Pediatric Dentistry

Pediatric dentistry is an age-defined specialty that provides dental health care for infants and children through adolescence, including those with special health care needs.

Pediatric dentists are trained to perform a wide range of dental procedures in children. Pediatric dentists have an in-depth knowledge on child psychology, which helps them to manage and provide efficient dental care to children. It is their responsibility to ensure a pleasant experience during a child's visit to the dentist. Most adults who are poor dental patients might have had a traumatic dental experience during their childhood.

Ideally the first dental visit of a child should begin at 8-12 months of age. Pediatric dentists are trained to perform infant examination and also to provide the necessary information regarding infant oral here. Most of the children who have regular dental visits from infancy remain caries free (decay free) throughout their lifetime.

Pediatric dentists provide children (also their parents) with information regarding prevention of dental caries, oral hygiene measures and other common oral problems thereby helping them achieve a smooth transition from milk teeth to an ideal set of permanent teeth.

Pediatric dentist provides the following dental procedures :

>> Amalgam and Composite Fillings for primary teeth
>> Pediatric root canal therapy
>> Minor orthodontic correction
>> Preventive care for cleft lip and palate children

>> Management of traumatic injuries in children

Orthodontics

Orthodontics is a specialty of dentistry that is concerned with the study and treatment of malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jaw relationships, or both. The word comes from the Greek words orthos meaning straight or proper, and odons meaning tooth.

Orthodontic treatment can focus on dental displacement only, or can deal with the control and modification of facial growth. In the latter case it is better defined as "dentofacial orthopedics".

Orthodontic treatment can be carried out for purely aesthetic reasons with regards to improving the general appearance of patients' teeth. However, there are orthodontists who work on reconstructing the entire face rather than focusing exclusively on teeth. Treatment is most often prescribed for practical reasons such as providing the patient with a functionally improved bite (occlusion).

Definition

Orthodontics is formally defined by the American Association of Orthodontics as, "The area of dentistry concerned with the supervision, guidance and correction of the growing and mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of the jaws within the craniofacial complex."

History

Irregular teeth have been a major problem for some individuals since antiquity and attempts to correct them go back to at least 1000 B.C. Orthodontic appliances have been found from Greek and Etruscan materials.

Edward Angle was the first orthodontist—the first dentist to limit his practice to orthodontics only. He is considered the "Father of Modern Orthodontics."

Methods

If the main goal of the treatment is the dental displacement, most commonly a fixed multibracket therapy is used. In this case orthodontic wires are inserted into dental braces, which can be made from stainless steel or a more aesthetic ceramic material.

Dental braces, with a powerchain, removed after completion of treatment.

Also removable appliances, or "plates", headgear, expansion appliances, and many other devices can be used to move teeth. Functional and orthopaedics appliances are used in growing patients (age 5 to 14) with the aim to modify the jaw dimensions and relationship if these are altered. This therapy is frequently followed by a fixed multibracket therapy to align the teeth and refine the occlusion.

Hawley retainers are the most common type of retainers. This picture shows retainers for the top and bottom of the mouth.

After a course of active orthodontic treatment, patients will often wear retainers, which will maintain the teeth in their improved position while the surrounding bone reforms around them. The retainers are generally worn full-time for braxes a short period, perhaps 6 months to a year, and then worn periodically (typically nightly during sleep) for as long as the ors. It is possible for the teeth to stay aligned without regular retainer wear. However, there are many reasons teeth will crowd as a person ages; thus there is no guarantee that teeth, orthodontically treated or otherwise, will stay aligned without retention. For this reason, many orthodontists recommend periodic retainer wear for many years (or indefinitely) after orthodontic treatment.

Appropriately trained doctors align the teeth with respect to the surrounding soft tissues, with or without movement of the underlying bones, which can be moved either through growth modification in children or jaw surgery (orthognathic surgery) in adults.

Headgear & J-hooks for connection into the patient's mouth.

Several appliances are utilized for growth modification; including functional appliances, Headgear and Facemasks.

These "orthopedic appliances" may influence the development of an adolescent's profile and give an improved aesthetic and functional result.

