Medical emergencies in pediatric dentistry

Medical emergencies that are life threatening can occur in dental practice. Complications may arise because of an underlying disease or a reaction to medication. Reactions to medications may be allergic and toxic.

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The most common reactions are toxic reactions to local anesthetics, whereas allergies occur mainly as a consequence of the application of antibiotics, usually penicillin.

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In response to stress, vasovagal syncope typically occurs. Other causes may be related to an underlying disease-specific pathology (such as acute asthma attack, diabetic ketoacidosis, hypoglycemia, or seizures) or accidents (aspiration of a foreign body causing obstruction of the respiratory system).

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For all the above conditions, guidelines have been established that need to be known. If complications occur or necessary measures are not taken, it can lead to cardiac and respiratory arrest. Therefore, cardiopulmonary resuscitation is needed. All procedures and dosages should be adapted to the age of the child.



° Vranić, D. N., Jurković, J., Jeličić, J., Balenović, A., Stipančić, G., & Čuković-Bagić, I. (2016). Medical Emergencies in Pediatric Dentistry. Acta stomatologica Croatica, 50(1), 72–80. https://doi.org/10.15644/asc50/1/10

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Diagnostic Aids in Pediatric Dentistry

Childhood is the period of life’s greatest physical, psychological and emotional growth; the child we see today is no longer the same tomorrow. The child patient presents a challenge to the dentist, who must solve the problems of today with an eye to the future and dental health of an adult.

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Diagnosis is a process by which the practitioner distinguishes one disease from another, differentiates between normal and abnormal, and determines the etiology of abnormal conditions (Forrester). Accurate diagnosis can only be achieved by systematic and methodical collection of data.

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The present article illustrates the various diagnostic aids that can be used clinically in pediatric dentistry for detection and evaluation of commonly seen dental diseases.

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The various diagnostic aids can be categorized as:

• Routine diagnostic aids
• Specialized diagnostic aids
• Advanced diagnostic aids.



° International Journal of Clinical Pediatric Dentistry, January-April 2011;4(1):1-7 1
° Gopakumar R, Manju Gopakumar

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Antibiotics: Use and misuse in pediatric dentistry

Antibiotics are prescribed in dental practice for prophylactic and therapeutic reasons. Prophylactic antibiotics are prescribed to prevent diseases caused by members of the oral flora introduced to distant sites in a host at risk or introduced to a local compromised site in a host at risk.

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In most cases, prophylaxis is used for prevention of endocarditis. Therapeutic antibiotics are prescribed, in most cases, to treat diseases of the hard and soft tissues in the oral cavity after local debridement has failed.

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Antibiotics are prescribed for oral conditions related to endodontic, oral surgical, and periodontal manifestations. Unwarranted use of antibiotics are reported in children; mostly for ear and dental infections. However, in children, increasing microbial resistance to antibiotics is a well-documented and is a serious global health concern.

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Antibiotic resistance is due to inappropriate use of antibiotics by clinicians. One factor that may contribute is the inappropriate use of antibiotics in dentistry.



° Peedikayil, Faizal. (2011). Antibiotics: Use and misuse in pediatric dentistry. Journal of the Indian Society of Pedodontics and Preventive Dentistry. 29. 282-7. 10.4103/0970-4388.86368.

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Oral lesions related to dentures

Oral lesions in denture wearers constitute a heterogeneous group of tissue changes, both with regard to pathogenesis, clinical and histopathological appearance, and possible complications.

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Dentures may be the direct cause of these conditions, due to changing environmental conditions of the oral cavity and loading of the oral mucosa. However, systemic conditions and general diseases may influence the oral environment and alter tissue responses and resistance.

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Different medical conditions associated with hyposalivation and parafunctional activity may result in higher risk of oral mucosal alterations. Dundar and IlhanKal reported diabetes mellitus as a risk factor for denture stomatitis and denture hyperplasia.

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The prevalence of oral mucosal lesions has been shown to increase with age.Coelho et al. have explained that tooth loss increases with age, and a removable partial denture (PD) may be later substituted by a complete denture (CD).



Souce: jispcd.org / Prevalence of denture-related oral lesions among patients attending College of Dentistry, University of Dammam: A clinico-pathological study
Authors: Suhayla Mubarak, Ali Hmud, Suresh Chandrasekharan, Aiman A Ali
Image: Aesthetic Dentures

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Preformed crowns for decayed primary molar teeth (Review)

Dental caries (tooth decay) affects around 60% to 90% of children globally (WHO Report 2003). It most commonly occurs in primary (baby) molar (back) teeth. If left unmanaged, dental caries will progress to give pain and infection, the consequences of which are unnecessary suffering, and lost days at school (Gift 1992).

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There is evidence of a linear relationship between higher levels of caries and anthropometric outcomes (height, weight and body mass index (BMI)) (Alkarimi 2014).

