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Pediatrics & Scope of Practice
A Self-Instructional Guide for Dental Therapists
Exfoliation and Eruption Sequences
Primary Dentition
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Exfoliation and Eruption Sequences
Permanent Dentition
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Normal Eruption of The Primary Dentition
• Chronological Order of Primary Dentition
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Normal Eruption of the Permanent
Dentition
• Chronological order of Eruption of the Permanent Dentition
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Examples of Age and Eruption
1. First Permanent Molars Present and Erupted
2. Both Mandibular and Maxillary Central and Lateral Incisors Present and Erupted.
3. No loss of primary canine, 1st molar, or 2nd molar.
4. No eruption of 1st premolar, 2nd premolar, or canines.
5. Predicted Age of Patient: 9-10 Years old
1. 3 permanent first molars present
2. Tooth #24 (central mandibular incisor) present
3. Loss of #O (central mandibular incisor)
4. No eruption of 1st premolar, 2nd premolar, or canines
5. Roots of permanent first molars not fully developed
6. Predicted Age of Patient: 6-7 years old
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Space Maintainers Overview
Space maintainers allow for preservation of the arch length
and provide unhindered eruption of the permanent teeth.
Indication or recommendation for a space maintainer is
after the premature loss of a primary tooth*.
Space closure will occur after 6 months post extraction.
Insertion of the device prior to this time period will aid in
maintaining the space. The mesial tipping of a distally
located tooth results in the loss of space.
To prevent closure, appropriate space maintainers must be
placed. The following will describe the four basic devices
used to help maintain the space for the permanent
dentition.
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Space Maintainer Review
• Four Basic Space Maintainers
o Nance Appliance
o Lower Lingual Holding Arch
o Band and Loop
o Distal Shoe
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Nance Appliance Indications?
o Loss of multiple primary teeth (bilaterally)
o Used only in the Maxillary Arch
o Acrylic button provides stability and prevents rotation and tipping of
#14 and #3.
Lower Lingual Holding Arch Indications?
o Loss of multiple primary teeth (bilaterally)
o Used only in the Mandibular Arch
o Should not be used with primary dentition
o Placed either on #K and #T OR #19 and #30.
Band and Loop Indications?
o Loss of single primary tooth (unilateral) or multiple
tooth loss (requires two band and loop appliances)
o Used in both Mandibular and Maxillary Arch
o Single tooth loss may not always need a space
maintainer placement*
Distal Shoe Indications?
o Loss of primary 2nd molars prior to eruption of
permanent first molars teeth (unilateral)
o In both Maxillary and Mandibular Arch
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Case Based Discussions
“Brittany”
Brittany presents to the clinic for an initial visit at the dental clinic. She is no pain, but her
mom and dad express “we know she has dental problems”. Below are Brittany’s
panoramic and bite wing radiographs. Please review the mandibular arch and chart any
abnormalities and pathology including caries.
Pathology and Abnormalities?
__________________________________________________________________________
__________________________________________________________________________
After review of the radiographs, what age is Brittany according to her eruption and
exfoliation?
__________________________________________________________________________
__________________________________________________________________________
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Complete a treatment plan for the mandibular arch, including any space maintainers and
restorations if indicated.
__________________________________________________________________________
__________________________________________________________________________
Assuming normal development, at what age would the space maintainer you placed be
removed and why at that age?
__________________________________________________________________________
__________________________________________________________________________
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Case Based Discussions
“Justin”
Justin was referred to your clinic because he has extensive caries crowding. He was unable
to get into that clinic for 6 months and his mom and dad needed something done sooner.
They do have dental insurance but want to have some routine care and any cavities taken
care of before he starts to feel pain. Below are Justin’s panoramic and bite wing
radiographs. Please review the maxillary and mandibular arch and chart any abnormalities
and pathology including caries.
Pathology and Abnormalities?
__________________________________________________________________________
__________________________________________________________________________
After review of the radiographs, what age is Justin according to her eruption and
exfoliation?
__________________________________________________________________________
__________________________________________________________________________
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Complete a treatment plan for the mandibular and maxillary arch, including any space
maintainers and restorations if indicated.
__________________________________________________________________________
__________________________________________________________________________
Assuming normal development, at what age would the space maintainer you placed be
removed and why at that age?
__________________________________________________________________________
__________________________________________________________________________
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Caries Detection and Lesion Management
Caries detection and lesion management are essential in everyday practice for the
Advanced Dental Therapist. Treatment planning and assessing for patients requires a
skillset that provides the best care for our patients.
Caries detection can be broken down into specific categories designed to help in the
management of the lesion. Below is a diagram of the classification of caries.
E1: Remineralization possible. Early incipient lesion to be carefully watched.
E2: Remineralization possible. Incipient lesion that needs to be properly maintained before
caries reaches dentin.
D1: Remineralization not possible. Tooth should receive restorative treatment.
D2: Remineralization not possible. Tooth may be experiencing sensitivity. Tooth should
receive restorative treatment, with a possible base or liner to aid in sensitivity (when
applicable).
D3: Remineralization not possible. Tooth may be experiencing sensitivity and possibly pain
upon hot and cold. Tooth should receive restorative treatment, with a possible base or
liner to aid in sensitivity (when applicable). Endo testing may need to be performed to
ensure pulp has not been infiltrated prior to removing decay.
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Case Based Examples
Above are bitewings for the right side of the mouth. Please mark where caries are
present. For example, if caries are present on tooth #15 on the mesial portion of the
tooth, please mark as “#15-M”.
__________________________________________________________________________
__________________________________________________________________________
Above are bitewings for the left side of the mouth. Please mark where caries are present
(disregard root tips).
__________________________________________________________________________
__________________________________________________________________________
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Above are periapical films for the maxillary incisors and canines. Please mark where
caries are present.
__________________________________________________________________________
__________________________________________________________________________
Above is a right bitewing film. Please mark where caries are present. (Disregard root tips
on mandibular arch).
__________________________________________________________________________
_________________________________________________________________________
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Patient Dan
Patient Case Summary:
30 year old male presents for appointment type: Periodic
Patient has a history of soda pop drinking and a history of drug use and self-
reports “I have had a lack of dental care intervention”
Chief Complaint:
Chief Complaint: 'I want to see what dental work needs to be done'
“I am in no pain at this time. Periodically I will have pain but none today”
Medical/Dental
History: asthma as a child no medications at this time,
Had a history of a staph infection in leg but resolved with no complications,
Periodically uses marijuana.
Hospitalized for stomach pain, never figured out why
Penicillin Alergy
The patient is reporting today for a periodic exam and a full mouth set of x-
rays have been taken.
Dan H.
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Dan H.
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Dan H.
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Dan
Radiographic and Clinical Exam Findings
Tooth Number
Findings
Tooth Number
Findings
1 17
2 18
3 19
4 20
5 21
6 22
7 23
8 24
9 25
10
26
11 27
12 28
13 29
14 30
15 31
16 32
Additional Findings
All teeth vital non-lingering to cold
Additional Findings
All teeth vital non-lingering to cold
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