Pediatric Dentistry
Paediatric dentistry tests the differences that matter: primary tooth anatomy, behaviour, growth, and the risk of injuring a developing permanent tooth.
Primary dentition
- Primary molars have thin enamel, large pulp chambers, flared roots and marked cervical constriction, so pulpal involvement follows caries quickly.
- Eruption: mandibular central incisor 6-10 months, first primary molar 12-16 months, primary dentition complete around 2.5-3 years, first permanent molar at 6 years.
- Stainless steel crowns are the restoration of choice for multi-surface caries or after pulpotomy.
Pulp therapy and prevention
- Indirect and direct pulp capping for small exposures; pulpotomy with MTA or ferric sulfate; pulpectomy with a resorbable iodoform paste when the radicular pulp is involved.
- Fluoride varnish 5% sodium fluoride for high caries risk; systemic fluoride is not indicated where water is already fluoridated.
- Space maintenance: band and loop for early loss of a single primary first molar; Nance appliance for bilateral loss.
Trauma
- Avulsed primary tooth: never replant, to avoid ankylosis and damage to the permanent germ.
- Intruded primary tooth: allow spontaneous re-eruption unless displaced toward the permanent bud.
- Permanent avulsion: replant immediately, flexible splint for two weeks, check tetanus status.
Worked example
A 5-year-old has a deep carious lesion in the mandibular primary first molar with furcation radiolucency, mobility and a sinus tract. Furcation involvement means the radicular pulp is infected, so pulpotomy is inappropriate; pulpectomy or extraction with a space maintainer is chosen. The reasoning rests on the primary molar's furcation anatomy, where accessory canals sit close to the chamber floor.
Traps
Replanting a primary incisor; choosing pulpotomy when furcation radiolucency is present; miscalculating lidocaine maximum dose by weight in a child; placing a space maintainer when the successor will erupt within months.