Dr Jileen Patel BDSc (Hons) WA, DClinDent, MRACDS, FADI, FICD, FPFA Specialist Paediatric Dentist Senior Lecturer, Clinical Dentistry UWA Dental School BOYAGONSC #### Presenter Profile **Dr Jileen Patel** BDSc (Hons) WA, DClinDent, MRACDS, FADI, FICD, FPFA - Specialist Paediatric Dentist - Senior Lecturer, Clinical Dentistry - UWA Dental School # **Lecture Outcomes** **The University of Western Australia** Students should be able to: - compare and contrast the differences between a clinical examination of a child and an adult - construct a comprehensive history for a paediatric patient from consultation with their parent/guardian - identify the fundamental elements that form part of an extra and intra-oral clinical examination of child - interpret various tooth numbering systems used in dentistry - make use of a history and examination in order to inform treatment planning in the context of paediatric dentistry - Examinable content: Chapter 1 (*Handbook of Paediatric Dentistry*, Cameron & Widmer) (Table containing logo and title) Students should be able to: - Compare and contrast the differences between a clinical examination of a child and an adult - Construct a comprehensive history for a paediatric patient from consultation with their parent/guardian - Identify the fundamental elements that form part of an extra and intra-oral clinical examination of child - Interpret various tooth numbering systems used in dentistry - Make use of a history and examination in order to inform treatment planning in the context of paediatric dentistry **Examinable content:** - Chapter 1 (*Handbook of Paediatric Dentistry*, Cameron & Widmer) What is different in Children **THE UNIVERSITY OF WESTERN AUSTRALIA** - May not be confident with strangers - Cannot sit still for long - Have little experience of - noise - taste - smells - paresthesia - Teeth are smaller - Pulp is proportionally larger - Access is more limited **Note:** In the original image, the word "Pulp" is followed by "are," which is grammatically incorrect. It likely should be "Pulp [is] proportionally larger." I have transcribed it exactly as written in the image: "Pulp are proportionally larger." #### Clinical and Anatomical Considerations - May not be confident with strangers - Cannot sit still for long - Have little experience of: - Noise - Taste - Smells - Paresthesia - Teeth are smaller - Pulp is proportionally larger - Access is more limited **Examining Children** **Personal details** • Name • Date of birth • Date of examination • Parent’s name IMG   #### Personal Details - Name - Date of birth - Date of examination - Parent’s name Clinical photo demonstrating the identification process during a child examination. A healthcare provider is holding a child's wrist which features an identification band with a barcode and text, illustrating the importance of verifying personal details like name and date of birth. Illustrative figure summarizing key patient identifiers. The graphic displays three numbered points: '1. PATIENT NAME', '2. BIRTHDAY', and '3. MED REC#' (Medical Record Number). Each point is accompanied by a cartoon character wearing a helmet, visually reinforcing the critical data required for examining children. # **History** History should be - taken in a logical and systematic way - updated regularly **Reason for visit** - Referred by - Routine examination - Recall- check what was done before - Painful teeth #### History Taking Requirements History should be: - Taken in a logical and systematic way - Updated regularly #### Reason for Visit - Referred by - Routine examination - Recall (check what was done before) - Painful teeth **History** **Current problem** * Pain * —nature * —onset or type of pain * —relieving and exacerbating factors * Not sleeping * Not eating * Irritable * Loose tooth/ teeth * Broken tooth/restoration * No problem **THE UNIVERSITY OF WESTERN AUSTRALIA**  #### Current Problem Assessment - **Pain** - Nature - Onset or type of pain - Relieving and exacerbating factors - **Associated Symptoms** - Not sleeping - Not eating - Irritable - **Dental Concerns** - Loose tooth/teeth - Broken tooth/restoration - **No problem** Clinical photo of a young child with blonde hair crying while holding their mouth. This visual demonstrates the symptom 'Irritable' and supports the context of dental pain or discomfort listed under 'Current problem'. # History – Medical history - It should be taken in a systematic fashion, covering all system areas of the body. The major areas include: - **Cardiovascular system** (e.g. cardiac lesions, blood pressure, rheumatic fever) - **Central nervous system** (e.g. seizures, cognitive delay) - **Endocrine system** (e.g. diabetes) - **Gastrointestinal tract** (e.g. hepatitis) - **Respiratory tract** (e.g. asthma, bronchitis, upper respiratory tract infections) - **Bleeding tendencies** (e.g. family history of bleeding problems) - **Urogenital system** (renal disease, ureteric reflux) - **Allergies** - **Past operations or hospital admissions** Medical history should be taken in a systematic fashion, covering all system areas of the body. The major areas include: - **Cardiovascular system**: e.g., cardiac lesions, blood pressure, rheumatic fever - **Central nervous system**: e.g., seizures, cognitive delay - **Endocrine system**: e.g., diabetes - **Gastrointestinal tract**: e.g., hepatitis - **Respiratory tract**: e.g., asthma, bronchitis, upper respiratory tract infections - **Bleeding tendencies**: e.g., family history of bleeding problems - **Urogenital system**: renal disease, ureteric reflux - **Allergies** - **Past operations or hospital admissions** **History – Medical history** **The University of Western Australia** **Pregnancy history** • Length of confinement • Birth weight • Apgar scores • Type of delivery (any complications) • Antenatal and perinatal problems, especially during delivery • Prematurity and treatment in a special or neonatal intensive care nursery   #### Pregnancy and Birth History - Length of confinement - Birth weight - Apgar scores - Type of delivery (any complications) - Antenatal and perinatal problems, especially during delivery - Prematurity and treatment in a special or neonatal intensive care nursery Clinical photo of a newborn infant lying on an electronic weighing scale. Contextually relevant to the 'Birth weight' and 'Pregnancy history' bullet points listed in the OCR text. Close-up clinical photo of a child's mouth showing teeth with visible enamel defects or discoloration. Contextually relevant to dental assessments often linked with medical history regarding birth conditions like prematurity mentioned in the text. History – **Medical history** **Growth and development** - Developmental milestones - Speech and language development - Motor skills - Socialization   #### Growth and Development - Developmental milestones - Speech and language development - Motor skills - Socialization Clinical photo of a young child in a striped shirt reaching up to measure their height against a wall-mounted ruler. Contextually illustrates 'Growth and development' and 'Developmental milestones'. Chart titled 'Speech Sound Development'. It displays four illustrated children representing ages 3, 4, 5, 6, and 8 years (labeled as 3, 4, 5, 6, and 8). Each child has a speech bubble listing phonetic sounds they should be able to say by that age (e.g., p, b, m, n at age 3; th blends at age 8). The chart serves to demonstrate 'Speech and language development' milestones. # History – Medical history Current medical treatment * **Medications**, including complementary medications * **Current treatments** * **Immunizations** #### Current Medical Treatment - **Medications**: including complementary medications - **Current treatments** - **Immunizations** # History ## Dental history * Previous dental treatment * What preventive treatment has been undertaken previously * Methods of pain control used previously * How the child coped with the treatment  - Previous dental treatment - What preventive treatment has been undertaken previously - Methods of pain control used previously - How the child coped with the treatment Clinical photo of a young child receiving dental treatment. The child is seated in a dental chair with mouth open, while gloved hands use dental instruments to examine or treat the teeth. This image visually supports the 'Dental history' section by illustrating the context of previous dental visits and treatment experiences mentioned in the bullet points. # History ## Family and Social history * Helps build a picture * Family history of serious illness * Family make up * Place of birth * No of siblings * Schooling, performance in class * Speech and language problems * Likes, dislikes * Other interests (pets, hobbies * sports, television, books, movies, video games)   #### Social Context and Background - Family history of serious illness - Family make up - Place of birth - Number of siblings - Schooling and performance in class - Speech and language problems - Likes and dislikes - Other interests (pets, hobbies, sports, television, books, movies, video games) A photograph showing a young child in a blue shirt interacting with a large Blue-and-yellow Macaw. This image visually represents the 'Family and Social history' bullet point 'Other interests (pets...)'. A screenshot or promotional image of the video game Minecraft featuring blocky characters and terrain. This image visually represents the 'Family and Social history' bullet point 'Other interests (...video games)'. **History** **Parent’s comment** * Record what the parent says * Concerns may be different than reason for appointment    #### Parent’s Comments - Record what the parent says - Concerns may be different than the reason for the appointment Clinical photo: A child sitting on a parent's lap during an appointment, illustrating the context of parental comments and concerns in medical history taking. # **Examination** ## **Extra oral examination** * General appraisal of the child’s well-being * General interaction with the parents or peers * Child’s gait * Height and weight assessment #### General Appraisal - General appraisal of the child’s well-being - General interaction with the parents or peers - Child’s gait - Height and weight assessment **Examination** The UNIVERSITY OF WESTERN AUSTRALIA **Extra oral examination** **Frontal profile** * round / tapering / square / symmetrical/asymmetrical Lateral profile * straight / convex / concave Skeletal pattern * I /II /III Normal Convex Concave Class I Class II Class III   #### Facial and Skeletal Assessment - **Frontal profile**: round / tapering / square / symmetrical / asymmetrical - **Lateral profile**: straight / convex / concave - **Skeletal pattern**: Class I / II / III Clinical comparison figure showing three side-profile photographs of female faces demonstrating extra-oral examination findings. The images are labeled from left to right as 'Normal', 'Convex', and 'Concave' to illustrate different facial skeletal patterns. Clinical comparison figure showing three side-profile photographs of female faces demonstrating skeletal pattern classifications. The images are labeled from left to right as 'Class I', 'Class II', and 'Class III' to illustrate different jaw relationships. **The University of Western Australia** # Examination ## Extra oral examination ### Lips * **Lips**: competent / incompetent / lip trap ### Eyes * Appearance of the globe, sclera, pupils and conjunctiva * Movements of the globe: indicate squints or palsy ### Skin/Soft tissue * **Colour** * **Appearance** – lacerations, scars, vesicles     #### Soft Tissue and Cranial Nerves - **Lips**: competent / incompetent / lip trap - **Eyes**: - Appearance of the globe, sclera, pupils and conjunctiva - Movements of the globe (indicate squints or palsy) - **Skin/Soft tissue**: - Colour - Appearance (lacerations, scars, vesicles) Clinical photo showing a mouth with lips in a competent position (closed), demonstrating normal lip seal as part of the 'Lips' examination category. Clinical photo