BOOK Pediatric-Dentistry-infancy-through-adolescence-5th-edition.pdf

peds infancy

1. Pediatric EAN

CASAMASSIMO FIELDS MCTIGUE NOWAK

Lea

3. Title ‘Autouris) Year

Clinical Aspects o Dental Ma

4. Tite

xin for Head and Nock Dion

‘Autouris)

5. Title ‘Autouris) Year

7. Antas of Or

8. Pediatric Dentistry

INFANCY THROUGH ADOLESCENCE

10. Pauı S. Casantassıno, DDS, MS

Frees nd ie

Divisio of PelintieDenstey and Community Or
Hath

alee Destiny

‘The Ohio sate Unters,

Chet

eparmen of Dent

‘storie Clr pad

Care Ohio

Haar W. Faros, Ja, DDS, MS, MSD
Dison f Onbosonte

Cage Dents

Re Bo Sue Une,

Deparment of Dentistry

Rai Chee opal

und Oh

Wi 2 tons

ses)

FIFTH EDITION

Dosis J. MeTiaur, DDS, MS.

Frame

reson of Pedi Dense a Community Ort
Hes

Cale len

The Ohio Sate Unes

Member

‘etoide Chien Hopi

Columba Ob

Axrnor J. Nowak, DMD, MA
Profr Enero

Demers of die Deny and Pear
Cole of Deny and Meine

Unive aoe

Iowa Gi ows

‘ae Proc

Universo Wangen

‘Sale Waagen

11. cateo

‘Shc no y Sands pol Der

ep pt ra rtd emi a om Y nant
Rp tc pl ern te

‘Ritter pnl ad a ng ás copes my e Cp Jam
en ca en nd o occ

D a np ape

bey fone Cage tn
Fete se 2 olny Gone a

a 9 47650020

12. CONTRIBUTORS

Steven M Ada, DDS. MS
Senior Vic Pride

nica Quai nitive and Edson CSHM LIC
le Rennes

Profesor Ener

Cole Dent Meine

(Georgi Heath Secos Unity

‘ops Gorga

oma Amin DDS, MP, MS
Scion hie and Progam Dr ela Denny

Nord Cie Hola

Assoc Profr Cial

Divison of ete entry nd Comuni Oral Hei
Cate of Demi

re Ohio Sate Une

Columbo Ohio

Pus Cosmo, DOS, MS
Profenor an Char

von of eile Dents and Community On Heat
Cage ol Denise

‘Teen Se Une,

Git

Department of Denise

Rome heen Hopi

Columba Ob

John Cien, DOS. MS
‘jue Acte Pear

Social ebay

‘Univesity of Noth Carla Chapel |
(Chapel i, Noh Carl

Pre Pros

Darum, Nort Carolina

Marcio Ad ons, DDS. MS
nevis Poker

Dit, Pest Dette Grat Program
“The Cen for Pi Deny

Solo! Deny

Urey Wagon

Sor Washington

Kein James Den DOS, MS
Profeorand Char.

Deparmen of Devdopmentl Dent

Dent Shoat

University of Tous Heh cence ente a Sn Antonio

lion 0. Dune Jr. DDS, MSD, MED?
Depart ol Fea Dent Losin Ste
‘Unive Socle Dent New Olean Loins

Henry else DDS. MS. MSD
‘rote nd Dion Ci
Dron of Orton
Coleg of Denia

The bio Se Ur,

Sean Chi

Department of Dent
None Cera ow
Cound, Oh

Catherine Fu, DDS, MS

Profasor of ral and Nant Pablogy and
Pediatrie Deity

Deparment Dinos Snes and Pedi Denis

is of Tea Dental Branch at Hooton

Dent Sait

Tous Chen Hop

‘ana Binder Fas, DDS
Dearie! of Pic Denis
aso hoot Dest Medici
‘The eee Unters
parts]

Seen L Gober DMD. MS
(Coie Braco end Chr
‘Seton of Det nebeagy
UCLA School a Det

as Angele Calor

Ann Gen, DDS. MS
Poor

Din of de Denny and Community Or
‘eth

Coleg a Denise

The Oo Se Une,
Member of Mei Sut

Norme Cher Hod

Columba Oh

13. Are roe and Chir
Depart ol edit Dent
Cole Dentistry
"nie of lorie

Gaelle Borde

tan Hing DMD. MSc
Clica Act tenor
Depateen of Endodontic
Ha Shel of Dental Meine
Tre ir Une fen
Dre

(Gideon on, DMD
‘Gil Act Poor
Diner Prada Progam
Deparment of Rai Dent
ale So ol Dental Medi
The Here Une of rer
pares]

AN Kai DMD, MSc FAAPD
inc Inc

aaah Sc of Del Meine

‘Te ico Unes

Fersen ek

ating rf

‘ney of Mattie and Dent, New ay
Neva eme

Tal Mabry. DOS, MS
Department of eit Denise
Coleg Destino

‘The Versi al

To loma

pa

a

A
=

See

=

ET

se

nel Ace Pro od
‘nies Ta Cres Hosp
Tow Ci owe

Artur Now DADMA
Pr era,

eparnen of ec entry and Petr
Coles ef Desa Medicine

Unive aoe

Joe iy owe

‘ate rar

The Caer or Pen Deny

Unive Washington

Seat Wangen

a Nan DMD
ial Inca

Depunmen of Ends

Hd Sol of Dental Medici
he ib Unies female
Female Ic

Tadic lel

Dennis anal DDS. MDS
Profesor Emer

Department ee Dentistry
‘Schoo ef Dental Meine

Unive Piar

Prof port Mode nd Nutria
‘Schoo Hal and Rotation See
Une of bar

berg, enya

Stephen F Rosenstiel BOS. MSD
rotor Eme

Dion Resorte nd Prosthet Denny
(Calg a Deny

Columbus Ob

Jonah D. She, DDS MPH

lia Asa rfesor o Heth Pe

Depa of Hel Serie Rare and ede
Dent

‘hol Beata Meine

Bown Une

‘Agar Pete Dent Prt rc

Wend Sage Pharm, RPL
Pharmacy Maag

‘Univers of owe Hop his
teva Gwe

14. Rebeca L Shon, DDS, PAD
Profesor and Chair
Depaımen of Peli Dent
Cole of Desi

Univers oft,

ewe loa

Profesor da
Department a Pei Denia
Sooo Desa Mabe
Une of Pur

Prada Fans

Dis ai, DDS, PAD
Prof and Dir

Acc ductos Progam Frodo
Dion of Peine

Cole of Dent

The Oh Se Urey

amd Ohio

Sara Tila, DOS MS
Din Panic Demir and Community Ora
lh

Colle of Denia
The Ohi State Uae
itor Per Den Serves
Naben Cress Ho
Cobbs One

aie As end, DDS MS
asian Profesor

Deparment el eric Desi
Lotina Ste Use

Now Oran Laia

Sy

336)

