Pediatric Dentistry
This domain tests the child as a whole patient: eruption timing, caries in the primary dentition, behaviour guidance, trauma, and the interceptive management of space.
Eruption and development
Primary teeth: mandibular central incisor 6–10 months, first primary molar 13–19 months, primary second molar 25–33 months. Permanent teeth: first molar at about 6 years (the first permanent tooth, often mistaken for a primary tooth), mandibular central incisor 6–7 years, canine 9–12 years, premolars 9–12 years, second molar 11–13 years. Teething causes local irritation but not high fever; persistent fever needs medical assessment.
Caries in the primary dentition
Early childhood caries is any caries in a child under 71 months. Risk assessment drives recall interval and prevention: fluoride varnish, supervised brushing with an age-appropriate fluoride concentration, dietary advice, and silver diamine fluoride for arresting active lesions. Restorative options include the Hall technique (sealing a preformed metal crown over the lesion without preparation), pulpotomy with MTA or formocresol, pulpectomy and strip crowns.
Behaviour guidance
Use tell-show-do, positive reinforcement and clear boundaries. The Frankl scale grades cooperation from definitely negative to definitely positive. Nitrous oxide is a useful adjunct in selected children; general anaesthesia is reserved for extensive treatment or where cooperation cannot be achieved.
Trauma
For an avulsed permanent tooth, handle by the crown, rinse briefly, and replant immediately if extraoral dry time is under 60 minutes, then flexible splint for about two weeks. With a closed apex, root canal treatment follows after replanting, typically using a calcium hydroxide dressing for a period before definitive obturation; with an open apex, revascularisation is preferred. Never replant a primary tooth - the risk to the developing permanent successor outweighs any benefit. Intruded primary teeth are usually left to re-erupt unless the apex is displaced towards the permanent bud.
Worked example
An 8-year-old arrives 30 minutes after avulsing an upper central incisor, the tooth stored in milk. Reasoning: open apex, short dry time, correct storage. Replant with gentle pressure, splint flexibly for two weeks, prescribe appropriate analgesia, check tetanus status, and follow up with sensibility testing and radiographs; revascularisation is the aim rather than immediate obturation.
Traps that cost marks
- Replanting a primary tooth.
- Recommending extraction of every intruded primary tooth.
- Ignoring safeguarding concerns; unexplained injuries need documentation and escalation.
- Under-dosing or over-dosing local anaesthetic by failing to weigh the child.