Notes

Outline

Treatment Planning Theory and Practice of Pediatric Dentistry

Lecture Overview Developing Tx Plans Advantages Considerations during Tx Planning Quadrant Dentistry Local Anesthesia Incipient Lesions Priorities External Factors Presentation to Parents Referrals

Tx Planning in Pediatric Cases Initiated only after a complete & comprehensive diagnosis is obtained. Caries Risk Assessment Clinical, historical and social risk factors are used to determine if the child is likely to have caries or not. Anticipatory Guidance Co-active counseling prior to the event happening. Diagnosis Medical Record Clinical Exam Radiographic Exam

Development of Tx Plans Most critical step in the successful future management of the child and parent. A poorly developed Tx Plan Disorganized Inefficient Dissatisfaction Confusion

Advantages of Developing a Tx Plan Sequences the care. Allows for prioritization of care. Elimination of the need for repeated decision making for each appointment. Saves time Shortens the chair time Allows the dental assistant to be prepared in advance Provides for an estimate for the time required for the appointment Fee arrangements can be made in advance

Quadrant Dentistry in Children Essential for many reasons Allows for effective use of the appointment time Allows for effective use of LA Since caries progresses very quickly in the primary dentition, allows for the teeth to be treated in a timely fashion

Anteriors versus Posteriors Consideration May want to restore the anterior teeth last. Anterior teeth are primarily for esthetic purposes. Posterior teeth are of greater importance in mastication, space maintenance, vertical dimension and are retained for a much longer time.

Emergency versus Non-Emergency Visit The first priority is always to get the child out of pain if that is what the child presents with. Trauma seen immediately after it happens is another condition that requires treatment immediately.

Local Anesthesia Considerations If the case has minimal needs, consider complete arch or half mouth restorations. Maxillary local infiltrations may be easier to ease a patient in to if they have never had any dental procedure before. Avoid bilateral mandibular blocks in young children.

Incipient Lesion Considerations If the tooth is going to exfoliate within a year, then do not restore. Child’s past dental experience. Parent and child cooperation. Caries active child must have the incipient lesions restored.

Determination of Tx priorities Emergencies always get priority! Minimally necessary Tx to relieve the pain and infection Plaque-control program should be instituted Plaque removal Diet counseling Topical Fluoride Education on home oral hygiene care Restorative Tx completed Prosthodontic or Orthodontic Tx completed if necessary Recall visit schedule decided and followed

External Factors Influencing Parental Acceptance Dental I.Q. Interest level Past Experiences Finances Availability for appointments Social and Medical Problems

Tx Plan Presentation to the Parents Good communication in a manner that the parent can understand Do not criticize the parent for the child’s condition Relaxed and informative environment Use of visual Aids Accurately inform the parent of Dental needs of the child Restorative procedures Amount of time required Total cost Preventive measures necessary to maintain the completed Tx.

Referrals Proper referrals should not be considered an admission of incompetence but a realization that the child’s need may be best handled elsewhere. 80% of children are excellent patients. There may be some instances when you may want to refer a child to a Pediatric DDS Your comfort level working with children Very young children (<2 yrs with rampant caries needing hospitalization) Developmental disturbances affecting the oral cavity Medically compromised children Congenitally and Developmentally handicapped conditions Severe management problem patients

The Referral Process Discuss the rationale for referring with the parent. Have the receptionist contact the specialist’s office and make the appointment. Communicate with the child specialist. Forward records and radiographs. Your office should receive some communication of the patients condition etc.

Summary Tx Planning is a critical step in the successful treatment of children. It helps sequence the care with proper prioritization of the child’s dental needs. It saves time and energy. “Definitely, definitely” a good idea!