aren 6. irs. DDS, PAD

orth er oma

‘Marcos Nips DDS MS
Preise

Department my Denis
Cie Denn

Unies off

Hama Coma

la E gor DDS.MS

Pte Pra Pda Del Care Act of at
Veg

Vs Neda

Kai Weber Gaspar DDS, MS PAD
‘socal Profs
Deparment of et Dentistry
Cole 0 Dent

Uni of

Jo Ci owe

Marth H. Web, DMD, MS
‘sant Pote

Deparimet el Pedi Dentistry
(Coleg of Dent

‘The De of ense Hat Science Car
Mepis, ene

Seen sn, DMD, MA, PRD
rola Chi of Dv

Department of eis

“nr Cher Hes Meda Cer
icin, Oo

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15. PREFACE

inc he Ss elton in 1908, here hasbeen erie
por af this toto Pla Dewi: Mn
‘rough tee, fm leis resent det and
‘Mice prtesonal,Thenovelapponthoemphaae
Ae arprepate themes instado dine res hemes
be val cad nd le comido.
fe eons ome fr ave ton ih others od a
ms ver inode. Te each bee alate
loo fe languages nd is ed in econ progama
rios mori.

"tions forthe fh tn nce floor deg
cea inmedie vial impacts reponses Ra:
espinal eu as eral eh (Chapter
AD ane on the eet of dental due on che
(Copier 17% reed information ca dental Ses
(ips 12 unes ae egin, se demon
‘ert mature weh (Chapter 4) nd the importance
sisi the ade patent ani o an dat
ea home (Chapter 3

here pole al information is eden bse sng
Andi palcisan dic gaine oi Amaia
cade of Pei Denis and Amer Academy ot

Fac e contemporary cri deinen afin
ration al ere san ebook via de Pape
Ba or pagaron).

Bene amar with te hon, bai th
Par The Fundamentals of eae Des. Ca
th he net four par, Beginn with he if and
dings e dan pun Alou age etd pars
‘rel out in simi format quick serch and et

ur ir nd th contributors hope hat hi on
vel farther enhanc yor none an mpeg in.
amine the orale pela pan. hog
Your detal od ong care tha they can nye
Ki.

16. m= PARTI
Fundamentals of Pediatrie
Dentistry 1

‘The Practical Importance of
Pediatric Dentistry 2

Pave Casas

Diflerential Diagnosis of Oral Lesions and

Developmental Anomalies 11
armani Me ame

‘Anomalies ofthe Developing Dentiion 54
Caron: Donner, Ja Sanar cross
Oral and Dental Care of Local and
Systemic Diseases 65

‘Topics in Pediatrie Physiology 81

Nonpharmacologc Issues in

and Contol 88

Perception

Pain Perception Control 98
Sram Watson, Seva. Guns
Pain Reaction Control: Sedation 105
“Antimicrobial in Pediatric Dentistry 118
Medical Emergencies 126
raval Garma

Dental Public Health Isues in
Pediatric Dentistry 139
Jona DS, Ho As

CONTEN

PART 2
Conception to Age Three 149

The Dynamics of Change 150

‘Aeron Nova

Examination, Diagnosis, and Treatment
Planning of the Infant and Toddler 184
Prevention of Dental Disease 200

Tao Manne, Ann Nowa
Introduction to Dental Trauma

Managing Traumatie Injuries in the
Primary Dentition 213

Sion Ho, Ds. MeTiour
Congenital Genetic Disorders

and Syndromes 231
Russ 1. uavrow

m PART 3
‘The Primary Dentition Years: Three to
Six Years 247

‘The Dynamics of Change 248.
Pave Casas, rev. ADAIR
Examination, Diagnosis, and
‘Treatment Planning 258

PAUL, Casse Jo Cunsrnsey,
oe We Pos
Prevention of Dental Disease 279
‘Asm I Novas, To R Maan

Dental Materials 291
vt Jas Dow

17. Restorative Dentistry for the

Primary Dentition 304

Winner, Wacom

Pulp Therapy for the Primary Dentiion 333
‘a Mere Fons, A Komo,

Manes Gnu

Behavior Guidance ofthe Pediatric

Dental Patient 352
Jus usa Towns

Periodontal Problems in Children

and Adolescents 371

‘ov Geen, Does N.Taraın
Space Maintenance inthe
Primary Denttion 379

Tom Rosen Hes ts,
Oral Habits 385

Jon Comer, Hi We Fos I
See Aou

(Orthodontic Treatment inthe
Primary Dentition 393

Jou Re Css, Has. Pos Je.
Local Anesthesia and Oral Surgery

in Children 398

PARTS
‘The Transitional Years: Six to
‘Twelve Years 411

‘The Dynamics of Change 412
exar W- Fits Seven ML ADAIR
Examination, Diagnosis, and
Treatment Planning. 423

Pau 8 Casanasso, Jom Cums,
ee

Prevention of Dental Disease 460,
‘Anson J Nowak TAD R Maty

Pit and Fissure Sealants Sciemifi and
Clinical Rationale 467

Pulp Therapy for he Young
Permanent Dentition 490

Managing Teaumatic Injures in the Young
Permanent Dentition 503

Daa) Meet

“Treatment Planning and Management of
Orthodontic Problems 518

Jon Crane, Has W. Fans

m= PARTS
Adolescence 557

‘The Dynamics of Change 558

Denon Somes Pari

Examination, Diagnosis, and Treatment
Planning for General and

Orthodontic Problems 566

PautS Casse Joux Comer,
Ho W. Fs Sri Garra
Prevention of Dental Disease 586.

