Treatment Planning in
Pediatric Dentistry
許修銘
93/04/20
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CONTENT
Ⅰ. Quality care for children
Ⅱ. Philosophy of treatment planning
Ⅲ. Diagnosis
Ⅳ. Dental caries assessment
Ⅴ. Dental charting
Ⅵ. Radiographs
Ⅶ. Choice of restoration
Ⅷ. Local analgesia & rubber dam
Ⅸ. Order of restorations
Ⅹ. Medical history & treatment planning
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• Children as individuals
–Developed and designed to
provide high-quality restorative care
for each individual child’s needs
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Ⅰ. Quality Care for Children
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Ⅰ. Quality Care for Children
• Whether children’s teeth should be
restored at all
• Children are future dental patients
–Cost of treatment
• Promote positive dental experiences
–Dental experience
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Ⅰ. Quality Care for Children
Ⅱ. Philosophy of Tx Planning
First Group
Æ no restorative care has been
attempted in the past,
but who now do need it
• Good quality restorative care,
care
as and when caries is diagnosed,
would also obviate the need
for extractions of primary teeth
under general anaesthesia
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Second Group
Æ already have had some restorations
or perhaps attempted restorations
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Ⅱ. Philosophy of Tx Planning
Ⅱ. Philosophy of Tx Planning
First GroupÆ
Group PDH（－）
Second GroupÆ
Group PDH（＋）
– StepStep-byby-step introduction
–Treatment planning must take into
account the degree of cooperation
–An amount of time
allowed for behaviour modification
–The necessary information on the
dental history & dental status of child
• Pain control (local analgesia)
• Rotary instruments
• Rubber dam
• Placing of restorations
– Ensure that they
do not develop a fear of dentistry
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Ⅱ. Philosophy of Tx Planning
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Ⅲ. Diagnosis
• The dental problems of a child
must be assessed before a
treatment plan is designed
• Ideal approach for restoring
children’s teeth involves the
practice of quadrant dentistry
• This involves not only examining
the teeth but also assessing the
child’s behaviour
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Ⅲ. Diagnosis
Ⅲ. Diagnosis
• In the waiting room:
• A history should be taken
–From the parents
–Including details of
previous behaviour,
restorations or attempted restoration
– Child’
Child’s behaviour
– Relationship with parents or carers
• Any apprehension or difficult
behaviour should be noted
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• These details should be recorded
on a dental history form
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Ⅲ. Diagnosis
• The first visit
– Simple examination of dentition
• an assessment of the extent of
dental caries, oral hygiene,
gingivitis & periodontal disease
– Examination of all oral tissue
– Oral hygiene
– Child’
Child’s behaviour
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Ⅳ. Dental Caries Assessment
Ⅳ. Dental Caries Assessment
• Record all carious lesions
• Restore a large cavity
in a primary tooth with a material
that will not hold very long
–Staining of pits and fissures
>1/3Æ
Æpulp therapy
>1/3enamel
–Discolouration of the
–Condition of the marginal ridge
(intact or broken)
• Leakage around the margins or
breakdown of the margins
leads to failure of the restoration
• Note chronic or acute abscesses &
draining sinuses
• Examine existing restorations
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Ⅳ. Dental Caries Assessment
Ⅴ. Dental charting
• Sufficient coronal dentine & enamel
Æ restored with strip crowns
• The condition of all teeth should be
recorded on a suitable chart
• Accurate dental records for
dental caries & restorations
–Drawing up a treatment plan
–Medico-legal requirements
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Ⅴ. Dental charting
Ⅴ. Dental charting
• An intra-oral charting together with
diagnostic quality radiographs and
other diagnostic tests
• All treatment is
accepted by the parent or carer,
& restorative work can be
completed with
cooperation of parent & child
• The success of the treatment
will be dependent on
parental enthusiasm and support
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Ⅵ. Radiographs
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Ⅵ. Radiographs
• Clinical examination alone would
mean that many early lesions will
be missed
• DIAGNOdent (KAVO)
• Bitewing radiography
• It is not possible to diagnose
early occlusal or proximal caries
by clinical examination alone
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• Orthopantomogram
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• Alveolar bone structures
• Development of primary
& secondary teeth
• PeriPeri-apical or furcation
pathology
• Other structures of
maxilla & mandible
• Presence/absence of
dental caries
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Ⅵ. Radiographs
• Radiographs should form
routine part of dental examination
& it is necessary to
repeat radiographs for
dental caries diagnosis at intervals
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Ⅶ. Choice of restoration
Ⅶ. Choice of restoration
• Type of restoration used for a
primary tooth will depend on:
• Repeated restoration of primary
tooth Æ bad dental care
–The tooth to be restored
–Past caries history
–Child cooperation
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• Caries on at least 2 surfaces or
marginal ridge has broken
Æ preformed metal crown (SSC)
SSC
is the restoration of choice
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Ⅶ. Choice of restoration
• Amalgam:
Amalgam one-surface or small
two-surface restoration
• Composite resin restorations &
glass ionomer cements:
cements
– Not survive beyond 48 months
– Technique-sensitive
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Ⅷ. Local Analgesia & Rubber dam
Ⅷ. Local Analgesia & Rubber dam
• Local analgesia should be
routinely used in
the restoration of primary teeth
• “Rule of 10”
10
– Age of child＋
child＋Number of tooth
(canine=3, 1st molar=4, 2nd molar=5)
– ＞10Æ
10 mandibular block
– ＜10Æ
10 infiltration
• Choice flavour of topical analgesia
• For pulp therapy in mandibular,
block analgesia should be used
–Degree of participation
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Ⅷ. Local Analgesia & Rubber dam
Ⅸ. Order of restorations
• Restoration of primary teeth should
always, as far as possible, be
carried out under rubber dam
• It is important to
start restorative treatment with
the easiest local analgesia,
analgesia
which will be an infiltration
• It is essential for pulp therapy,
therapy &
highly desirable if quadrant
dentistry is to be accomplished
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Ⅸ. Order of restorations
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Ⅸ. Order of restorations
Maxillary left
• If primary mandibular incisors are
involved then
the caries rate is probably so high
that a more radical approach is
needed
Maxillary right
Mandibular left
Mandibular right
Maxillary incisors
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Ⅸ. Order of restorations
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Ⅹ. Medical History & Tx Planning
• Hasty restoration of badly broken down
teeth in mandible at a first visit (×)
• Obviously a full medical history
should be completed for every
child before dental care
commences
• Dress teeth with temporary restoration
& plan the treatment in such a way as
to introduce local analgesia in a
controlled and simple manner so that
child readily accepts the treatment
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Ⅹ. Medical History & Tx Planning
• Bleeding disorders
–Extraction of teeth in a child with any
form of bleeding disorder is
contraindicated
–Pulpotomies or pulpectomies are
mandatory as long as the tooth is
restorable
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Ⅹ. Medical History & Tx Planning
• Heart conditions & immunosuppression
At risk of infective endocariditis with heart disease
Immunosuppression for any reason
With shunts
–Pulp therapy should not be carried out
–Extracted with appropriate precautions
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ANC = Total WBCs x (segs
(segs + bands)
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KaVo DIAGNOdent®.
Ê655 nm diode laser
Thanks for Your Attention
ÊReads 2mm into the tooth
ÊDetects “fluorescence” in
ANYTHING you aim it at
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