Introduction to pediatric dentistry. Anatomical and physiological features of teeth in children

28.03.2020 -

Name: Therapeutic stomatology of children's age.

The textbook presents all the main sections of pediatric therapeutic dentistry, provided for by the relevant state educational standards. The state of the children's dental service, modern methods of examining patients, the characteristics of the child's body are described in detail; the latest data on the ethnology, pathogenesis, diagnosis, treatment and prevention of dental caries and its complications, non-carious lesions, periodontal diseases and oral mucosa are presented. The book is intended for students of dental faculties medical schools, pediatric dentists.

Pediatric dentistry is the youngest branch of dentistry and, as a science, did not arise immediately. Its development and formation was facilitated by the accumulation of knowledge on dentistry in Russia, the study of the heritage of outstanding doctors in our country, other countries, as well as doctors and healers of the ancient world.
Hippocrates described the clinic of teething in the chapter "De dentitione" of the famous book of aphorisms: he noted that during teething there is itching in the gums, fever, diarrhea, especially in children with a tendency to constipation.
One of the founders of Russian medical terminology, A.A. Maksimovich-Ambodik, in his work “The Art of Wiping or the Science of Womanhood” outlined the issues of pediatric dentistry, namely: useful information on oral hygiene of a child, a description of diseases of the teeth and oral mucosa.
N. Timofeev developed approaches to surgical treatment cleft lip in children. They carried out many successful operations for that time.
Ivan Fedorovich Bush - Russian surgeon, one of the founders of Russian traumatology, academician of the Medical and Surgical Academy in St. Petersburg, published in 1807 the "Guide to the Teaching of Surgery", in this work he outlined the causes of improper teething, types of anomalies, methods for their elimination.

CONTENT
- Chapter 1. The state of children's dental service in Russia
The history of the development of children's dental service
Organization, structures and tasks of pediatric dentistry in the new economic conditions
- Chapter 2. Development of the face and mouth
Facial development
Development of the oral and nasal cavities
Language development
Development of the salivary glands
Tooth development
Tooth histogenesis
Histogenesis of hard dental tissues
Enamel histogenesis
Histogenesis of dentin
Cement histogenesis
Histogenesis of the periodontal gap
Development of the jaws
Tooth development
upper jaw
Lower jaw
- Chapter 3. Anatomical and physiological features of the child's body
Features of the structure of the maxillofacial region of the child
Anatomy of children's teeth
Anatomical structure of the oral mucosa
- Chapter 4. Psycho-emotional status in various age periods and preparing the child for research
Psycho-emotional status of the child
- Chapter 5. Methods of examination of children with dental diseases
Determination of the general condition of the child
Methods for detecting an allergic condition in children
Biopsy
Cytological examination
Examination of the oral environment
The study of the electrical excitability of the dental pulp
X-ray examination of the dento-jaw system in children
- Chapter 6. Anesthesia in pediatric dentistry
Mechanism of toothache
Anesthesia at the level of nerve receptors
Pain relief at the level of pathways
Anesthesia at the level of the cerebral cortex
Mistakes and complications during anesthesia
- Chapter 7. Non-carious lesions of the teeth
Classification
Dental lesions that developed during the period of formation and mineralization of teeth (before eruption)
Non-carious lesions that developed after eruption
- Chapter 8. Dental caries
General information
Classification of dental caries
Clinical picture of dental caries
Influence of microorganisms
The role of saliva
The role of nutrition
- Chapter 9. Treatment of caries in children
Treatment of initial caries
Treatment of superficial caries
Milk teeth treatment
General pathogenetic therapy
- Chapter 10. Pulp diseases
General information
Pulp blood supply
Pulp nerves
Inflammation of the dental pulp
Classification and diagnosis of pulpitis
pathological anatomy
Peculiarities clinical course
Pulpitis treatment
- Chapter 11. periodontal inflammation
Etiology
Pathogenesis
Classification of periodontitis
Periodontitis of milk teeth
Periodontitis permanent teeth
Sharp and aggravated chronic periodontitis milk and permanent teeth
- Chapter 12. Endodontic intervention for pulpitis and periodontitis
Mechanical and medical treatment of root canals
Methods of filling (obturation) of the root canal
- Chapter 13. Modern filling materials for restoration and filling of root canals
Filling materials for temporary fillings
Filling materials for permanent fillings
Filling materials for permanent filling of root canals

