Pediatric 3

In this part of the lecture we will talk about INTRAORAL EXAMINATIONS ( IOE) , these examinations include : 1- THE GENERAL ASSESSMENT >>> which includes : ♦ asessment of speech : in term of ability to talk and pronounce letters properly ,without marked lisp ,especially cleft pts. Or mentally retarded, downs syndrome , deaf pts. ♦ Assessment of TMJ : Range of opening of mouth, deviation ,discomfort or pain. ♦ Assessment of head & neck soft tissues : muscle tenderness, swellings. ♦ lymph nodes : tenderness , swelling. ♦ Lip posture: competence, everted or normal. ♦ Facial profile:convex, concave, straight . ♦Tongue function & rest position: the tongue position during rest is at the floor of the mouth & when we talk it becomes in a labiodental position , some pts. move their tongue abnormally when they talk so they will have what's we call lisping & thrusting.

2- GENERAL ASSESSMENT OF INTRAORAL FEATURES FOR PATHOLOGY :

♦ Lips : we examine the lips in term of >>> * color ( its normally pink, but we still have some physiological

variation btw different people ) ,

** dryness ( usually bcoz of dehydration , 4-example the pt. come to

the clinic & he forget to drink adequate amount of water , or it may be due to a disease in the salivary glands such as sjogren syndrome which affect saliva production & cause xerostomia , also there are some medication which have an effect on the salivary glands ( they found that asthmatic pts. who continuously use ventoline inhaler , have erosions in their teeth & that’s becoz ventoline is one of the medication which decrease saliva production >>>> so acidic food & drinks will have bad effect on teeth >>> erosions will occur, Alyrephen (anti histamine ) is another drug which affect saliva production , so pts. who receive this medication will feel thirst together with drowsiness & if they do not drink adequate amount of water , they will become dehydrated .

*** laceration

**** swelling .

* color ** dryness *** ulcers ♦ Tongue : in term of **** attached frenum ( tongue tie ).

♦ oral mucosa : we examine the palate , cheeks, floor of the mouth , check for inflammation, swelling, white / red patches , ulcers .

♦ periodontium : it includes the cementum, bone , PDL & gingiva ( here in the gingiva we examine >>> * the color , which is normally pink , but if there is inflammation then the gingiva becomes erythmatous & its color becomes red, also if the gingiva has pale color , then we will think of anemia, if it is blue ,then we think of cyanosis .

** stippling , normally the gingiva has stippled architecture , but when there is inflammation , gingiva becomes edematous & loose its normal stippled architecture. If the pt. has cyanosis then it will be noticed firstly by the dentist , becoz cyanosis starts to appear on the oral mucosa ( gingiva , tongue , lips ) , after that it appears on the nails , eyes, etc ……

◄ Oral hygiene : it’s a problem here in Jordan , most of the children have poor oral hygiene which lead to plaque accumulation & calculus formation, many parents don’t know that their children teeth should be brushed !! so our duty as a dentists to construct the parents about their Children oral hygiene , we have to tell them that if their child is less than 2 yrs old & his lower incisors have been erupted ,they have to clean them by GOOSE , * nowadays there are some types of goose which contain XYLITOL & this is good for children becoz xylitol have a good taste & at the same time it can protect their teeth from caries . * Some types of chewing gums also contain xylitol instead of normal sugar & this is better , becoz xylitol cant be fermented by bacteria , so we can protect our teeth against caries …

Xylitol Xylitol occurs naturally in foods in small quantities. Its use at present is confined to confectionery and toothpaste. Xylitol like other sugar alcohol, is caloric, but has been shown to be noncariogenic and to possess the properties of a marketable sweetener. Numerous incubation experiments have demonstrated that Xylitol is fermented to acid very slowly (if at all) in comparison with glucose or even sorbitol. Plaque pH studies confirm the non-acidogenicity of Xylitol. Some laboratory findings suggested that Xylitol also may promote demineralization. At present Xylitol is not available in the United States after animal studies suggested that Xylitol might be carcinogenic.

* When the child becomes 4 or 5 yrs old , he can use the toothbrush & the toothpaste to clean his teeth , but he has to choose the smallest type of toothbrush with fine bristles , ♦ recently a new type of toothbrush has been introduced to the markets which is the electric toothbrush which work with batteries , it’s a good one but not necessary , we can depend on the ordinary hand brush as long as we are using them correctly. ♦ if we use the electric toothbrush , we have to monitor it & move it correctly . ♦ The electric toothbrush is useful in 2 situations : 1- in physically handicapped persons , becoz they cant move the ordinary toothbrush properly. 2- in case of children to encourage them to brush their teeth.