‘Tap Re Maney, nr Nova Mer os J
‘Aesthetic Restorative Dentistry for

the Adolescent 597

Sports Dentistry and Mouth Protection 609.
Doom N Rasa

Appendix. 618

18. PART ONE

Fundamentals of
Pediatric Dentistry

1 The Pete Importance of Pedr 6 Non sue in Pin
Dentistry Pons oul

2 Diférental Diagnosis of Oral Lesions 7. Pain Perepion Control
sndDepnentl Amar en

3 Anomalies ofthe Developing Denton 6 a

4 ls Deal Ge ofc and Drees

ne enla Pie

The test section ofthis textbook deals with information and themes pertinent
te den frere ata ages Much e thisinfrmation is covered incor ets
‘of dental education. ut becaue ofthe difrence between char and ats,
Including thar pyslogy and active growth and development no textbook on
estare dentistry wou be complete without discuss ofthe topics covered in
‘this section ofthe textbook as they relate 1 hn.

19. The Practical Importance
1 of Pediatric Dentistry

PAULS. Casasasso

ease deny is smonymous with deny for
iden. abate deny ets Bese ben
‘nguetonbly ree out ‘ofthe ped to mame dee
es ands eg of pubis atin dp
‘cited with need ppl ve and sppuration in
‘Shestrbone
Tt war gic tht fom ts eration bei
ring ed deny to nde cae mercy
‘rithancmpason gro procedure ad the mate
oneal ch tga tec on de toda
‘oth renova were soon dm fo be probe
Resort chaques pl therapy. pce maintenance,
aire et were he main thes of
a hich say sl ot ener ec ofthe ging
eben of xy cod cares ands recent ieee,
{he sine cigare inden hsbc.
edt dent ay emphasis prevent o dena
es wih i par foes of hs book sods
Fene te organization of his book Cars rk asenimet,
ds rs o india pee, lalo and in
it ion or ıhe Soon fee aed ra
hace

Historical Perspective

‘Unite mid 18h tet on sate he Unie Sate,
jr deal suple uel ew ts opening eta
‘tesa sr had ign ht i No chien de e
13 ated af Fatal, sich tudes are now
{the ret of trove econ and science ey
eto peda dent Speci duro aies
For pda dentin re rowan ner pa De fare
cui polo ldenalschoß acre
bye Commision on Dental Arden Graduates of
‘acceded deta schol nthe nied Sans har oth
(hand oie demo force Pre
‘heme hough the cor of one demi and
‘ng sn hol thf cen the tan hat
the ab tech da deere cr bcn ou I he
ney has gy dape,

‘Theor pres tht det are hou bein at 3
presagiar onthe beef hath nde
Beas sto dia fo we, pt ya sect and
en ing pharmacloge technic, resi aril to
‘nif speci, Thought oe tha tenet
‘hen iat be thchld age 3 ea men at man
len mol esperen da er and er etal
‘fice vi rere and pin management ne. The
Amer Academy of Feit Dentistry oy acte à
‘nal at nor ber thet Did Im May 208 the
‘erin Academy of Plates (AAP) sed pidan to
demente of moran 50100 peices pe
on Ra amont at moth 8 ag ing wl cd
‘Sis lng with apatin of Hude am" Us

on te appropriate of ths recommendtion fr
ler ein 1 dest are by ba profi
ue 1 the recognition today that ea chldhod aies
‘not be elmistedhoogh resort or tl fot
‘ection and bar hen ad wih et hood
is re more pone o dental aio in the permanent

20. CHAPTER 1 The Practical Importance of Pediatric Dentistry 3

Milestones in Dentistry for
Children in the United States

“Bile 1-1 provide «tment depict ion of
ens for ee. Lik he spay of ended,
pedi demi grow ot of sor dentro cum.
Posed by genet dentists who joy working with
Een nd ad compan fr the suring y under
ei id anche etl art he pre Bote
reacia sat pi det prec

‘hen its affa ogni a spec md ie
Tas cen Dario rie sec ar, peda e
‘hy cd à path dar 1 eer dnt specie,
egining with eres groups of entity the forman
‘rata pliers nube epidemia
Fring program tnd cel rain y opal

iio la deny cet rue on a
‘met of inns, chien, and seen nd au came
the grp in oral ety ering for persons wth
‘pel heh cred Ihe mi the cal de
tno de sr four o lena der,

Milestones Dentistry for Chen nthe United States

ine Fre a dts om on ni ao Grn Ua in

stomps devi in abd.

The spot del dc atest on ft aera Er ope

pipi

1907 Ar mann dea of ston ng ra pm Senay Tar ia Sy ar
‘ie sin fess Chen eae the ming he Asean Del Aci ADA in Deo.

reporta Cage Commis oran Sci rte roman of Den Che ate ai
hd prod o tal een th nen 042 hoa o at ie

ASE gd pra andi prado propa ei in peon

190 Tosen Sc be eatin of ety r Cte ng ee Aan Sia D

SC Deal ya led Oa ad ade Dena eh Weare in,

PE Tecno pi Sordos evening sel Te Canal Deal can
Pommes heine are cr.

