EXAMINATION

DIAGNOSIS AND
TREATMENT
PLANNING FOR
A CHILD
PATIENT

DIAGNOSIS

IDENTIFICATION OF DISEASE

DIFFERENCES

Physical, emotional, and

psychological
Behavior integral part of childs
oral health needs
Preventive care preventive rather
than rehabilitative process
Dentist-patient relationship is
triangular rather than linear
Recognition that the child is a
changing person

THE DIAGNOSTIC
PROCESS
Pedodontic diagnosis and
treatment planning involves both
the seen and the anticipated

1. DIAGNOSTIC
ARMAMENTARIUM
As minimum as
possible

2. VITAL STATISTICS

Date
Hospital number
Name
Age
Sex
Class
Occupation
Address

3.CHIEF COMPLAINT
DEFINED AS:
a symptom or symptoms, described in
patients own words, related to the
presence of an abnormal condition

4.THE HISTORY
Broadly categorized into:
a.
b.
c.

The general health history

The oral health history
Behavioral history

a.THE GENERAL HEALTH

HISTORY

Past medical history

Family history
Prenatal and natal histories
Postnatal and infancy histories
Social history

b.THE ORAL HEALTH

HISTORY

C.BEHAVIORAL HISTORY

5.CLINICAL EXAMINATION
A.

THE GENERAL APPRAISAL:

1.
2.
3.
4.
5.
6.
7.

Gait
Stature
Size
Skin
Hands
Hair
Speech

THE GENERAL APPRAISAL

CONTD
GAIT: general mobility
stability
age-appropriate function
balance
symmetry of movement
limitation of movement
Waddling,equinus,scissors,hemiplegic,wo
bbly, staggering, steppage, ataxic
1.

THE GENERAL APPRAISAL

CONTD
2. STATURE: posture
asymmetry
scoliosis
kyphosis
presence of gross deformity
bracing
flexibility
height

THE GENERAL APPRAISAL

CONTD
3. SIZE: appropriateness for age
obesity
thinness
proportionality of body parts

THE GENERAL APPRAISAL

CONTD
4. SKIN: color
ulcerations
pigmented lesions
bulla
scarring
burns
acne
dryness and scaling

THE GENERAL APPRAISAL

CONTD
5. HANDS: missing/ fused digits
webbing
clubbing
quality of nails
sores
movements and functions
evidence of habits

THE GENERAL APPRAISAL

CONTD
6. HAIR: quality/ quantity
infestations
patchy baldness
lesions

THE GENERAL APPRAISAL CONTD

7. SPEECH: 4 common types of
speech
disorders -:
a.
Aphasia
b.
Delayed speech
c.
Stuttering/ repetitive speech
d.
Articulatory speech disorders

Substitution
Omission
Insertion and distortion

5.CLINICAL
EXAMINATION
CONTD
B. ESTABLISHMENT OF BASELINE
DATA/ VITAL SIGNS:
a.
b.

Height and weight

Blood pressure and respiratory rate

Purpose:- to identify abnormalities

- to provide baseline data for
emergency situation

C. THE HEAD AND NECK

EXAMINATION
EXAMINATION OF CHILD DIFFERS
FROM THAT OF ADULT BY:
1.
2.
3.
4.
5.
6.

Excessive movement
Short attention span
Variable communication
Small stature
Physiologic changes (anxiety/ fear)
Variation in anatomy

GENERAL APPROACH TO HEAD

AND
NECK EXAMINATION:
1.
Extra-oral
2.

Intra-oral

3.

Hard-tissue

4.

Soft-tissue

THE HEAD AND NECK

EXAMINATION CONTD
1.

EXTRAORAL EXAMINATION:
a. Size and shape of the head
b. Hair and skin
c. Facial swelling and symmetry
d. Temporomandibular joint
e. Eyes/ Ears
f.
Nose/ Neck

EXTRAORAL EXAMINATION
CONTD
a. Size and shape of the head:

EXTRAORAL EXAMINATION CONTD

b. Hair and skin:

EXTRAORAL EXAMINATION CONTD

c. Facial examination:

Overall facial pattern

- anteroposterior plane profile

Position of the maxilla and mandible

- vertical reference line from the bridge of nose

Vertical facial relationship

- proportionality - into thirds

Facial swelling and symmetry

- at 12 oclock position

EXTRAORAL EXAMINATION
CONTD
d. Temporomandibular joint:

EXTRAORAL EXAMINATION
CONTD
e. Eyes:

EXTRAORAL EXAMINATION
CONTD
f. Ears:

EXTRAORAL EXAMINATION
CONTD
g. Nose:

EXTRAORAL EXAMINATION
CONTD
h. Neck:

THE HEAD AND NECK

EXAMINATION CONTD
2. INTRAORAL EXAMINATION:
beginning

with the lips post.

pharyngeal wall
-

Mucosa, Vestibule
Gingiva, Frenal attachments
Floor of the mouth
Tongue
Palate

THE HEAD AND NECK

EXAMINATION CONTD
3. EXAMINATION OF THE TEETH:
- Number - missing/
supernumerary
- Carious/ Filled
- Mobile
- Over-retained
- Occlusal review

6.MAKING A DIAGNOSIS
Provisional diagnosis +
Investigations

Confirmatory diagnosis

7.THE TREATMENT
PLAN
DIFFERENT PHASES:
1.
2.
3.
4.
5.

Systemic phase
Preventive phase
Preparatory phase
Corrective phase
Maintenance phase

1.SYSTEMIC PHASE
-

Premedication
Medical consultation and treatment
Medication for behavior control

AIM: to eliminate/ control underlying

systemic disease and get the
child to the point at which active
oral health therapy begins

2.PREVENTIVE PHASE
-

Caries risk assessment

Other preventive measures:

Fluoride application

Pit and fissure sealant

Diet counseling

3.PREPARATORY
PHASE
-

Preventive considerations
Periodontal care
Behavior control
Dental consultations

AIM: to control the child's oral disease

before attempts are made to correct
the ravages of the disease

PREPARATORY PHASE
CONTD...
-

Gross caries excavation and

temporary restoration
Parental involvement
Orthodontic consultation
Behavior management programme
Endodontic therapy
Oral surgery

4.CORRECTIVE PHASE
-

Operative
Prosthetic
Orthodontic

AIM: to restore the teeth and

occlusion to their proper level
of health

5.MAINTENANCE PHASE
-

Recall scheduling

Long term preventive and

orthodontic needs