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The elaboration of the treatment plan for children and

teenagers

The treatment plan in case of children and teenagers needs to include all the elements of
the dental-maxillary apparatus and to balance the means of treatment with the development process
that is characteristic for this stage. To respond to this request the examination of the patient needs
to be accomplished by adhering to a specific algorithm.

The treatment plan respects the following sequence:


 Emergency treatment to eliminate the charge of pain, to establish the specific
treatment to diagnose odonto-periodontal affections
 Preventive treatment-the use of preventive dental procedures for dental caries
motivates the patient, improves the collaboration with him and assures appropriate
stability in time for the conservative treatments applied
 Restorative treatment- in concordance with the patient’s age, the need for
orthodontic treatment, skeletal and facial typology, development.
 Surgical treatment- the extraction of unrecoverable teeth, to facilitate the eruption
of successional teeth
 Orthodontic treatment
 Individualized recommendations for the prophylaxis of dental caries, periodontal
affections, muscular dysfunctions and the TMJ etc.
 Periodic check-up (1,3)

ORAL HEALTH represents an element of general health. To ensure appropriate oro-


dental health assesses the following:
 The first consultation in the dental office should be done after the eruption of the
first temporary teeth between 6-12 months
 The posing of some individualized recommendations for the prevention of dental
caries and dento-periodontal trauma
 To provide an effective collaboration between pediatric doctor –dentist-family
 Establishing regular checks (4)

The First consultation follows the evaluation of the following elements:


 Family records-to appreciate the importance given by the family to the oro-dental
health
 Personal records-general affections, medication associated
 Psychosomatic development- fall within the standard grade specific for the age. The
appreciation of individual cognitive capacity that allows the dentist to establish a
direct communication relationship with the child or teenager which will have a
positive effect in long term regarding individual implication in keeping an
appropriate health
 Evaluation of caries risk- this indicator has a dynamic nature/character and it can
be modified by the action of general and individual factors. It is recommended to
appreciate the individual risk for caries with the occasion of periodical controls
 The development of DM apparatus, dentition, teeth ( dentatie ,dentitie) (3,4)

6-12 MONTHS. Specific elements that are recommended to be analyzed in this period
are represented by:
 To appreciate the correlation between dental age and chronological age
 Oro-dental hygiene-this has to be performed by the mother, once with the eruption
of the first teeth
 Suitable alimentation-to avoid consuming of sweet beverages with the use of the
bottle, to consume sweets etc
 The individualized prophylaxis of dental caries with the administration of
endogenous flour. Establishing the dose in agreement with the pediatric doctor
according to the individual exogenous dose of the flour, general health of the child,
family records;
 The prophylaxis of dental traumas through prevention of playing accidents or
learning to walk
 To combat vicious habits- the suck of the finger, para-functions of the inferior lip,
comforter
 The treatment of accidents caused by the eruption of the temporary teeth
 Establishing regular checks (2,4)
12-24 months. Specific elements that are recommended to be analyzed in this period are
represented by:
 Carioprophylactic alimentation- the appropriate diversify of alimentation to allow
an active mastication
 Oro-dental hygiene- done by the parents
 Specific prophylaxis of dental caries
 The treatment of dental affections (incipient lesions at the level of temporary
incisors)
 Periodical check-ups (3,4)

2-6 years. Specific elements that are recommended to be analyzed in this period are
represented by:
 The specific prophylaxis of dental caries-the sealing of temporary molars, topical
fluoridation
 The treatment of dental affections – morphofunctional restoration of dental crowns
to assure normal functionality of the dento-maxillary apparatus and maintaining
space
 The treatment of dental traumas- preserving affected teeth, maintaining space,
prevention of dental migrations
 Orthodontic evaluation to diagnosticate skeletal differences, muscular dysfunctions
 Periodical check-ups
 The eruption of the 6 years molar- to respect/adhere to the age of eruption, specific
prophylaxis of dental caries (sealing, fluoridation) (4,5)

6-12 years. Specific elements that are recommended to be analyzed in this period are
represented by:
 Oral hygiene- motivation of the patient, the appropriate brushing technic. It is
recommended the parents to supervise the oral hygiene program of the child at least
up to 8 years
 The specific prophylaxis of dental caries for young permanent teeth
 6 years molar- specific prophylaxis of dental caries
 The treatment of dental lesions with the respect criteria tissue economy and use of
biocompatible dental materials
 The support area- the treatment of dental lesions and maintaining the space
according to the order of eruption
 Incisor area- the prevention of dental trauma, aligning the teeth in the frontal area
and to assure correct occlusal reports
 Radiological evaluation- the presence of permanent teeth replacement buds and
completion, the order of the eruption
 Periodical check-ups (3,4)

12-18 years. Specific elements that are recommended to be analyzed in this period are
represented by:
 Periodical check-ups- frequent motivation and re-motivation for the compliance of
oro-dental hygiene and carioprophylactic alimentation
 Specific prophylaxis of dental caries- premolars, 12 years molars
 Evaluation of the third molar- prevention of orthodontic treatment relapse and
residual dental crowding’s
 Alimentation-food imbalances characteristic for adolescence, an excess of sweets
and carbonated soft drinks, chaotic food timetable
 Behavioral disorders- neglect of oneself, the influence of group in disagreement with
the families recommendation
 Orthodontic treatments- the patient wishes to correct dento-maxillary anomalies
especially for esthetic considerations
 Pre-prostatic orthodontic treatments-for the correction of negative effects caused by
dental migrations due to dental extractions and to facilitate complex rehabilitation at
adult age (2,4)

Stages of treatment characteristic in pediatric dental medicine are conducted in the following
succession:
 Emergency treatment-fighting pain allows establishing a climate/an environment in
which the collaboration with the patient is appropriate
 Realization of restorations with temporary characteristics to allow to reduce the level
of microbial contamination from the level of the buccal cavity. In plus, it will improve
the collaboration with the patient and it will be appreciated the individual and
families implication in the recommendation on oro-dental hygiene
 Evaluation of caries risk-dynamic indicator appreciated on periodical control
 Preventive treatment-alimentation, oro-dental hygiene, specific prophylaxis of dental
caries
 Surgical treatment-the extraction of irretrievable teeth’s by conservative methods,
extractions for orthodontic purposes
 Orthodontic treatment- accomplished after the restoration of the oral cavity
 Restorative treatment with a definitive character using dental materials and methods
that are in accordance with the age of the patient and physiological evolution stage
of the teeth(2,3,4)
Bibliografie:

1.American Academy of Paediatric Dentistry. The Handbook. Second edition.Chicago; 1999:


p.122-126.

2.Welbury RR. Paediatric dentistry. Oxford Univerity Press; 1997:p.37-51.

3.McDonald RE, Avery DR, Dean JA. Dentistry for the child and adolescent. Ninth edition.
St. Louis:Mosby Inc;2011:p.638-663.

4.Rodd H, Wray A. Treatment Planning for the Developing Dentition. London: Quintessence
publishing Co.Ltd; 2006: p.129-135.

5.Andlaw RJ, Rock WP. A Manual of Paedodontics.Edinburgh: Churchill


Livingstone;1987:p.3-29.