STE ha cd vt Ari nt qu Gnd apa Maia

1907 The Aen Aen al elos md he ope tsa ll mappy Bend
mu ici ued opus concen wah der best en)

FR etnias Seed of Mole spy ined oc pera aay SRE
oma si the Coulon Der anon oi ADA

Th et of beni dol Nat iD RENE

TS tor ac cnr did

1 rn pe peg pega pope pia

Bir ees u ke ede pe

17° Weinen Wip a Fr and De Cates RENE PRE

opening ae bith po ( roman mat mod core ur

‘tons ee)

sry desd Nal Cen Dal Hah oi

BET stan Aen ol Peo Gg eae nan Reo PGE DT =

1995 Ane sion oper the pt fed deny bythe ADK as Deus Peri ern
{ed py prvi iar and umgehen. pene ape ll em
{thao og ware cn oe ih pl are

300 The AAP ents Fo Stern Or el REE Ann Tag u ER oa De TO
nc oa alme une i sve oss ning th nd en eet mn ar
eo oregon dt rae oe tren fi a cm,

21. 4 Fandamenth of Pediatrie Dentistry

atin patie many au vias remand he
at aire detitsand oso toda tease ofthe di
‘eas in among perl raciones

For sera rasos, ie peal denis community
‘erin the arr prover of rl hehe o
ce. Mos iden simpy need bse nl series,
predominantly drone and prevent in ate. Tit
efor tery one anime baren den
‘lease and sil ed a dra home Gates odes
‘ev lucio pen wel pegar ade ab.
the mow diet of pe or el es Another
Important eon si pia ess ae nt lefa
and ten ith amor efor to educate more pele e
"soe telat mo deca the number racing wel
‘iow 100 tions compared ith oe 00,50 en
ess. Convenience and complace alo sc) spt
the concep fly deta ey al fy ere.

Challenges for Pediatric Dentistry
in the 21st Century

‘With recen recognition of he ine ey hl
hod cute in the Und Sun and other iu
‘ibs, und he aan of ts dene In por and
nino ren the fool pi enya ied.
À det eating hen neds w be ae le new
enges in ping cd ci Ge enge hi
io. td meh nd commend rn
1 comal, ae nam bd to be high Inc y
‘icrsteondthe opal ones deal ate
e Keys melo intencion cria sage and
‘hac oder forse the ef ol commune
‘tem db ley ane not aga i tue. What
man that the dent sin cen or cer
may ile eens an nt Jus the id and ami
fd the Moog ol the mouth, Prete dent nde,
destin the fle a expen neal ors
in cs natn sl prog, peal lr poor and
epoque Import sean me
‘hoe cera

+ The imporae fine ral baht et opor
yt pret cond car y prov am.
Be oil rome omic an the greens
rae working with nodes profess

+ Ach ecg seu ad compas eos nd
‘her plein pedi deny, bic ow ao ndo
rome approcher and concerns shou oy

+ Den rth aed paint and ober cen with
‘spec med wo reno ig longer bce of tial
hace, bt me dent erent fen egies
Arten of medicos, oran fncon, má aer
pa

CZ

2

- Bay orten diagnosis an ment, which ho
en show to Bene many che in terms fig
a dpt ed iting ogy at

+ Mote spe pin and ande contol, sch as
sedan chiqui reus anden
comida of contemporary puddin: fr sl nd
crue

+ Expanding res with Morass due the quit
rene dl ria e eve tnd dung in

+ Obes und ter eng rd a ir implican
Lu eu nd ca palets e entr

+ Sophia of graphic techniques as dial nd
“ire dimensional imag became more common ad
prod alce dente dares information on
with concems about por el ident dation

+ Substance dus, ining molles tbc we, ee
prescription pain medication which is epidemsc in many

+ Digi of hath information fe mangement and
nor aná te rk an porn aise
Invalys crol ivan

+ Nery out dem ict apport ca ha
{community Ja icing Sent parton e
rah bons, schoo por teams Hea Stat Program.
Sonata od ote our of afce mie rng a
Ei re perse

+ Socal changer reco in pin shee a
ques andthe lp plates of tae hangs a
nde

ht phenome hat wil arto Be adi he
a centr ar deemed import enough 1 Be revered
in ntrodocory caper Tex ate ch she nd
neglect the chien of pve. informed ease ad sk
tangent, deceased det practi, tinc
een and emergence of peda Sentry in e

CHILD ABUSE AND NEGLECT
(Oi abuse ad eld neg re ul and made
‘charged asco the more gene problem of fly dr.
funcion in our socie, Sic the 19508 hese themes he
‘shed inca stron fe te le and beth pr
Fenn B 196 echo eso ts ud dt egin
lacing room of profesional toreport ou
pe ato len. Tes le ht man de
{isso repn speed use fe alo pote er fm
al ion Drag by angry and ene parents
Tee es ao Spell ou he Ip implacs fr the
ett who knowing and wf isto repr suspected
‘habe Aiough ws vary fom teste gene,

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22. ‘CHAPTER 1 The Prac! Importance of Pedir entry 5

the dats who aso por access one guy
‘fs Simple midemcaos ad wate ts era
ence The nal al mas ent iy ae for
{ny magos the hd ease y feo por ls
‘Thee spe emi an doce ase
ae he ad deel of o de»
ey derbi procedure alado scan. The
Ameca Aadeny of Pei Deny ols dis
‘Seaton! mate hou management of chil hae i
counteredinthe coun of ental remen Whe xa
ning A, be est ma encore base another
io lan prompting a intervie withthe for
{elation ofthe ery Ate be ean come
‘eed the pure hold imei carte om Be
‘hl ose ter her or cate If eps
Se tente eo accounts of he jr the dr
oi mae Jaen and if abs ls speed, de
prop ators wold be informed

Ped abuse an be cued by During, tapping,
ining haine, sing alla an pinching broken
‘eth burns in ny paces rin pate an cerro

roles in varios sages leal sould ae e

tie gre dc sen cp of psc abs
pom noble doing a del camion, Ses
base fr more del teni) and muy e beyond
the puri ofthe deni. Arcs acted y en ste
onl ote edi en by the dens however se
ate cd may demomtratinapeopte bees
‘eth the dni, esque inspec sem
vem iba

ges may be mre sb nd le ey end
(fen: por othe ge ha prompts dent
rie further e posit o nel The eit
‘hoaldlonk athe ch eal in and ohn wel
dent hpee Spin of our tion aye om
ty and unl hair sty thing und sparen ck of
‘mea are ar idence by nso such pet.
"The ent b topan or ng sam sprach
ele to ab reporto och ul mandato The
American Aadeny of Peli Denisty dis desa
et flee of De pare or ann seen
forces oaliaions ron pin or alrcoeparen
Brunn flo og wih ment ocehe rl
info d tat e formen colin Sol
ie enc ma became nahe ose mor ©
{nove de dd fon bth an base und eget anon
ino à fr eirnment. While report oth neal
‘del mandate the ue of ae, he dns muy
dt dental ect needle mer tt nd
‘shel ot beam aed withthe iby of ac
terio den cue my when mov tod
Fear pt becas