Conditions

The most common condition that the methods of orthodontics are used for is correcting anteroposterior discrepancies. Another common situation leading to orthodontic treatment is crowding of the teeth.

Anteroposterior discrepancies

Anteroposterior discrepancies are deviations between the teeth of the upper and lower jaw in the anteroposterior direction. For instance, the top teeth can be too far forward relative to the lower teeth ("increased overjet".) The headgear is attached to the braces via metal hooks or a facebow and is anchored from the back of the head or neck with straps or a head-cap. Elastic bands are typically then used to apply pressure to the bow or hooks. Its purpose is to slow-down or stop the upper jaw from growing, hence preventing or correcting an overjet. For more details and photographs, see Orthodontic headgear.

Orthodontic treatment of crowded teeth; the canine is being pulled down into proper position with highly flexible co-axial wire. This patient also presents with a cross bite, where the upper molar is more lingual (towards the tongue) than the opposing lower molar.

Crowding of teeth

Another common situation leading to orthodontic treatment is crowding of the teeth. In this situation, there is insufficient room for the normal complement of adult teeth, which may require tooth removal in order to make enough room for the remaining teeth.

Diagnosis and treatment planning

In diagnosis and treatment planning, the orthodontist must (1) recognize the various characteristics of malocclusion and dentofacial deformity; (2) define the nature of the problem, including the etiology if possible; and (3) design a treatment strategy based on the specific needs and desires of the individual. (4) present the treatment strategy to the patient in such a way that the patient fully understands the ramifications of his/her decision.

Training

Orthodontics was the first recognized specialty field within dentistry. Many countries have their own systems for training and registering orthodontic specialists. A two to three year period of full-time post-graduate study is required for a dentist to qualify as an orthodontist.

Europe

In the United Kingdom, this training period lasts three years, after completion of a membership from a Royal College. A further two years is then completed to train to consultant level, after which a fellowship examination from the Royal College is sat. In other parts of Europe, a similar pattern is followed. It is always worth contacting the professional body responsible for registering orthodontists to ensure that the orthodontist you wish to consult is a recognized specialist.

United States, Canada, Australia, and New Zealand

A number of dental schools and hospitals offer advanced education in the specialty of Orthodontics to dentists seeking postgraduate education. The courses range from two to three years (with the majority being 3 years) of full-time classes in the theoretical and practical aspects of orthodontics together with clinical experience. Generally, admission is based on an application process followed by an extensive interviewing process by the institution, in order to select the best candidates. Candidates usually have to contact the individual school directly for the application process.

India

In India, many dental colleges affiliated to universities offer orthodontics as specialisation in Master of Dental Surgery ( M.D.S ) programme.The minimum qualification for M.D.S is Bachelor of Dental Surgery ( B.D.S ). The present course for MDS in Orthodontics stands at 3 years in all dental colleges in India which are recognised by the Dental Council of India. The Indian Orthodontic Society was established in 1965. The Indian Society of Orthodontics for General Practitioners (ISOGP), established in 2008, represents GP's and members from other dental specialties who practices orthodontics.

Oral and maxillofacial surgery

Oral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. It is a recognized international surgical specialty.

Regulations

• In the U.S.A., Canada, Australia, and New Zealand, oral and maxillofacial surgery is one of the 9 specialties recognized by the American Dental Association, Royal College of Dentists of Canada, and Royal Australasian College of Dental Surgeons, training programs lead to the trainee obtaining qualifications in both Medicine and Dentistry.

In other parts of the world oral and maxillofacial surgery as a specialty exists but under different forms as the work is sometimes performed by a single or dual qualified specialist depending on each country's regulations and training opportunities available.

Oral and maxillofacial surgeons

An oral and maxillofacial surgeon is a regional specialist surgeon treating the entire craniomaxillofacial complex: anatomical area of the mouth, jaws, face, skull, as well as associated structures.

