FUN AND PROFITABLE PEDIATRIC DENTISTRY

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FUN AND PROFITABLEPEDIATRIC DENTISTRY

• Kaneta R. Lott, DDS
• Board Certified Pediatric Dentist
• 404-349-7777

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The dentist and staff must understand that
Pediatric Dentistry is in the Business of
Education.
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The dentist and staff must know,Who is in
Control?

• Have you communicated well with the parent and
  the child?
• How do you neutralize the effect of the parent on
  the child?
• Has the doctor been informed of the staffs
  observations?

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Never say the words hurt, pain, mad, sad,
afraid, scared, stick, needle or shot.
Do say push, tickle, shake, brush, count,
uncomfortable, and pinch.
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Dental Caries Etiology Transmission
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EARLY CHILDHOOD CARIES(Baby Bottle Tooth
Decay/Nursing Caries)

• Initially affects primary maxillary incisors.
• Causes
• Nursing bottle at sleeptime
• Breast feeding (at will) after teeth have erupted
• Continuous use of the sippy cup
• Frequent snacking

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Always smile. Your mood will show.
Only ask those questions that you know will
receive a positive answer.
IF THE PARENT IS AFRAID. THE CHILD WILL ALSO BE
AFRAID.
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Tooth Decay Is Infectious Tooth To Full Body
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Tooth Decay Is Infectious Primary
To Permanent
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Tooth Decay Is Transmissible
Parent To Child
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Tooth Decay Is Transmissible Tooth To Tooth.
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Tooth Decay Begins As White Spots.
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Early Childhood Caries Progresses Rapidly.
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Caries Risk Assessment(Counseling)

• Fluoride History
• Dietary Habit
• Sleeptime Habit
• Medications
• Non-Nutritive Sucking Habits
• Family History
• Oral Hygiene Habits

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TOPICAL FLUORIDE

• 20 TO 40 CARIES REDUCTION
• PROFESSIONALLY APPLIED
• FLUORIDE VARNISH, 2.26
• APF GEL, 1.23
• OVER-THE-COUNTER RINSES
• PRESCRIPTION RINSES AND GELS
• DENTRIFICES
• DIETARY FLUORIDE SUPPLEMENT

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FLUORIDE SUPPLEMENTS

• FORMS
• Drops
• Chewable Tablets
• Tablets
• In combination with vitamins
• DOSAGES
• 0.25 mg
• 0.5 mg
• 1.0 mg

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DIETARY FLUORIDE SUPPLEMENTATION SCHEDULE

• Less than More than
• Age 0.3 ppm F 0.3 0.6 ppm F 0.6
  ppm F
• Birth 6 mos. 0 0 0
• 6 mos. 3 yrs. 0.25 mg 0 0
• 3 yrs. 6 yrs. 0.50 mg 0.25 mg 0
• 6 yrs. Up to 1.00 mg 0.50 mg 0
• at least 16 yrs.

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ORAL HABITS

• Bottles
• Pacifiers
• Digits
• Sippy Cups

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M E D I C A T I O N S
Check sucrose content. Evaluate medicat-ions
taken for chronic conditions.
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A cup with a straw is still a sippy cup!!!!!
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Parents Whos Helping?
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Have nap sack will travel.
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TOOTHBRUSHING TECHNIQUE
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Toothbrushing Should Begin With The Eruption Of
The First Tooth.
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Follow Seven Basic Rules When Treating Children

• Introduce yourself to the parent and to the child
  or children in the same formal tone of voice. It
  is important to establish a level of authority at
  this time.
• Remember that the first impression is the lasting
  impression.
• Always find something about which you can give a
  compliment.

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Follow Seven Basic Rules When Treating Children
(Continued)

• Speak with the parent about the medical history.
• Now is the time to tell the child with the parent
  listening, all of the things that you will be
  accomplishing at this visit. It is very
  important that the parent remains quiet. Use
  words that are age appropriate.

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Follow Seven Basic Rules When Treating
Children(Continued)

• While interviewing the parent it is important to
  remind them that the dental staff will give the
  instructions.
• If the child is two years old or younger, invite
  only one parent into the treatment area with the
  child.

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Separation From Parent

• Separate child from parent at the reception room
  door.
• Reassure child that the parent will wait right
  there until they return.
• Hold the childs hand and lead them into the
  clinical area.
• You may have to pick the child up in order to get
  them into the clinical area.

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Help The Child Into The Chair

• This is the first step to good cooperation.
• Encourage and praise the childs efforts.
• Help but do not place the child in the chair.
• Praise, praise, praise.

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Reclining The Second Test

• Once the child has gotten into the chair the
  second test comes when you try to recline the
  chair.
• Keep the chair reclined at all times.
• Hug and talk while the chair is reclining.

• Your arms and entire body will have to be
  involved.

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Evaluate The Body Language

• Beware of the talkative child.
• Children that give directions and are overly
  confident find it hard to take directions.
• Watch for the fidgety child.
• Look for mood changes.

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Intraoral Examination

• Begin by asking to see the childs tongue.
• The first instrument should be a mirror and a
  tongue blade.
• Be very discrete with the explorer.
• Your assistant should pass it from behind the
  childs head.
• Touch other parts of the mouth and chin before
  you touch the teeth.
• Count out loud.