CHILDREN OF POVERTY

ile wo come om the cecumsance of poner are
A ingen ik fr derdopmen of dena ais dete
A Be preventie dentin accomplishments of the ast

0 ears Recent dts om he Centers for Diese Cota
and rei! show à dica nc a pim
‘el crestor children sod cot lingering pcs

‘on for both primary snd permanent desta ar w cor
Jn dt de Sor ler scene wats (gre
12 Unfors the number of cen in poet it
Increasing Gennio pve fest the perpen
of pore srs map generas, wheres Sal
poverty mesas ras dt desis
{ofp problems due o dor, cion blo ar

ren fom porn haben we izo, an ton
‘hat sts pfncon ton ines, edo Stemi

den dr The chen of poverty ve as
rend cages een pcia The ik af
ours make eomplnce wih preventive commente
‘one ell cen the con of che ad Bore
Senke can lenge some por fie: Transporte
to detal piments may be ut swe, so at he
spoiiment false rte of Medic sore chien
‘Neues à rating comply dents” Di pres
pat oie we a cy are character by
F propnity twat high aloe prepare fondo bene
be ons ae hin he Ananda resources of the poor,
nd do sc to the and ala ocak ma be
Tite Desi en compense for te Incas ce
"kof poor te by moe agree reten ch as
ane el ens tr thn complex composts ar
Ama. Th com of todo examen may a be
out obres formas poor bre, les e dent
Fo mal mot of pace management when deal rs
ee reson ete

"The Arial Cae Actof200 made rate fr
ie angl pce ohh career e United
‘Ste and more eave ces a al eh
‘afore page Ti vl calenge he deal Ma o
ste nd ty age the pater fete dey de
‘Sen dental seis covered bth pt and poe
‘pet hei plan andthe alban ening
rics ean snd gene ani À pub
on afin be Gal aoa per oi
"plane stand ac im al genet
‘af ra cae sen lor che los han bos mon
bei Med or Che Heath rn Program
(Co) under Bar Peode Sening,Diposo,and
Treatment Program (EST) e Chapter 1), The ena
proto nd other advocacy rieron cocersedwith
bare motion tat chen eng
hong poe have cs to necesa dentro

INFORMED CONSENT AND
RISK MANAGEMENT

Infomed content she leal mechanism that pte à
teat’ ight ott Be touched o in ay ey eed
‘thot thorn, Tene se a ight of

23. 6 Fundamentals of Petite Dentistry

by ae, ees om et ih shoud aba ove ep ef be ef
‘era oma boa (hm ap e o E mal on Be Dont nat lnea a mar
Ca cede pate ns aaa o get

24. ‘CHAPTER The Practical Importance of Pediat Densty 7

1 FIGURE 1-2 Des essen gray te
‘ae gs tar pony re
(tate Teal en tone
BES tens i Sot Cde tea
‘tt Cone or Ona má Pron)

en competent dat humanteing to determine wt
iat pooner may do 1 his her body.

“Terese to Kinde feet taped tod imp
Im coses derive the avi of teen
Farin, de ade sto ental ch ope
mou, bot js sting ad the mln at the
Pen Roos wat I gig fo hapen and agreste
Nappes Epresed cat ven er À nel
is cn rente men aba cet
or prin he pen om undue tentar har
Anda de on Segun gain

Informed consent ao imple tt pet saute
nature fete nas etme in

‘dng naling he à nain. probable eae of
{teeta pti tenes and pase ro an.
traten other word an “informal” palet inc
[blo gvinIfrcd cnc A gaan the poet
Suniel eles a.

Minor anna the respons fr vinginformed
corset To moi abi he cenit mu ete consent
rom the presto the pron acting kn poet An
‘Step fo ts woud be rendrng eme ar at
preserve or prevents vere compromi ote cd
Bei when the pares aot beat ee va
the Ti oe tothe atmen a ado tag 16
‚rar whe thepesen can determine wheter hor shel
capte In many sate prs wi ited nel
Teta iy ae hi own urs ad an eerie
hte hy wl cp ame een y ae under
Tecate ofa ani verve or thar parent

bring tome coment con change the denia
who tas cie: Ole crn and adlecents muy
Come to the den) fice unaccompuied ya puren rin
‘he company ofan le sing tve nian my
ot understand the ed fr al pret appv exe
and ed cen with aly ind with ep eatin
‘hip ote cl bcs thar acepte ni eure
eater pects my have cd el poner opecaly fa
‘iis the andy temporary which maybe an sue

In cae of domen valence Sc evi apace may
ee a ayi tre Dore separe prs
maybe ited and note bet coment free
"Ta may alo be the ue with dome partes Deis
hou hve pas vete by sound lea ai,
(bal ih hse ccc ná ory aan hey
eat ran ten whose paren we ue ah
Sats when they dd th fails who de teak
Engh elena o nderstnd consent nro sd
que vane beth tano

ik management son tem ht desi hatt
tea pocas nd thus that» dent and the all
an have and can do to manie ll eme ad
‘neues cation ad prcdarrpeiady dor.
ru. tp desi manson! dee
‘ony hw the dent ode itt at a por
{ln how the den and ld pete or pardons

