Tooth Development

• Initiation (Bud Stage): Begins in the 6th week of embryonic development. Issues can lead to missing teeth, supernumerary teeth, fusion, or gemination.
• Proliferation (Cap Stage): Formation of enamel epithelium. Disruptions can cause cysts, odontomas, or supernumerary teeth.
• Histodifferentiation and Morphodifferentiation (Bell Stage): Differentiation of odontoblasts and ameloblasts. Faults result in structural issues like amelogenesis or dentinogenesis imperfecta.
• Apposition and Calcification: Matrix deposition and mineralization. Interruptions can cause hypoplasia, hypocalcification, or tetracycline staining.
• Calcification times and eruption sequences are critical for diagnosing developmental issues.
• Primary teeth calcify in the sequence: Central → First Molar → Lateral → Canine → Second Molar.
• Permanent teeth calcify and erupt in specific mandibular and maxillary sequences.

Tooth Anatomy and Characteristics

• Primary teeth have thinner enamel, larger pulp chambers, and shorter roots, making them more prone to decay and pulpal exposure.
• Differences in enamel rod orientation and crown-to-root ratios affect treatment approaches.
• Each tooth type has unique anatomical characteristics, such as cusp patterns and occlusal outlines.

Dental Abnormalities

• Supernumerary Teeth: Commonly associated with syndromes like Apert’s or Down syndrome.
• Hypodontia/Oligodontia/Anodontia: Missing teeth, often linked to genetic conditions like ectodermal dysplasia.
• Issues like fusion, gemination, macrodontia, and microdontia can affect aesthetics and function.
• Discoloration can result from systemic conditions (e.g., porphyria, cystic fibrosis) or medications (e.g., tetracycline).
• Enamel hypoplasia, hypocalcification, and genetic conditions like amelogenesis or dentinogenesis imperfecta impact tooth structure and durability.

Common Pediatric Conditions

• Conditions like herpetic gingivostomatitis, herpangina, measles, and candidiasis are common in children and require palliative or antifungal treatments.
• Gingivitis, puberty gingivitis, and acute necrotizing ulcerative gingivitis (ANUG) are common, often linked to poor oral hygiene or systemic factors.
• Techniques like “Tell-Show-Do,” positive reinforcement, and sedation are used to manage children’s behavior during dental visits.

Restorative Dentistry

• Early childhood caries (ECC) is a significant concern, often linked to sugary diets and poor oral hygiene.
• Preventive measures include fluoride varnish, proper brushing techniques, and dietary counseling.
• Stainless steel crowns are the gold standard for posterior primary teeth with extensive decay.
• Composite restorations are preferred for anterior teeth or small lesions.
• Options include pulp capping, pulpotomy, and pulpectomy, depending on the extent of pulpal involvement.

Trauma Management

• Includes concussions, luxations, intrusions, extrusions, and avulsions.
• Treatment varies based on the type and severity of the injury, with splinting often required for permanent teeth.
• Trauma can lead to pulpal necrosis, resorption, or ankylosis, requiring careful follow-up and management.

Fluoride and Toxicity

• Fluoride is essential for caries prevention, enhancing enamel resistance and inhibiting bacterial activity.
• Excessive fluoride intake can cause fluorosis or toxicity, with symptoms like nausea and abdominal pain.
• Systemic fluoride supplementation is recommended only when water fluoride levels are insufficient.

Anesthesia and Sedation

• Dosages are calculated based on weight, with 2% lidocaine being the safest option for children.
• Techniques vary for maxillary and mandibular teeth, with nerve blocks and infiltrations commonly used.
• Used for conscious sedation to reduce anxiety and pain perception.
• Proper oxygenation post-procedure prevents diffusion hypoxia.
• Chloral hydrate and benzodiazepines are occasionally used for sedation in pediatric patients.

Behavioral and Developmental Disorders

• Conditions like ADHD, autism, and craniofacial syndromes (e.g., Treacher Collins, Crouzon syndrome) require tailored approaches to dental care.
• Behavioral management and sedation may be necessary for successful treatment.