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Pediatric  Dental   Health

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• Provide oral and dental health care for infants.
• Provide oral and dental health care for apprehensive children.
• Provide pharmacologic, as well as non-pharmacologic behavior management for children in the dental office.
• Advise parents on age-appropriate preventive dental health measures.
• Provide diagnosis and treatment for problems in the developing dentition.
• Provide interceptive orthodontic treatment for children.
• Diagnose and treat traumatic injuries to the teeth, mouth, and perioral structures of children.
• Recognize and report child abuse and neglect.
• Diagnose and treat disease of the dental pulp and nerve tissue in children.
• Provide oral and dental treatment for children in the operating room.
• Provide oral and dental treatment for pediatric patients admitted to the hospital.
• Provide useful and relevant pediatric dental health information to the community.
  
  To become a pediatric dentist requires nearly eleven years of study and education after high school. After completing four years of college, another four years is required to complete dental school. After dental school, pediatric dentists must undergo two or three additional years of intensive training in pediatric dentistry.
  
  The pediatric dentistry residency program includes:
• Biomedical Science Courses: biostatistics and clinical epidemiology, pharmacology, microbiology, embryology, genetics, anatomy, and oral pathology.
• Clinical Science Courses: child development, behavior management, informed consent, sedation and principles of general anesthesia, treatment of oral disease in children, restorative dentistry for children, biopsy procedures, laboratory tests, pediatric oral radiology, prevention and management of medical emergencies, dental treatment of medically compromised children, and diagnosis and treatment of craniofacial and dentofacial growth anomalies.
• Other Relevant Courses: treatment of patients with special health care needs, language development and disorders, the practice of pediatric dentistry, jurisprudence and risk management, the use of computers in dentistry, and biomedical ethics.
• Clinical Experiences: Basic Life Support and Pediatric Advance Life Support training, pharmacologic and non-pharmacologic behavior management of pediatric dental patients, comprehensive dental restorative care for pediatric patients, management of oral injuries, diagnosis and treatment of periodontal disease in children, management of disease of the dental pulp tissue, management of the oral health of patients with special health care needs, and diagnosis and treatment of abnormalities in the developing dentition.
• Hospital Experience: dental care in the hospital-based operating room, inpatient oral and dental health care, pediatric dental emergency service, anesthesiolgy rotation, pediatric medicine rotation, and evaluation of pediatric patients with special health care needs.
  
  An article in Pediatric Dentistry reviews the standards for advanced specialty education programs in pediatric dentistry:
  Ferretti GA : Status of guidelines and the scope of the specialty. Pediatric Dentistry 19(3):193-202,1997.
  
  
  
  Community Oral Health Programs
  In the United States, approximately 20 percent of the children have 80 percent of the dental caries. Children from families with limited financial resources are burdened with a disproportionate share of the caries disease. Many communities have elected to provide preventive oral health programs for infants who are at risk for developing dental caries.
  
  Early childhood caries is the term now used to describe baby bottle tooth decay and nursing caries. Since early childhood caries is a multifactorial disease, community preventive oral health programs must address factors such as the feeding practices which promote caries, and infant oral hygiene practices.
  
  An ideal community preventive oral health program would be similar to one recently published by Cunha et al in the April issue of the Journal of Dentistry for Children.
  
  PROTOCOL FOR A COMMUNITY PREVENTIVE ORAL HEALTH PROGRAM
  
• To maximize the benefits of oral health maintenance, restrict participation in the program to infants between the ages of 1 to 12 months.
• Reinforce the concepts of shared responsibility for oral health by making parents active participants in the oral health of their infants.
• The Introductory Lecture: The lecture discusses the principles of oral and dental health for infants, eating and feeding habits, the importance of primary teeth, oral hygiene instruction, fluoride and fluoride supplementation, and the development of dental caries.
• The First Clinical Visit: The dentist takes a health history of both the family and the infant, performs a clinical examination of the infant's teeth, assesses oral hygiene, examines the oral structures for any problems, inquires about dietary and feeding habits, performs an individual caries risk assessment for the infant, assesses the need for fluoride supplements, and discusses oral hygiene techniques for the infant. This first clinical visit should not take more than 15 minutes to complete.
• Four More Consecutive Weekly Clinical Visits: All of these visits include hands-on instruction for infant oral hygiene, which the parent is expected to perform at home. The exact protocol for these visits depends on whether the infant was determined to be a low or high risk for developing dental caries. These visits are never more than 15 minutes long.
• The Low Risk Group Visits:
  During the first visit, the teeth are cleansed, and fluoride is applied in the form of 0.2 percent NaF solution. The infant's oral health is recorded. Parents are instructed on how to brush the child's teeth every day at home, ideally at bedtime.
  During the second, third, and fourth weekly visits, the success of the protocol is assessed. Parents are asked about their infant feeding practices, and asked to demonstrate their individual infant oral hygiene procedures. Finally, the dentist performs an oral and dental evaluation of the infant, and charts the results. The protocol is adjusted according to the individual needs of the infant.
  
