primary molars where preparation

does not extend beyond the proximal line angles

• Class II restorations in permanent molars and premolars

• Class V restorations in primary and permanent posterior

teeth.
RESIN-BASED COMPOSITES are indicated for:

1. Class I pit-and-fissure caries

2. Class I caries extending into dentin

3. Class II restorations in primary teeth that do not extend

beyond the proximal line angles

4. Class II restorations in permanent teeth that extend

approximately one third to one half the buccolingual
intercuspal width of the tooth

5. Class III, IV, V restorations in primary and permanent teeth

6. Strip crowns in the primary and permanent dentitions.

STAINLESS STEEL CROWNS given to restore teeth in;

1. “Children at high risk exhibiting anterior tooth caries

and/or molar caries treated with SSC to protect remaining
tooth surfaces.

2. Children with extensive decay, large lesions, or multiple

surface lesions in primary molars.

3. For teeth having received pulp therapy.

ENDODONTIC TREATMENTS

• Vital pulp therapies :

- Direct & Indirect pulp capping
- Pulpotomy
- Apexogenesis

• Non – vital pulp therapies :

- Root Canal Treatment
- Apexification
C)SURGICAL PHASE :

• Extractions & Impaction surgeries

• Frenectomy
• Gingivectomy & Gingivoplasty
• Cystectomy
• Apicocectomy
• Surgical Exposure Of Unerupted Teeth
• Surgical Derotation
• Flap Surgery
• Enucleation Of Mucoceles
D)ORTHODONTIC PHASE :
• Habit Breaking Appliances
• Preventive orthodontics
• Interceptive orthodontics
• Removable & Fixed Orthodontic Appliances
• Myofunctional Appliances
• Orthopaedic Appliances
E) FOLLOW UP & RECALL

• Follow up appointment changes according to treatment done

• Children with less caries risk recalled every 6 months

• Children who exhibit higher risk of developing caries would

benefit from recall appointments at greater frequency than
every 6 months ( 3 – 4 months)

• On recall appointments check for;

- oral hygiene & diet maintenance
- previous restorations
- detection new carious lesions
CONCLUSION :

Thorough case history & examination;

• Helps us reach to an exact final diagnosis

• Prepare a specific treatment plan for every case

• Help anticipate future problems

• Helps us to maintain child’s dental, medical as well as overall

social well being
 REFERENCES :

• Textbook of ORAL MEDICINE - Burkette, Greenberg,

Glick; 10th edition

• Textbook of ORAL MEDICINE – Anil Ghom; 2nd edition

• ENDODONTIC PRACTICE – Louis I. Grossman, Seymour

Oliet, Carlos E. Del Rio; 11th edition

• Dentistry for Child and Adolescent – Mc Donald’s, Avery

• CLINICAL PEDODONTICS – Sidney B. Finn; 4th edition

• PEDIATRIC DENTISTRY infancy through adolescence –

Pinkham, Casamassimo, Fields, McTigue, Nowak; 4th
edition
• Stephen Cohen, Richard Burns – pathways of the pulp - 8th
edition

• Shafer, Hine, Levy - Shafer’s Textbook of ORAL

PATHOLOGY – 6th edition

• S.I. Balajhi - Orthodontics the art and science 3rd edition

• William Proffit - Contemporary Orthodontics 4th edition

• Principles and Practice of MEDICINE – Davidson’s; 19th

edition
 INVESTIGATIONS
• These include all necessary investigations required to reach
a final diagnosis.

• Various investigations are needed specifically to reach

confirm the provisional diagnosis & reach to a final
diagnosis, so that a correct treatment can be planned &
delivered.

• Investigations normally required are :

- Radiographs
- Pulp vitality • Oblique plate radiograph
- Caries activity test a film cassette is held against the patient’s
- Blood examinations cheek. The patient’s had is rotated and
- Advance diagnosis tilted. The x-ray cylinder is placed just
inferior and posterior to the angle of the
- Biopsy mandible on the opposite side of the face.