Paediatric Dentistry by Unknown

Author:Unknown
Language: eng
Format: epub
Publisher: OUP Oxford
Published: 2012-11-11T16:00:00+00:00

Figure 10.26 An example of a hypomineralized first permanent molar temporized using a glass ionomer cement material. Image by kind permission of Dr J. Winters.

If a child is disturbed by the appearance of their incisors, aesthetic improvements can often be achieved using more conservative approaches such as micro-abrasion ± bleaching. However, some of the more severe brown or white opacities may require localized composite veneers.

10.7 Hypodontia

Individuals with missing teeth may present at any age requesting replacement of their missing teeth for both aesthetic and functional reasons. A detailed discussion of the management of hypodontia is beyond the remit of this text, but a few principles can be considered here. During infancy and early school years there is rarely a need for any active intervention. An exception may be adolescents with ectodermal dysplasia who can have multiple missing teeth (Fig. 10.27). In such cases, the provision of removable partial or even complete dentures can be very successful at a young age. However, as children move through the mixed and permanent dentition phases, aesthetics become increasingly important. Replacing one or two teeth may be relatively straightforward using either removable partial dentures or adhesively retained bridges. However, those individuals with multiple missing teeth often have associated skeletal and dento-alveolar discrepancies which demand a multidisciplinary approach (Fig. 10.28). The multidisciplinary team (MDT) should include at least a paediatric dentist, orthodontist, and prosthodontist, but access to a periodontist and a maxillofacial surgeon is also useful.

Early referral to such an MDT is essential for discussion and preliminary planning. Consideration needs to be given to the number and position of the missing dental units, the age of the child, their level of and attitude towards oral health, and importantly the wishes and expectations of the individual and their family. The aim of orthodontic treatment is to consolidate the spacing and place the existing teeth in the optimum position to support the definitive restorations. However, consideration also needs to be given to any underlying skeletal discrepancy or dento-alveolar deficiency that may require a more surgical approach. Interim restorative solutions, such as removable dentures, composite veneer, or partial veneer restorations, can be placed during the mixed dentition phase but will require maintenance throughout adolescence. Proactive preventive strategies need to be supported in order to achieve optimum dental and periodontal health. This is essential for the long-term success of definitive prosthodontic solutions which may include removable dentures, porcelain veneers or crowns, fixed conventional or adhesively retained bridges, and osseo-integrated implants. Finally, access to a geneticist with expertise in orofacial anomalies can be beneficial as adolescents begin to contemplate the implications of their dental anomaly on family planning. (See Key Points 10.5.)

Key Points 10.5

• Children with multiple missing teeth should be:

– referred early to an MDT

– exposed to proactive prevention to optimize their periodontal health.

• Treatment options may include:

– interim measures—partial dentures or composite veneers in childhood and adolescence

– definitive restorations—crowns, bridges, veneers, and dental implants post growth

– surgical interventions—orthognathic surgery and bone grafting.

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