1.2 Examination of the mouth and relevant structures and 

Behavior guidance in pedo clinic

① Examination of the mouth and relevant structures（part one）   

   

  Δ key points:

A. Time of the first dental visit and recall interval

   Some recommendations for children:

    1. All-inclusive clinical examination.

    2. Must be repeated regularly and frequently to maximize effectiveness.

    3.Timing, selection, and frequency determined by a child’s history, clinical findings, and susceptibility to oral disease.

    4. Consider when systemic fluoride exposure is suboptimal. Up to at least 16 years of age or later in high-risk patients.

    5. Appropriate discussion and counseling should be an integral part of each visit for care.

    6. Initially, the responsibility of parent; as the child matures, jointly with the parent; then, when indicated, only child.

    7. At every appointment; initially discuss appropriate feeding practices, followed by the role of refined carbohydrates and frequency of snacking in caries development and childhood obesity.

    8. Initially for play objects, pacifiers, car seats; then while learning to walk; and then with sports and routine playing, including the importance of mouthguards.

    9. At first, discuss the need for additional sucking: digits vs. pacifiers; then the need to wean from the habit before malocclusion or skeletal dysplasia occurs. For school-aged children and adolescent patients, counsel regarding any existing habits such as fingernail biting, clenching, or bruxism.

    10. For caries-susceptible primary molars, permanent molars, premolars, and anterior teeth with deep pits and fissures; placed as soon as possible after the eruption.

 B. Parents' involvement

      Parents should be informed before the examination that it might be necessary to restrain the child gently and it is normal for the child to cry during the procedure.

 C. The importance of early detection and management of oral diseases

     Early detection and management of oral conditions can improve a child's oral health, general health and well-being.

 D. Components of assessment in the first dental visit of a pediatric patient

      • General health and growth;• Chief complaint, such as pain;• Oral habit;• Extraoral soft tissue and TMJ evaluation;• Intraoral soft tissue;• Oral hygiene and periodontal health; • Developing occlusion;    • Caries risk and behavior of child.

 E. CLASSIFYING of CHILDREN’S DENTAL BEHAVIOR

     Such as Frankl behavior rating scale:

       • Rating 1: Definitely negative. Refusal of treatment, forceful crying, fearfulness, or any other overt evidence of extreme negativism;

       • Rating 2: Negative. Reluctance to accept treatment, uncooperativeness, some evidence of negative attitude but not pronounced (sullen, withdrawn);

       • Rating 3: Positive. Acceptance of treatment; cautious behavior at times; willingness to comply with the dentist, at times with reservation, but patient follows the dentist’s directions cooperatively;

       • Rating 4: Definitely positive. Good rapport with the dentist, interest in the dental procedures, laughter and enjoyment.

 F. How to develop a treatment plan? - Information gathering（IG）, clinical examination

   1. Information gathering（IG）:

      • Be familiar with the medical and dental history and familial history.

      • Child’s social and psychological development is important.

      • If a young child was hospitalized previously for general anesthetic and surgical procedures, it should be noted. 

      • The patient’s dental history should also be summarized in the examination chart. 

   2. Clinical examination                                                                     

      • Size, stature, gait, or involuntary movements 

      • Patient’s hair, head, face, neck, and hands 

      • The mouth and relevant structures 

                                                                                                                                                                             

★ Discussion one:

If a child came to your clinic to do an oral examination, what would you do and in which order?

Do you have the answer to the question in the video?                

 （Please discuss in wechat group and send your answer  as assignment #1）    

                                                                                                                                                                             

  

② Examination of the mouth and relevant structures（part two）   

 

  Δ key points: 

 A. Radiographic examination

   • When indicated, radiographic examination for children must be completed before a comprehensive oral health care plan can be developed, and subsequent radiographs are required periodically to enable detection of incipient caries lesions or other developing anomalies.

   • A child should be exposed to dental ionizing radiation only after the dentist has determined that radiography is necessary to make an adequate diagnosis for the individual child at the time of the appointment.

   • Obtaining isolated occlusal, periapical, or bite-wing films is sometimes indicated in very young children (even infants) because of trauma, toothache, suspected developmental disturbances, or proximal caries. It should be remembered that carious lesions appear smaller on radiographs than they actually are.

 

③ Behavior guidance                    

 Δ key points: 

  A. Difference between the treatment of children and adults

  B. Variables influencing children’s dental behaviors:

Parental Anxiety; Medical Experiences; Awareness of Dental Problem; General Behavior Problems

  C. Definition of behavior guidance

     Behavior guidance is the means by which the dental health team effectively and efficiently performs treatment for a child and, at the same time, instills a positive dental attitude.

  D. Communication with children

    •  Establishment of Communication 

    • Establishment of the Communicator 

    • Message Clarity • Voice Control 

    • Active Listening • Appropriate Responses

  E. Advanced behavior guidance:

     Such as sedation, protective stabilization and general anesthesia.

NITROUS OXIDE ADMINISTRATION

OBJECTIVES

The objectives of nitrous oxide sedation, as stated by the American Academy of Pediatric Dentistry, include the following:

    • Reducing or eliminating anxiety 

    • Reducing untoward movement and reaction to dental treatment

    • Enhancing communication and patient cooperation

    • Raising the pain threshold

    • Increasing tolerance for longer appointments

    • Aiding in the treatment of a patient with mental and/or physical disabilities or a medically compromised patient

    • Reducing gagging

    • Potentiating the effects of sedatives

Disadvantages of nitrous oxide–oxygen inhalation may include:

    • Lack of potency

    • Dependence on psychological reassurance

    • Interference of the nasal hood with injection to the anterior maxillary region

    • Need for the patient to be able to breathe through the nose

    • Nitrous oxide pollution and potential occupational exposure health hazards