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 Dentistry
for the
Child
and
Adolescent
RALPH E. McDONALD, DDS, MS
Dean Emeritus and Professor Emeritus
of Pediatric Dentistry
Indiana University School of Dentistry
Indianapolis, Indiana

DAVID R. AVERY, DDS, MSD

Ralph E. McDonald Professor and Director
of Pediatric Dentistry
Indiana University School of Dentistry
James Whitcomb Riley Hospital for Children
Indianapolis, Indiana

JEFFREY A. DEAN, DDS, MSD

Associate Professor of Pediatric Dentistry and Orthodontics
Director, Advanced Education Program in Pediatric Dentistry
Acting Chair, Department of Oral Facial Development
Indiana University School of Dentistry
James Whitcomb Riley Hospital for Children
Indianapolis, Indiana

EIGHTH EDITION

with 710 illustrations

An Affiliate of Elsevier

11830 Westline Industrial

Drive St. Louis, Missouri
63146

DENTISTRY FOR THE CHILD AND ADOLESCENT, EIGHTH E D I T I O N 0-323-02450-5

Copyright © 2004, Mosby, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or

by any means, electronic or mechanical, including photocopying, recording,
or any information storage and retrieval system, without permission in writing
from the publisher. Permissions may be sought directly from Elsevier's Health
Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 238
7869, fax: (+1) 215 238 2239, e-mail: [email protected]. You
may also complete your request on-line via the Elsevier Science homepage (
http://www.elsevier.com), by selecting 'Customer Support' and then '
Obtaining Permissions'.

NOTICE

Dentistry is an ever-changing field. Standard safety precautions must be followed, but as new
research and clinical experience broaden our knowledge, changes in treatment and drug therapy
may become necessary or appropriate. Readers are advised to check the most current product
information provided by the manufacturer of each drug to be administered to verify the
recommended dose, the method and duration of administration, and contraindications. It is the
responsibility of the licensed prescriber, relying on experience and knowledge of the patient, to
determine dosages and the best treatment for each individual patient. Neither the publisher nor the
authors assume any liability for any injury and/or damage to persons or property arising from this
publication.

Previous editions copyrighted 1969, 1974, 1978, 1983, 1988, 1994, 2000

Library of Congress Cataloging-in-Publication Data

Dentistry for the child and adolescent / [edited by] Ralph E. McDonald, David R. Avery,
Jeffrey A. Dean.—8th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-323-02450-5
1. Pedodontics. 2. Youth—Dental care. I. McDonald, Ralph E., 1920- II. Avery, David
R. III. Dean, Jeffrey A., D.D.S.
[DNLM: 1. Dental Care for Children. 2. Pediatric Dentistry—methods. WU 480 D4145 2004]
RK55.C5D44 2004
617.6'45-dc22 2003068648

Executive Editor: Penny Rudolph

Senior Developmental Editor: Jaime Pendill
Publishing Services Manager: Patricia Tannian
Senior Project Manager: Anne Altepeter Book
Design Manager: Gail Morey Hudson

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 Contributors

CHRISTOPHER EDWARD BELCHER, MD DONALD J. FERGUSON, DMD, MSD

Director Professor and Chair, Department of Orthodontics
Pediatric Infectious Diseases Director, Advanced Orthodontic Training
Infectious Diseases of Indiana Program
Indianapolis, Indiana Henry M. Goldman School of Dental Medicine
Boston University
DAVID BIXLER, DDS, PhD Boston, Massachusetts
Professor Emeritus of Oral Facial Genetics
and Medical and Molecular Genetics CHARLES J. GOODACRE, DDS, MSD
Indiana University Dean and Professor, Department of Restorative
Indianapolis, Indiana Dentistry, School of Dentistry
Loma Linda University
DAVID T. BROWN, DDS, MS Loma Linda, California
Professor, Department of Restorative Dentistry
Indiana University School of Dentistry ANN PAGE GRIFFIN, BA Clinical
Indianapolis, Indiana Associate Professor Department
of Family Medicine
DAVID A. BUSSARD, DDS, MS East Carolina University
Assistant Clinical Professor of Oral and Maxillofacial Greenville, North Carolina
Surgery Faculty Associate, Department of Pediatric
Indiana University School of Dentistry Dentistry
Private Practice of Oral and Maxillofacial Surgery College of Dentistry, University of Tennessee
Indianapolis, Indiana Memphis, Tennessee

