INTRODUCTION TO PEDIATRIC DENTISTRY HISTORICAL PERSPECTIVES DEFINITIONS AIMS

Ø INTRODUCTION TO PEDIATRIC DENTISTRY Ø HISTORICAL PERSPECTIVES Ø DEFINITIONS Ø AIMS Ø OBJECTIVES Ø SCOPE Ø SETTING UP OF PEDIATRIC DENTAL CLINIC Ø MODIFICATIONS OF PEDIATRIC DENTAL CLINIC FOR HANDICAPPED CHILD

INTRODUCTION ØPediatric dentistry is synonymous with dentistry for children, it exists because children have dental and orofacial problems. ØPedodontics is the branch of dentistry concerned with providing comprehensive dental care and treatment for the child patient. ØPedo is derived from the word “Pais” which in Greek means child, “Dontics” stands for the study of tooth. ØPediatric dentistry does in fact borrow a lot from other disciplines, but beyond this borrowing it is a discipline unto itself.

Ø The notion that the baby teeth don’t deserve care because you lose them anyway is largely disappearing. Ø Previously because of the behavioral reasons and the inability of the clinician and the child patient to communicate the customary age of the first dental appointment was on or after the third birthday. Ø Currently the recommendation for the first dental appointment is before the first birthday.

Ø The child is not just a miniature adult but a dynamic organism undergoing constant mental, physical, and emotional changes. Ø The very specific problems of child management and the understanding of the complexities of growth and development are but two of the issues that delineate pediatric dentistry as a specialty in its own right.

HISTORICAL PERSPECTIVES Ø From extraction oriented beginnings, Pediatric Dentistry phased into an era of decay interception with an emphasis on diagnostic procedures and the maintenance of arch integrity in instances of tooth loss. Ø Restorative techniques, pulpal therapy, space maintenance, and interceptive orthodontics are the main theme of this era along with the emphasis for prevention.

Ø Father of Pedodontics: Robert Bunon Ø Father of Pedodontics in India: Dr. B. R. Vacher Ø The foundation of Pedodontics in India was laid down in Amritsar Govt. Dental College in 1950 Ø DCI recognized it as a separate entity in 1988

A child differs from an adult in various ways: • Physical • Emotional and psychological • Behavior • Type of treatment • Dentist - patient relationship • Parent - dentist relationship

DEFINITIONS (Stewart, Barber, Troutman, Wei 1982); “Pediatric dentistry is the practice and teaching of comprehensive preventive and therapeutic oral health care of child from birth through adolescence. It is construed to include care for special patients who demonstrate mental, physical or emotional problems. ” (American Academy of Pediatric Dentistry 1999); “Pediatric dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. ”

AIMS Ø Total physical, mental and emotional well being of patients. Ø To improve knowledge by knowing latest techniques and equipments. Ø To begin the oral care of the child from the expectant mothers. Ø Early diagnosis and treatment in order to eradicate oral diseases. Ø To observe and control developing dentition problems. Ø To relieve pain and sepsis. Ø Encourage the dental profession to use preventive method and resources so that children of future generation will have less dental problems.

OBJECTIVES 1. Create not only a good oral health in the child but also a good citizen tomorrow. 2. Instill a positive attitude and behavior in children. 3. Understand the principles of prevention and preventive dentistry right from birth to adolescence. 4. Guide and counsel the parents in regards to various treatment modalities including different facets of preventive dentistry. 5. Prevent and intercept developing malocclusion.

SCOPE OF PEDODONTICS Ø The scope refers to the range of activities considered in the practice of Pedodontics. In addition to be knowledgeable about the dental needs of the child patient, basics in the pediatric medicine, general and oral pathology, growth and development and child psychology also need to be known. Ø Regarded objectively, the pediatric dentist has the scope for a far wider and more meaningful career than any other dental specialist.

SCOPE COMPRISES OF: 1. 2. 3. 4. 5. 6. 7. 8. Preventive dentistry Public health dentistry Child psychology and management Clinical dentistry Preventive and interceptive orthodontics Special care dentistry Child abuse and neglect Genetics in pediatric dentistry

SETTING UP OF A PEDIATRIC DENTAL CLINIC Ø An office run in a disorderly, disorganized manner is wasteful and reduces the quantity and probably the quality of service provided. Ø Good practice management increases productivity and quality of care while reducing stress to the dentist and the staff.

DENTAL CLINIC ENVIRONMENT Ø The ideal office/clinic should be easy to approach for self, staff and patients with ample car parking. Ø An attractive and comfortable environment should be designed for both children and parents. Ø Decorations and themes depicting definite settings such as the circus, the outer space, or nursery rhymes add to the warmth and fantasy of the office and tend to dispel fear. Ø Certain dental drawings used in conjunction with different procedures to be displayed.

Ø Solid bright colors establish a cheerful feeling of belonging. Ø Fully carpeted suites can be used to create a softer look. Ø Pictures, wall coverings, and other decorations provide warmth. Ø An aquarium is always a source of entertainment and may be placed either in the reception room or in the treatment room where it is visible to the child in the chair. Ø An audiovisual system is used for child entertainment, as well as patient education.

