Illustrated Pediatric Dentistry - Part 1

Pediatric dentistry is the only speciality that has an abundance of knowledge for the management and treatment of the oral health care needs of infants and children. Pediatric dentistry concentrates on the integration of appropriate tactics and knowledge of various specialities into a framework of quality oral health care for children. It is necessary to implement procedures that are safe, comprehensive, accessible, affordable, high quality, and respectful for children. The role of a Paediatric dentist is to promote the dental health of children as well as serve as a resource person to the parents.

The emotional development of a child is the progressive process of the child’s ability to control their feelings. The emotions of the child are expressed through facial expressions. Emotions in a child are influenced by their inborn temperament depending on the inherited genes. Crying, laughing, anger, fear, anxiety, or phobia represent different types of emotions. The impact of dental anxiety and fear often leads to avoidance or delay of dental treatment. Moreover, such individuals are difficult to treat and have behavioral problems further resulting in an unpleasant dental experience. All these factors lead to worsening oral health, which often requires complicated dental procedures. Hence, it becomes difficult for the patient to get out of this vicious cycle. Management of such patients is critical and requires careful handling and assessment. Various behaviour management techniques and advanced specialist care in the dental setting can assist fearful patients in attaining optimum oral health and significant overall improvement towards dentistry. 

Child psychology is an important part of paediatric dentistry, which acts as a guide for understanding children who are in different stages of physical, mental, emotional, and social development. Understanding the psychological development of the child helps in professional recognition of the child’s needs, fear and anxiety at each stage which helps in better execution of behaviour management techniques. Child psychology provides an insight into principles of behaviour management that should be tailor-made for each child for effective and efficient dental treatment. This would enable the child to have a better and more pleasant dental visit, and also give the clinician a sense of professional satisfaction and reduce the fatigue in treating an uncooperative child.

Behaviour guidance, earlier known as behaviour management, of the child, is an essential part of paediatric dental practice. Various techniques are used by the dental health team for effective and efficient dental treatment of the child. At the end of the treatment, it is necessary to instil a positive dental attitude in the child’s behaviour. The phrase ‘behaviour management’ has been replaced by ‘behaviour guidance’ in recent days, but both phrases are used as synonyms in most studies. Various behaviour management/guidance techniques can be used independently or in combination to ensure an efficient and effective dental treatment in the child patient. This chapter describes various behaviours of the child and appropriate non-pharmacological behaviour guidance techniques which can be employed by the dental health team for a successful dental treatment, thereby instilling a positive dental attitude in the child. 

Oral disease is one of the most significant global health concerns. Oral diseases have a monetary impact on people in developing countries. Disease can occur at any age and across a variety of demographic and socioeconomic conditions. Dental caries is a chronic microbial disease caused by a variety of factors, including the production of acid by bacteria via carbohydrate fermentation, which causes demineralization of tooth enamel, eventually leading to the loss of tooth structures and pulp infection. Caries is caused by an imbalance between tooth minerals and dental biofilms, which can develop over time in many people. Symptoms of dental caries begin with tooth pain and cavities and can lead to tooth loss. To prevent disease and maintain good oral health conditions, caries risk assessment is critical for controlling the progress of dental caries. Risk assessment is done by performing caries activity tests. Knowing the etiological factors associated with dental caries is important for clinicians and patients to prevent the disease from developing or halt its development and complications.

A balance between demineralization and remineralization is crucial for caries progression. Dental caries can progress if demineralization, which is associated with pathogenic factors, outweighs remineralization, which is linked to protective factors. In some sites, carious lesions are benign, whereas in others they progress and invade deep cavities. Dental caries can be classified according to the site where they occur and their size. Untreated carious lesions can lead to pulpal and periapical diseases. Treatment plan options are based on the diagnosis (pulpal or periapical).

The importance of sugars as a cause of dental caries is underemphasized and not prominent in preventive strategies. Quantitative analysis shows a log-linear doseresponse relationship between sucrose or its monosaccharide intakes and the progressive lifelong development of caries. This results in a substantial dental health burden throughout life. Processed starches have cariogenic potential when accompanying sucrose. Dental diseases impair quality of life and hurt self-esteem, eating ability and health, causing pain, anxiety, and impaired social functioning. So, it was also thought that diet could be controlled or modified, to exert an anti-caries effect. Several experiments, studies and research have been carried out to assess the effect of diet on dental caries.

Early childhood caries (ECC) is a serious and common public health problem affecting young children across the globe. It is prevalent in both developing and developed countries. ECC starts and progresses rapidly in high-risk children. It can lead to various physical, psychosocial and financial consequences for the child and their family, leading to compromised quality of life. There are some factors unique to this type of caries due to the developmental stage and dependence of the child on the mother or caretaker for feeding and oral hygiene practices. The faulty feeding practices can affect the primary dentition severely. ECC also indicates higher risk of caries development in later stages of life.