ROBERT L. CREEDON, DDS LEE M. HARRISON, Jr., DDS, MS

Professor Emeritus Clinical Associate Professor
Department of Pediatrics/Dentistry Department of Pediatric Dentistry
College of Medicine, University of Cincinnati School of Dentistry, Louisiana State University
Director, Division of Pediatric Dentistry (retired) New Orleans, Louisiana
Department of Pediatrics Private Practice of Pediatric Dentistry
Cincinnati Children's Hospital Medical Center Shreveport, Louisiana
Cincinnati, Ohio
JAMES K. HARTSFIELD, Jr., DMD, MS, MMedSci, PhD
ROBERT J. CRONIN, Jr., DDS, MS Professor and Director of Oral Facial Genetics Professor
Professor and Director, Graduate Division of Orthodontics
Department of Prosthodontics Department of Oral Facial Development
The University of Texas Health Science Center at School of Dentistry, Indiana University
San Antonio Dental School Professor, Department of Medical and Molecular
San Antonio, Texas Genetics
School of Medicine, Indiana University
MURRAY DOCK, DDS, MSD, RPh President, Meridian Orthodontics, PC
Associate Professor Indianapolis, Indiana
Department of Pediatrics
College of Medicine, University of Cincinnati ROBERTA A. HIBBARD, MD
Director, Residency Program in Pediatric Dentistry Professor, Department of Pediatrics
Division of Pediatric Dentistry School of Medicine, Indiana University
Cincinnati Children's Hospital Medical Center
Indianapolis, Indiana
Cincinnati, Ohio

ROBERT J. FEIGAL, DDS, PhD RANDY A. HOCK, MD, PhD

Professor and Chair, Department of Preventive Medical Director
Sciences Department of Pediatric Hematology/Oncology and
School of Dentistry, University of Minnesota Pediatric Hospice
Minneapolis, Minnesota St. Vincent Children's Hospital
Indianapolis, Indiana

v
 vi Contributors

DONALD V. HUEBENER, DDS, MS, MAEd JOHN S. McDONALD, DDS, MS, FACD
Professor, Plastic and Reconstructive Surgery Volunteer Professor
Department of Surgery, School of Medicine Departments of Surgery and Anesthesia
Washington University, St. Louis, Missouri Volunteer Associate Professor
Professor, Pediatric Dentistry Department of Pediatrics
School of Dental Medicine
Division of Pediatric Dentistry
Southern Illinois University
College of Medicine, University of Cincinnati
Alton, Illinois
Cincinnati, Ohio
Private Practice of Oral and Maxillofacial
CHRISTOPHER V. HUGHES, DMD, PhD Pathology/Head and Neck Pain
Associate Professor and Chair Cincinnati, Ohio
Department of Pediatric Dentistry
Henry M. Goldman School of Dental Medicine DALE A. MILES, DDS, MS, FRCD(C)
Boston University Professor of Oral and Maxillofacial Radiology
Boston, Massachusetts Associate Dean for Clinical Affairs and Faculty
Development
JAMES E. JONES, DMD, MSD, PhD, EdD Arizona School of Dentistry and Oral Health
Dean and Professor, School of Health Sciences Mesa, Arizona
Indiana University Purdue University
Fort Wayne B. KEITH MOORE, PhD
Fort Wayne, Indiana Professor and Director of Dental Materials
Professor of Pediatric Dentistry Graduate Program
Indiana University School of Dentistry Indiana University School of Dentistry
Indianapolis, Indiana Indianapolis, Indiana