showing an incompetent lip condition where the upper and lower lips do not meet completely, exposing teeth, illustrating the 'incompetent' state mentioned in OCR text. Clinical photo showing a lip trap deformity where the central portion of the lips is recessed or folded inward, visually representing the 'lip trap' condition described in the OCR text. Clinical photo showing skin/soft tissue with visible vesicles (small fluid-filled blisters) and redness on the cheek and neck area, illustrating the 'vesicles' finding under the 'Skin/Soft tissue' section. **Examination** **Extra oral examination** **Temporomandibular joints** * movements * sounds * symptoms **Lymph nodes** * cervical * submandibular * occipital #### TMJ and Lymphatics - **Temporomandibular joints**: - Movements - Sounds - Symptoms - **Lymph nodes**: - Cervical - Submandibular - Occipital **Examination** **Intra-Oral Examination** **Soft tissues** * Lips * Tongue * Mucosa * Gingiva * Frenums * Floor of mouth * Palate * Salivary glands * Oropharynx * Tonsils * Uvula    #### Soft Tissue Assessment - Lips - Tongue - Mucosa - Gingiva - Frenums - Floor of mouth - Palate - Salivary glands - **Oropharynx**: - Tonsils - Uvula Clinical intra-oral photograph showing the soft palate and uvula region. The image demonstrates anatomical structures relevant to the 'Oropharynx' examination category listed in the text. Clinical intra-oral photograph displaying the floor of the mouth, tongue base, and oropharyngeal area. This visual corresponds to the 'Floor of mouth', 'Tongue', and 'Oropharynx' items in the examination checklist. Close-up clinical photograph of the anterior tongue tip. A distinct, raised lesion (likely a papilloma) is visible on the surface, demonstrating a specific finding relevant to the 'Tongue' and 'Mucosa' examination points. Examination THE UNIVERSITY OF WESTERN AUSTRALIA    Clinical photo of the upper left posterior dentition showing inflamed gingival tissue and a localized swelling or lesion adjacent to the premolars. Clinical photo of the upper anterior region showing significant gingival inflammation and a prominent, raised, erythematous nodule on the attached gingiva near the lateral incisor/canine area. Clinical photo of the maxillary anterior teeth showing generalized gingival inflammation with multiple small pustular lesions (pimples) on the gingiva between the central incisors and canines. **Examination** THE UNIVERSITY OF WESTERN AUSTRALIA      Clinical photo of the oral cavity showing a red, ulcerated lesion on the lower gum line between teeth. A dental mirror is visible retracting the cheek for examination. Clinical photo of the upper anterior teeth and gingiva showing significant swelling and inflammation of the gum tissue above the central incisors. Clinical photo of the tongue displaying a large, white, patchy area (plaque) covering the dorsal surface with surrounding erythema. Clinical photo of the tongue showing deep longitudinal fissures running down the center of the dorsal surface. Clinical photo of the ventral surface of the tongue being retracted by gloved fingers, showing the smooth underside anatomy.     Clinical photo showing a close-up view of the lower left buccal mucosa. A distinct, dark blue to purple, well-circumscribed lesion is visible on the inner cheek, adjacent to the molar teeth. Clinical photo displaying an intraoral view with a clear retractor in place. The image shows generalized gingival inflammation and discoloration (erythema), particularly affecting the anterior maxillary region. Clinical photo focusing on the anterior mandibular labial mucosa. There is a prominent, large, diffuse blue-purple swelling or bruise located centrally over the lip area, extending across the midline. Clinical photo showing the right lateral aspect of the oral cavity. A focal, slightly raised, translucent to whitish lesion is visible on the buccal mucosa near the premolar region. # **Examination** The University of Western Australia ## **Oral hygiene** * **Plaque disclosing** * **Record** * Plaque location * Quantity ## **Periodontal status** * Healthy * Unhealthy * Developmental * Why?   #### Oral Hygiene - Plaque disclosing - Record: - Plaque location - Quantity #### Periodontal Status - Healthy - Unhealthy - Developmental - Etiology (Why?) Clinical photo showing plaque disclosing results on anterior teeth. The image demonstrates the 'Plaque disclosing' examination step mentioned in the text, with blue and pink dye highlighting areas of bacterial biofilm accumulation on the tooth surfaces. Clinical photo of a patient's mouth demonstrating periodontal status. The image shows gingival inflammation (redness) and potential developmental issues such as crowding or malalignment of the teeth, relevant to the 'Periodontal status' section discussing healthy vs unhealthy conditions. # Examination **The University of Western Australia** ## Dental hard tissues ### Teeth * Tooth identification * Dental charting * Dental caries / restorations * Anomalies * Abnormalities #### Teeth Assessment - Tooth identification - Dental charting - Dental caries / restorations - Anomalies - Abnormalities # Examination ## Dental hard tissues Dental charting systems - Universal or ADA System - Palmer notation system - FDI or international system Commonly used systems include: - Universal or ADA System - Palmer notation system - FDI or international system # Universal or ADA System ## Permanent teeth <table> <thead> <tr> <th>Maxillary right</th> <td>1</td><td>2</td><td>3</td><td>4</td><td>5</td><td>6</td><td>7</td><td>8</td> <td>9</td><td>10</td><td>11</td><td>12</td><td>13</td><td>14</td><td>15</td><td>16</td> <th>Maxillary left</th> </tr> </thead> <tbody> <tr> <th>Mandibular right</th> <td>32</td><td>31</td><td>30</td><td>29</td><td>28</td><td>27</td><td>26</td><td>25</td> <td>24</td><td>23</td><td>22</td><td>21</td><td>20</td><td>19</td><td>18</td><td>17</td> <th>Mandibular left</th> </tr> </tbody> </table> ## Primary teeth <table> <thead> <tr> <th>Maxillary