Midtern

-all professionals should give risk assessment, education & prevention by 6 MONTHS OLD

-caregiver should have dental home by 12 MONTHS OLD

-those w caries need diagnosis, tx or referral

-parents

-daycare

-family dentist & pediatric dentist

-dental staff

-primary are prevention

-dental home is BEST

-TALK TO THE PARENTS FIRST!!!!!

-if child gets upset, you will not have the parents attention anymore

-parent needs to know you will not be upset if the kid cries & you shouldnt feel bad if kid cries

-parental brushing

-periodic exam

-normal tooth development

-teething

-non nutritive suck habits

-parents role in exam

-other concerns

-bottle usage & contents

-night time feeding

-sweetened meds

-fluoride exposure

-DONT BE CRITICAL OF THEM!!!

-looking at a large number of healthy infants will make it easier to evaluate caries or pathology in non healthy infants

-good to review the eruption sequence of teeth

-USUALLY ON teeth the ERUPT FIRST

=USUALLY ON: maxillary incisors & first primary molar occlusals

-mandibular incisors are PROTECTED by the tongue & sublingual saliv = NO CARIES

-CAN occur on LINGUALS so you must look/feel there

the YOUNGER the child is, the FASTER the decay process

-supernumerary teeth

-neonatal teeth: present at/near birth, USUALLY primary mand centrals, may be supernumerary, extract for feeing

-trauma

-pulpal infection

-the KNEE to KNEE position is very effective

-use 4-HANDED dentistry

-parents want kid to lie on top of them..this DOES NOT work well

-prepare everything ahead of time

-2 regular chairs FACING eachother

-dental assistant to adjust light & pass instruments

-bite stick or molt mouth prop

-mouth mirror or explorer

-fat handled toothbrush

-fl varnish & applicator

-be quick, focus on childs ORAL condition

-dont compromise your look because child is fussing

-have assistant record

-feet need to be past parents body

-mom/dad should control kids hands

-assistant will pass & record for you

-verbal/behavioral management

-hold & go, restraint, protective stabilization

-nitrous oxide

-oral sedation (healthy kids ONLY)

-general anesthesia (insurance pays for kids up to age 5, can be for healthy or UNhealthy kids

-temperment/behavior of child

-age of child

-length of procedure

-finances

-childs mental/physical status

-parent style & choice

-2% lidocaine with 1:100,000 epi = DOC

-2% lidocaine, plain

-3% mepivacaine (mild dilation, long duration, good for post op pain control)

-health of patient

-weight

-maximum dosage

-concentration of anesthetic (amt in carpule can be 1.7 or 1.8 mL)

2 mg/lb x's 30lb = 60 mg

*2 carpules gives 68 mg of epi which is TOO MUCH

*1.5 carps gives 51 mg of epi which is GOOD

*for a SINGLE primary tooth = typically use 1/3 carpule

1g per 1 ml =1 g/ml

1000 mg per 1 ml = 1000 mg/ml

20 mg per 1 ml = 2%

=.02 (.02 x's 1000 mg/ml)

=20 mg lido per 1 ml of total solution

- 2% = 20 mg/ml

- 1 carpule = 1.7 ml

=(20 mg/ml)(1.7 ml) = 34 mg lido per carpule

*absolute max = 300 mg

*# of 1.7 ml carps --> mg of 2% lido:

-1 carpule = 34 mg

-1.5 carps = 51 mg

-2 carps = 68 mg

-3 carps = 102 mg

-it readilty crosses the BBB & in HIGH levels produces depression of inhibitory pathways

-kids have immature liver & are more sensitive to drug doses

-signs: drowsy, tachycardia, talkative, nausea, vomit, tremors, seizures

INFILTRATION: 2-4 min onset, 1 hr pulpal, 2.5 hrs of soft tissue

BLOCK: 4-8 min onset, 1.5 hrs pulpal, 3-5 hrs of soft tissue

*DO NOT START TO QUICKLY!!!!

INFILTRATIONS: buccal, palatal, intraligamentary, intrapulpal

BLOCKS: inferior alveolar, long buccal, PSA

BUCCAL: ensure that its applied at the apices

PALATAL: accomplished via buccogingival papilla, be sure palatal area is blanched

-use suction & mouth prop

-depth on needle is reduced because ramus is SHORTER VERTICALLY & NARROWER ANTERIOPOSTERIORLY

-level of md foramen is LOWER/ inferior in YOUNGER kids than adults

-do NOT use a LONG 30 gauge BLUE needle for a block on a KID

-needle may break at the HUB

-there is no less pain using a 30 gauge

-USE A 27 GAUGE NEEDLE!!!!!!

*brusing

*post op discomfort

*soft tissue trauma from lip, cheek, tongue biting

-allergy, infection, hematoma, trismus, facial paulsy

-advise parent that kid will be numb for 2 hours

-advise that after it wears off, pt may have discomfort due to tingling feeling

-warn about biting, sucking, pulling etc

-childrens tylenol or motrin prn

= PROFOUND LOCAL ANESTHESIA

*ALTERS pts MOOD, NOT the PATIENT!!!!