GEORGE E. KRULL, DDS EDWIN T. PARKS, DMD, MS

Private Practice of Pediatric Dentistry Professor of Oral Pathology,
Clarkston, Michigan Medicine and Radiology
Indiana University School of Dentistry
JOHN T. KRULL, DDS Indianapolis, Indiana
Assistant Professor of Pediatric Dentistry
Indiana University School of Dentistry
Private Practice of Orthodontics ALAN MICHAEL SADOVE, MD
Indianapolis, Indiana James Harbaugh Endowed Professor of
Plastic Surgery
Indiana University School of Medicine
THOMAS H. LAPP, DDS, MS Chief, Plastic Surgery
Clinical Assistant Professor of Oral and Maxillofacial James Whitcomb Riley Hospital for Children
Surgery Indianapolis, Indiana
Indiana University School of Dentistry
Private Practice of Oral and Maxillofacial
Surgery BRIAN J. SANDERS, DDS, MS
Indianapolis, Indiana Associate Professor of Pediatric Dentistry
Indiana University School of Dentistry
Director, Clinic Pediatric Dentistry
JASPER L. LEWIS, Jr., DDS, MS James Whitcomb Riley Hospital for Children
Clinical Assistant Professor, Department Indianapolis, Indiana
of Pediatric Dentistry, College of
Dentistry
University of Tennessee AMY D. SHAPIRO, MD
Memphis, Tennessee Medical Director
Clinical Professor, Department of Surgery Indiana Hemophilia and Thrombosis Center, Inc.
Chief of the Division of Dentistry Indianapolis, Indiana
Clinical Assistant Professor
Department of Family Medicine GEORGE K. STOOKEY, MSD, PhD
School of Medicine, East Carolina University Distinguished Professor Emeritus of Preventive and
Private Practice of Pediatric Dentistry Community Dentistry
Greenville, North Carolina Indiana University School of Dentistry
Indianapolis, Indiana
JAMES L. McDONALD, Jr., PhD
Professor of Oral Biology JAMES A. WEDDELL, DDS, MSD
Associate Dean for Dental Education Associate Professor of Pediatric Dentistry
Indiana University School of Dentistry Indiana University School of Dentistry James
Whitcomb Riley Hospital for Children
Indianapolis, Indiana
Indianapolis, Indiana
 Contributors vii

GERALD Z. WRIGHT, DDS, MSD, FRCDIC) KAREN M. YODER, MSD, PhD

Professor Emeritus Associate Professor and Director of Community
The University of Western Ontario Dentistry
London, Ontario, Canada Indiana University School of Dentistry
Secretary General, Indianapolis, Indiana
International Association of Paediatric Dentistry
 Preface

The eighth edition of Dentistry for the Child and a section on anxiety control, pain, and the use of anal-
Adolescent presents current diagnostic and treatment gesics in pediatric dentistry. Chapter 14, Pharmacologic
recommendations based on research, clinical experi- Management of Patient Behavior, has a new lead author
ence, and current literature. This newest edition follows and has been thoroughly reviewed and updated to
the same basic structure and format of the previous provide the latest information regarding sedation tech-
seven editions. The contributors who joined us in niques for children. Chapter 17, Pit and Fissure Sealants
preparation of this latest revision express a coordinated and Preventive Resin Restorations, has undergone a
philosophy in the approach to the most modern major revision; a new co-author has provided fresh
concepts of dentistry for the child and adolescent. The illustrations for the chapter as well. Chapter 18,
information contained herein is relevant to the con- Restorative Dentistry, provides an increased emphasis
temporary science and practice of pediatric dentistry. on the latest restorative materials and in particular on
This textbook is designed to help undergraduate dental the "alternative restorative technique." Treatment
students and postdoctoral pediatric dental students modalities for pulp therapy and trauma have been
provide efficient and superior comprehensive oral incorporated in Chapters 19 and 21 that utilize the new
health care to infants, children, teenagers, and medically science and information associated with molecular biol-
compromised individuals. It also provides experienced ogy, in an attempt to maintain the vitality of the tissues
dentists with reference information regarding new associated with these treatments whenever possible.
developments and techniques. Chapter 23, Dental Problems of Children with
Chapter 2, Child Abuse and Neglect, includes an up- Disabilities, and Chapter 24, Management of the
to-date overview of this topic and management of Medically Compromised Patient, have been updated
documentation and reporting requirements. In addi- and revised to include information regarding the dental
tion, the chapter contains several new photographs to management of patients with sickle cell anemia. The
help illustrate this societal problem. Chapter 5, latest information on the incorporation of early
Radiographic Techniques, includes new information on orthodontic treatment has been added to Chapter 27,
the use of digital radiography in pediatric dentistry. Management of the Developing Occlusion, and a new
Chapter 6, Clinical Genetics for the Dental Practitioner, co-author has helped with Chapter 28, Multi-
has a new lead author and provides updated informa- disciplinary Team Approach to Cleft Lip and Palate
tion in several topic areas, particularly in genetic influ- Management. In particular, the protocols developed by
ence on external apical root resorption associated with the American Cleft Palate—Craniofacial Association
orthodontic treatment. Theories relating to the molecu- have been incorporated. And finally, Chapter 29,
lar biology of tooth eruption are provided in Chapter 9. Practice Management, has been revised significantly
Chapter 10, Dental Caries in the Child and Adolescent, and Chapter 30, Community Oral Health, has been
has been reformatted and presents much new informa- completely rewritten.
tion to reflect contemporary knowledge and manage-
ment of the disease as well as an increased emphasis on Ralph E. McDonald
early childhood caries. Chapter 13, Local Anesthesia for David R. Avery
the Child and Adolescent, has been expanded to include Jeffrey A. Dean