Maxillofacial surgeons are usually initially qualified in dentistry and have undergone further surgical training. Some OMS residencies integrate a medical education as well & an appropriate degree in medicine (MBBS or MD or equivalent) is earned, although in the United States there is legally no difference in what a dual degree OMFS can do compared to someone who earned a four year certificate. Oral & maxillofacial surgery is universally recognized as a one of the nine specialties of dentistry. However also in the UK and many other countries OMFS is a medical specialty as well culminating in the FRCS (Fellowship of the Royal College of Surgeons). Regardless, all oral & maxillofacial surgeons must obtain a degree in dentistry (BDS, BDent, DDS, or DMD or equivalent) before being allowed to begin residency training in oral and maxillofacial surgery.

They also may choose to undergo further training in a 1 or 2 year subspecialty fellowship training in the following areas:

• Head and neck cancer - microvascular reconstruction
• Cosmetic facial surgery
• Craniofacial surgery/Pediatric Maxillofacial surgery
• Cranio-maxillofacial trauma

The popularity of oral and maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing. Integrated programs are becoming more available to medical graduates allowing them to complete the dental degree requirement in about 3 years in order for them to advance to subsequently complete Oral and Maxillofacial surgical training.

Surgical procedures

Treatments may be performed on the craniomaxillofacial complex: mouth, jaws, neck, face, skull, and include:

• Dentoalveolar surgery (surgery to remove impacted teeth, difficult tooth extractions, extractions on medically compromised patients, bone grafting or preprosthetic surgery to provide better anatomy for the placement of implants, dentures, or other dental prostheses)
• Diagnosis and treatment of benign pathology (cysts, tumors etc.)
• Diagnosis and treatment (ablative and reconstructive surgery, microsurgery) of malignant pathology (oral & head and neck cancer).
• Diagnosis and treatment of cutaneous malignancy (skin cancer), lip reconstruction
• Diagnosis and treatment of congenital craniofacial malformations such as cleft lip and palate and cranial vault malformations such as craniosynostosis, (craniofacial surgery)
• Diagnosis and treatment of chronic facial pain disorders
• Diagnosis and treatment of temporomandibular joint (TMJ) disorders
• Diagnosis and treatment of dysgnathia (incorrect bite), and orthognathic (literally "straight bite") reconstructive surgery, orthognathic surgery, maxillomandibular advancement, surgical correction of facial asymmetry.
• Diagnosis and treatment of soft and hard tissue trauma of the oral and maxillofacial region (jaw fractures, cheek bone fractures, nasal fractures, LeFort fracture, skull fractures and eye socket fractures.
• Splint and surgical treatment of sleep apnea, maxillomandibular advancement, genioplasty (in conjunction with sleep labs or physicians)
• Surgery to insert osseointegrated (bone fused) dental implants and Maxillofacial implants for attaching craniofacial prostheses and bone anchored hearing aids.
• Cosmetic surgery limited to the head and neck: (rhytidectomy/facelift, browlift, blepharoplasty/Asian blepharoplasty, otoplasty, rhinoplasty, septoplasty, cheek augmentation, chin augmentation, genioplasty, oculoplastics, neck liposuction, lip enhancement, injectable cosmetic treatments, botox, chemical peel etc.)

Australia, Canada, New Zealand and the United States

Oral and Maxillofacial Surgery is one of the 9 dental specialties recognized by the American Dental Association, Royal College of Dentists of Canada, and the Royal Australasian College of Dental Surgeons. Oral and Maxillofacial Surgery requires 4–6 years of further formal University training after dental school (DDS, BDent, DMD or BDS). Four-year residency programs grant a certificate of specialty training in Oral and Maxillofacial Surgery. Six-year residency programs grant the specialty certificate in addition to a medical degree (MD, MBBS, MBChB etc.). Specialists in this field are designated registrable U.S. “Board Eligible” and warrant exclusive titles. Approximately 50% of the training programs in the U.S., 100% of the programs in Australia and New Zealand, and 20% of Canadian training programs, are dual-degree leading to dual certification in Oral and Maxillofacial Surgery and Medicine (MD, MBBS, MBChB etc).