“Tepes innocents sti manage
ment However ik management ines ss cr hn
‘hove tht ae miel var a mic in
mania Dec he kan and de pub can
mania indivi wi von be or he wer he
‘eof den fo chien rk management encre
pes que been he ent ande poe win og
‘hen othe ne Over hela ever sad parenting,
as changed” ahve parent expan or wat happens
th the el in he Set al? Mach ofthe ange
ents sound aviar glance wed in peda en.
Parents ed toby ay rom gener essa ad
pharmacie mangement of the cre ut today
‘hey want he pete deny expen 1 e pails
nd ope a poule Ths = ait Cd
etl aoe urbe, pres wat ob preset tog
Rien nose ate than wat nthe pin se
aly pret fare wg aw se of eat
now led protectin sation inca ofthe land
hs may even extend ase of vale conte y he dei
toga e sation. Oe es common sues ee
thet pela dentista th my ac cone e
lua seo oi patents or ey rt we
‘sf macho technique that pret eel preset» het
tony su a Ari ama composts où ni
thon The den nd undarind the be nave
inform fr mic ho expr cocoa

EVIDENCE-BASED DENTAL PRACTICE

Mach of dent prac i u on iter ound prac
{ies when pation ad sentis ave de ft ar
std ach tamente andard of re hs e
‘he ger and realen of e nthe pre com
mani: Ec ma have ne senti support. ad se
‘ofthe echigue may ave ben ed pl on no nh
alates Today the a sage a fr pate
td a cet rnc ec in prose dal
tle dened to rt he chen. Im ite he

25. (8 Fundamentals of Pei Dentistry

for cidenc ti wellknown that atl ily se
Pace can be ey bed o the ihe eves en
‘dene nd many el ber be sed opor opinen In
‘et man of tas deal aiment ar fed on ower
«ui evidence ent are alegada design paces
round evidence bed concepts when cid dos nu
(ai the cle sanded of cre in cont
nes aprowdure ns rang supported by evdece bat
canon provided ren, the eit at kit
not prermed on patents Comer newer but or
uy ese pescar may st be covered y Payment
laa whee unes mor me and log ad
qu mae covered seems oi agar
Ty! pci manhave quod undesandng fe
Ieee eens Sod teen ad the sac
etch lading tat Werte Pure, the det
‘hod te se tat a een dcr no harm an it ast
telas th aies o ing nothing fora ond
tion Ra, à dentist pate shuld lade tern
qua surance roe to rate the ficas of
‘hose praedae wii he pack for wheter erences
ting
TECHNOLOGY AND MATERIALS
Techno is ply changing and it sino 1 dental
price meee Dial ies bud, mal ae
osu dang und eed epi aw hr more
‘ena trading patent ar and ie le factions
lke lg ad chen The st entry promise now
eral adn echte banner tan he ae
‘nee nov comprime most sore 8 paper
es Pl therapy oe sen of pete dens that at
‘Syed aan chang o rend improve ec. rc
‘loner conte se cepted mtr he formocresol
bu mine ió age DAA) and dei inducio
Baie manche been id one sce aa
tar ten dot thon in mute pete
‘etsy mos ily ene cot and m wein
‘hiya prt of deal sens ruine pac

The let dental ecard ar ao led ornements
in rcs funcion In ado to sing pepe and
‘ying he improed dat manage ih arent le
tron ene shows Sent ue qua surco in
acc without seg o mile suber y hand
Ar ha are more It à qualite er, capa
‘iwi play mere Seon bing ocio
Inn las evo dl sl Se th cite edi
{reduced co Fil, ceding upon ht ine
Seicing pain atomica fat opointmens,
‘Seeing them fo any spec dreamstancs Ike dar
tions o Mita requirement ao siesta ine ad
o

‘Other eile dance cbicape eng crie
tances, pana adora! arumen,
nenn bel entered be ff perc
‘enya ied to improd and ls con are

HEALTH CARE DELIVERY AND
PAYMENT STRATEGIES

eat ae dehvery and payment aegis were ot themes
in efes or cond eon a th bok; seva, berth
rm the Und Ste demand har areponie
‘cto in pei dei oa inchs bee themes.
‘Te mor ng np deity eed tans
eae ae er neo die he omnes
‘ae argaizon for pula ened programs sc as
Men and growing race e deal quid bl
entes (FOHED. Corra ery going lb
bbe and pte ses tease the os of Ses
vou remera In population the ay o
‘erat an in ney pasted det ens of hie
‘util dh nda Gare y exiting sor it
ters sl paces Teer ee them fom bes
‘menage yet alow hen tobe employed Coon
‘es av emerged tt eas en dren corras by
edad in sat cire reunen foo à ro
bh semis pone god ao many cies,
(beyhve bc gud ld pty bout Bios
pres id an ru cmpye ens render
Eng ant of ae ch we Ths race smc the
hid and amy a based gal repress fer some
tae rations

"Th pot of managed ce opinions (MICO hat
ers Pop len and alias ested om
(he dee of ate o col oer berg Moda
‘pelts by allowing NCOs 10 cote ean
Mb veting the rated Wenpiywakeson er.
par The impact sr of hres hs Ben ei
Fram tt sate Some trav ed the nerdy
MCD o rire dentists reg pre ot
apropia tan pr Toe on
nd sought rr of revenue fom dt ha the MOD
{tha provided unneceary sten Some CO ve
rede sor mid procedures at an be provide. The
rel impact has been din parco y den
id mor ica ace fon covery te Mei
eye ine tes Cims we made hat more ch
ren hve ged ac, tt many ehren simply ein
‘overage dueto canon ef the Meal program ad, in
rely ith delingor milenaria. cr
fda den sig to refor ie.