right</th> <td>A</td><td>B</td><td>C</td><td>D</td><td>E</td> <td>F</td><td>G</td><td>H</td><td>I</td><td>J</td> <th>Maxillary left</th> </tr> </thead> <tbody> <tr> <th>Mandibular right</th> <td>T</td><td>S</td><td>R</td><td>Q</td><td>P</td> <td>O</td><td>N</td><td>M</td><td>L</td><td>K</td> <th>Mandibular left</th> </tr> </tbody> </table>   #### Permanent Teeth | Quadrant | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | **Maxillary** | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | | **Mandibular** | 32 | 31 | 30 | 29 | 28 | 27 | 26 | 25 | 24 | 23 | 22 | 21 | 20 | 19 | 18 | 17 | #### Primary Teeth | Quadrant | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | **Maxillary** | A | B | C | D | E | F | G | H | I | J | | **Mandibular** | T | S | R | Q | P | O | N | M | L | K | Chart showing the Universal or ADA System for Permanent teeth. The chart displays a full set of permanent teeth arranged in quadrants: Maxillary right (teeth 1-8), Maxillary left (teeth 9-16), Mandibular right (teeth 17-24), and Mandibular left (teeth 25-32). Each tooth is labeled with its corresponding number. Chart showing the Universal or ADA System for Primary teeth. The chart displays a full set of primary teeth arranged in quadrants: Maxillary right (teeth A-E), Maxillary left (teeth F-J), Mandibular right (teeth T-P), and Mandibular left (teeth O-K). Each tooth is labeled with its corresponding letter. # Palmer Notation System THE UNIVERSITY OF WESTERN AUSTRALIA ### Permanent Teeth <table> <tr> <td colspan="8">Maxillary right</td> <td colspan="8">Maxillary left</td> </tr> <tr> <td>8┘</td> <td>7┘</td> <td>6┘</td> <td>5┘</td> <td>4┘</td> <td>3┘</td> <td>2┘</td> <td>1┘</td> <td>└1</td> <td>└2</td> <td>└3</td> <td>└4</td> <td>└5</td> <td>└6</td> <td>└7</td> <td>└8</td> </tr> <tr> <td>8┐</td> <td>7┐</td> <td>6┐</td> <td>5┐</td> <td>4┐</td> <td>3┐</td> <td>2┐</td> <td>1┐</td> <td>┌1</td> <td>┌2</td> <td>┌3</td> <td>┌4</td> <td>┌5</td> <td>┌6</td> <td>┌7</td> <td>┌8</td> </tr> <tr> <td colspan="8">Mandibular right</td> <td colspan="8">Mandibular left</td> </tr> </table> ### Primary Teeth <table> <tr> <td colspan="5">Maxillary right</td> <td colspan="5">Maxillary left</td> </tr> <tr> <td>E┘</td> <td>D┘</td> <td>C┘</td> <td>B┘</td> <td>A┘</td> <td>└A</td> <td>└B</td> <td>└C</td> <td>└D</td> <td>└E</td> </tr> <tr> <td>E┐</td> <td>D┐</td> <td>C┐</td> <td>B┐</td> <td>A┐</td> <td>┌A</td> <td>┌B</td> <td>┌C</td> <td>┌D</td> <td>┌E</td> </tr> <tr> <td colspan="5">Mandibular right</td> <td colspan="5">Mandibular left</td> </tr> </table>   #### Permanent Teeth - **Maxillary Right**: 8┘ to 1┘ - **Maxillary Left**: └1 to └8 - **Mandibular Right**: 8┐ to 1┐ - **Mandibular Left**: ┌1 to ┌8 #### Primary Teeth - **Maxillary Right**: E┘ to A┘ - **Maxillary Left**: └A to └E - **Mandibular Right**: E┐ to A┐ - **Mandibular Left**: ┌A to ┌E Table displaying the Palmer Notation System for Permanent Teeth. It is a grid with four rows and sixteen columns. The top row labels sections as 'Maxillary right' (columns 1-8) and 'Maxillary left' (columns 9-16). The bottom row labels sections as 'Mandibular right' (columns 1-8) and 'Mandibular left' (columns 9-16). The cells contain numbers 1 through 8 combined with corner brackets (┘, └, ┌, ┐) to denote specific tooth positions. Table displaying the Palmer Notation System for Primary Teeth. It is a grid with four rows and ten columns. The top row labels sections as 'Maxillary right' (columns 1-5) and 'Maxillary left' (columns 6-10). The bottom row labels sections as 'Mandibular right' (columns 1-5) and 'Mandibular left' (columns 6-10). The cells contain letters A through E combined with corner brackets (┘, └, ┌, ┐) to denote specific tooth positions. # FDI or International System The University of Western Australia ### Permanent teeth | | | | | | | | | | | | | | | | | |---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---| | | Maxillary right | 18 | 17 | 16 | 15 | 14 | 13 | 12 | 11 | | | Maxillary left | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | | | Mandibular right | 48 | 47 | 46 | 45 | 44 | 43 | 42 | 41 | | | Mandibular left | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | ### Primary teeth | | | | | | | | | | | | | | | | | |---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---| | | Maxillary right | 55 | 54 | 53 | 52 | 51 | | | Maxillary left | 61 | 62 | 63 | 64 | 65 | | | Mandibular right | 85 | 84 | 83 | 82 | 81 | | | Mandibular left | 71 | 72 | 73 | 74 | 75 |   #### Permanent Teeth - **Maxillary Right**: 18, 17, 16, 15, 14, 13, 12, 11 - **Maxillary Left**: 21, 22, 23, 24, 25, 26, 27, 28 - **Mandibular Right**: 48, 47, 46, 45, 44, 43, 42, 41 - **Mandibular Left**: 31, 32, 33, 34, 35, 36, 37, 38 #### Primary Teeth - **Maxillary Right**: 55, 54, 53, 52, 51 - **Maxillary Left**: 61, 62, 63, 64, 65 - **Mandibular Right**: 85, 84, 83, 82, 81 - **Mandibular Left**: 71, 72, 73, 74, 75 FDI or International System diagram for permanent teeth. The image displays a labeled diagram of the human dentition with tooth numbers arranged in a grid format. The top section shows the maxillary (upper) teeth, divided into right and left quadrants, with numbers ranging from 18 to 28. Below that is the mandibular (lower) teeth, also divided into right and left quadrants, with numbers ranging from 31 to 48. Each tooth is represented by an illustration showing its root structure. FDI or International System diagram for primary teeth. The image displays a labeled diagram of the human dentition with tooth numbers arranged in a grid format. The top section shows the maxillary (upper) teeth, divided into right and left quadrants, with numbers ranging from 51 to 65. Below that is the mandibular (lower) teeth, also divided into right and left quadrants, with numbers ranging from 71 to 85. Each tooth is represented by an illustration showing its root structure. **Examination** **THE UNIVERSITY OF WESTERN AUSTRALIA**  Clinical examination photos of a patient's dentition showing multiple dental anomalies. The images include occlusal views of the maxillary