The typical training program for an Oral and Maxillofacial Surgeon is:

• 4 Years Undergraduate Study (BA, BSc, or equivalent)
• 4 Years Dental Study (DMD, BDent, DDS or BDS)
• 4 - 6 Years Residency Training (additional time for acquiring medical degree)
• After completion of surgical training most undertake final specialty examinations: (U.S. "Board Certified (ABOMS)"), (Australia/NZ: "FRACDS(OMS)"), or (Canada: "FRCD(C)(OMS)").
• Many dually qualified oral and maxillofacial surgeons are now also obtaining Fellowships with the American College of Surgeons (FACS)
• Average total length after Secondary School: 12 - 14 Years

In addition, graduates of Oral and Maxillofacial Surgery training programs can pursue fellowships, typically 1 – 2 years in length, in the following areas:

• Head and neck cancer - microvascular reconstruction
• Cosmetic facial surgery (facelift, rhinoplasty, etc.)
• Craniofacial surgery/Pediatric Maxillofacial surgery (cleft lip and palate repair, surgery for craniosynostosis, etc.)
• Cranio-maxillofacial trauma (soft tissue and skeletal injuries to the face, head and neck)

Notable oral and maxillofacial surgeons

• Luc Chikhani reconstructed Trevor Rees-Jones's face, which was literally flattened by the impact of the car crash that killed Diana, Princess of Wales.
• Bernard Devauchelle a French oral and maxillofacial surgeon at Amiens University Hospital who in November 2005 successfully completed the first face transplant on Isabelle Dinoire.

Organizations

• Asosiacion Colombiana de Cirugia Oral y Maxilofacial- ACCOMF
• Association of Oral and Maxillofacial Surgeons of India
• American Association of Oral and Maxillofacial Surgeons
• American Board of Oral and Maxillofacial Surgery
• American College of Surgeons
• Australian and New Zealand Association of Oral and Maxillofacial Surgeons
• The Royal College of Surgeons of England
• Association canadienne des spécialistes en chirugie buccale et maxillo-faciale
• Faculty of Dental Surgery of The Royal College of Surgeons of England
• Directive 2001/19/EC (Official Journal of the European Communities L 206, 31.07.2001)
• Indonesia Association Of Oral and Maxillofacial Surgeon
• European Association for Cranio-Maxillofacial Surgery
• Internacional Association of Oral and Maxillofacial Surgeons
• British Association of Oral and Maxillofacial Surgeons

Oral and maxillofacial radiology

Orthopantomogram

Oral and maxillofacial radiology is a specialty of Dentistry; that is mainly concerned with performing ,understanding and interpretation of diagnostic imaging modalities used in dentistry and other health care professions related to facial, neck and oral structures.

Dental/Maxillo-facial imaging techniques including Ultrasound scan, cone beam CT, MRI, Orthopantomogram, intra-oral imaging (e.g. bitewing, peri-apical and occlusal radiographs) in addition to special tests like sialographs.

Stomatognathic disease

Stomatognathic disease refers to the diseases of the mouth ("stoma") and [[jaw]] ("gnath"). The etymology is similar to that of the term Gnathostomata. It is the term used by MeSH (along with the synonym dental diseases), but other organizations use different terms.

The American Dental Association uses the term "oral and maxillofacial pathology", and describes it as "the specialty of dentistry and pathology which deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes and effects of these diseases."

The World Health Organization uses the term "Diseases of oral cavity, salivary glands and jaws."

Endodontics

If decay progresses to the first stage, a small filling will be required. If decay develops to the third stage depicted, root canal therapy will be required.

Endodontics, from the Greek endo (inside) and odons (tooth), is one of the nine specialties of dentistry recognized by the American Dental Association, and deals with the tooth pulp and the tissues surrounding the root of a tooth. If the pulp (containing nerves, arterioles and venules as well as lymphatic tissue and fibrous tissue) has become diseased or injured, endodontic treatment is required to save the tooth.

Lentulo spiral

A lentulo spiral. The notches at left allow it to fit into a slow-speed latch handpiece.

A Lentulo spiral is a dental instrument used to properly distribute root canal sealer and cement evenly throughout the root canal system, as when performing endodontic therapy or a post and core cementation.

Maillefer’s Lentulo spiral, produced by Dentsply, is the only one licensed to use the Lentulo name; however, the term is generally used to refer to any of the various brands of root canal sealer and cement distributing spirals.