The disease can be challenging to manage in advanced stages due to limited specialized personnel and resources and behavioral management problems in young children. An effective prevention protocol is our best tool to manage this disease, reducing the burden the healthcare system and society.

Human growth, development, and maturation are multifaceted processes that involve different aspects, including biological, physical, social, and intellectual aspects. Between conception and maturity, the size and complexity of the human body change dramatically. A multitude of changes in sensory, cognitive, and motor coordination are also associated with the development of an individual from infancy to adolescence and are related to brain growth and maturation. All the different facets of development are, however, interrelated. This chapter summarizes the various concepts, principles, theories, factors affecting growth and the parameters used to measure and assess maturity from time to time.

Growth is defined as the normal changes in the amount of living substance. Development refers to all the naturally occurring unidirectional changes in an individual's life, from its existence as a single cell to its elaboration as a multifunctional unit terminating in death. It encompasses the normal sequential events between fertilization and death. Note that development to the biologist refers to the individual in contradistinction to species. The life of the individual does not start as a gamete or zygote, but as primordial germ cells that give rise to gametes. In some invertebrates and plants, life starts from almost any cell which is properly stimulated and maintained. The term multifunctional unit emphasizes the elaboration of multiple functions rather than multiple cellularities. Unidirectional changes continue until death. Therefore, development is a result of a combination of growth, differentiation, and translocation: These terms are not synonymous.

The development of dentition and occlusion is an integral part of craniofacial growth as the formation, eruption, exfoliation, and exchange of teeth occur during this period. It is an assimilation of facts, predictions, and studies in static and dynamic situations, the factors influencing them, and their clinical implications. The development of dentition and occlusion is a dynamic concept. The first sign of tooth development appears late in the third week of intrauterine life. An ideal occlusion is the perfect interdigitation of the upper and lower teeth, which results from a developmental process consisting of three main events, jaw growth, tooth formation, and eruption. Development of occlusion starts before the eruption of first teeth in the oral cavity and lasts lifelong thereafter. 

Study of dental morphology or characteristics refers to phylogenetic data related to different species. The morphology of a tooth is affected by the genetic constitution, environmental factors, habit of digit sucking, and a variety of parafunctional habits. Tooth development is a long process that involves interactions at molecular and cellular levels, which are influenced by environmental, genetic, and epigenetic factors. Human dentition is undergoing constant evolutionary changes. However, these changes are occurring at different rates in different geographical populations. Knowledge and information about the morphological features of each primary tooth are crucial for pediatric operative dentistry and forensic dentistry. The mesiodistal dimensions of individual teeth provide important information related to human evolution. The differences in tooth eruption, shape, and size can reflect the process of evolution and provide a method of studying evolutionary mechanisms. Measurements of teeth and dental arches have been used for the description and comparison of different populations or racial groups.

Teething is a natural process of eruption of the first deciduous teeth. Over the years, teething has been blamed for a wide array of childhood illnesses. Hippocrates (fourth century B.C) and others observed that teething was associated with fever, convulsions, diarrhea, and inflammation of the gums. The association of teething with infant mortality was popular in medieval times. By the twentieth century, the controversy surrounding teething subsided and the morbid conditions initially associated with teeth in infants were found to have other causes. It is assumed that the inflammatory mediators present in the dental follicle are responsible for the local symptoms of teething. The most frequent signs and symptoms associated with teething are irritability, drooling, decreased appetite, sleeping problems, rhinorrhea, fever, diarrhea, rash, and vomiting.

Childhood developmental disorders have serious adverse impacts on the psychological and social well-being of children and their families. Despite the burden that developmental disorders impose on children and adolescents, most countries do not provide satisfactory care to those in need. These developmental disorders can either be present as a single finding or as a part of syndrome. This chapter focuses on the developmental disorders affecting the teeth, tongue, and lip. The spectrum of these developmental disorders varies widely. In each case, the anomaly is first described, followed by diagnostic information, including the availability of various treatment options. Early diagnosis is often crucial for the effective treatment of functional and developmental aspects. This will improve the prognosis for better functional and aesthetic outcome for these patients and lead to a better quality of life, not only for the patients themselves but also for their families.

In children, lesions of the oral mucosa are common, and they can have various clinical signs such as ulceration, changes in the colour of mucosa or the presence of nodular lesions. Some lesions are asymptomatic, whereas others are symptomatic and sometimes even can disturb the routine activities of a child. It is important that, while evaluating the soft tissue lesions, dentists should be able to distinguish between normal, pathological conditions and normal anatomical variations. Sometimes children can present with oral mucosal lesions like those present in adults with a predisposition for some lesions. It was also observed that most of the common oral diseases were dental caries and mucosal diseases associated with cancer treatment. In literature, ere is a scarcity of information about oral lesions in children. This chapter explains various oral mucosal lesions in children along with their clinical presentation and management.