Pediatric Dentistry

Pediatric dentistry is a specialized field that does not rely on a specific set of skills but rather draws on the full range of technical abilities within the broader dental profession. The philosophy of pediatric dentistry is grounded in a comprehensive understanding of child development in both healthy and diseased states. This approach ensures that dental care for children is not only technically proficient but also tailored to meet the unique needs and vulnerabilities of young patients. (1)

Definition and Overview

Pediatric dentistry, according to the American Academy of Pediatric Dentistry, is a specialized field that focuses on providing primary and comprehensive preventive and therapeutic oral health care to infants, children, and adolescents, including those with exceptional health care needs. Becoming a pediatric dental specialist requires the completion of an advanced education program accredited by the Commission on Dental Accreditation of the American Dental Association that provides additional knowledge and skills beyond the basic DDS or DMD training.

Pediatric dentists work in a variety of settings, including private practice and public health, and collaborate with other healthcare providers to ensure optimal outcomes for children.

Unlike other dental specialties that focus on a specific area of expertise, pediatric dentistry encompasses a wide range of disciplines, procedures, and skills that are adapted to meet the unique requirements of infants, children, adolescents, and those with exceptional health care needs. These disciplines include behavior guidance, management of medical conditions and physical and developmental disabilities, supervision of orofacial growth and development, prevention of dental caries, sedation, hospital dentistry and pharmacological management, like other traditional fields of dentistry. Pediatric dentists utilize these skills to provide age-appropriate care and to address conditions and diseases that are specific to growing individuals. (2)

Procedures

Pediatric dental treatments include a range of services that are specifically tailored to meet the dental needs of children. Some common pediatric dental treatments are:

• Dental Cleanings
• Dental Exams
• Fluoride Treatments
• Dental Sealants
• Fillings
• Root Canal Treatment 
• Crowns
• Extractions

It is important to note that pediatric dental treatments may vary depending on the individual child's needs and the recommendation of the pediatric dentist. (3)

Candidates

Pediatric dentistry involves providing oral health care to children and young people, specifically those who have 

• extensive oral disease, 
• complicated oral health care needs due to factors such as intellectual, medical, physical, social, psychological, or emotional disability, 
• developmental disorders of the teeth and mouth, 
• or who are too young or anxious to accept routine dental treatment. 

The age range covered by the specialty is generally from 0 to 16 years, although the transition to adult oral health services may begin before a child's 16th age. Pediatric dentists may also provide care for vulnerable children, including those with special educational needs or disabilities, who are looked after by the local authority and require healthcare arrangements made by commissioning bodies. (4)

Risks and Side Effects

Although this operation is considered safe and straightforward, as with any medical procedure, there are potential risks involved. 

• Soreness and Swelling

After the extractions, the child's mouth may experience pain, but the dentist will provide pain medication to alleviate these symptoms. 

• Bleeding

There may be some bleeding from the teeth sockets, even if dissolvable stitches are used. However, this bleeding typically stops after biting on a gauze swab for 10 minutes. 

• Infection

While there is a low risk of infection, the dentist may prescribe antibiotics if necessary. The dentist will provide further information about these risks and discuss them with parents in detail. (5)

Post-Procedure and Follow-up

Regular checks of the patient's pulse, temperature, and wound will be conducted by the nurse to ensure that they have sufficient pain relief until they are discharged. To alleviate pain after the surgery, such as when adult teeth have been extracted, the surgeon may have administered local anesthesia into the patient's gum, resulting in numbness that lasts for 2-3 hours following the procedure. It is crucial to ensure that the patient does not bite or chew their lip or cheek while the numbness is still present.

Once the patient has regained consciousness from the anesthesia, they can start drinking and, if they do not feel nauseous, eat small amounts of food. It is advised to avoid mouthwashes and hot drinks for 24 hours following the operation, as these may increase the risk of bleeding. Once the bleeding has ceased, the patient can eat and drink normally the day after the operation.

The minimum recovery time before being discharged is typically 2 hours, which is adequate time for the staff to ensure that the patient is recovering well and that they are urinating after the operation. If the patient has not passed urine within 6 hours of the surgery, the ward should be contacted for guidance.

After a general anesthetic, the patient cannot use public transportation to return home; they must be taken home by car. Loose-fitting and comfortable clothing should be provided for the patient to wear during the trip home. Sometimes, the anesthetic may cause nausea for up to 24 hours, and the best treatment for this is rest and small, frequent amounts of fluid,biscuits or toast. If the patient continues to feel sick for more than 24 hours, it is recommended to seek medical attention.

The hospital experience can be strange and unsettling for some children, so parents should not be alarmed if their child is more clingy, easily upset, or has disturbed sleep. (6)

Recovery

Following the completion of dental treatment for pediatric patients, parents may inquire about the recommended rest and recuperation period for their children. Although certain procedures may be more intrusive than others, extended recovery time is not typically expected. 

Results

When treatment is fully completed, common sense is advised and parents should educate their children on the importance of allowing adequate rest to support proper recovery and prevent any mishaps while continuing with regular activities.