BASIC FLOOR PLANS AND TRAFFIC PATTERNS Ø It is essential to analyze the circulation patterns within the different areas of the office as a whole as well as within each operatory so that bottlenecks are avoided. Ø It is advisable to have more than one operatory for each dentist to reduce time wasted between patients and in resetting the operatory. Ø If more than one operatory is used color coding of the instruments to each room will permit easy identification and replacement after cleaning.

RECEPTION AREA Ø The decoration should be appealing and require little rearranging and reorganizing. Ø Light should be good enough for reading but safe and fastened to avoid accidents. Ø If fish tank is kept, it should be enclosed to avoid damage by children. Ø If a bulletin board is used it should be regularly updated.

Ø Toys or books that can easily soil and break are inappropriate. Ø Patient education material can be displayed to be read or to be taken home. Ø Soothing muffled music in the reception room has a comforting effect on both parent and the patient. Ø Children are attracted to colorful books and magazines. Ø Cookery books for mothers.

RECEPTION AREA

BUSINESS AREA Ø It is the major area of activity, must be well planned. Ø Neat and uncluttered. Ø Ample storage facilities. Ø Carefully selected lighting. Ø Adequate for all the people who use it.

OPERATORY

LABORATORY AND RADIOGRAPHIC PROCESSING AREA Ø Depends on needs of the office and type of machine used. Ø Some offices even have small developing units in the master operatory. Ø Laboratory space is necessary for pouring of models and their preparation. Ø Size of this area directly depends on the amount of such work done. Ø A good storage area and good retrieval system is necessary.

HEALTH EDUCATION/PRIVATE OFFICE AND CONSULTATION ROOM Ø Space should be allocated in the dental office where the child and the parents can be given proper instructions. Ø Used for discussion of details such as type of infection, severity, reasons for pain, nature of defects, treatment plans with patients and parents. Ø Dietary counseling can be given in this room. Ø Should be pleasant and quiet with a view box. Ø If educational films are provided for instruction, a separate space is set aside for this purpose.

EQUIPMENT Ø The arrangement and selection is a matter of personal preference and available space. Ø The equipment should be such to give the child a sense of security and to allow the dentist to restrain if necessary. Ø If adult chair is used special types of inserts may be necessary. Ø Working table can be kept in front or behind the child. The major advantage of keeping it behind is instruments will not ‘fly’ due to unexpected patient movement.

Ø The chair selected for at least one operatory should permit easy wheel chair transfer of patients so that handicapped children can be treated. Ø Doorways wide enough for wheel chairs should be provided. Ø Hygienic considerations should play an important part in equipment selection. ØThe equipment should be functional, with good technical performance, as simple as possible, and have high safety standards.

PROPER MAINTENANCE OF CLINIC The flooring, walls, ceilings and all the surfaces of the equipment and instruments and cabinets must be made of such materials so that they can be very easily maintained.

EFFECTIVE INFECTION CONTROL MEASURES Ø To protect the dentists self by using good quality gloves, masks, protective eye glasses etc. Ø To protect the patients from cross contamination by making sure that all the instruments are properly sterilized. Ø The infection control must be given utmost importance.

AUXILIARY PERSONNEL Ø It includes; • Office assistant • The front desk manager/receptionist • Dental hygienist ØThey are the first personnel to have contact with the patient and his or her family. Ø It is important that they communicate well with parents and patients and are prepared to handle telephone calls and questions promptly and properly.

Ø A child should never be left alone in the operatory if the dentist must leave, the assistant should remain with the child. Ø Help from the chair side assistant decreases the number of steps and movement necessary resulting in less fatigue to the dentist. Ø It decreases the length of the dental appointment thus aiding in child management.

INITIAL COMMUNICATION WITH THE PARENTS Ø The receptionist should project true interest in the child patient. Ø Friendly telephone voice conveys a cordial feeling toward the patient. Ø The patients full name and nickname, both the parents names, address and telephone number should be recorded by the receptionist.

CONSENT Ø A signed written consent to treatment is the most substantial consent for protecting a dentist from litigation. Ø Also taken before any complicated diagnostic or invasive procedures, anesthesia, and surgery. Ø In rare circumstances such as life threatening emergencies, on a court order or on request of the police consent can be taken later. Ø Should be in local language and signed by the parents or guardians.

MANAGEMENT OF TIME/APPOINTMENT Ø Guide the parents in choosing the most desirable hour for the child’s appointment. Ø Morning appointments are preferable in a young patient. Ø The length of the appointment should be short(30 -40 min). Ø Well planned and effectively designed appointment book. Ø The daily schedules should include the name of the patient, length of time reserved, the type of work expected to be performed, and how many members of the family are in treatment at the same time. Ø Allotment of time for emergency is convenient. Ø Longer appointments may be scheduled first with shorter appointments around the longer ones.

OFFICE COMMUNICATION SYSTEM Ø Receptionist who answers telephone should do promptly and pleasantly. Ø Should be trained in obtaining and collecting information and determining whether emergency appointment is required. Ø More information should be obtained when the patient arrives for the first visit. Ø After office hours electronic answering devices permit adequate continuity of services. Ø Intercom system which relays information through signs or numbers rather than voice is highly desirable.

