I was so excited to start my comprehensive pediatric case this semester because I’m considering Pediatric Dentistry as my specialization. Comprehensive cases are cases wherein you have to do everything that needs to be done to one patient.
December of last year (2017), I had a 7-year old female patient who complains of pain on tooth 55 and 65. Teeth are very sensitive to cold beverages with on and off pain.
Photos of initial examination are shown in the slideshow below:
Initial diagnosis showed badly carious 55 and 65. 55 is non-restorable already while 65 is still restorable. Other findings include proximal caries on teeth 54(mesial), 64(distal), 74(distal), and 84(distal). Cervical caries on teeth 53 & 63. Hypomineralization on cervical of teeth 54 & 64. Patient has minimal plaque accummulation.
Within 3 months, the following treatments are made.
- Extraction/Removal of Tooth 55
- Scaling & Polishing with Oral Hygiene Instructions (Oral Prophylaxis)
- Fluoride Treatment (used Fluoride Varnish)
- Pit & Fissure Sealant on all Permanent 1st molars (Teeth 16,26,36,46)
- Restoration of Carious teeth (54,64,74,84,53,63)
- Pulpotomy of Tooth 65 (this was done to save it, instead of extracting tooth)
- Fabrication of Stainless Steel Crown for Tooth 65 (a tooth-shaped crown to cap the severely damaged tooth)
- Fabrication of Band & Loop Space Maintainer on the space left by removing tooth 55.
The photos below are the Post-Op photos. I had to replace the sealants after taking these photos since the sealants were removed prior to this day.
Why does the patient need Pulpotomy & Stainless Steel Crown?
Primary Teeth or Baby Teeth are the best space maintainers prior to eruption of the permanent teeth. Complications (such as crooked teeth, impacted teeth) arise when baby teeth are removed earlier than it should be. Since the tooth is still restorable, pulpotomy is the treatment of choice. Pulpotomy is done by removing the infected part of the root chamber only which leaves the root canal vital. Afterwards, stainless steel crown was placed to restore the tooth and prevent it from decaying further.
What is Space Maintainer?
Space maintainer is an orthodontic appliance which keeps the space open to allow the permanent tooth to erupt properly into place. Losing the primary teeth earlier than it should be can cause tilting and rotating of the adjacent teeth which can occupy the space meant for the permanent teeth. If that happens, permanent teeth will have a hard time erupting to its proper place and may erupt at different angulation or spot which can eventually cause crooked or impacted teeth.
Here is a side-by-side comparison of the Pre- and Post-Operative photos:
Upper Teeth (L-before; R-after): Pit & Fissure Sealants of Permanent 1st molars (16&26), Extraction (Tooth 55), Band & Loop Space Maintainer, Restoration of Mesial Caries (Tooth 54), Restoration of Distal Caries (Tooth 64), Pulpotomy (Tooth 65), Stainless Steel Crown (Tooth 65)
Lower Teeth (L-before; R-after): Pit & Fissure Sealants of Permanent 1st Molars (36&46), Restoration of Distal Caries (Tooth 74 & 84).
Right Side (photos above): L-before; R-after
Left Side (photos above): L-before; R-after
I have to be honest… I don’t think I’ll be a good pediatric dentist. I don’t have much patience in dealing with kids. The management is not that easy. They have a lot of questi
ons, they’re afraid of the tools, and they’re very delicate. I have explained to her why we need to do every single procedure and she understands it… and she cooperates well! 😊
At the end of our treatment day, my patient gave me a chocolate bar and a Thank You note. I love how patients appreciate my work to them… it pays off all the hard work!
If you have any questions regarding your child’s dental health (or even yours!), let me know it through comments or you can DM me on IG (@athleyyy)… I’d be happy to help!
See you on my next dental case post!