arch (top row) and frontal view of the anterior teeth (bottom row), with red circles highlighting specific areas of interest such as supernumerary teeth, crowding, and malpositioned incisors. **Examination**   Clinical examination photos showing multiple teeth with visible caries and decay. The top image displays anterior teeth with enamel defects or early decay, while the bottom image shows posterior molars with significant cavitation and discoloration indicative of advanced dental caries. Close-up clinical photo of a molar tooth exhibiting extensive brownish-yellow carious lesions on the occlusal surface, surrounded by healthy gingival tissue. # Examination ## Occlusion and orthodontic relations * **Eruption** * – Normal * – Abnormal * **Terminal plane**  #### Eruption and Terminal Plane - **Eruption** - Normal - Abnormal - **Terminal plane** Labelled diagram illustrating three types of terminal plane relationships in occlusion. Top panel shows 'Flush terminal' with two posterior teeth having aligned distal surfaces next to a vertical blue reference plane. Middle panel depicts 'Mesial step', where the upper tooth's distal surface is more mesial than the lower tooth's. Bottom panel shows 'Distal step', where the upper tooth's distal surface is more distal than the lower tooth's. Each illustration includes a simplified tooth outline and a blue rectangular plane indicating the terminal plane position relative to adjacent teeth. **Molar Relationship** Class I Class II (Full unit) Class II (1/2 unit) Class III     #### Molar Relationship - Class I - Class II (Full unit) - Class II (1/2 unit) - Class III Figure demonstrating Molar Relationship Class I. The image consists of a clinical photograph on the left showing occlusion with a vertical reference line, and a corresponding schematic diagram on the right illustrating the ideal alignment where the mesiobuccal cusp of the maxillary first molar fits into the buccal groove of the mandibular first molar. Figure demonstrating Molar Relationship Class II (Full unit). The image includes a clinical photograph on the left and a schematic diagram on the right showing distal displacement of the mandibular arch relative to the maxilla. A red arrow in the diagram points to the right, indicating the distal shift of the mandibular teeth. Figure demonstrating Molar Relationship Class II (1/2 unit). This panel features a clinical photograph on the left and a schematic diagram on the right. The diagram shows a partial distal relationship compared to Class I, with a red arrow pointing to the right to indicate the direction of the discrepancy. Figure demonstrating Molar Relationship Class III. The image displays a clinical photograph on the left and a schematic diagram on the right illustrating mesial displacement of the mandibular arch. A red arrow in the diagram points to the left, highlighting the anterior positioning of the mandibular molars relative to the maxillary molars. **Canine Relationship** - Occlusion and orthodontic relations - Caine - Canine relationship - Class I - Class II - Class III  #### Canine Relationship - Class I - Class II - Class III Diagram illustrating canine relationships in orthodontics. Three labeled panels show: Class I (normal occlusion), Class II (overjet), and Class III (underbite). Each panel includes arrows indicating tooth positions relative to the opposing arch. **The University of Western Australia** **Examination** **Occlusion and orthodontic relations** * Overjet * Overbite * Crossbite * Rotations     #### Occlusal Parameters - Overjet - Overbite - Crossbite - Rotations Clinical photo showing a close-up view of anterior teeth with significant overjet and overbite. The upper central incisors are positioned far forward relative to the lower incisors, demonstrating the 'Overjet' and 'Overbite' conditions listed in the OCR text. Clinical photo displaying an anterior view of the dental arches. This image demonstrates severe crowding and misalignment, illustrating the 'Rotations' condition mentioned in the OCR context. Clinical photo showing a lateral (side) view of the occlusion. The image highlights how the upper teeth overlap significantly with the lower teeth, providing a visual example of the vertical relationship discussed under 'Occlusion and orthodontic relations'. Clinical photo showing another angle of the anterior teeth, likely focusing on crossbite or specific rotational issues of individual teeth within the crowded arch, consistent with the 'Crossbite' and 'Rotations' categories. **Examination** **Occlusion and orthodontic relations** * **Midline** * **Dentition** * **spacing** * **crowding** * **arch deformity**   #### Arch and Midline Assessment - **Midline** - **Dentition** - Spacing - Crowding - Arch deformity Clinical intraoral photograph of the anterior dentition showing occlusion and midline alignment. Yellow vertical lines are superimposed to indicate the dental midlines for assessing symmetry. The image corresponds to the 'Midline' examination point listed in the text. Clinical intraoral photograph of the mandibular arch viewed from above (occlusal view). This visual demonstrates the arrangement of teeth within the lower jaw, relevant to examining 'spacing', 'crowding', or 'arch deformity' as noted in the OCR context. # Examination **THE UNIVERSITY OF WESTERN AUSTRALIA** ## Occlusion and orthodontic relations ### Habits * Digit sucking * Mouth breathing * Tongue thrusting    #### Oral Habits - Digit sucking - Mouth breathing - Tongue thrusting Clinical photo demonstrating 'Digit sucking' habit: A child is shown in profile with their hand placed over the mouth, illustrating the physical action associated with this orthodontic risk factor. Clinical intraoral photo demonstrating 'Tongue thrusting': The tongue is positioned between the upper and lower front teeth during occlusion, showing how this habit affects dental alignment. Clinical intraoral photo demonstrating 'Mouth breathing': The image shows an open-mouth posture or lack of lip seal, consistent with