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Untreated dental caries has an adverse effect on children’s ability to grow and thrive (Sheiham 2006), and in underweight children, extraction of severely carious primary teeth can improve weight gain (Monse 2012).

Teeth undergo a constant process of demineralisation (caused by the acids and enzymes produced by cariogenic bacteria in the dental biofilm (plaque)) and remineralisation (from protective factors such as fluoride and salivary components).

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Dental caries occurs when the rate of demineralisation is greater than that of remineralisation. When dissolution of enamel and dentine leads to cavitation (a hole in the tooth), the carious lesion can no longer be cleaned and it becomes more difficult to arrest the caries process as the biofilm becomes more sheltered, which favours the cariogenic bacteria (Fejerskov 2015).



° odontologiapediatrica.com
° Cochrane Library / Cochrane Database of Systematic Reviews
° Innes NPT, Ricketts D, Chong LY, Keightley AJ, Lamont T, Santamaria RM

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Ludwig's Angina. Presentation of a pediatric case

Ludwig’s angina is a serious, a rapidly progressive cellulitis of the floor of the mouth which, involves the submandibular, submaxillary, and sublingual spaces of the face, it is life threatening if not early recognised and complications like septicemia and asphyxia caused by expanding edema of soft tissues of the neck may occur.

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A 11-year-old boy referred to, our clinic had tender swelling of the floor of his mouth. Based on his history and symptoms, the diagnosis of Ludwig’s angina was suspected. Infected teeth were diagnosed in oral and radiological examination.

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The child was treated appropriately by extraction of infected teeth after antibiotic therapy. Many departments may have limited experience of the disease because of its rare occurrence. So, it is important to recognize Ludwings angina in the earlier stages of the disease.

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Introduction: Ludwig´s angina was firstly described by Wilhelm Frederick von Ludwing in 1836. Ludwig´s angina is a serious, life threatening if not early recognised and treated due to septicemia and asphyxia caused by expanding edema of soft tissues of the neck.



Souce: JBR Journal of Interdisciplinary Medicine and Dental Science
Authors: Mine Simsek / Esma Yildiz / Mutar Hamdi Aras

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An update on primary teeth pulpotomy medicaments

The aim of this paper was to review the history and the scientific literature published on pulpotomy medicaments and to present the findings of these studies.

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The review showed that pulpotomy of primary teeth has been treated with many different techniques and medicaments, that some of these approaches are controversial and that their results have presented variables of success rates in term of clinical, radiographic and histologic observation.

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It is important that all clinicians, particularly for pediatric dentist, be up to date with the recetn trends in this area of dental treatment for children.

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Vital pulpotomy is the clinical treatment of choice for primary teeth with exposed pulp. Pulpotomy can be defined as the surgical removal or amputation of the coronal pulp of the vital tooth.



Souce: The Journal of Contemporary Dental Practice
Author: Yousef H Al-Dlaigan

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Guideline on Pediatric Oral Surgery

The American Academy of Pediatric Dentistry (AAPD) intends this guideline to define, describe clinical presentation, and set forth general criteria and therapeutic goals for common pediatric oral surgery procedures that have been presented in considerably more detail in textbooks and the dental/medical literature.

Preoperative evaluation

Medical : Important considerations in treating a pediatric patient include obtaining a thorough medical history, obtaining appropriate medical and dental consultations, anticipating and preventing emergency situations, and being prepared to treat emergency situations.

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Dental : It is important to perform a thorough clinical and radiographic preoperative evaluation of the dentition as well as extraoral and intraoral soft tissues.

Radiographs can include intraoral films and extraoral imaging if the area of interest extends beyond the dentoalveolar complex.

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Behavioral considerations Behavioral guidance of children in the operative and perioperative periods presents a special challenge. Many children benefit from modalities beyond local anesthesia and nitrous oxide/oxygen inhalation to control their anxiety.

Management of children under sedation or general anesthesia requires extensive training and expertise. Special attention should be given to the assessment of the social, emotional, and psychological status of the pediatric patient prior to surgery.



° aapd.org / American academy of pediatric Dentistry

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Reimplantation of avulsed dry permanent teeth after three days: A report of two cases

Avulsion is a traumatic injury which results in loss of the tooth from the alveolus, while reimplantation is the technique of reinserting an avulsed tooth into the alveolus or tooth socket after its loss.

The success of reimplantation depends on many factors among which are the time lapse before the tooth is reimplanted in the socket and the storage medium of the avulsed tooth.

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Other factors which may affect the success of reimplantation include the condition of the tooth, particularly the periodontal ligament tissue remaining on the root surface, sex, age, type of tooth reimplanted, stage of root formation, type of cleansing procedure following contamination of the root surface, duration of splinting, and the use of antibiotics.

With favorable conditions such as the periodontal ligament remaining on the root surface, the tooth stored in adequate storage medium for not more than 60 minutes, and immediate reimplantation after the accident, the tooth may be retained for as long as 5 to 10 years and few for a lifetime, but some fail soon after reimplantation.

