PEDO- 2

DIAGNOSIS AND TREATMENT PLANNING

includes assembling

all the relevant facts obtained through history and

examinations to weigh the importance each in

determining the course of treatment.

DIAGNOSIS

the art of identifying a disease from its signs and

symptoms followed by thoughtful interpretation of data

• dental light

• air syringe

• front surface mirror

• sharp right angled explorer

INSTRUMENTS FOR DIAGNOSIS

INITIAL CONTACT

builds trust and set expectations

TYPES OF EXAMINATION APPOINTMENTS

• emergency examination

• recall examination

• complete examination

• emergency examination

• recall examination

• complete examination

TYPES OF EXAMINATION APPOINTMENTS

EMERGENCY EXAMINATION

aims to eliminate the chief complaint

EMERGENCY EXAMINATION

type of examination that is limited to the site of injury

RECALL EXAMINATION

a follow up examination after the initial complete examination

RECALL EXAMINATION

usually 4-6 months

RECALL EXAMINATION

type of examination that is done to monitor changes post treatment

COMPLETE EXAMINATION

a thorough evaluation during the first visit

COMPLETE EXAMINATION

the basis for diagnosis and treatment planning

OUTLINE OF A COMPLETE EXAMINATION

• case history

• clinical examination

• diagnosis

• case history

• clinical examination

• diagnosis

OUTLINE OF A COMPLETE EXAMINATION

SEQUENCE OF CASE RECORDING AND EVALUATION

• vital statistics

• chief complaint

• history

• evaluation

• vital statistics

• chief complaint

• history

• examination

SEQUENCE OF CASE RECORDING AND EVALUATION

VITAL STATISTICS

used for records, billings, and legal purposes

Name

recording nicknames are useful, for:

identification, to main records, communication to

develop rapport with the patient, psychological

importance

Age

behavior management techniques change according to

age, sequence of teeth

Sex

certain diseases are common in one sex, such as

hemophilia in males or juvenile period in females,

behavior management, variation in timing of growth

spurts

Class and School

helpful to correlate the patient's

chronological age with mental age

Parent's Name and Occupation

for communication,

understanding the socioeconomic condition

Address

communication, some areas are endemic to

certain diseases or condition

CHIEF COMPLAINT

reason which prompted the patient to seek dental treatment

CHIEF COMPLAINT

common reasons are pain, swelling and to improve esthetics

DM, epilepsy, blood dyscrasias, rheumatic

disease, allergies to nickel and acrylic

Conditions that limit orthodontic treatment

teratogens

may cause

abnormal development of

the fetus

tetracycline

may cause

discoloration of the teeth

German measles

during the

first trimester may result in

cleft lip and cleft palate.

Viral infections

are said to

be cause of cleft formation

Past dental history

Gives the attitudes of the patient towards

dentistry

PERSONAL HISTRY

inclues oral habit history, oral hygiene history, and diet history

• oral habit history

• oral hygiene history

• diet history

PERSONAL HISTORY

ORAL HABIT HISTORY

includes recording the frequency,

intensity, duration of the habits

ORAL HYGIENE HISTORY

includes number of times and methods of

tooth brushing, use of fluoridated or

non fluoridated dentifrices, type of

toothbrush, use of oral hygiene aids

like floss and etc.

24 hour recall history

is routinely

used, ideal method would be to

record a full week diet history

including weekend

• general examination

• extraoral examination

• intraoral examination

• hard tissue examination

TYPES OF EXAMINATION

GENERAL EXAMINATION

evaluates the general well being of the child

GENERAL EXAMINATION

a brief survey of the entire body is made

Height

use percentile growth charts/tables for

comparision

Height

can be influenced by nutrition, heredity,

disease, anomalies, and endocrine issues

Height

can be classified into one of three

categories:

