
Contents
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The child patient The child patient
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Principal aims of Rx Principal aims of Rx
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Points to remember Points to remember
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The first visit The first visit
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Treatment planning for children Treatment planning for children
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Diagnosis Diagnosis
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Rx plan Rx plan
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Other considerations Other considerations
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Delivery of care Delivery of care
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The anxious child The anxious child
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Techniques for behaviour management Techniques for behaviour management
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General principles General principles
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Tell, show, do Tell, show, do
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Behaviour shaping Behaviour shaping
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Reinforcement Reinforcement
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Cognitive behavioural therapy Cognitive behavioural therapy
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Modelling Modelling
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Desensitization Desensitization
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Should a parent accompany the child into surgery? Should a parent accompany the child into surgery?
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Sedation Sedation
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Inhalation Inhalation
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Intravenous Intravenous
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Oral Oral
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Intramuscular Intramuscular
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Per rectum Per rectum
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Hypnosis Hypnosis
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General anaesthesia General anaesthesia
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Other behaviour problems and their management Other behaviour problems and their management
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The child with toothache The child with toothache
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History History
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Examination Examination
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Percussion Percussion
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Sensibility testing Sensibility testing
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Radiographs Radiographs
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Diagnosis Diagnosis
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Abnormalities of tooth eruption and exfoliation Abnormalities of tooth eruption and exfoliation
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Natal teeth Natal teeth
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Teething Teething
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Eruption cyst Eruption cyst
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Failure of/delayed eruption Failure of/delayed eruption
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General causes General causes
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Local causes Local causes
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Infraoccluded (ankylosed) primary molars Infraoccluded (ankylosed) primary molars
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Ectopic eruption of first permanent molars Ectopic eruption of first permanent molars
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Premature exfoliation Premature exfoliation
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Abnormalities of tooth number Abnormalities of tooth number
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Anodontia Anodontia
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Hypodontia (oligodontia) Hypodontia (oligodontia)
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Prevalence Prevalence
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Aetiology Aetiology
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Hyperdontia Hyperdontia
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Prevalence Prevalence
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Aetiology Aetiology
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Classification Classification
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Effects on dentition and Rx Effects on dentition and Rx
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Abnormalities of tooth structure Abnormalities of tooth structure
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Disturbances in structure of enamel Disturbances in structure of enamel
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Hypoplasia Hypoplasia
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Hypomineralization Hypomineralization
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Aetiological factors Aetiological factors
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Localized causes Localized causes
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Generalized causes Generalized causes
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Chronological hypoplasia Chronological hypoplasia
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Fluorosis Fluorosis
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Rx of hypomineralization/hypoplasia depends on extent and severity Rx of hypomineralization/hypoplasia depends on extent and severity
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Posterior teeth Posterior teeth
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Anterior teeth Anterior teeth
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Molar incisor hypomineralization (MIH) Molar incisor hypomineralization (MIH)
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Hypomineralized second primary molars (HSPM) Hypomineralized second primary molars (HSPM)
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Amelogenesis imperfecta (AI) Amelogenesis imperfecta (AI)
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Main types Main types
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Disturbances in the structure of dentine Disturbances in the structure of dentine
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Dentinogenesis imperfecta (hereditary opalescent dentine—DI) Dentinogenesis imperfecta (hereditary opalescent dentine—DI)
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Disturbances in the structure of cementum Disturbances in the structure of cementum
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Abnormalities of tooth form Abnormalities of tooth form
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Double teeth Double teeth
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Gemination Gemination
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Fusion Fusion
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Rx Rx
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Macrodontia/megadontia Macrodontia/megadontia
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Microdontia Microdontia
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Prevalence Prevalence
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Dens in dente Dens in dente
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Dilaceration Dilaceration
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Turner tooth Turner tooth
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Taurodontism Taurodontism
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Abnormalities of tooth colour Abnormalities of tooth colour
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Extrinsic staining Extrinsic staining
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Intrinsic staining Intrinsic staining
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Enamel opacities Enamel opacities
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Rx Rx
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Approach 1 Approach 1
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Hydrochloric acid technique (quicker, but great care needed) Hydrochloric acid technique (quicker, but great care needed)
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Phosphoric acid technique (slower but potentially safer) Phosphoric acid technique (slower but potentially safer)
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Approach 2 Approach 2
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Approach 3 Approach 3
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Approach 4 Approach 4
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Approach 5 Approach 5
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Approach 6 Approach 6
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Approach 7 Approach 7
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Anatomy of primary teeth (and relevance to cavity design) Anatomy of primary teeth (and relevance to cavity design)
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Thinner enamel Thinner enamel
