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Dr.

Carmen Savin

Pediatric dentistry (pedodontics) 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.

American Dental Association (ADA), 2000
Paedodontics - from the Greek words pais-paidos = boy/child and odontos = tooth
What are the key elements of this definition that
make it so unique?

age-defined: most specialties are procedure defined (endodontics, periodontics, etc.),
while pediatric dentistry provides care for their specific age group of patients.

primary and comprehensive...care: pediatric dentists are primary providers. There is no
need for a referral of patients. Parents can choose to have their children evaluated and
treated by a pediatric dentist just like they can choose to have their child treated by a
pediatrician.

infants and children through adolescence: pediatric dentists manage patients at any age
from birth up to their late teens.

special health care needs: pediatric dentists must have the training and experience to
evaluate and treat patients that are medically compromised. This includes patients with
hemophilia, leukemia, congenital syndromes, etc.
What are the study objects for Pediatric Dentistry?

infants and children through adolescence
normal and special health care needs children


What does provide Pediatric Dentistry?

primary and comprehensive preventive oral health care
primary and comprehensive interceptive oral health care
both primary and comprehensive therapeutic oral health
care
Paedodontics, or paediatric dentistry are synonymous
with dentistry for children.

It exists because children have dental and oral-
facial problems.

The genesis of dentistry for children is unquestionably
linked to dental caries, pulpitis as well as inflammation
and pain associated with infected pulp tissue and
sometimes with alveolar bone suppuration.
1. Growth and development of dental-maxillary system
in an integrated psychological, social, somatic and
aesthetic concept.
2. Normal and pathological variability of growth and
development of dental-maxillary system.
3. Pain, dental anxiety, dental fear and child management
in dentistry.
4. Study of the morphological and structural, biological
and functional particularities of temporary
(primary/deciduous teeth) and young permanent
(immature) teeth.
5. Epidemiology, etiology, physiopathology, clinic and
therapy (preventive and curative) of:
dental caries of TT and PT
dental and periodontal trauma of primary and young
permanent teeth
dental dystrophies
periodontal diseases
oral mucosa pathology in children and teenagers
(adolescents)
6. Lost of space phenomenon.

7. Children and adolescents special restorative
problems.
8. Childrens oral surgery.

9. Orthodontics (preventive and interceptive).
10. PREVENTION
I . First childhood (small childhood) =0 3 y.o. stage.
A. Prenatal period:
Prenatal growth from conception to birth is usually divided into three
trimesters, without any clear-cut borderlines between them.
1. First trimester (0-12 week) - embryo stage - is characterized by
differentiation of tissue and formation of organs. Mineralization of bones and teeth
has not started yet.
2. Second trimester (12-27 weeks) is characterized by a rapid growth and
maturation. Of special importance in this period is the development of the internal
organs and their preparation for postnatal function.
3. Third trimester (28-40 weeks) together with the second are named the
fetal period. The dominant factor in the third trimester is the increasing weight of
the fetus. Accumulation of the calcium due to the mineralization of bones and teeth
is also very important.
Some problems may occur due to:
cellular differentiation disorders
absence of facial buds union
branchial membranes resorption problems.

To prevent these problems, some actions should be
considered:
genetic advice
avoidance of radiation, anaesthesia, alcohol, tobacco and
drugs in the first quarter of pregnancy
treatment of mother's acute and chronic infections
before/during pregnancy

I. First childhood (small childhood) = 0 3 y.o. stage.
A. Prenatal period:
B. Birth moment
Is a traumatic moment. The compression of cephalic extremity
may cause hypoxia and determines hypomineralization of primary
teeth enamel (circular Stein caries).
I. First childhood (small childhood) = 0 3 y.o. stage.
C. 0- 30 days = new born baby period:
nurseling stage
incomplete immunitary system development.
D. 30 days - 1 year period:

The autonomic nervous system phenomena prevails in this
period: breast feeding is very important and it is possible due to the
inborn suckling reflex.
Advantages of breast feeding:
nourishing principal contributionn
immunity factors contribution
harmonious psycho-somatic development
continuation of mother-child affective symbiosis
maxillary development
first physiological mandible mesial movement (1
st
mesialisation
of occlusion)
D. 30 days - 1 year period:

deficiencies in childs oral hygiene and Candida albicans are
favorable factors for infectious stomatitis
Riga-Fede lesion may occur, due to natal or neonatal incisors and/or
due to the cerebral palsy at this age
permanent teeth mineralisation around 3 4 months;
temporary teeth eruption around 6 months (may occur: eruption
gingivitis, Riga eruptive stomatitis)
due to artificial feeding, in the nursling stage may occur repeated
dyspepsia and rickets.