○ normal height to his age, too short or

too tall

• ENDOMORPH

• ECTOMORPH

• MESOMORPH

CLASSIFICATION OF BUILD

ENDOMORPH

well built

ECTOMORPH

poorly build

MESOMORPH

average built

GAIT

observe as child walks into operatory

WEAK

most common abnormal gait

Unsteady gait

lathargic patient,

weak, or sick

Malaise

gait of ill patients

Speech

depends on hearing and developmental

stage

21-24 MONTHS

time when the child begins phrases

2-3 YEARS

time when the child begins sentences

• aphasia

• delayed speech

• stuttering or repetitive speech

• cluttering

• articulatory disorders

TYPES OF SPEECH DISORDERS

APHASIA

rare type of speech disorder

APHASIA

caused by damage to CNS and di nagsasalita si pt

DELAYED SPEECH

no talking by the age of 3

DELAYED SPEECH

causes: hearing loss,

intellectual delay, prolonged

illness, poor environment,

sensory defect

STUTTERING OR REPETITIVE SPEECH

STUTTERING OR REPETITIVE SPEECH

linked to psychological

stress and anxiety

CLUTTERING

an unusual type of speech

characterized by repetition

of words or phrases, false

starts, changes in content

in the middle of the sentence and general verbal confusion

ARTICULATORY DISORDERS

substitution, omission,

insertion, and distortion in

speech

ARTICULATORY DISORDERS

causes: cleft palate,

malocclusion, cerebral palsy,

and neuro damage

1. Informal appraisal during

conversation

2. Early referral to speech pathologist =

better outcome

3. Identifying underlying cause

Management of speech concerns

Hands

assess: temperature, moisture, and dryness and lesions

Temperature

may rise after eating, exercise, or exposure to heat

Fever

one of the most common

symptoms in children

anhidrotic ectodermal dysplasia

children that lacks sweat glands and prone to overheating

Extraoral examination

evaluates the physical characteristics of the child

abnormal head shape

result from

premature closure of sutures, disturbed

cranial bone growth, and abnormal

intracranial pressures

Mesocephalic

average head

Dolichocephalic

long and narrow

Brachycephalic

broad and short

Macrocephaly

enlarged head caused

by development or early traumatic

disturbances

Microcephaly

small head caused by

growth disturbance, disease, or

trauma affecting CNS

Mesoprosopic

average- squar

Euryprosopic

low facial skeleton,

broad and short, round

Dolichorprospic

high

facial skeleton, long and narrow

anteroposterior

eccentric movements

is done to diagnose any clicking and crepitus

• palpation

• floss alignment test

DIAGNOSTIC METHODS FOR TMJ

Palpation

reveals pain and

pressure and

synchrony of action

of left and right

condyle

Palpation

wherein the dentist

places hands on

cheeks (over TMJ)

→ child

opens/closes

mouth, then moves

side-to-side (“chew

slowly back on

teeth”)

Floss alignment test

place floss line

from forehead,

nose, chin →

observe deviations

while px

opens/closes

mouth

submandibular and sub mental

lymph nodes

lymph nodes that are commonly involves during dental infections

Nasal drainage

caused by upper respiratory infection

Scar

caused by past surgery/trauma

Saddle nose

caused by congenital syphilis

Intraoral examination

soft tissues should be examined for 3C’s:

• change in coclor

• change in contour

• change in consistency

3C’s

Change in color

is associated with change

in color to red, blue or white

Change in contour

associated with either

swelling or ulcer

Change in consistency

may be soft, firm

or hard change

Tongue

considers size, shape, color and

movement

Ankyloglossia or tongue tie

requires an

intervention; dapat

magundergo ng lingual

frenectomy bago matutong

magsalita si baby

Lip tie

ang tawag pag ang

labial frenum ay extended.

okay lang na di agad bigyan

ng pansin kasi di naman

naaapektohan ang speech

niya

heredity

plays the greatest role in

predetermination of the size of teeth

• extrinsic factors

• intrinsic factors

TYPES OF ABNORMAL STAINING

EXTRINSIC FACTORS

• can be caused by

  chromogenic

  bacteria which

  may invade

  deposits of materia

  alba and calculus,

  causing an array of

  colors on children’s

  teeth

INTRINSIC FACTORS

generalized

discoloration of the

enamel and dentin

caused by blood

amelogenesis

imperfecta,

dentinogenesis

imperfecta, internal

resorption, and

drugs (tetracycline

series)