"The FHC movement ha rested mor comuni
sd cle roving del ev en in rs tt
vel ot supper «pit practice bcs Fa patent mix
‘eve to lw income The FOHCS novel rimburenent
‘pele whichis based o it abr han procedure,
race cannes However FOHC a it cm
eps ress they ofen ave diia eng po
Vides FONC alo pondeveryitecretoclenscss
Bean,

26. ‘CHAPTER 1 The Pract Importance of Pediatric Densry 9

CARIES RISK ASSESSMENT
Caves ik assent ia vig cece tat il ey
Fein coms rough vided re adprone ula
br redacing nee procedures wäh ie evidence of
‘net re fhe eae oo cate ri
issment suas that even ith or mare decades of
‘Sythe et pate of u sepas tor
dtl a One acs e diana Terie espe:
ree som prev power tthe popltion ere bat
‘ot eng 10 me the dal weh fo lode
fat Te eine ar ant lng wa fot
ing u o ind une sry and pee
A ae 10 lw to provide ptes surance hat thei
‘Sheed xe tat cat Mo cre rk tol ae
tied een or pte education highlighting cel
‘bhai pers that pues can ars, pea
roving ther chic wth some dee of pri
From tre cre Cares ik men of to sc
‘ately den vic patent eure sonal tn
st as tik asesment ol reci scioconomi
tate an plc iden In an aa aan nape of
ther beba o neal il to cobro at he
cerner Many of hese rn ays.
[yh slow ak of doin ai

Most proponents fei amet leon
ge thr we o ene deg een services

iden who ely ned hen Lite kn aout he
realise bid prevention lok chien More
‘sath nd before cri ik sena com à
‘ely well With tha eng mi, a conscious
esto shoul rer aka sd ici fc
foreach ptr in some form tie the paces
Fat pol Some ofthe many outcomes of ak ass
nent cd pact wl be 1) ntrdaci sy es
tremens tht ae medial Da, (2) ser stechen
td ral among Be ete hai cae team, and (3)
‘onder developmen of det eves and mater wed
1 rotor deni ht wl prove therpete ww
Asesor peces o management o ees.
ADVOCACY

‘The concep of id advocacy er dns not ne; me
Ie been umpioning oral eh for hen ol
son fr decadent shown In he inline in Ta 12
Organ dent ed he way for ate Sonica and
Ju ordre o improve orl hath of cle à
e]
a and general peda heh wii e publi The
es specs of vaca at I india dents
Siri o prove petrol ea beyond te diet
ovio are Denis a funcion ach ade
sey ld The fs thin be len remoto
th and pee eth or ren gh pates

“Timeline fer Milestones a the American Recognition and Approach to Family Dysfunetion and Other

ii Hoof pe ven ca yr Ca eT LL PD
‘inn neve fe

TBs The ek Sx Pv of Cayo Cen el mn os Ba et

TTR cou ese wh he i ene oo en SS Ob WR a rea
Pr

BETT papery a daca til EnBW Bong ne ae
ines au a bcp dee.

caer a ch a ts eng To of is ve rn Br BTS

[bel Pere en tere ch um hi

BeAr nac poli aura of i Perr Neal Aca wl he ea
artless made be Soy tine thea evened omen st ee

TE AO tota palos oer de rps ol Dan rn nori pe

[Bit Tons pops mr bl dnt of matt chen net y mr ao
panne.

FFF Ai Gee CA rg RR Gre pl fl ig de
ote pei ld al bl aed a a of id hse

EI e mera eto 0 poned analy hes 1 om 766 WR chen FLT ea pe

15 Thenunk oop leid hm moine op ml

enim sh ech a
Ney ae ve ra nd ml al pa oT I HS

rg rege ion om ol da |

27. roche, audi announcements on ter picos while
ens end bybavingbel aries tr
a ideo svat orig ars Jus ote the
fic, o the oa comuni ests an parut on
‘eh ath board a a sal pce em mi.
snake sth poor tama and partie cales
‘ir Head Sn Program rein and oumber er
tie Ul rough the legate acy of the
etl sot dots anwerkmiheedundappited
‘tsa ad provide ech adver on ral base,
‘aly and pic educa A estat and atin lee,
Ent on ea de ek fp acon ct
tees and part la bring fr peda al ath
‘Ths satan experince ti man dni hve ad, bat
elt stem ce ad spite is re
‘expected o make dco aboot » myriad of ses and
‘Seed armes to make be best decos. Oral
bo ea oleate lh mater ac
fate para al the importance of ral hal cri
Hate many ei mal roy god rl lh and
Faye irn thy may at apprit Be prevalent of

‘voce in plate diy scored an equi
Jet pat ofthe dents espn in protein the
heath le Ting programs np deme
Arrow expected ah cides about dey ndare
nero to le them pst in community ed
‘sf des y understand the pial an beth
esse the United Stats they relatos
beca atl lev the Bal ae chen of ds
oy nt ik

REFERENCES

Re

A em
er
ner
a etn omen iy Dn wt ln
D ee
18. US Gun canin Ot ral ete ao cri
aes
Rene

28. Differential Diagnosis
of Oral Lesions and

2

Developmental Anomalies

ide varity of rain and sof ur enorme

e cdi ten bt he regan at which
ny of the ens cor maes them cleging to
Sika dignos. The purpose ofthis hope ist gh
hei rl en are mos common food
ren ad publ emir alpina ero in
‘eval pci Gore and specie mince, which
a mie bene rent enden reia
15 broaden the diese soe. The materi i uti
tome comprime bet mae cnt an
‘sero rei. The rie ern fr uch nity sm
aries mor important coal informate ra
‘rant the child paient Recent examples thee
dicos nde ote e carac ch
‘rradiogapie fetes.

ch rt ons dese seceding 1 Bey pi
(0) de owt cmon pete a rupee ad the
ende edn 2) e caracte cal andra
[epic ndings eso, (he mat frequent ao
forthe ling, (the pei pianos he een,
(5 the este and proposa for he eon and (6 he
teen gn Is pertinent thi ape ou

rcpt for tet table on eked. dal
Anales, de oler tas we aang to pare the
Ron dial or oa cscs forthe
‘he tabs incide he flowing dese categories

Developmental ara able 2.
ie ok te eins (al 22,
‘Wate race mater os

We mare ions

Sy

336)

(Carvin M. rarrz

Darko in hos (Tellez, re 23)
Redo purple oe eons
rie

Viera sons (adeza, Figure?)