ix
 Acknowledgments

A textbook can be planned and written only with the editor; Jaime Pendill, senior developmental editor; and
supportive interest, encouragement, and tangible Anne Altepeter, senior project manager.
contributions of many people. Therefore, it is a privilege The faculties of pediatric dentistry and other disciplines
to acknowledge the assistance of others in the prepara- at Indiana University have contributed substantially to
tion of this text. First of all, we would like to thank the this work in many ways. We truly appreciate their
many authors and co-authors who have made this willingness to share information relevant to scientific
eighth edition possible. Donna Bumgardner and accuracy of the manuscripts. In particular, we gratefully
Elizabeth Holsapple provided manuscript preparation acknowledge Drs. Michael Baumgartner, Howard Eigen,
and valuable editorial assistance. Mark Dirlam, Kyla Margherita Fontana, Richard Gregory, Michelle
Jones, Tom Meador, and Terry Wilson provided assis- Howenstine, Vanchit John, Gopal Krishna, Chris Miller,
tance with new illustrations. Our excellent library staff John Rau, Paul Walker, and Susan Zunt. Many pediatric
was eager to help in any way possible, and the assis- dentistry postdoctoral students and auxiliary staff have
tance of Susan Beane, Janice Cox, Amy Edwards, Sue also assisted in numerous ways. The encouragement
Hutchinson, and Kirk Smith is much appreciated. We and support of all members of our families sustained our
also gratefully acknowledge the professional staff at resolve to complete this task when it seemed that it
Elsevier who has provided valuable assistance and would not get done. We extend our heartfelt thanks to all
superb guidance in the publication of this eighth edition; who played a role in helping us bring this project to a
special thanks to Penny Rudolph, executive successful conclusion.

xi
 Contents

1 Examination of the Mouth and Other 12 Nutritional Considerations for the

Relevant Structures, 1 Pediatric Dental Patient, 257
RALPH E. McDONALD, DAVID R. AVERY, AND JAMES L. McDONALD, Jr.
JEFFREY A. DEAN
13 Local Anesthesia and Pain Control for the
2 Child Abuse and Neglect, 23 Child and Adolescent, 270
ROBERTA A. HIBBARD AND BRIAN J. SANDERS RALPH E. McDONALD, DAVID R. AVERY, AND
JEFFREY A. DEAN

3 Nonpharmacologic Management of Children's

Behaviors, 33 14 Pharmacologic Management of Patient
GERALD Z. WRIGHT Behavior, 285
MURRAY DOCK AND ROBERT L. CREEDON

4 Development and Morphology

of the Primary Teeth, 50 15 Hospital Dental Services for
RALPH E. McDONALD AND DAVID R. AVERY Children and the Use of General
Anesthesia, 312
5 Radiographic Techniques, 59 JAMES A. WEDDELL AND JAMES E. JONES
DALE A. MILES AND EDWIN T. PARKS
16 Dental Materials, 333
6 Clinical Genetics for the Dental Practitioner, 79 B. KEITH MOORE AND DAVID R. AVERY
JAMES K. HARTSFIELD, Jr. AND DAVID BIXLER
17 Pit and Fissure Sealants and Preventive
7 Acquired and Developmental Disturbances Resin Restorations, 353
of the Teeth and Associated Oral BRIAN J. SANDERS, ROBERT J. FEIGAL,
Structures, 103 AND DAVID R. AVERY