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Genre: Dentistry

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Description: The textbook covers the issues of the clinic, diagnosis and treatment of major dental diseases in children. The sections of the textbook correspond curriculum and typical curriculum majoring in Pediatric Dentistry.
Outlined modern views on the etiology and pathogenesis of caries, its complications, periodontal disease, diseases of the mucous membrane of the stripes and mouth in children, etc. Special attention paid modern methods diagnosis of dental diseases in children. The classification and principles of treatment of non-carious lesions of hard dental tissues are presented.
According to modern requirements, the textbook includes test tasks corresponding to all sections of the discipline "Pediatric therapeutic dentistry".
The text of the textbook is accompanied by rich illustrative material. For students of dental faculties, interns and dentists.

"Therapeutic dentistry of children's age"

Development of temporary and permanent teeth

Development of temporary teeth
Development of permanent teeth

Anatomical structure of temporary and permanent teeth

Anatomical structure of temporary teeth
Anatomical structure of permanent teeth

Histological structure of hard tissues of temporary and permanent teeth

The structure of enamel
The structure of dentin
The structure of cement

Methods of examination of children with dental diseases

Clinical examination methods
Physical diagnostic methods in the clinic of pediatric therapeutic dentistry
Laboratory research methods in the clinic of pediatric therapeutic dentistry
Blood tests in the clinic of pediatric therapeutic dentistry
Immunological examination methods

Protective mechanisms of the oral cavity

Prevention of dental diseases in children

General (endogenous) prevention
Local (exogenous) prevention

Dental caries in children

Etiology, pathogenesis and pathological morphology of caries
Clinic, diagnosis and differential diagnosis of caries of temporary teeth
Clinic, diagnostics, differential diagnostics of permanent teeth caries
Treatment of caries in temporary teeth
Treatment of caries in permanent teeth, more details on the website https://deti-euromed.ru/specialist-and-prices/priem-detskogo-stomatologa/
Mistakes and complications in the treatment of dental caries in children

Dental filling materials used in pediatric therapeutic dentistry

Filling materials for permanent fillings
Temporary filling materials
Gasket materials

Non-carious lesions of the teeth

Enamel hypoplasia
Fluorosis (endemic fluorosis)
Hereditary malformations of teeth

Pulpitis of temporary and permanent teeth

The structure and functions of the pulp
Etiology and pathogenesis of pulpitis in children
Pulpitis of temporary teeth
Pulpitis of permanent teeth
Treatment of pulpitis of temporary teeth
Treatment of pulpitis of permanent teeth
Mistakes and complications in the treatment of pulpitis of temporary and permanent teeth in children

Periodontitis of temporary and permanent teeth

Structure and functions of the periodontium
Etiology, pathogenesis and classification of periodontitis of temporary and permanent teeth in children
Clinic of periodontitis of temporary teeth
Clinic of periodontitis of permanent teeth
Treatment of periodontitis

Practical endodontics in pediatric dentistry

Topographic and morphological features of the root canal system of teeth in children
Instrumentation for root canal treatment
Ensuring access to root canals and primary cleaning of the canal
Determination of the working length of the tooth
Instrumental processing of the root canal of the tooth
Medical support of instrumental treatment of root canals
Medical treatment in root canals
Permanent root canal obturation
Endodontics of temporary teeth
Endodontics of permanent teeth with incomplete