♦ About the toothpaste it should be a special type for children & not to use the adult one. ♦ Some toothpaste companies produce a toothpaste for children from age 0 to 2 yrs & another type for children from age 2 to 6 yrs , then from 6 to 12 yrs , and after 12 yrs children can use the adult type toothpaste >>>>> these types are differ from each other by the concentration of fluoride & by the flavor ( usually the adult type with mint flavor but the children type with fruit flavor) .

♦ The quantity of the toothpaste that we use for the child is very important, when the child is less than 3 yrs we tell his parent to put the proper amount of the tooth paste which is ( 2d 7abet el 3adas ), after 3 yrs we can increase the amount to become ( 2d 7abet el bazeelah ), SO … we

need a minimum amount of the toothpaste just enough to cover the bristles of the toothbrush. ♦ Some parents say that they don’t brush their children teeth becoz they swallow the paste !! we have to tell them that if their child can spit the paste out its OK … , but if he cant & he is using the children toothpaste there is no harm if he swallow it . ♦ It’s the responsibility of the parents to brush their children teeth when they are less than 4 or 5 yrs , but when the child becomes more than 5 yrs , he has to brush his teeth by his own , but under the supervising of his parent , when the child becomes 12 yrs , he should start to brush his teeth alone . ** the way by which the parents can brush their children teeth when they are less than 4 yrs , is by asking them to turn around & lying down with their mouth facing their parents , its an easy way by which the parents can see all the child teeth & brush them correctly …

3- ASSESSMENT OF THE GINGIVA : Gingival index : is an index by which we can determine the stage of gingival inflammation . The mouth is divided into sextants … ( we choose 6 key teeth, 3 in each arch , 2 of them should be buccally ( the 1st molar -6- & the 1st premolar – 4 - & one should be labially which is the 1st central incisor -1- , if we choose the upper right 6 & the upper right 1 & the upper left 4 , then we should choose the opposite in the lower arch y3ne … we have to choose the lower left 6 & the lower left 1 & the lower right 4 ,

in the same arch 6& 1 should be on the same side & 4 on the other side , then we give a grade for each tooth we examine ,then we add these grades together and divide them by 6 to find the average, which is the gingival index ). The grades are : 0 >>> absence of inflammation. 1 >>> mild inflammation ( slight change in color & texture ). 2 >>> moderate inflammation (redness, edema ,bleeding on probing ) 3 >>> sever inflammation ( marked redness , edema , ulceration , spontaneous bleeding).

4- ASSESSMENT FOR ORAL HYGIENE : Debris or oral hygiene index >>> the mouth is divided into sextants ( 2 buccal & 1 labial segment per arch ), the same as

the gingiva ..

0 >>> No debris or stain . 1 >>> soft debris covering no more than 1 /3 of tooth surface. 2 >>> soft debris covering more than 1/3 of tooth surface , but less than 2/3rds . 3 >>> soft debris covering over 2/3rds of tooth surface.( has

very poor oral hygiene ) .

** in case of deciduous teeth we select E instead of 6 , D instead of 4 & A instead of 1. 5- ASSESSMENT OF TEETH : Number >>> count the teeth & compare with age, if their No. less than normal then the case is hypodontia & if the No. more than normal then it is supernumerary.

Morphology >>> micro / macrodontia, fusion , gemination. Color >>> normal , pink ( due to internal resorbtion ), bluish ( due to pulp necrosis or after RCT ) , yellowish ( due to extrinsic staining ), chalky ( becoz of fluorosis ) , brownish . Mineralization defects >>> caused by fluorosis , trauma , systemic illness .

6- ASSESSMENT FOR DENTAL CARIES :

** Methods are >>> Visual : inspecting the caries with good mirror & bright light source after drying the tooth . Probing : tactile examination of the surface with a sharp dental explorer , an area is defined carious when the explorer resist withdrawal after insertion with moderate pressure , in addition there is softness , opacity , discoloration & loss of translucency . ( carious lesion is not always soft , it can be hard ).

** Clinical aids are >>> 1- Bitewing radiographs , especially for interproximal lesions . 2- Transillumination probes . 3- Electronic caries detector ( the conductivity is increased with demineralization ).

7- ORTHODONTIC ASSESSMENT : Facial profile : convex , concave , straight . Teeth / jaw discrepancy : if the teeth are large & the jaw is small then the case is crowding & if the teeth are small in relation to the jaw , then the case is spacing . The remaining slides are not read by the doctor … ‫ا‬

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DONE BY : JAMILEH MOHAMMED HASAN .