RALPH E. McDONALD, DAVID R. AVERY, AND

JAMES K. HARTSFIELD, Jr. 18 Restorative Dentistry, 364
RALPH E. McDONALD AND DAVID R. AVERY
8 Tumors of the Oral Soft Tissues and Cysts
and Tumors of the Bone, 148 19 Treatment of Deep Caries, Vital Pulp
JOHN S. McDONALD Exposure, and Pulpless Teeth, 388
RALPH E. McDONALD, DAVID R. AVERY,
9 Eruption of the Teeth: Local, Systemic, and AND JEFFREY A. DEAN
Congenital Factors That Influence the
Process, 174 20 Gingivitis and Periodontal Disease, 413
RALPH E. McDONALD, DAVID R. AVERY, AND RALPH E. McDONALD, DAVID R. AVERY,
JEFFREY A. DEAN AND JAMES A. WEDDELL

10 Dental Caries in the Child and 21 Management of Trauma to the Teeth and
Adolescent, 203 Supporting Tissues, 453
RALPH E. McDONALD, DAVID R. AVERY, AND RALPH E. McDONALD, DAVID R. AVERY,
GEORGE K. STOOKEY AND JEFFREY A. DEAN

11 Mechanical and Chemotherapeutic 22 Prosthodontic Treatment of the

Home Oral Hygiene, 236 Adolescent Patient, 504
JEFFREY A. DEAN AND CHRISTOPHER V. HUGHES CHARLES J. GOODACRE, ROBERT J. CRONIN, Jr.,
AND DAVID T. BROWN
 xiv Contents

23 Dental Problems of Children with 27 Management of the Developing

Disabilities, 524 Occlusion, 625
JAMES A. WEDDELL, BRIAN J. SANDERS, JEFFREY A. DEAN, RALPH E. McDONALD, AND
AND JAMES E. JONES DAVID R. AVERY

24 Management of the Medically Compromised 28 Multidisciplinary Team Approach to Cleft Lip

Patient: Hematologic Disorders, Cancer, and Palate Management, 6 8 4
Hepatitis, and AIDS, 5 5 7 JAMES E. JONES, ALAN MICHAEL SADOVE,
BRIAN J. SANDERS, AMY D. SHAPIRO, RANDY A. HOCK, JEFFREY A. DEAN, AND DONALD V. HUEBENER
JAMES A. WEDDELL, AND CHRISTOPHER EDWARD BELCHER

29 Practice Management, 712

25 Growth of the Face and Dental Arches, 5 8 0 ANN PAGE GRIFFIN, LEE M. HARRISON, Jr.,
DONALD J. FERGUSON AND JASPER L. LEWIS, Jr.

26 Cephalometrics and Facial Esthetics: 30 Community Oral Health, 739

the Key to Complete Treatment Planning, 5 9 8 KAREN M. YODER
JOHN T. KRULL, GEORGE E. KRULL, THOMAS H. LAPP,
AND DAVID A. BUSSARD
Examination of the
Mouth and Other
Relevant Structures
RALPH E. McDONALD

DAVID R. AVERY

JEFFREY A. DEAN

1
0
INITIAL PARENTAL CONTACT WITH THE INFANT DENTAL CARE
DENTAL OFFICE DETECTION OF SUBSTANCE ABUSE
THE DIAGNOSTIC METHOD Etiologic Factors in Substance Abuse Specific
PRELIMINARY MEDICAL AND DENTAL HISTORY Substances and Frequency of Use
CLINICAL EXAMINATION TEMPOROMANDIBULAR SUICIDAL TENDENCIES IN CHILDREN AND
EVALUATION UNIFORM DENTAL RECORDING ADOLESCENTS
RADIOGRAPHIC EXAMINATION INFECTION CONTROL IN THE DENTAL OFFICE
EARLY EXAMINATION Biofilm
EMERGENCY DENTAL TREATMENT