Traumatic damage to teeth

Classification of traumatic damage to teeth
Clinic and treatment of injuries of permanent teeth
Injuries of temporary teeth in children

Periodontal disease in children

Anatomical and morphological features of the periodontium
Classification of periodontal diseases
Etiology and pathogenesis
Clinical diagnosis of periodontal disease
Gingivitis
Periodontitis
Idiopathic diseases with progressive lysis of periodontal tissues
Prevention of periodontal disease in children

Diseases of the oral mucosa

The structure of the oral mucosa and its features in childhood
Classification of diseases of the oral mucosa
Principles and methods for verifying the diagnosis in diseases of the oral mucosa
Traumatic damage to the oral mucosa
Viral diseases of the oral mucosa
Changes in the oral mucosa in acute viral and infectious diseases
Fungal diseases of the oral mucosa
Allergic diseases of the oral mucosa
Manifestations on the mucous membrane of the cavity in some systemic diseases
Anomalies and self-diseases of the tongue
Cheilitis

Childhood

Lecture (methodological development)

For 4th year students, specialty pediatric therapeutic dentistry

SUBJECT:
Introduction to therapeutic dentistry childhood age. Anatomical and physiological features of teeth in children. Methods of examination of the child.

PURPOSE: (to promote the formation of a system of theoretical knowledge in pediatric therapeutic dentistry).

LECTURE TIME: 2 hours.

MAIN QUESTIONS:

1. Periods of development of childhood dentistry

2. Pediatric therapeutic dentistry, its sections and tasks.

3. Anatomical and physiological features of the structure of milk and permanent teeth in children.

4. Examination of children in the pediatric dentistry clinic. Completion of medical documentation.

LECTURE PREPARED: ass. G.

The methodological development was approved at the meeting of the department No. ___ from "____"

Head Department_______________________________________ (full name)

Pediatric dentistry is the youngest branch of dentistry.

For the first time in Russia, a free school dental outpatient clinic was organized in 1886 by Alexander Karlovich Limberg, who can rightly be called the founder of pediatric dentistry. He was the first to develop the basis for the planned rehabilitation of the oral cavity in students. In the 20-30s 20 th century N. I. Agapov scientifically substantiated in principle new method planned sanitation of the oral cavity in children.

However, pediatric dentistry as an industry began to develop rapidly in the 60s of the 20th century.

In 1963, the first department of pediatric dentistry was organized in MMSI, headed by Alexander Alexandrovich Kolesov.

In 1968, the V-All-Union Congress of Dentists took place, which was entirely devoted to the issues of pediatric dentistry.

A huge contribution to the development of pediatric dentistry was made by T. F. Vinogradova, who for more than 30 years headed the department. pediatric dentistry at TsOLIUv and was the main pediatric dentist in the country.

In DSMA, the Department of Pediatric Dentistry was organized in 1985. For more than 10 years, it was headed by Viktor Vasilievich Schwartz and made a great contribution to the development of pediatric dentistry in Dagestan.

Pediatric dentistry is a complex and multicomponent specialty.

It includes pediatric therapeutic dentistry, all types of maxillofacial surgery, orthodontics and pediatric prosthetics.

A pediatric dentist must know all its sections and understand their organic relationship, taking into account the growing and developing child's body. He must have sufficient general pediatric knowledge to understand the patterns of occurrence and development of major dental diseases in children of different ages.

“A child is not a miniature adult. The development of the organs of the child is distinguished by a number of features in the period of both health and illness; in development children's body undergoes not only quantitative but also qualitative changes, ”S. F. Khotovitsky pointed out back in 1847 in his work Pediatrics.

Pediatric therapeutic dentistry deals with the features of the course and treatment of diseases of the hard tissues of the teeth, periodontal and oral mucosa in children.

Anatomical and physiological features of teeth in children.

