HEDC PAEDIATRIC DENTISTRY PERSPECTIVE

history, examination, diagnosis, consent

outline paediatric challenges and considerations

• think about why they have been referred

• anxiety, past dental experience and cooperation (pre-cooperative VS cooperative)

• completely new environment

• child’s age and level of understanding and language

• it may be a 3 or 4 way conversation if you have an interpreter and other family members present

outline communication and situational awareness in paediatric dentistry

• first moments matter

• use warm body language, soft tone, open expressions and smile

• choose guiding phrases over questions that allow refusal

• take time for gentle ice-breakers, nothing clinical for the first few minutes

• situational awareness incl. time of yr e.g. ask about xmas plans, DOB close to holidays, uniforms, clothes

supporting child-centred care

medical history forms

social and family history forms

education for children

• if homeschooled, check with local authority

• all children are entitled to an education under UN law

• it is the legal responsibility of parents to ensure their children are receiving an appropriate full-time education

• a record of a child’s school/ education provider is an important safeguarding check

• post- COVID rise in no. of children being home-schooled

what is a kinship agreement

• a family agreement not registered with social services e.g. if mother is not well the child will live with grandparents

family history: Children’s Social Services form

family history: parental responsibility form

dental history form

what else should you ask about pain history

• is it affecting sleep, drinking/ eating

• have they ever taken paracetamol or ibuprofen

past dental history information

dental history form summary section

what is PICA

eating non-food items of no nutritional value e.g. gravel, sand

examination of paediatric patients in the waiting room

• general appearance - do they look well, cleaned, cared for?

• body language

• gait

• hair/ nails/ hands/ skin

• growth - appropriate for age?

• unexplained injuries - ask

• anxiety

“you’re a bit messy today, what have you been up to”

transitioning from history taking to examination

“let’s have a look at those lovely teeth”

if you think a child is pre-cooperative and you will only get one look, what should you do

get the tutor over for 2 pairs of eyes

scene setting and support sheet

which instrument can be substituted in a paediatric patient

metal mirror » plastic mirror

childrenese

non-pharmacological behaviour support techniques

• tell-show-do

• enhancing control

• positive reinforcement

• distraction

• modelling

• voice control

outline the simplified/ modified BPE

• UR6

• UR1

• UL6

• LR6

• LL1

• LL6

examination form

outline paediatric extra-oral examination

• general appearance

• skull and facial bones

• swelling, lymphadenopathy

• soft tissues

• asymmetries/ facial dysmorphia

—

full extra oral exam is not necessary e.g. lymph nodes, TMJ unless they have been referred for it

what should you watch out for in children when examining them

head lice

important note for intra-oral examination

gentle air from 3in1

outline soft tissue intra-oral examination

• tongue, FOM, palate, throat, buccal mucosa, lips

• gingival condition - plaque index, BPE

• oral cleanliness - fair, good, sub-optimal

• pathology - ulceration, colour change, swelling

• frenal attachment - high FA may lead to diastema

  • high FA = closer to lower arch

intra-oral examination: teeth

intra-oral examination: trauma

what does the tenderness of the buccal sulcus tell you about

root fracture

intra-oral examination: occlusion/ orthondontics

what to do if you encounter an AOB

• measure AOB overjet

• note down anything over 6mm

radiographic investigation

patient cooperation and choice of radiograph

• good cooperation = intraoral radiograph

• sort of cooperative/ pre-cooperative = extraoral style bitewings

can you see caries on a radiograph

NO - you can only see a radiolucency consistent with caries

radiographic reporting

outline special investigations

risk assessment

how many carious teeth does it take to be considered ‘high caries risk’

it takes 1 carious tooth to be at a high risk of caries

risk assessment form

diagnosis form

diagnosis and treatment planning

what are the five pillars of prevention

consent for children and young people

basic principles of paediatric consent

• the consent form should itemise specific items of treatment and state whether primary or permanent teeth are involved

• on occasion, definitive plans may depend on a further examination and radiographs under general anaesthetic if the patient is unable to manage an examination on clinic

• input of child is encouraged where appropriate

in what situations may parental consent be null

• parental consent may not be possible in an emergency or where parents disagree with life-saving treatment for their child

a young person may give their own consent if considered what

Gillick Competent

assessing Gillick Competence