At the completion of the course, the student should be able to: - Diagnose all carious and non-carious pathologies in children and adolescents and propose and implement appropriate treatments. Content Clinical Paediatric Dentistry allows interns to learn practical management of buccodental hygiene in children and adolescents.
Methods Under the guidance of the clinic's supervisor and his assistants, the intern welcomes the child and his parents and proposes the procedures necessary for diagnosis and treatment.
The treatment plan, including all of its preventive and therapeutic components, is then submitted to the supervisor for review. Prerequisites Paediatric Dentistry, clinical training courses in orthodontics, operative dentistry, dental prosthetics, and stomatology Evaluation Grades for each of the acts the student performs during the course of Clinical Paediatric Dentistry will be recorded in a notebook. Support The Paediatric Dentistry Clinic, with permanent supervision from principal supervisors and their assistants.
Discussion of the management of children affected by psychological or physical conditions not pertaining to routine paediatric dental medicine.
They reported that the instrument was very sensitive to the presence of stains, deposits and calculus, all of which led to erroneous readings. Similarly, any changes in the physical structure of the enamel, including disturbed tooth development or mineralization, produced erroneous readings. Second repeated sets of DIAGNOdent measurements showed better cor relation with the microradiography standard, which was construed as revealing operator learning and skill development.
Reproducibility for the DIAGNOdent device was high in this study, but there was also evidence of different degrees of learning for individual dentists, and for 2 of the clinicians reproducibility was poor.
The investigators used low cut-off values 10 to 18 for diagnosis and recommended caution in extrapolating their results to the clinical situation. In the end, Lussi and others 4 concluded that, because of its rapidity and very high specificity, visual diagnosis remains the method of first choice and they suggested that this type of examination be carried out before any other technique.
The DIAGNOdent device could then be used for sites of clinical uncertainty, as a second opinion or diagnostic adjunct. The results of Shi and others 6 and Lussi and others, 4 who evaluated the DIAGNOdent device in vitro for the detection of occlusal decay, cannot be directly generalized to clinical practice.
Dental caries treatment plan
The prevalence of caries in those studies was higher than in the typical clinical situation. Air-dried occlusal surfaces of molars and premolars were examined visually along with bite-wing radiographs if available and with the DIAGNOdent device.
The extent of decay was determined by means of an explorer during operative intervention. A high sensitivity 0. However, the calculated sensitivity was based on a population of teeth with a very high prevalence of caries, since only teeth that appeared clinically to require operative intervention were assessed for the presence of decay. There was a wide range of readings for enamel caries approximately 7 tosuperficial dentinal caries approximately 7 to and deep dentinal caries approximately 12 toand the ranges for each overlapped considerably.
The DIAGNOdent device was not able to distinguish clearly between deep dentinal caries and more superficial dentinal caries. However, the available documentation for its use is limited and involves primarily in vitro studies.
Whereas the basic research behind the typical QLF technique, which uses lower wavelength light, is relatively plentiful, little documentation exists for the measurement of enamel fluorescence with the red nm diode laser light source used in the DIAGNOdent system.
For example, there is no basic research to show the correlation between DIAGNOdent measurements and the degree of tooth demineralization. The typical QLF methods use a nm high-pass filter to receive the nm autofluorescent light from enamel and to exclude the lower-wavelength light scattered by the teeth.
In contrast, the DIAGNOdent system uses a nm filter and detects caries by measuring changes in fluorescence intensity rather than by analyzing spectral differences. It is of considerable concern that scientific evidence showing a direct correlation between the numeric DIAGNOdent reading and the severity of disease is lacking.
Also of concern is how the DIAGNOdent readings relate to the presence of dentinal decay and the need for operative intervention. As stated previously, typical QLF results show a strong correlation with the degree of enamel demineralization only but no correlation with the degree of dentinal decay.
Furthermore, correlation with the degree of enamel demineralization is limited in depth. At this time, in light of the unanswered questions and given the overall reduction in the prevalence of caries in the population, the clinical value of the device requires further investigation. Conclusions The development of reliable, accurate quantitative methods to diagnose and monitor early carious lesions is critical. EC and LF demonstrate significant improvements over established diagnostic methods, especially for in vitro applications and particularly with regard to sensitivity and reproducibility.
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