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Larger pulp horns Larger pulp horns
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Pulpal outline Pulpal outline
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Narrower occlusal table Narrower occlusal table
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Broad and flat contact points Broad and flat contact points
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Bulbous crown Bulbous crown
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Inclination of the enamel prisms Inclination of the enamel prisms
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Cervical constriction Cervical constriction
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Alveolar bone permeability Alveolar bone permeability
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Thin pulpal floor and accessory canals Thin pulpal floor and accessory canals
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Root form Root form
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Radicular pulp Radicular pulp
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Extraction versus restoration of primary teeth Extraction versus restoration of primary teeth
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Age Age
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Medical history Medical history
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Motivation and cooperation of parents Motivation and cooperation of parents
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Extent of caries Extent of caries
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Pain Pain
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Extent of lesion(s) Extent of lesion(s)
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Position of tooth Position of tooth
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Presence/absence of permanent successor Presence/absence of permanent successor
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Malocclusion Malocclusion
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Local analgesia for children Local analgesia for children
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General principles General principles
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Choice of anaesthetic agent Choice of anaesthetic agent
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First choice First choice
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Second choice Second choice
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Infiltration injection Infiltration injection
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Block injection Block injection
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Inferior dental block Inferior dental block
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Posterior superior alveolar block Posterior superior alveolar block
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Alternative techniques Alternative techniques
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Intraligamentary injection Intraligamentary injection
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Jet injection Jet injection
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Computer-controlled delivery (e.g. The Wand®, Single Tooth Anesthesia (STA®) system) Computer-controlled delivery (e.g. The Wand®, Single Tooth Anesthesia (STA®) system)
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Restoration of carious primary teeth Restoration of carious primary teeth
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Local anaesthesia Local anaesthesia
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Isolation Isolation
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Instruments Instruments
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Material selection for intracoronal restorations Material selection for intracoronal restorations
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GIC GIC
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Resin-modified GI cement (RMGIC) Resin-modified GI cement (RMGIC)
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Compomer Compomer
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Composite resin Composite resin
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Amalgam Amalgam
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Principles of cavity design Principles of cavity design
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Outline form Outline form
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Caries removal Caries removal
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Resistance form/retention form Resistance form/retention form
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Reasons for failure of restorations in primary teeth Reasons for failure of restorations in primary teeth
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Useful tips Useful tips
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Communication Communication
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Plastic restoration in primary molars Plastic restoration in primary molars
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Stainless steel crowns Stainless steel crowns
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Indications Indications
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Instruments Instruments
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Conventional technique Conventional technique
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‘Hall’ technique ‘Hall’ technique
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Basic ‘Hall’ technique Basic ‘Hall’ technique
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Success rates Success rates
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Class III, IV, and V in primary teeth Class III, IV, and V in primary teeth
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Management Management
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Rx options Rx options
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Class III restoration Class III restoration
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Class IV restoration Class IV restoration
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Class V restoration Class V restoration
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Composite strip crowns Composite strip crowns
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Severe early childhood caries Severe early childhood caries
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Aetiology Aetiology
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Nursing bottle or bottle mouth caries Nursing bottle or bottle mouth caries
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Rampant caries Rampant caries
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Radiation caries Radiation caries
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Primary molar pulp therapy Primary molar pulp therapy
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Indication and contraindications Indication and contraindications
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Indicators of possible pulp involvement Indicators of possible pulp involvement
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Definitions Definitions
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Pulp therapy techniques Pulp therapy techniques
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Indirect pulp Rx Indirect pulp Rx
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Technique Technique
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Pulpotomy (for the vital primary molar pulp) Pulpotomy (for the vital primary molar pulp)
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Pulpectomy (for non-vital primary molar pulp) Pulpectomy (for non-vital primary molar pulp)
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Success rate Success rate
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Pulp therapy for primary anterior teeth Pulp therapy for primary anterior teeth
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Dental trauma Dental trauma
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Note Note
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History History
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Aims of Rx Aims of Rx
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Principles of Rx Principles of Rx
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Emergency Rx Emergency Rx
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Intermediate Rx Intermediate Rx
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Permanent Rx Permanent Rx
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Classification of tooth injuries Classification of tooth injuries
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Prevention Prevention
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Safeguarding children Safeguarding children
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Management Management
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If abuse is suspected If abuse is suspected
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Where to get help and advice Where to get help and advice
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Making a referral Making a referral
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Injuries to primary teeth Injuries to primary teeth
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Management Management
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Concussion of tooth Concussion of tooth