SUITABLE RECORD SYSTEM Ø It is legally mandatory to keep proper records. Ø It is important that the system selected should not become too cumbersome if enlarged. Ø Photographs provide a ‘before’ and ‘after’ record of the treatment and may be particularly useful if malocclusion has to be evaluated at regular intervals. Ø This must cover the Medical history, chief complaint, investigation advised and carried out, diagnosis plan and treatment plan, appointment schedule, and fee chargeable and recovered. Ø Computer and good software can have a remarkable use.

SETTING OF FEES AND COLLECTION Ø Fee should be uniform for all patients. Ø The fees must be revised from time to time. Ø A rational method for determining the fee and payment system should be followed

RECALL SYSTEM Ø A good periodic recall system is the best method of maintaining good preventive programs and assuring adequate care of teeth and previous dental care. Ø It is a means of educating patients and parents in maintaining good dental health and periodic evaluation of dental conditions.

ACCOUNTABILITY Dentist is morally, ethically, and legally accountable to the patient in particular and the society in general.

HANDLING THE CHILD IN THE DENTAL CHAIR Ø The assistant sits across the chair from the dentist completely. Ø The dentist operates in a sitting position on a comfortable, contoured stool. Ø Everything needed for any specific procedure is within easy reach without leaving the chair. Ø All instruments are handed to and removed from the dentist’s hand by the assistant. Ø The concept of “four handed dentistry” implies that the assistant’s hands are constantly employed.

PEDIATRIC PRACTICE BUILDING Ø The longer a dentist is in practice, the greater becomes the average of the patients he treats. Ø Use of regular and frequent family educational mailers like; - holiday greetings with list of low carbohydrate recipes. - seasonal mailer recommending use of mouth guards during summer holidays etc. Ø Encouraging patients to call office any time in case of emergency.

Ø Children love receiving mail in their names and will be receptive to any form of direct communication. Ø The pediatricians, family physicians, and other health care providers should be approached and informed of the recommended pediatric oral services available in the office. Ø Undoubtedly the main factor is the quality oriented pediatric care with obvious concern for those children under his supervision.

MODIFICATION OF OFFICE DESIGN FOR HANDICAPPED PATIENTS Dentists must be sensitive to the needs of handicapped and should be prepared to modify treatment areas to accommodate handicapped patients who desire dental treatment.

OFFICE LOCATION Ø Ideally office should be located on the ground floor. Ø Should include evaluation of the surrounding i. e. - ramped walkways into the building - wide sidewalks with gentle slopes - pressurized or heavy doors - nonskid surfaces - handrails

PARKING Ø Reserved spaces should be provided close to office entry or near ramped areas. Ø These spaces should be wide enough to allow vans with automatic lifts to unload.

PARKING

DOORWAYS Ø Should have a minimum clear opening of 32 inches. Ø Adjacent areas on either side of the door should provide enough room to turn a wheelchair around. Ø Spring operated door is not advised as it requires more strength and maneuverability. Ø All doormats should be removed for a patient walking with crutches, braces or in a wheelchair.

DOORWAY

FLOOR SURFACES Ø Interior office floors should also be covered with nonskid materials. Ø The use of thick carpet and rugs should be avoided. SIGNS Ø Raised – letter visual signs, and audible signals may be appropriately used for blind and deaf persons.

RESTROOM Ø Toilet seats should be positioned approximately the same height as a standard wheel chair. Ø Handrails must be sturdy and properly located. Ø Space must be provided for easy accessibility, maneuvering, and transfer. Ø Wash basin should not be higher than 34 inches from floor. Ø Faucet handles must be lever type for neuromuscular disorder patients. Ø For wheelchair patient a storage shelf, towel dispenser, and lowered or tilt mirror should be provided.

REST ROOM

WATER FOUNTAINS Ø If the office has a fountain it should be located no higher than 32 inches. TELEPHONES Ø The office should have telephone accessible to handicapped individual. Ø Ideally it should be push button type located no more than 32 inches above the floor.

RECEPTION ROOM Ø Should provide adequate space for the wheelchair bound patients. Ø Chairs of varying heights should be available for patients with compromised lower body strengths who have difficulty raising from a low chair. Ø The front desk should be located at a height that allows wheelchair patient to communicate easily with the receptionist.

TREATMENT ROOM Ø The guidelines for doorway width and floor surfaces apply here also. Ø The dental chairs should be maneuverable and allow easy transfer of the patient from wheelchair. Ø Units with hoses hanging in contact with the patient can cause problems. Ø Across the patient delivery systems are hazardous when used with patients having neuromuscular disorders, muscle spasms or seizure disorders. Ø The office staff should have an understanding of the functional parts of wheelchair before a transfer is attempted.

CONCLUSION Children are a resource of the world. They are a promise of what our future is going to be, therefore a dental health of any child is a concern to the world’s dental community regardless of the child’s nationality, ethnicity, and geographic location.