1
1
 CHAPTER 1 Examination of the Mouth and Other Relevant Structures

initial communication with parents is presented in

Chapter 29.
dentist is traditionally taught to perform a com-
plete oral examination of the patient and to develop a THE DIAGNOSTIC METHOD
treatment plan from the examination findings. Then the Before making a diagnosis and developing a treatment
dentist makes a case presentation to the patient or plan, the dentist must collect and evaluate the facts
parents, outlining the recommended course of treat- associated with the patient's or parents' chief concern
ment. This process should include the development and and any other identified problems that may be unknown
presentation of a prevention plan that outlines an to the patient or parents. Some pathognomonic signs
ongoing comprehensive oral health care program for the may lead to an almost immediate diagnosis. For exam-
patient and establishment of the "dental home." ple, obvious gingival swelling and drainage may be
The plan should include recommendations designed to associated with a single, badly carious primary molar.
correct existing oral problems (or halt their progression) Although the collection and evaluation of these associ-
and to prevent anticipated future problems. It is essential ated facts are performed rapidly, they provide a diag-
to obtain all relevant patient and family information, to nosis only for a single problem area. On the other hand,
secure parental consent, and to perform a complete a comprehensive diagnosis of all the patient's problems
examination before embarking on this comprehensive or potential problems may sometimes need to be post-
oral health care program for the pediatric patient. poned until more urgent conditions are resolved. For
Anticipatory guidance is the term often used to describe example, a patient with necrotizing ulcerative gingivitis or
the discussion and implementation of such a plan with a newly fractured crown needs immediate treatment, but
the patient and/or parents. The American Academy of the treatment will likely be only palliative, and further
Pediatric Dentistry has published guide-lines concerning diagnostic and treatment procedures will be required
the periodicity of examination, preventive dental later.
services, and oral treatment for children as summarized The importance of thoroughly collecting and evaluat-
in Fig. 1-1. ing the facts concerning a patient's condition cannot be
Each pediatric patient should be given an opportunity overemphasized. Moskow and Barr' have described
to receive complete dental care. The dentist should not several examination methods that aid the dentist in this
attempt to decide what the child, parents, or third-party process.
agent will accept or can afford. If parents reject a portion The following list of methods is based largely on their
or all of the recommendations, the dentist has at least chapter "Examination of the Patient" in Current Therapy
fulfilled the obligation of educating the child and the in Dentistry:
parents about the importance of the recommended
procedures. Parents of even moderate income will usually • Medical and dental history taking
find the means to have oral health care completed if the • Inspection
dentist explains to them that the child's future oral • Palpation
health and even general health are related to the • Auscultation
correction of oral defects. • Exploration
• Radiography
INITIAL PARENTAL CONTACT • Percussion
WITH THE DENTAL OFFICE • Transillumination
The parent usually makes the first contact with the • Vitality tests
dental office by telephone. This initial conversation • Study casts
between the parent and the office receptionist is very • Laboratory tests
important. It provides the first opportunity to attend to • Photography
the parent's concerns by pleasantly and concisely
responding to questions and by offering an office In certain unusual cases all of these diagnostic aids
appointment. The receptionist must have a warm, may be necessary to arrive at a comprehensive diagno-
friendly voice and the ability to communicate clearly. The sis. Certainly no oral diagnosis can be complete unless
receptionist's responses should assure the parent that the diagnostician has evaluated the facts obtained by
the well-being of the child is the chief concern. medical and dental history taking, inspection, palpation,
The information recorded by the receptionist during exploration (if teeth are present), and often imaging (
this conversation constitutes the initial dental record for radiographs, etc.). For a more thorough review of eval-
the patient. Filling out a patient information form is a uation of the dental patient, the reader is referred to the
convenient method of collecting the necessary initial chapter by Glick, Siegel, and Brightman in the textbook
information (see Fig. 29-2). Additional discussion of the Burket's Oral Medicine.
 4 Dentistry for the Child and Adolescent

Guidelines on Periodicity of E x a m i n a t i o n , 3. Provide topical fluoride treatments every 6 months or as

