Treatment planning in CDH

Treatment planning in CDH

1. Consent requirements

   • Pt understands nature of treatment
   • Risks
   • Benefits
   • Alternate treatment options
   • Purpose of treatment

2. Key stages of development

   • Age 8-9 years
     • Overjet?
     • Crossbite?
       • Early intervention
     • Traumatic bite
     • Anterior open bite
     • Failure of eruption
       • causes
         • Supernumery
         • Hypodontia
         • Trauma to primary
         • Crown/root dilaceration
         • Retained primary
   • Age 10+ years
     • Are canines palpable bucally?
     • Are primary canines mobile?
       • If not canines may be ectopic

3. Further Investigations

   • Radiographs
     • BW
       • Interproximal caries
       • High caries risk
         • FGDP
           • BW Every 6 months
         • EAPD
           • BW every 12 months
       • Low caries risk
         • FGDP
           • BW 2 years permanent dentition
           • BW 12-18 months primary dentition
         • EAPD
           • BW 3 years if over 16
           • BW 2 years if 12-16yrs
           • BW 3 years if 5 or below
   • Sensibility tests
     • Ethyl chloride
     • EPT
   • Caries Diagnosis
     • BW
     • Transillumination
       • FOTI
         • 0.5mm light source to embrasure space
         • Carious lesion= dark shadow
     • Laser Fluorescence detection
       • New
       • Digital reading
     • Tooth separation using seps
     • Visual
   • TTP
   • Mobility
   • Study models
   • Periodontal probing
   • Photos

4. Factors predisposing you to oro-facial trauma

   • Overjet >6mm
   • Contact sports
   • Previous dental trauma
   • Motor disabilities
   • Neurological disabilities
   • Age
     • 1-2 yrs
     • 8-10 yrs

5. Order of operative treatment

   • Maxillary first then mandibular
     • LA
   • Simple restorations first
   • Posterior before anterior
   • Quadrant dentistry
   • Endo after simple restoration
   • Extractions should be last
     • Co-operation

6. Recall

   • Recall no more than 12 months
   • Important milestones
     • 6
     • 9
     • 12
   • 3 mnths
     • High caries risk
   • Caries develops more rapidly in primary than permanent

7. Behaviour Management

   • Pharmacological
     • Inhalation sedation
     • IV sedation
     • GA
     • Nasal sedation
   • Non-pharmacological
     • Tell, show, do
     • Positive reinforcement
     • Systematc desensitisation
     • Modelling
     • Distraction

8. Extractions

   • Balance
     • Avoid centerline shift
   • Compensate
     • Over-eruption