the airway-related habits listed in the text. # Radiographs THE UNIVERSITY OF WESTERN AUSTRALIA - Bitewing radiographs - Periapical radiographs - Occlusal films - Panoramic radiographs - Extra-oral facial films - Cone-beam CT    #### Modalities - Bitewing radiographs - Periapical radiographs - Occlusal films - Panoramic radiographs - Extra-oral facial films - Cone-beam CT Two side-by-side bitewing radiographs labeled 'a' and 'b', showing upper and lower posterior teeth with clear visualization of interproximal areas, used for detecting caries and assessing bone levels. Occlusal film radiograph displaying a broad view of multiple posterior teeth from an occlusal perspective, useful for evaluating root morphology, impacted teeth, and maxillary/mandibular arch relationships. Panoramic radiograph showing a wide-field view of the entire dentition and surrounding structures including mandible, maxilla, and temporomandibular joints; useful for comprehensive dental assessment. Radiographs **The University of Western Australia** Intra oral Film Sizes * 0, 1, 2 anterior occlusal Show * Dental caries - interproximal and occlusal * Alveolar bone health * Enamel defects * Root health * Developing teeth * Pulp chamber * Outline of restorations * Sequential radiographs * Disease progression #### Intra-oral Film Sizes and Indications - **Sizes**: 0, 1, 2 (anterior occlusal) **Diagnostic Value**: - Dental caries (interproximal and occlusal) - Alveolar bone health - Enamel defects - Root health - Developing teeth - Pulp chamber - Outline of restorations - Sequential radiographs for disease progression Radiographs **Panoramic** * Developing teeth * TMJ * Bone health * Pathology #### Panoramic Radiographs - Developing teeth - TMJ - Bone health - Pathology **Special Tests** Photographs Diagnostic cast Blood investigations Microbiology Salivary tests Caries activity tests Diet analysis Caries risk assessment The University of Western Australia #### Available Investigations - Photographs - Diagnostic cast - Blood investigations - Microbiology - Salivary tests - Caries activity tests - Diet analysis - Caries risk assessment # Special Tests ## Photographs * Clinical record * Medico-legal record * Before and after treatment * Provides record of growing children ## Diagnostic cast * Essential in treatment planning * Study Model Analysis * Space measurement * Space maintenance? * Space regaining? * Cross bite correction THE UNIVERSITY OF WESTERN AUSTRALIA   #### Photographs - Clinical record - Medico-legal record - Before and after treatment - Provides record of growing children #### Diagnostic Cast - Essential in treatment planning - Study Model Analysis - Space measurement - Space maintenance? - Space regaining? - Cross bite correction Clinical intraoral photograph showing a child's upper and lower dental arches. The image demonstrates the 'Special Tests' mentioned in the OCR context, specifically serving as a visual record for clinical or medico-legal purposes. It shows visible gingival inflammation and potential trauma to the anterior maxillary region. Photograph of a diagnostic study model (cast) of dentition. This figure illustrates the 'Diagnostic cast' section from the text, used for treatment planning, space measurement, and analysis of occlusion (e.g., cross-bite correction). **Special Tests** Pulp sensibility (viability) test - Thermal - Electrical stimulation - Percussion - Mobility - Transillumination **THE UNIVERSITY OF WESTERN AUSTRALIA**  #### Pulp Sensibility (Viability) Tests - Thermal - Electrical stimulation - Percussion - Mobility - Transillumination Clinical photo demonstrating a pulp sensibility test. A dental instrument (likely an endodontic file or cotton pellet holder) is shown applying a stimulus to the gingival margin of an upper anterior tooth. **Special Tests** **Blood investigations** - Full blood count with differential white cell count - Clinical chemistry **Microbiological investigations** - Culture of microorganisms and antibiotic sensitivity - Cytology - Serology - Direct and indirect immunofluorescence - Plaque pH activity - S mutans count The University of Western Australia Saliva-Check Mutans for 10 tests Saliva-Check Saliva-Check 1 2   #### Blood Investigations - Full blood count with differential white cell count - Clinical chemistry #### Microbiological Investigations - Culture of microorganisms and antibiotic sensitivity - Cytology - Serology - Direct and indirect immunofluorescence - Plaque pH activity - S. mutans count (e.g., Saliva-Check Mutans) Clinical photo showing a gloved hand holding a blood collection tube alongside other tubes in a rack, illustrating the 'Blood investigations' section. Product photography of a 'SALIVA-CHECK MUTANS' detection kit box and individual test strips, illustrating the 'Microbiological investigations' section, specifically 'S mutans count'. **Special Tests** **Quantity of saliva** * **Salivary flow rate** * unstimulated (resting) * Stimulated * **Salivary Buffering Capacity** **Stimulated Saliva** **Quality of saliva** * Measuring resting salivary pH **Saliva-Check** BUFFER TEST STRIP 1 PIECE    #### Salivary Quantity - **Salivary flow rate** - Unstimulated (resting) - Stimulated - **Salivary Buffering Capacity** #### Salivary Quality - Measuring resting salivary pH - Saliva-Check Buffer test strips Clinical photo showing a clear measuring cup containing liquid labeled 'Stimulated Saliva' with volume markings up to 20mL. Next to the cup is a foil packet of a stimulant (likely citric acid or sugar-free candy) used to stimulate salivary flow rate. Clinical photo of a packaged product labeled 'Saliva-Check BUFFER TEST STRIP'. The packaging indicates it is for measuring resting salivary pH and includes a test strip applicator inside the silver foil pouch. Color-coded pH chart illustrating saliva acidity levels. It displays three ranges: 'very acidic' (orange/yellow, 4.5–6.5), 'balanced' (yellow/green, 6.75–7.25), and 'too alkaline' (green/blue, 7.5–9.0). The chart serves as a visual reference