Preventive D e n t a l Services, Anticipatory indicated by the individual patient's needs.
G u i d a n c e , a n d O r a l Treatment for Children, 2 - 6 Years
Revised M a y 2 0 0 0 1. Repeat 12- to 24-month procedures every 6 months or
as indicated by the individual patient's needs/sus-
Birth-12 Months ceptibility to disease. Provide age-appropriate oral
1. Complete the clinical oral assessment and appropriate hygiene instructions.
diagnostic tests to assess oral growth and development 2. Complete a radiographic assessment of pathology
and/or pathology. and/or abnormal growth and development, as indi-
2. Provide oral hygiene counseling for parents, guardians, cated by the individual patient's needs.
and caregivers, including the implications of the oral 3. Scale and clean the teeth every 6 months or as indi-
health of the caregiver. cated by the individual patient's needs.
4. Provide topical fluoride treatments every 6 months or
3. Remove supra- and subgingival stains or deposits as as indicated by the individual patient's needs.
indicated. 5. Provide pit and fissure sealants for primary and per-
4. Assess the child's systemic and topical fluoride status ( manent teeth as indicated by the individual patient's
including type of infant formula used, if any, and needs.
exposure to fluoridated toothpaste), and provide 6. Provide counseling and services (athletic mouth guards)
counseling regarding fluoride. Prescribe systemic fluo- as needed for or ofacial trauma prevention.
ride supplements if indicated, following assessment of 7. Provide assessment/treatment or referral of developing
total fluoride intake from drinking water, diet, and oral malocclusion as indicated by the individual patient's
hygiene products. needs.
5. Assess appropriateness of feeding practices, including 8. Provide diagnosis and required treatment a n d / o r
bottle feeding and breast-feeding, and provide appropriate referral for any oral disease, habits, or
counseling as indicated. injuries as indicated.
6. Provide dietary counseling related to oral health. 9. Assess speech and language development, and provide
7. Provide age-appropriate injury prevention counseling appropriate referral as indicated.
for orofacial trauma. 6 - 1 2 Years
8. Provide counseling for non-nutritive oral habits (e.g., 1. Repeat 2- to 6-year procedures every 6 months or as
digit, p acifiers). indicated by the individual patient's needs/susceptibility
9. Provice diagnosis and required treatment an d/ o r to disease.
appropriate referral for any oral diseases or injuries. 2. Provide substance abuse counseling (e.g., smoking,
10. Provide anticipatory guidance for smokeless tobacco).
parent/guardian. 1 1. Consult with the child's 1 2 - 1 8 Years
physician as indicated. 1. Repeat 6- to 12-year procedures every 6 months or as
12. Based on evaluation and history, assess the patient's indicated by the individual patient's needs/susceptibil-
risk for oral disease. ity to disease.
13. Determine interval for periodic reevaluation. 2. At an age determined by the patient, parent, and
dentist, refer the patient to a general dentist for
1 2 - 2 4 Months continuing oral care.
1. Repeat birth to 12-month procedures every 6 months or
as indicated by the individual patient's needs/
susceptibility to disease.
2. Review patient's fluoride status, including any child
care arrangements that may affect systemic fluoride
intake and provide parental counseling.

f I G. 1-1. General oral health care guidelines for children.

ask the questions informally and then to present the

PRELIMINARY MEDICAL AND findings to the dentist and offer personal observations
DENTAL HISTORY and a summary of the case. The questions included on
It is important for the dentist to be familiar with the the form will also provide information about any previ-
medical and dental history of the pediatric patient. ous dental treatment.
Familial history may also be relevant to the patient's oral Information regarding the child's social and psycho-
condition and may provide important diagnostic logic development is important. Accurate information
information in some hereditary disorders. Before the reflecting a child's learning, behavioral, or communica-
dentist examines the child, the dental assistant can tion problems is sometimes difficult to obtain initially,
obtain sufficient information to provide the dentist with especially if the parents are aware of their child's devel-
knowledge of the child's general health and can alert the opmental disorder but are reluctant to discuss it.
dentist to the need for obtaining additional information Behavior problems in the dental office are often related
from the parent or the child's physician. The form to the child's inability to communicate with the dentist
illustrated in Fig. 1-2 can be completed by the parent. and to follow instructions. This inability may be attrib-
However, it is more effective for the dental assistant to utable to a learning disorder. An indication of learning
 C H A P T E R 1 Examination of the M o u t h and Other Relevant Structures

[ I G 1-2. F o r m used in c o m p l e t i n g the p r e l i m i n a r y m e d i c a l a n d d e n t a l history. Continued

disorders can usually be obtained by the dental assis- A notation should be made if a young child has been
tant while asking questions about the child's learning hospitalized previously for general anesthetic and
process; for example, asking a young school-aged child surgical procedures. Shaw has reported that hospital-
how he or she is doing in school is a good lead question. ization and a general anesthetic procedure can be a
Remember, though, to keep the questions age- traumatic psychologic experience for a preschool child
appropriate to the child. and may sensitize the youngster to procedures that will
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