DOES: reduces anxiety/fear, anxiolytic, alters memory, amnesiac, reduced pain, analgesic

DOES NOT: reduce defiant behavior, eliminate pain (needs local)

-anxiety

-gagging

-bronchial asthma (dilation of bronchi)

-safe for several medically compromised kids: seizures, epilepsy, sickle cell anemia, just keep oxygen high!

-psychiatric disorders

-claustrophobic pts

-severe behavioral problems

-upper resp infection or obstruction

-COPD

-OTITIS MEDIA

-chronic mouth breathers

-pregnancy

-rapid onset of action within minutes

-rapid peak clinical action

-sedation level & duration can be altered easily by operator

-rapid recovery

-pretty safe with appropriate titration & monitoring

-high cost of equip & refills

-potentiation in combo with other sedatives

-staff training

-some degree of amnesia

-long term over exposure is not conclusive yet

-not for pregos!

-talk with parents about using nitrous

-emphasize safety & oxy supplementation

-can cause nausea

-recommend a light meal

-have kid eat 2 hours BEFORE appt

INTRO: 100% oxygen for 1-2 mins

INDUCTION: 20% with 5% increase for 3-5 mins

INJECTION: 50% nitrous and 50% oxygen

MAINTAINENCE: 30-50% nitrous, adjust according to kids response for rest of tx

WITHDRAWL: 100% oxygen for 3-5 mins

-total flow of 4.5 to 6 liters is adequate

-3 liters of oxygen

-check reservoir bag

-impossible to give anyting less than 20% oxygen thanks to ADA

Tell: funny nose, pilot mask, elephant

Show: on you, assistant, stuffed animal, parent. Unconnected from the hoses

Do: place scent in mask so it doesnt smell, talk with hypnotic voice, breath in/out of nose, tummy up and down

-do you feel a butterfly walking on your hand

-does your tummy feel warm

-in my voice far away

-do you feel like your flying

-EVERY weird feeling is OK except your TUMMY FEELING BAD

10-20%: some sedation will begin like warm tingly feeling

20-30%: numbness of extremities

35-40%: sedation, some analgesic like 15mg morphine, heavy, tranced eyes, distinct but distant noises, numb hands feet thighs

50%: all SUBJECTIVE symptoms INTENSIFIED, except the actual ANALGESIA

over 50%: deep sedation, dangerous!!

-suggestive state

-light headed dizziness

-increased heart rate and peripheral vasodilation

-tingling numbness of hands and feet

-wave of warmth

-feeling euphoria

-lightness or heaviness of extremities

-take off mask

-turn pt towards you on the side initially

-have suction ready

-100% oxygen

-does NOT undergo biotransformation i nthe body

-DIFFUSED out of the blood to the ALVEOLI EASILY

-its EXHALED thru the LUNGS (in 3-5 mins for kids and 10-15 mins in adults)

=occurs if oxygen is turned off and the pt breathes in room air or air in mask

=large volume of nitrous rapidly diffuses out of blood into lungs & prevents diffusion of oxygen in blood

symptoms: headache, nausea, lethargy

**3-5 mins of 100% o2 must be given at end

-abuse of it by health care practitioners

-sexual awareness: consider having a 3rd person in the room at all times

-necessary for proper diagnosis

-parents cannot release the  provider for liability for damages that a xray might have prevented

-if needed, have parent hold film or restrain child during exam

-if needed, have assitant hold film and wear a lead apron

-AAPD requires a clinical exam prior to xray exposure

-attempt to get PRIOR xrays

-take only when theres an expectation that the diagnosis will affect pt care

-use caries risk guidelines for earliest possible repeat set or initial

-initial or periodic oral exam

-post op evaluation

-specific clinical indications

-suspected or visible caries

-suspect pulpal or periapical pathology

-traumatic injuries

-problems with eruption

-developmental anomalies

-unexplained discoloration of teeth

-orthodontic eval

-swelling/fistula

-unexplained mobility of teeth

-used in pedo for surgical cases & clinical panorex cases

-advantages: time efficiency, can manipulate images, easy to save & retrieve

-disadvantages: high replacement costs, high initial set up costs, size of sensors and rigidity

-used primarily for interproximal caries detection, occlusal caries that has penetrated into the dentin and possible caries under existing restorations

-size 2, 1 and 0 in descending order

-use largest film possible (size 2)

-will show: surfaces involved, depth of lesion in relation to pulp, presence or absence of perm teeth

-used primarily to detect normal AND pathologic conditions involving roots of teeth & supporting structures

-will show: furcation, calcified tissues, root or bone resporption, anomalies of supporting bone like cysts, supernum, ectopic teeth

-periapical is more COMMON

-occlusal can be used more advantagiously to see supernumerary teeth, impacted canines, trauma to anterior teeth

-used primarily to provide baseline data for growth & development & to evaluate changes occuring over time

-will show: presence or absence of perm teeth, position of perms in relation to prims, eval of bony lesions, the TMJ

-resolution of pano is less then BW or PA so not good for caries or periapical patho

-needed prior to ortho tx

-tell show do with camera

-match film size to comfort (may do vert)

-get LEAST difficult xray first like ant occlusal film

-have machine ready to go! cant sit still

-may use MEDICAL IMMOBILIZATION selectively for non-compliant or special needs kids who are suspect of caries or pathology

-xrays for special needs or behavior probls are usually done under general anesthesia in hospital or while immoblized for a dental procedure