for interpreting results from the Saliva-Check strips shown above. # Special Tests ## Caries Risk Assessment * Past disease experience * Current dental status * Family history and carer status * Diet considerations * Oral hygiene * Concomitant medical conditions * Future expectations of disease activity CAMBRA  #### Assessment Factors - Past disease experience - Current dental status - Family history and carer status - Diet considerations - Oral hygiene - Concomitant medical conditions - Future expectations of disease activity - CAMBRA (Caries Management by Risk Assessment) Labelled diagram titled 'The caries balance/imbalance' illustrating the CAMBRA model. The visual is a seesaw balancing two sides: the left side represents 'Demineralization' (pushed down by 'Disease indicators' such as white spots and cavities, and 'Risk factors' like bad bacteria), while the right side represents 'Remineralization' (supported by 'Protective factors' such as saliva, sealants, fluoride, and effective lifestyle habits). The fulcrum is labeled 'pH', indicating that the balance between disease progression and health depends on maintaining an optimal pH environment. # Caries Risk Assessment **Low risk of disease** - No caries present - Favourable family history (appropriate diet, dentally healthy siblings, motivated parents and caregivers) - Good oral hygiene - Access to community water fluoridation **Moderate risk** - One or two new lesions per year **High risk or future high risk** - Three or more new lesions per year - Orthodontic treatment - Chronic illness or hospitalization - Medically compromised children - Social risk factors #### Risk Categories - **Low risk of disease** - No caries present - Favourable family history (appropriate diet, healthy siblings, motivated caregivers) - Good oral hygiene - Access to community water fluoridation - **Moderate risk** - One or two new lesions per year - **High risk or future high risk** - Three or more new lesions per year - Orthodontic treatment - Chronic illness or hospitalization - Medically compromised children - Social risk factors **Diagosis/problem list** * Acute * Dental age * Caries risk * Periodontal status * Oral hygiene * Behaviour * Occlusion * Trauma * Other "...diagnostic skills cannot be learnt from textbooks alone, but require clinical training " (Nyvad, 2004) #### Clinical Problem List - Acute issues - Dental age - Caries risk - Periodontal status - Oral hygiene - Behaviour - Occlusion - Trauma - Other *"Diagnostic skills cannot be learnt from textbooks alone, but require clinical training" (Nyvad, 2004)* # Treatment plan * Based on the assessed need of the child * Addresses all oral conditions, dental diseases & injuries * Establishes a preventive programme * Allows for forward planning by all involved * Know number of visits required * Scheduling of these visits * Time off school, time off work * Baby sitters for siblings * Appointments can be so treatment is completed in weeks rather than months * Clinician prepared before child arrives * Endpoint -Child to reach adulthood with a healthy mouth, positive attitude to dental care #### Objectives and Logistics - Based on the assessed need of the child - Addresses all oral conditions, dental diseases & injuries - Establishes a preventive programme - Allows for forward planning (number of visits, scheduling, time off school/work) - Clinician preparation - **Endpoint**: Child to reach adulthood with a healthy mouth and positive attitude to dental care # Treatment Plan ## What needs to be included? * Medical management * Behaviour management * Relief of pain/ emergency care * Prevention * Restorative needs * Surgical treatment * Orthodontic treatment * Extensive restorative or further surgical management * Growth & Development * Aesthetic considerations * Payment agreement * Recall Timing * Referral * Consent - who is able to give consent? #### Components of the Plan - Medical and behaviour management - Relief of pain/emergency care - Prevention and restorative needs - Surgical and orthodontic treatment - Growth & Development monitoring - Aesthetic considerations - Payment agreement and recall timing - Referral and Consent (identifying who is able to give consent) # **Treatment plan** ## Personalised * All children are different * Social needs * Medical * Dental * Age * Expectations –child’s/ parents child’s / parent’s understanding management concerns * Financial constraints * Appointments #### Individualized Care - All children are different - Social, medical, and dental needs - Age-appropriate expectations - Parent/child understanding and management concerns - Financial constraints and appointment scheduling # Treatment plan ## Holistic - Treating a child not a tooth - Not a list of procedures - Behaviour shaping - Prevention - Growth and development - Interceptive orthodontics? #### Comprehensive Approach - Treating a child, not just a tooth - Not a list of procedures - Behaviour shaping - Prevention - Growth and development - Interceptive orthodontics **Treatment plan** Flexible • Circumstances & dental status change Sequenced • Gradual introduction of new experiences • Prophylaxis • Small restorations before large • Upper teeth before lower #### Flexibility and Sequencing - **Flexible**: Circumstances and dental status change - **Sequenced**: - Gradual introduction of new experiences - Prophylaxis first - Small restorations before large - Upper teeth before lower **Treatment plan** ### Forward thinking - Longer term picture - Interventions – reduce complexity of future treatment ### Realistic - Remember you are treating a patient – a young patient - Not able to keep still for hours #### Long-term and Realistic Goals - **Forward thinking**: Longer term picture; interventions to reduce future complexity - **Realistic**: Remember the patient is young and unable to sit still for extended periods **major difference between adult and pediatric dental patients** **did not request the treatment** **do not even understand why** --- The University of