The concept of children's teeth refers to the teeth of milk, removable and permanent bite in children. For pediatrician dentist, anatomical and physiological features of the structure of the teeth, which are related to the course of the carious process, the spread of inflammation in the pulp and periodontium, and those data that are directly related to dental treatment, are of great practical importance.

These are, first of all, signs that distinguish dairy and permanent teeth. Age features structures of enamel, child, pulp chamber and roots. Stages and timing of the development of the roots of milk and permanent teeth and, naturally, the physiological features of the crown and root pulp and periodontitis in teeth with incomplete development and formed teeth.

Tooth development is a very complex process that begins at 6-7 weeks of fetal development and continues for several years after tooth eruption in the oral cavity.

Tooth enamel is formed from the epithelium of the enamel organ. The formation of enamel (amelogenesis) occurs as a result of the activity of ameloblasts and is divided into 2 phases: the formation of the enamel matrix and the maturation of enamel. Moreover, the maturation of the enamel does not end before the eruption of the tooth, but continues for a certain time after its eruption (aging of the enamel) in the oral cavity. When the enamel reaches its final thickness and calcifies, the role of the enamel organ is not fulfilled. Despite the fact that with age, the crystal lattice of the enamel becomes denser, in each person, as a result of the chewing load, the physiological erasure of the enamel occurs, i.e., the enamel layer decreases.

Dentin and pulp are formed from the mesenchyme of the dental papilla.

Odontoblast cells are involved in the formation and calcification of dentin. The activity of odontoblasts continues after teething, as a result of which the size of the pulp chamber and the lumen of the root canals decrease with age.

Tooth development can be observed with x-rays.

Tooth germs look like enlightenment oval shape with a clear compact plate, beginning calcification - in the form of blackout areas. According to the R-gram, one can also observe the stages of the formation of the roots of the teeth and periodontium.

An important role in the development and eruption of teeth is played by the state of the nervous, endocrine system metabolic processes etc. A sign of correct eruption is the paired eruption of symmetrical teeth in a certain sequence.

Milk (temporary) teeth differ from permanent ones in the size of the crown (smaller), color (white-blue, and in permanent ones - white-yellow).

The thickness and degree of mineralization of hard tissues of milk teeth and permanent teeth with unformed roots is small, so they are more susceptible to caries. Moreover, in these teeth, the dentin layer is not only smaller, but the dentinal tubules are much wider and shorter, the size of the tooth cavity (pulp chamber) is larger, and the root canals are wider. As a result, when a carious process occurs, microorganisms and their decay products quickly penetrate into the dental pulp, causing inflammation, sometimes acute, accompanied by pain, and more often, an imperceptible, primary chronic course.

Methods for examining children in a pediatric dentistry clinic

The method of clinical examination is a certain algorithm of actions that the doctor must follow when examining a child.

1. Acquaintance with the child - establishing a relationship between a small patient and a doctor.

A relationship of trust (contact) must be established between the patient and the physician. In children, the feeling of fear can be associated with an unpleasant personal experience, and with the stories of others. Therefore, the doctor with his personality, behavior (calm, trusting, confident, friendly, sometimes strict) should try to reduce the feeling of fear.

2. The main methods of examination: - questioning and examination

Poll- must be targeted. Complaints of the patient can be very diverse: pain, aesthetic dissatisfaction, bleeding gums, bad smell from the mouth, etc.

The most common complaint is pain. In this case, it is necessary to find out the nature of the pain, the duration, from which it arises or intensifies, the irradiation of pain, at what time of the day the pain occurs more often.

Next, you need to find out the development of the present disease, general state health (the presence of chronic dental diseases of the liver, kidneys, ENT organs, blood diseases, neuropsychiatric diseases, endocrine diseases, viral hepatitis, tuberculosis, AIDS)

Inspection:

External examination: study of posture, examination of the face, identification bad habits, the study of the function of breathing, swallowing, speech, closing lips.

