Sign In Although in paediatrics, levels of dental decay have fallen significantly since the introduction of fluoride toothpaste in the 1970’s, there remains a large population of children who suffer from an extensively decayed primary dentition. The Public Health England Oral Health Survey of Five-Year-Old-Children 2015 reported on the prevalence and severity of decay nationally. It showed a high dmft in five-year-old children in the North West and a low care index.
Official statistics from https://www.gov.uk/
The care index gives an indication of the restorative activity of dentists in each area. It is the percentage of teeth with decay experience that have been treated by restoration. Care must be taken when interpreting this data as other factors such as deprivation, level of decay and availability of dental services must also be considered.
Being aware of eruption dates is important in paediatric dentistry, because as a clinician you should know what teeth you should expect to see in the patients mouth depending on their age.
If certain teeth are not present that you would normally expect, then this could alter your treatment plan.
Tooth eruption – permanent teeth (years):
Upper 1’s: 7-8
Upper 2’s: 8-9
Upper 3’s: 11-12
Upper 4’s: 10-12
Upper 5’s: 10-12
Upper 6’s: 6-7
Upper 7’s: 12-13
Upper 8’s: 17-21
Lower 1’s: 6-7
Lower 2’s: 7-8
Lower 3’s: 9-10
Lower 4’s: 10-12
Lower 5’s: 11-12
Lower 6’s: 6-7
Lower 7’s: 11-13
Lower 8’s: 17-21
Tooth eruption – primary teeth (months):
Upper A: 7.5
Upper B: 8-9
Upper C: 16-20
Upper D: 12-16
Upper E: 16-20
Lower A: 6.5
Lower B: 7
Lower C: 16-20
Lower D: 12-16
Lower E: 16-20
Completion of root formation – permanent teeth (years):
Upper 1’s: 10
Upper 2’s: 11
Upper 3’s: 13-15
Upper 4’s: 12-13
Upper 5’s: 12-13
Upper 6’s: 9-10
Upper 7’s: 14-16
Upper 8’s: 18-25
Lower 1’s: 9
Lower 2’s: 10
Lower 3’s: 12-14
Lower 4’s: 12-13
Lower 5’s: 13-14
Lower 6’s: 9-10
Lower 7’s: 14-15
Lower 8’s: 18-25
Completion of root formation – primary teeth (months):
Upper A’s: 1.5
Upper B’s: 1-2
Upper C’s: 3
Upper D’s: 2-3
Upper E’s: 3
Lower A’s: 1-2
Lower B’s: 1-2
Lower C’s: 2-3
Lower D’s: 2-3
Lower E’s: 3
- Space Maintenance
- Guidance of eruption
- Mastication
- Aesthetics
- Positive attitude to Dentistry
- Minimise pain/ Infection
- Medical reasons
Acceptable procedures for the pulp endangered by a carious lesion are as follows:
1. Cavity liner/base
2. Indirect pulp therapy
3. Direct pulp capping (permanent teeth only)
4. Vital pulpotomy (Ferric Sulfate or MTA)
5. Pulpectomy
NB – there is no indication for a “non-vital” pulpotomy in Paediatric Dentistry or the use of medicaments such as formocresol or cresophene.
Burs:
- Small flat fissure bur for cavity prep in posterior teeth.
- Flame shaped bur and pear shaped bur for the preparation of conventional crown preparation in primary molars.
Handpieces:
- Air turbine to be used for the preparation of cavities.
- Slow speed with various sizes of round burs to remove caries.
- Paediatric handpieces are preferred.
Cavity preparation:
- Emphasis should be toward minimal preparation, removing only the affected tooth substance.
Quadrant dentistry:
- It should be the aim of every student to practice quadrant dentistry. This will enhance behaviour management by reducing treatment time and need for repeated local analgesia.
Amalgam:
This material is not used in the department of Paediatric Dentistry
Composite resin:
Students are encouraged to use composite resin for the restoration of occlusal cavities and small class II cavities.
Matrix bands must be well approximated to the tooth.
Wedges are mandatory for the restoration of proximal restorations.
Rubber dam is mandatory for all posterior restorations in the Department of Paediatric Dentistry apart from the placement of a PMC using the Hall technique.
Dry dam is mandatory for all anterior restoration in the Department of Paediatric Dentistry.
Indications
Rubber dam is used to ensure moisture control for routine procedures such as fissure sealants, composites and endodontic treatment. Rubber dam is often described to children as ‘raincoat’.
Advantages
- Moisture-free operating field is ideal for the placement of moisture sensitive restorative materials such as composites
- Improves access by retraction of soft tissues including tongue/buccal mucosa
- Improves patient comfort. Patients often feel more secure
- Improves efficiency of restoring multiple teeth (trough technique)
- Reducing the risk of aspiration
- Minimise mouth breathing (especially useful when inhalation sedation is used)
- Reducing cross-infection by minimising aerosol– Even more so with the current situation in the world!
Contraindications
- Latex allergy has been a concern in the past but latex free rubber dam sheets are readily available now.
- LA is mandatory prior to the placement of a rubber dam clamp. Without LA it’s placement is contraindicated.
It is important to choose a correctly-fitting clamp to achieve 4-point contact with the tooth. Otherwise, the clamp is at risk of “pinging” off mid treatment. In general, an fw clamp is the most appropriate clamp for a permanent molar tooth and a dw clamp is the clamp of choice for a primary molar tooth.
Note that these are not winged clamps.
Once you have chosen the appropriate clamp, floss must be placed to prevent the patient swallowing or inhaling it accidentally if it “pings” off.
When practising quadrant dentistry it will be necessary to isolate the entire quadrant. We do this using the “trough” technique.
This differs from single tooth isolation in that up to 6 overlapping holes are made in the centre of the dam.
The rubber dam is secured over the clamp as in the single tooth isolation technique, and is then stretched forward to the mesial of the primary canine tooth.
The dam may be secured mesial or distal to the primary canine using a wooden wedge, dental floss or a rubber wedget.
Anterior teeth are isolated using a dry dam, which is held in place with loops over the patient’s ears. This is a useful technique for endodontic therapy or anterior restorations.
When working under GA it is possible to isolate two quadrants–usually upper and lower at the same time (double dam). This allows the clinician to work faster and reduce the time the patient is under anaesthetic.
Minimal cavity preparation and composite restorations are preferred for the restoration of primary teeth. The remaining susceptible tooth surfaces should be fissure sealed at the same time.
See also Pulp Therapy