E. Small child period = 1 3 y.o.
fontanels closing
skull ossification (1 2 years)
slow rhythm of growth
perfecting the locomotors function
development of a second system of signal speaking
child contact with childrens community and the first contagious
diseases of childhood
metabolic problems (2.5-3 years old) and sometimes severe teeth
hypo-calcifications
sequential continuation and finalizing eruption of primary teeth may lead to
odontiasic stomatitis
first occlusion elevation around 18
th
months, related to the first temporary
molar clinical eruption
occurence of the vicious habits
the function of maxillary-facials system is more complex
early caries of child (ECC), severe early caries of child (SECC) (due to oral
hygiene and child nutrition and/or lack of oral hygiene after repetitive night oral
administration of medical sweetened syrups).
E. Small child period = 1 3 y.o.
This stage (age 1-3 years) is favorable for a proper insertion of a correctly
oral and nutritional hygiene and for general fluoridation (in close interrelation
with the fluoride concentration in air, water and food).
I I . Second childhood (middle childhood) =3 6 y.o. stage:
general rhythm of growth slows down
psycho-somatic development increases
contact with preschools community - contagious disease of childhood creates
favorable conditions for:
teeth hypoplasia
teeth hypocalcification
caries (as consequences of dehydration and loss of minerals)
from psycho-intellectual, behavioural and emotional point of view:
at 4-5 years old qualitative leap bursts of questions and answers
at the same age (4-5 y.o.) the first emotional and behavioural negativism
(denying) crisis.
from the dental point of view: in this period appears the temporary teeths
attrition (bluntness), which favors the 2
nd
physiological mandible mesial
movement (2
nd
occlusal mesialisation);
I I I . Third childhood (big childhood) =6/7 14/16 y.o.stage:
initial development has a slow rithm
8-9 y.o. is the age of some becoming permanent elements, concerning:
temper
child personality structure.

from the dental point of view:
temporary teeth root resorption and exfoliation
coexistence of the temporary and permanent teeth
period of teeth changing - instability in occlusal relation.
the prepuberty stage (10-11/12 years):
it is an ungrateful age stage [Maxim et al.]
a crochet's development:
- for boys prevail statural growth
- for girls prevail weight growth
very active metabolism: it is the period of accelerated internal
burns - insatiable hanger, peaks of polyphagia
hormonal period, when general affections may occur
this is the second psychological-behavioural-emotional
negativism stage.
I I I . Third childhood (big childhood) =6/7 14/16 y.o.stage:
I V. The puberty stage =14 16 y.o. stage
It is a passing stage from childhood to adolescence:
appearance of secondary sexual character difference debut between sex (the
childrens morphology is typical for this stage)
profound psycho-somatic transformation, which are reflected in behavior
awareness of self personality
from the dental point of view:
sequential eruption of the permanent teeth may still continue;
permanent teeth eruption finalizing (inclusion of the second molar may be
observed);
the 2
nd
(around 6 years the eruption of 1
st
permanent molar) and the 3
rd

(around 12 years the eruption of 2
nd
permanent molar) physiological
occlusion elevation (highest occlusion).
Wrong dental care habits during the mixed dentition may lead to:
caries (symmetric caries with increased prevalence)
gingivitis of eruption
periodontal irritation events
prepuberal periodontitis
juvenile periodontitis
transitory (self adjustments) or permanent dental alveolar-maxillary
anomalies.

This age stage is favorable for:
establishing the correct habits and preoccupations concerning oral, nutritional
and functional hygiene.
I V. The puberty stage =14 16 y.o. stage
V. The adolescence (teenage) =16 20 y.o. age
It is a passing stage from puberty to young adult, characterized by:
entirely development of the psychic characters
residual growth which may occur
identity, individual autonomy and social insertion crisis
[Maxim et al.]

VI . The young adult:
the destiny develops in terms of emphasizing the independence and the
individual autonomy
the individualization of a psycho-somatic equilibrium, more or less
harmoniously, between desires and reality.