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Unfavorable conditions include teeth out of the mouth for more than 6 hours in no storage media and without periodontal ligament on the root surface.



° njcponline.com
° Nigerian Journal of Clinical Practice
° IN Ize-Iyamu, BDO Saheeb

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Management of Endodontic Emergencies: Pulpotomy Versus Pulpectomy

Recent studies report a 60-82% incidence of endodontic emergencies among all dental emergencies. Within this group, 20-42% of patients seek care for teeth with symptomatic irreversible pulpitis (SIP).

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Additionally, about 60% of SIP patients also complain of symptomatic apical periodontitis (SAP). While pain due to a severely inflamed pulp is characterized by dull, throbbing and lingering pain sensations, it can be spontaneous or in response to an external stimulus, such as hot, cold or chewing.

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This makes SIP the bulk of the emergency cases seen in dental clinics. The goal of management of endodontic emergencies is to quickly and effectively manage pain and infections thereby also minimizing the development of persistent pain and the formation of periapical pathology.

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Pharmacological management such as intramuscular or infiltration injection of ketorolac trimethamine (injectable NSAID) can significantly attenuate pain in patients with moderate to severe pulpal pain over a three-hour tested time or oral administration of ibuprofen sodium dihydrate over a one-hour time period.



Souce: aae.org / American Association of Endodontists (AAE)

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How does hypertension affect oral health?

The World Health Organization attributes hypertension, or high blood pressure, as the leading cause of cardiovascular mortality. An elevated arterial pressure is probably the most important public health problem in developed countries.

It is common, asymptomatic readily detectable and easily treatable, and if untreated, often leads to complications. Although our understanding of the pathophysiology of elevated arterial pressure has increased, in 90 to 95% of cases the etiology is still largely unknown.

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As a consequence, in most cases hypertension is treated non-specifically, resulting in the large number of minor side effects and relatively high non-compliance rate. The ratio of hypertension frequency in women versus men increases from 0.6 to 0.7 at age 30 to 1.1 to 1.2 at age 65.

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Dentists have a rare opportunity to detect cases of hypertension. It is a professional responsibility of a dental clinician to inform the patient of their hypertensive state and to offer medical advice, including epropriate referrals.



Souce: Journal of Oral and Maxillofacial Pathology Vol. 16 Issue 2 May - Aug 2012 215
Authors: Prashant Kumar, KMK Mastan, Ramesh Chowdhary, K Shanmugam

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Oral manifestations of human immunodeficiency virus in children

Human immunodeficiency virus (HIV) infection is considered a pandemic by the World Health Organization (WHO). From its discovery in 1981 to 2006, acquired immunodeficiency syndrome (AIDS) has killed more than 25 million people.

HIV infects about 0.6% of the world's population. In 2005, AIDS claimed an estimated 2.4-3.3 million lives, of which more than 570,000 were children. Most of the cases are seen in sub-Saharan countries and developing nations.

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Antiretroviral treatment reduces both the mortality and the morbidity rates of HIV infection, but routine access to antiretroviral medication is not available in all countries. HIV transmission in children occurs mainly through vertical transmission (mother to child).

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° Journal of Oral and Maxillofacial Pathology Vol. 16 Issue 2 May - Aug 2012
° Srinivas Rao Ponnam / Gautam Srivastava / Kotaih Theruru

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Radiographic Techniques for the Pediatric Patient

Clinicians are in agreement the foundation of an accurate diagnosis and treatment plan is based on a comprehensive medical and dental history, a thorough clinical examination, and diagnostic radiographs.

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Of the three, obtaining diagnostic radiographs in the pediatric dental patient is probably the most difficult to accomplish, not only from a technical standpoint but because of parental fears and misconceptions.

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With the news media reporting on a daily basis the environmental insults experienced by the human body, parents are preoccupied with the effects of diagnostic and treatment procedures on the child's health.

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°dentalcare.com
°Radiographic Techniques for the Pediatric Patient
°Steven Schwartz, DDS
Image: Tooth Fairy Pediatric Dental

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Pseudo class III treatment in 2-year-old children

Timing of orthodontic treatment especially for children with developing Class III malocclusions has always been somewhat controversial. Pseudo class III malocclusion is recommended to be treated early as this type of malocclusion doesn’t diminish with age.

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Untreated pseudo class III may lead to serious problems. The case report describes pseudo class III in primary dentition successfully treated by using Protrusive Arch Wire.



INTRODUCTION: Timing of orthodontic treatment, especially for children with developing class III malocclusions, has always been somewhat controversial.

The earlier the interceptive phase is initiated, the greater the orthopedic effects will be to the detriment of the unavoidable orthodontic and orthopedic effects.

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Source: Open Journal of Stomatology, 2014, 4, 10-13
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