• The High Risk Group Visits: High risk infants were previously determined to have incipient dental caries and white-spot lesions on the teeth. This protocol differs from the low risk group's in that fluoride varnish is also applied to the teeth at the same visit. At home, the parents need to brush their infant's teeth every evening with either a 0.12 percent chlorhexidine gluconate solution, or with a 0.2 percent NaF solution. All other aspects of the weekly visits remain the same.
• Establish An Appropriate Recall Schedule: A recall schedule is determined by the dentist during the last of the four consecutive weekly visits. The recall visits will take place every two months, and more frequently in case of high risk infants. The community program's recall visits end when the child is 3 years old.
  
  A report in the April issue of the Journal of Dentistry for Children presents a protocol for preventing early childhood caries:
  Cunha RF, Delbem A, Percinoto C: Dentistry for babies: A preventive protocol. Journal of Dentistry for Children, 67:89-92, March-April 2000.
  
  
  
  Oral Manifestations Of HIV Infection In Children
  HIV infection is the seventh leading cause of death among children in the United States. Child-bearing women who are infected through IV drug use or sexual contact with an IV drug-using partner are the major cause of pediatric HIV infection in the U.S. Transmission of HIV from mother to infant may occur before, during, or after birth, and accounts for 85% of pediatric HIV infection. Breast-feeding with HIV-tainted milk is a major cause of post-natal HIV infection. The remaining 15% of the children infected with HIV are the recipients of tainted blood or blood product transfusions.
  
  HIV is an RNA retrovirus which loves to infect a particular type of immune cell called a CD4 lymphocyte. These CD4 type of T4 helper cells are critical for the proper functioning of the body's immune response system. HIV infection causes a severe suppression of the body's immune system. As a result, infected children are susceptible to a variety of opportunistic infections and neoplasms. HIV infection in children progresses more rapidly than in adults because of the rapid growth of children's organs, and because children's immune systems are not yet fully developed and competent. Half of infected infants show clinical symptoms before their first birthday.
  
  Oral disease is one of the first manifestations of the HIV infection in children. Since the mouth harbors so many microorganisms, it is a part of the body which is very susceptible to the development of fungal, viral, and bacterial infections - as well as neoplasms (malignancies).
  
  Three of the most common oral and extraoral problems seen in children infected with HIV are:
• Thrush (pseudomembranous candidiasis).
• Enlargement of the jaw and neck lymph nodes (cervical lymphadenopathy).
• Chronic swelling of the parotid glands (parotitis).
  
  Recurrent candidiasis which is resistant to conventional treatment is the most common oral manifestation of HIV infection in children. The development of oral candidiasis is ominous, and indicates a severely depressed immune system. Candidiasis often occurs in children whose CD4 lymphocyte count is less than 1000/sq. mm. In HIV-infected children, candidal lesions are usually the pseudomembranous type. Pseudomembranous candidiasis appears to have white and yellow areas, and can easily be removed with a piece of gauze, leaving a raw and bleeding surface. Oral antifungal medications contain lots of sugar, and may cause dental caries.
  
  Another finding in pediatric HIV infection is cervical lymphadenopathy, which involves swelling of the submandibular, mental, and parotid lymph nodes. The enlargement of the lymph nodes is related to a decline in the number of CD4+ T cells. Chronic swelling of the parotid (cheek) glands is also a distinctive feature of HIV infection in children, but does not require treatment. This swelling (parotitis) is always associated with hepatomegaly, splenomegaly, and lymphadenopathy. Both lymphadenopathy and parotitis are actually good signs, and point to a good chance for long-term survival in HIV infected children.
  
  A recent study published in the International Journal of Pediatric Dentistry discusses HIV in children:
  Ramos-Gomez FJ, Petru A, Hilton JF, Canchola AJ, Wara D, Greenspan JS: Oral manifestations and dental status in paediatric HIV infection. International Journal of Paediatric Dentistry, 10(1) 3-11, 2000.
  
  
  

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