Status of regional lymph nodes

Oral examination:

Condition of lips and oral area

The vestibule of the oral cavity (depth in N from 5 to 10 mm, the size and shape of the frenulum, bands)

The condition of the gingiva

The state of oral hygiene

The shape of the dentition and the relationship of the jaws

Condition of the oral mucosa

Condition of dental tissues (hypoplasia, fluorosis, etc.)

The condition of the teeth, the presence of carious, filled and extracted teeth.

Inspection of the teeth is carried out using a mirror and a probe in a certain order - starting with the teeth upper jaw right to left and to mandible from left to right.

The data obtained are entered into the dental formula in the form symbols(caries - C, filling - P, tooth to be removed - U).

Milk teeth are indicated by Roman numerals, and permanent Arabic.

Currently, an international digital system designation of teeth, proposed International Organization Standards (ISO). According to this system, each tooth is designated by two numbers, the first of which determines whether the tooth belongs to one of the four quadrants, and the second - the number of the tooth within this quadrant. The quadrants are indicated by Arabic numerals from 1 to 4 in permanent dentition and from 5 to 8 in deciduous dentition clockwise from the maxilla to the right. The teeth within each quadrant are numbered one to eight (permanent) and one to five (deciduous) from the midline distally; numbers must be pronounced separately. For example, the designation of permanent fangs sounds like this: one-three (13), two-three (23), three-three (33), four-three (43).

Additional research methods for caries

1.Probing, percussion, palpation

2. Temperature tests

3. Determination of the hygienic state of the oral cavity (G. I. according to Fedorov - Volodkina, G. I. according to Yrecn - Wermillion)

4. Vital staining (Borovsky method - Aksamit)

5. Evaluation of enamel acid resistance - TER - test (Okuneko, Kosareva, 1983)

6. Determination of the speed of remineralization - KOSRE-test (Rednikova, Leontiev, Ovrutsky, 1982)

7. Luminescent study

8. Electroodontrometry (EOD)

Electroodontodiagnostics (EDI)- a method for assessing the excitability of the sensory nerves of the tooth when they are irritated by an electric current. EOD allows presumably to assess the condition of the dental pulp. Pulp intact healthy teeth responds to current strength in the range of 2-6 μA. To determine the electrical excitability of a tooth, devices OD-1, OD-2M, EOM-3, IVN-1, etc. are used. The study is carried out by a doctor together with an assistant. The reliability of the testimony largely depends on the psycho-emotional mood of the patient. Electroodontodiagnosis for caries in children is rarely used. The electrical excitability of milk teeth has not been studied enough, which is explained by the difficulties in obtaining objective information in children aged 3-5 years. The electrical excitability of permanent teeth varies: during the period of eruption, it is lowered; as the roots grow and form, the excitability increases, reaching normal numbers by the time the root formation is completed. With caries, the sensitivity to electric current does not noticeably change (2-6 μA). With deep caries, especially in children with III degree activity, there is a decrease in the sensitivity of the dental pulp to 10 μA . The most sensitive points for electrode placement are the middle of the incisal edge of the anterior teeth, the apex of the buccal cusp of the premolars, and the apex of the anterior buccal cusp of the molars. In carious teeth, indicators are taken from the bottom of the carious cavity, cleared of necrotic decay. To date, very compact devices have been developed for determining the vitality (viability) of the pulp (for example, the Digitest pulp tester). They allow us to state only two states of the pulp: it is alive (normal) or necrotic.

EDI, like traditional thermodiagnostics, is a relative and subjective method of additional research.

Electrometric method for diagnosing caries (K.) is based on the ability of hard tissues of the tooth affected by caries to carry out electricity different sizes depending on the degree of their damage.

9. Radiography - in the diagnosis of dental caries in children, it is used much more often than in adults, since it is the most reliable method when examining a small patient. This research method is used in case of suspicion of the formation of carious cavities on the proximal surfaces and with a close arrangement of teeth, when a defect in hard tissues is not available for examination and probing. According to the radiograph, one can judge the depth of the carious cavity, the size of the pulp chamber, the condition of the roots and periodontal tissues, which is very important in the differential diagnosis of caries and its complications.