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Infant - Intraoral Exam

• Parent holds the child in their arms.
• Knee to knee examination with parent.
• You hold baby in the feeding position.

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Your Clinical Staff Can Help

• Send children to the rest room before allowing
  them to get into the chair.
• Block the view of other patients.
• Suggest the use of N2O.
• Do tooth brush prophy.
• Give oral hygiene instructions.

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Your Clinical Staff Can Help (Continued)

• Practice 6 handed dentistry.
• Answer questions honestly Not too many details.
• What are you going to do?
• Is that blood?
• Are you going to give me a shot?

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Restraint May Be Needed

• Hold the knees, you are less likely to get
  kicked.
• Hold the wrists, you will not be surprised.
• Parents are good at doing this job.
• Children often will restrain themselves. This is
  the goal.
• A papoose board may be needed with parental
  consent.
• Older children may need a little encouragement.

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Radiographs On A Three-Year-Old Child Are
Necessary And Possible
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Progressive Decay 18 month Delay
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DENTAL SEALANTS

• Non invasive Procedure
• Preventive
• Seals Deep, Narrow Grooves

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INJECTIONS
Only ask those questions that you know will
receive a positive answer. Always smile. Your
mood will show. IF THE PARENT IS AFRAID. THE
CHILD WILL ALSO BE AFRAID.

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LIP, CHEEK AND TONGUE BITING

• Anesthetize both sides of the same arch.
• Limit lip biting by not treating the upper and
  lower on the same side of the face.
• Protect the lip with a cheek pad between the
  cheek and teeth.

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LIP, CHEEK AND TONGUE BITING

• Warn the parent and limit eating for 1 hour after
  treatment.
• Administer Tylenol or Motrin before the child
  leaves the office.
• Provide palative treatment, it will heal in 5-7
  days.

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LIP BITING PREVENTION

• CHEEK PADS
• PUT THEM IN THE MOUTH UPON EXITING
• GIVE EXTRAS TO PARENT
• TALK WITH THE CHILD

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OPERATIVE TREATMENT

• Never Lie.
• Tell-Show-Do but dont show everything.
• Use nitrous oxide/oxygen and a mouth prop as a
  routine.
• Introduce the handpiece as a whistle.
• Work as quickly as possible.
• Hug before the child departs.
• Consider using the Wand for anesthesia.

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WHEN RUBBER DAMS DONT FIT

• COTTON ROLLS ARE GOOD
• CHEEK PADS ARE BETTER
• CHEEK EXPANDERS HELP
• MOLT MOUTH PROPS ARE ESSENTIAL

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PULPOTOMY

• Indications
• Coronal tissue is infected.
• The radicular pulp tissue is vital
• Objectives
• Maintain vitality of the radicular pulp
• No internal or external resorption
• No pain, sensitivity or swelling

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STAINLESS STEEL CROWNS

• WHY DO PEDIATRIC DENTIST DO SO MANY?

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RAMPANT CARIES
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Indications for Long-Term Provisional Restorations

• Extensive dental procedure
• Compromised medical condition
• Pediatric Considerations
• Economic considerations
• Patient age

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DECALCIFICATION AND/OR ENAMEL
DYSPLASIA
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Attributes of Stainless Steel Crowns

• Maintains Space
• Creates a good marginal seal
• Restores function and occlusion
• Protects remaining tooth structure
• Maintains good gingival health

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SPACE MAINTENANCE

• Retain existing space.
• Prevent additional loss of space.
• Provide restorative appliance for missing teeth.
• Provide esthetic prosthesis.

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Premature Removal of Primary Molar Requires Space
Maintenance
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Offending Tooth - 1st Primary Molar
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Do say push, tickle, shake, brush, count,
uncomfortable, and pinch. Never say the words
hurt, pain, mad, sad, afraid, scared, stick,
needle or shot
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Too Early for Lingual Arch
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Impression of TPA on Tongue
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Space Loss
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Pedo Partial
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Two Tooth Partial
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Two Tooth Pedo Partial
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• Children love to hug.
• Let them.
• You will have a patient for life.

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Items That You Should Keep Handy

• A regular toothbrush
• A comfortable toy
• A blanket
• A molt mouth prop
• Cheek retractors
• Cheek pads
• Love for ALL CHILDREN

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Rewards Stickers and Toys

• Give rewards for good behavior, only.
• Dont give a reward if the unwanted behavior
  continues.
• Never give a reward during treatment. You lose
  your bargaining power.
• Exit the patient immediately after the reward is
  given.
• Brag to the parent about the childs good
  behavior while you show off the reward.
• Give more than one reward for exceptionally good
  behavior.

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Exiting The Patient

• Coach the parent to greet the patient with a
  smile.
• Coach the child to, Let your mom see your
  teeth.
• Allow parent to enter the operatory and escort
  the child to the front desk.
• Stoop down to the childs level and thank them
  for good behavior.

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OUR CHILDREN ARE WHAT WE HAVE TAUGHT THEM TO BE
LottSeminars EDUCATE INSPIRE LEAD Kaneta R.
Lott, D.D.S. Childrens Dentistry with a Lott
of Love.