Orthodontics and Pediatric Dentistry
Core concepts
Pediatric dentistry rewards knowledge of growth, development, and behaviour management. Know the eruption chronology: primary teeth begin around 6 months, first permanent molars and incisors around 6-7 years, canines and premolars around 9-12 years, second molars around 12, third molars in late adolescence. Understand the mixed dentition traps: ectopic eruption, ankylosis, retained primary teeth, and supernumerary teeth.
Caries risk assessment in children includes diet, fluoride exposure, oral hygiene, previous caries, and medical factors. Learn fluoride varnish indications and the safety threshold for fluoride ingestion. Know minimally invasive options such as silver diamine fluoride and Hall technique indications and limitations.
Behaviour management and prevention
Recognise tell-show-do, positive reinforcement, and the role of parents. Know when general anaesthesia or sedation is appropriate. For orthodontics, understand the difference between interceptive and comprehensive treatment, the timing of referral for skeletal problems, and the role of habits such as digit sucking. Learn the anchorage concept and the biological basis of tooth movement - pressure causes bone resorption on the compression side and deposition on the tension side.
Traps
- Confusing the timing of primary and permanent eruption.
- Recommending extraction of a retained primary tooth without checking for an absent successor.
- Overlooking medical or safeguarding issues in a child with repeated trauma or untreated disease.
Worked example
A 7-year-old has a retained primary incisor with a permanent successor erupting palatally. Rule of thumb: if the successor is visible and the primary is mobile, extraction of the primary is usually appropriate; if the successor is not evident, radiograph before extracting to avoid removing a tooth with no successor.