The X-ray method of research allows to determine:

The condition of the hard tissues of the tooth (presence of hidden cavities, enamel cracks);

The condition of the root canals (length, width, degree of passage, quality

filling, the stage of root formation, the state of the growth zone, the stage of resorption of the roots of milk teeth);

The condition of the periapical tissues and periodontal tissues (expansion of the periodontal gap, rarefaction of bone tissue);

The position of the teeth;

The structure of neoplasms, sequesters, stones in the salivary glands;

Condition of the temporomandibular joints.

In dentistry, radiography is used:

intraoral:

a) close-focus contact;

b) contact in the bite.

Extraoral:

a) panoramic;

b) orthopantomography;

c) tomography;

d) contrast radiography.

Radiovisiography (digital radiography).

10.Method of indication of carious dentin. Carious dentin consists of two layers. The first layer (outer) is infected. The second layer (inner) is uninfected, partially demineralized, capable of remineralization. In the treatment of caries, the outer layer must be removed, the inner layer must be preserved. To indicate the layers, the Caries Detector preparation is used, which is a 0.5% solution of basic fuchsin or a 1% solution of red sour in propylene glycol. A swab with a dye is inserted into the carious cavity for 15 seconds. In this case, the outer, non-viable layer is colored, but the inner one is not. Analogues of the drug: Caries Marker (Voco), Color test No. 2 (Vlad-Miva).

11. Laboratory research methods

The data obtained during the examination of the patient is entered into medical card dental patient (account form No. 000 / y) and, on the basis of a real dental situation, draw up a plan for treatment and preventive measures hostility. One of the important tasks initial examination is the development of parents responsibility for the health of the oral cavity of their child. It should be noted the importance of their participation in the implementation of the program of treatment and preventive measures, in particular, in matters of oral hygiene, compliance with the terms of visits to the doctor, monitoring the implementation of prescriptions, and much more. Only full mutual understanding between all participants in the process - the doctor, the child (patient), the parent - is the key to the success of the treatment.

Pediatric therapeutic dentistry is engaged in the study of the characteristics of the clinical course, treatment and prevention of major dental diseases in children (caries and its complications, periodontal and mucous membrane diseases, as well as diseases of the hard tissues of teeth of a non-carious nature). A pediatric dentist must know all sections of pediatric dentistry and understand their organic relationship, taking into account the growing and developing organism. During the examination, it is very important to follow a certain sequence to know the options for the norm, in order to early detection developing pathology. The key to the success of the treatment of a small patient is a complete understanding between all participants in the process - the doctor, the child (patient), the parent.

QUESTIONS AND TASKS FOR SELF-CHECKING STUDENTS.

1. Where and when was the first department of pediatric dentistry organized? Who led it?

In 1963 At MMSI

A. A. Kolesov

2. What signs are typical for the process of teething in the norm?

Pairing, symmetry, sequence and order at certain times of eruption

3. In what sequence are the dentitions examined?

4. What cells are involved in the formation of dentin?

Odontoblasts

5. Give the concept of the term "Maturation of enamel"

Final mineralization of enamel occurring in the oral cavity in the presence of oral fluid

LITERATURE.

1. V. Therapeutic pediatric dentistry. M. "Medical book", N. Novgorod. Publishing house of NGMA, 2001.

2. S., M., V. Dentistry of children's age M. "Medicine" 2003.

3. McDonald, Avery. Dentistry for children and adolescents. M. Medical News Agency. 2003.

4. E. Dentistry of children's age. Practical guide. Rostov-on-Don Phoenix 2006.

5. P., Yu. Pediatric therapeutic dentistry. Guide to practical exercises. M. GEOTAR - Media 2012.

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