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Subluxation Subluxation
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Lateral luxation/extrusion Lateral luxation/extrusion
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Intrusion Intrusion
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Avulsion Avulsion
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Crown fracture Crown fracture
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Root fracture Root fracture
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Sequelae of trauma Sequelae of trauma
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Primary dentition Primary dentition
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Discoloration Discoloration
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Ankylosis Ankylosis
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Pulp death Pulp death
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Permanent dentition Permanent dentition
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Injuries to permanent teeth—crown fractures Injuries to permanent teeth—crown fractures
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Enamel only Enamel only
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Enamel and dentine Enamel and dentine
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Acid-etch composite tip technique Acid-etch composite tip technique
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Enamel, dentine, and pulp Enamel, dentine, and pulp
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Pulp cap Pulp cap
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Partial (Cvek) pulpotomy Partial (Cvek) pulpotomy
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Full coronal pulpotomy Full coronal pulpotomy
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Root fractures Root fractures
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Prevalence Prevalence
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Apical third Apical third
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Middle third Middle third
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Coronal third Coronal third
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Oblique Oblique
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Vertical Vertical
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Luxation, subluxation, intrusion, and extrusion Luxation, subluxation, intrusion, and extrusion
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Definitions Definitions
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Concussion Concussion
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Lateral luxation Lateral luxation
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Subluxation Subluxation
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Intrusive luxation Intrusive luxation
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Extrusive luxation Extrusive luxation
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Rx Rx
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Concussion Concussion
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Luxation Luxation
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Subluxation Subluxation
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Intrusion Intrusion
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Extrusion Extrusion
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Splinting Splinting
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Indications Indications
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Methods Methods
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Factors affecting choice of splint Factors affecting choice of splint
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Management of the avulsed tooth Management of the avulsed tooth
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Factors affecting prognosis Factors affecting prognosis
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Immediate Rx (if avulsed tooth not already replaced) Immediate Rx (if avulsed tooth not already replaced)
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Intermediate Rx (7–10 days later) Intermediate Rx (7–10 days later)
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Prognosis Prognosis
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Sequelae Sequelae
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Surface resorption Surface resorption
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Replacement resorption (ankylosis) Replacement resorption (ankylosis)
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Inflammatory resorption Inflammatory resorption
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Delayed presentation Delayed presentation
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Pulpal sequelae following trauma Pulpal sequelae following trauma
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Pulp death Pulp death
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RCT of teeth with immature apices RCT of teeth with immature apices
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Resorption Resorption
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Internal resorption Internal resorption
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External resorption External resorption
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Root canal obliteration Root canal obliteration
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Management of missing incisors Management of missing incisors
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Skeletal relationship Skeletal relationship
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Crowding/spacing Crowding/spacing
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Colour and form of adjacent teeth Colour and form of adjacent teeth
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Inclination of adjacent teeth Inclination of adjacent teeth
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Buccal occlusion Buccal occlusion
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Unilateral loss Unilateral loss
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Smile line Smile line
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Patient’s wishes and cooperation Patient’s wishes and cooperation
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Kesling set-up Kesling set-up
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Space closure Space closure
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Space-maintenance/opening Space-maintenance/opening
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Resin-bonded bridge Resin-bonded bridge
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Transplantation Transplantation
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Implant Implant
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Common childhood ailments affecting the mouth Common childhood ailments affecting the mouth
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Viral Viral
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Primary herpetic gingivostomatitis Primary herpetic gingivostomatitis
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Secondary herpes labialis Secondary herpes labialis
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Hand, foot, and mouth disease Hand, foot, and mouth disease
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Herpangina Herpangina
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Warts Warts
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Bacterial Bacterial
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Impetigo Impetigo
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Streptococcal sore throat Streptococcal sore throat
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Necrotizing ulcerative gingivitis (NUG) Necrotizing ulcerative gingivitis (NUG)
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Fungal Fungal
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Candida Candida
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Miscellaneous Miscellaneous
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Aphthous ulceration Aphthous ulceration
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Orofacial granulomatosis Orofacial granulomatosis
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Common causes of oral ulceration in children Common causes of oral ulceration in children
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Common causes of soft tissue swellings in children Common causes of soft tissue swellings in children
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Sugar-free medications Sugar-free medications
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Cite
Abstract
This chapter introduces the principal aims of treatment in paediatric patients, detailing examination, treatment planning, and prevention. Various approaches to behaviour management are discussed including tell, show, do; behaviour shaping; reinforcement; and desensitization. The emergency management of children with toothache is also discussed alongside developmental abnormalities (including abnormalities of tooth eruption and exfoliation, tooth number, tooth structure, tooth form, and tooth colour)
local anaesthesia, and restorative techniques. Injuries to primary teeth and to permanent teeth are discussed. The chapter also provides advice on the management of dental trauma, with information on safeguarding children.
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