Western Australia #### Major Differences in Paediatric Patients - Did not request the treatment - Do not even understand why [^1]: Original PDF page 1: [[L1 The Paediatric Clinical Examination LMS.pdf#page=1|L1 The Paediatric Clinical Examination LMS, p.1]] [^2]: Original PDF page 2: [[L1 The Paediatric Clinical Examination LMS.pdf#page=2|L1 The Paediatric Clinical Examination LMS, p.2]] [^3]: Original PDF page 3: [[L1 The Paediatric Clinical Examination LMS.pdf#page=3|L1 The Paediatric Clinical Examination LMS, p.3]] [^4]: Original PDF page 4: [[L1 The Paediatric Clinical Examination LMS.pdf#page=4|L1 The Paediatric Clinical Examination LMS, p.4]] [^5]: Original PDF page 5: [[L1 The Paediatric Clinical Examination LMS.pdf#page=5|L1 The Paediatric Clinical Examination LMS, p.5]] [^6]: Original PDF page 6: [[L1 The Paediatric Clinical Examination LMS.pdf#page=6|L1 The Paediatric Clinical Examination LMS, p.6]] [^7]: Original PDF page 7: [[L1 The Paediatric Clinical Examination LMS.pdf#page=7|L1 The Paediatric Clinical Examination LMS, p.7]] [^8]: Original PDF page 8: [[L1 The Paediatric Clinical Examination LMS.pdf#page=8|L1 The Paediatric Clinical Examination LMS, p.8]] [^9]: Original PDF page 9: [[L1 The Paediatric Clinical Examination LMS.pdf#page=9|L1 The Paediatric Clinical Examination LMS, p.9]] [^10]: Original PDF page 10: [[L1 The Paediatric Clinical Examination LMS.pdf#page=10|L1 The Paediatric Clinical Examination LMS, p.10]] [^11]: Original PDF page 11: [[L1 The Paediatric Clinical Examination LMS.pdf#page=11|L1 The Paediatric Clinical Examination LMS, p.11]] [^12]: Original PDF page 12: [[L1 The Paediatric Clinical Examination LMS.pdf#page=12|L1 The Paediatric Clinical Examination LMS, p.12]] [^13]: Original PDF page 13: [[L1 The Paediatric Clinical Examination LMS.pdf#page=13|L1 The Paediatric Clinical Examination LMS, p.13]] [^14]: Original PDF page 14: [[L1 The Paediatric Clinical Examination LMS.pdf#page=14|L1 The Paediatric Clinical Examination LMS, p.14]] [^15]: Original PDF page 15: [[L1 The Paediatric Clinical Examination LMS.pdf#page=15|L1 The Paediatric Clinical Examination LMS, p.15]] [^16]: Original PDF page 16: [[L1 The Paediatric Clinical Examination LMS.pdf#page=16|L1 The Paediatric Clinical Examination LMS, p.16]] [^17]: Original PDF page 17: [[L1 The Paediatric Clinical Examination LMS.pdf#page=17|L1 The Paediatric Clinical Examination LMS, p.17]] [^18]: Original PDF page 18: [[L1 The Paediatric Clinical Examination LMS.pdf#page=18|L1 The Paediatric Clinical Examination LMS, p.18]] [^19]: Original PDF page 19: [[L1 The Paediatric Clinical Examination LMS.pdf#page=19|L1 The Paediatric Clinical Examination LMS, p.19]] [^20]: Original PDF page 20: [[L1 The Paediatric Clinical Examination LMS.pdf#page=20|L1 The Paediatric Clinical Examination LMS, p.20]] [^21]: Original PDF page 21: [[L1 The Paediatric Clinical Examination LMS.pdf#page=21|L1 The Paediatric Clinical Examination LMS, p.21]] [^22]: Original PDF page 22: [[L1 The Paediatric Clinical Examination LMS.pdf#page=22|L1 The Paediatric Clinical Examination LMS, p.22]] [^23]: Original PDF page 23: [[L1 The Paediatric Clinical Examination LMS.pdf#page=23|L1 The Paediatric Clinical Examination LMS, p.23]] [^24]: Original PDF page 24: [[L1 The Paediatric Clinical Examination LMS.pdf#page=24|L1 The Paediatric Clinical Examination LMS, p.24]] [^25]: Original PDF page 25: [[L1 The Paediatric Clinical Examination LMS.pdf#page=25|L1 The Paediatric Clinical Examination LMS, p.25]] [^26]: Original PDF page 26: [[L1 The Paediatric Clinical Examination LMS.pdf#page=26|L1 The Paediatric Clinical Examination LMS, p.26]] [^27]: Original PDF page 27: [[L1 The Paediatric Clinical Examination LMS.pdf#page=27|L1 The Paediatric Clinical Examination LMS, p.27]] [^28]: Original PDF page 28: [[L1 The Paediatric Clinical Examination LMS.pdf#page=28|L1 The Paediatric Clinical Examination LMS, p.28]] [^29]: Original PDF page 29: [[L1 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LMS.pdf#page=36|L1 The Paediatric Clinical Examination LMS, p.36]] [^37]: Original PDF page 37: [[L1 The Paediatric Clinical Examination LMS.pdf#page=37|L1 The Paediatric Clinical Examination LMS, p.37]] [^38]: Original PDF page 38: [[L1 The Paediatric Clinical Examination LMS.pdf#page=38|L1 The Paediatric Clinical Examination LMS, p.38]] [^39]: Original PDF page 39: [[L1 The Paediatric Clinical Examination LMS.pdf#page=39|L1 The Paediatric Clinical Examination LMS, p.39]] [^40]: Original PDF page 40: [[L1 The Paediatric Clinical Examination LMS.pdf#page=40|L1 The Paediatric Clinical Examination LMS, p.40]] [^41]: Original PDF page 41: [[L1 The Paediatric Clinical Examination LMS.pdf#page=41|L1 The Paediatric Clinical Examination LMS, p.41]] [^42]: Original PDF page 42: [[L1 The Paediatric Clinical Examination LMS.pdf#page=42|L1 The Paediatric Clinical Examination LMS, p.42]] [^43]: Original PDF page 43: [[L1 The Paediatric Clinical Examination LMS.pdf#page=43|L1 The Paediatric Clinical Examination LMS, p.43]] [^44]: Original PDF page 44: [[L1 The Paediatric Clinical Examination LMS.pdf#page=44|L1 The Paediatric Clinical Examination LMS, p.44]] [^45]: Original PDF page 45: [[L1 The Paediatric Clinical Examination LMS.pdf#page=45|L1 The Paediatric Clinical Examination LMS, p.45]] [^46]: Original PDF page 46: [[L1 The Paediatric Clinical Examination LMS.pdf#page=46|L1 The Paediatric Clinical Examination LMS, p.46]] [^47]: Original PDF page 47: [[L1 The Paediatric Clinical Examination LMS.pdf#page=47|L1 The Paediatric Clinical Examination LMS, p.47]] [^48]: Original PDF page 48: [[L1 The Paediatric Clinical Examination LMS.pdf#page=48|L1 The Paediatric Clinical Examination LMS, p.48]] [^49]: Original PDF page 49: [[L1 The Paediatric Clinical Examination LMS.pdf#page=49|L1 The Paediatric Clinical Examination LMS, p.49]] [^50]: Original PDF page 50: [[L1 The Paediatric Clinical Examination LMS.pdf#page=50|L1 The Paediatric Clinical Examination LMS, p.50]] [^51]: 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