Sof is enlrgemens (able 5 are 25)
Papaya
‘estar lone
mor aná tamer sone

Raoluent esos of bone (Table, Figure 26)

Maxi eadolcet and raopegue lant of bone
‘abe 27 pue 29)

adage ons of bone (abe 24, Fe 2)

Pinca te ga ai en
ee eee
to gan eher
a sa oad vay nee

se ml ah on
leh et maar
seb hl ma pa
si ec cr Pl al pes ofr eg
Sanjay Pana Cd sil ete nt

Kaduse.com

29. 12 Ripdamenul of Pei Demis

Developmental Anomalies (Se Figure 22)
Pasumc Tr
ma Cie Paume 2 Duras
Cowon Gema Fines tocar SwmicaNer Proioss Dumas
Fondue Peut Depart Delon Tecos Brahe E
per nd gone, Me aot ame mp
este Mir ger are me Mid
opener tete, indi ponte sc
clio Wi may ‘rims we eee
ee caen te oct
Aa states pen
sad
Fo St nes Gamme ON Cape
Tr
CR co ot mern ieee
min nd ma fedag, mal Mapa
ee Fumer amet
Pe power)
atte ps
‘mie tm
pers
a a
pe
Be Rene Norman Mirad Srp veep Wi Kap
le pitos gu Aid hormone pei
rios Tem gil ep dem Heme
‘ice dou em aon ppg
moe unit etn the athe Eng
Sos ann prats
épars ae don
owe mein nomas
A CC CIC El]
pa Mae ‘ad ‘soot ete a
precio raging Lan nr des
‘indy rase pl
spel
‘tat Fst ond Ale Anson Ne vege M
Veh aymmene mic énemex Sets
Nowe mem Genie neh mie Moni ae
Patton opi vermin déipes mim Die
soe pa de pic
cos dead
chatons
o
pil ele dd im normal Ca
a
Fem met Mme 4 CRETE
Prediction bate! peta

30. ‘hapten 2 Direnial Diagnosis of Oral Lesions and Developmental Anomalies 13

Developmental Anomalies (5e Figure 2-J=cont
Tano
Croma Paume ann Dar.
Common Foner __Locanow — Srommcaice Promome _ Ducvoss
Cr Milne poorer Mlle, Miren Newt qe Trama ee
me pain ann ae

Fee Fora
mm heh

Tony Fle

Nope rover
pos =.
Se
Fe
Fa Gone sep Fri
‘gal Femie “a ‘ean pa
ioe) Treten Comet me
ow dng Per
‘ond Melun pit
Es

ES
Cicero Coms
podais es
os septic
ps

Cader Treten

pa]

Gadir Fasci Orca
Mon = =
om ee
=i
eye

31. 1 Fundamentals of Pedic Dei

* FIGURE 21 Devoto mom À Fs age 8 Pl ahs i gale tm Be 1 l
‘setae oa ocn taps min par vemo ln qe Mo
aer ti.

32. MATER 2 Differential Diagnosis of Oral Lesions and Developmental Anomalies 15

2 FIGURE 24, contd an Conn ip (wt eth sey proa be 0) Frei eo
‘si ppt af Oe gb gua J Bd aK pre mary bl eam ty Ts puts Be ai
‘rite Sat nen of ater mina aes, ace (D € iy. Uy to Cae o
mtn)

33. = TABLE 22

White Soft Tissue Lesions (See Figure 2-2)

Pepraraic
AGE AND ‘Trearmenr AND DIPFERENTIAL
Lesion Genre > CumicarFiDimos Location PEDIATRIC SIGNIFICANCE — PROGNOSIS. Diaonosıs
White Surface Thickening Lesions
Fritinalkeratoss Firtand Lecilkeitodiise,whi, — Mucamadjacentto — Causedbychronicbiingor — Hliminadonofcauses Leukoedema
second rough or shredded ‘celusal plane, suckinghabits,iitation lesion regrsses Linea alba
decades patches adherent indudingbuccal, from orthodontic Smokeles tobacco
Nogender ‘symptomatic labial mucosa, appliances, facture teeth eratosis
prediction lateral tongue, and improper tooth Ginnamon contact
attached gingiva Drushing stomatitis
Lupus erythematosus
Smokeless tobacco — Second decade Die, white, winked Vesibular nbialand Highlyaddictive habit lesions Dicontinuation of Leukoedema
keratosis Male Patch adherent; buceal mucosa; develop afer 1-5 yes of Habitreulsin Frctional keratosis
predilection asymptomatic gingival usually mandibular use; increased isk for lesion reveal; Cinnamon contact
recession; tooth staining ste periodontal disease, dental biopsy of persistent stomatitis
‘ares toth sensitivity, and Iesonsslow risk Chronic hyperplastic
hats for malignant candids.
transformation
Tekosdema Firwand Wiese Aly white, Biater bucal labial Most prominent in Back None required: Fricionalkernoss
second ‘wrinkled mucosa; mucnmandsoft children; condiionincrenses common variant of Linea alba
decades adherent disappears pal with ages more pronounced normal mucosa Wie sponge nevus
"No gender when stretched clgaretesmokers
predilection
Cinnamon contact Second decade Oblongio broadly near, Gingiva, mucosa Cinnamon favoring candy, ently and Check bing Keatons
stomatitis Nogenter white plagues with a adjacent toocclusil chewing gum, toothpaste, continue use of | Hyperpasticandidiasis
predilection shaggy thickenedsurface; — planesincluding mouth rinses offending product Smokeles tobacco
fe erythems tender. buccal mucosa and keratosis.
lateral tongue Hairy leukoplak

a

E
a
a
z
a
E

34. Lines alba ‘Any age Smooth or shaggy white Bilateral bucaal Associated with biting None required; may Cinnamon contact
following line: maybe salope mucosa, along Trritationorsuckinghabit, spontaneously stomatitis
‘the eruption asymptomatic cclusal plane may be associated with regress Sear formation,
oftecth leukoedema CCheckbiting keratosis
No gender
predilection
Fairy tongue Second decade Cream to brown Doral tongue ‘Contributes to alos Heu Cned
No gender coloration: difuse associated with cigarette rush tongue Frictional keratosis
predilection elongation of filiform smoking, por oral hygiene, Hypecplastc candidiasis
papillae antibiotics, dry mouth,
overuse of mouth rinses
coated tongue is more
common in children
‘Whitespongenews Fist decade, Diffie symmetric, ‘Bilateral buccal “Autosomal dominant kim None required, Teukoedema
maybe ‘corrugated or velvety mucosa is most disorder defectinkeraind condition stabilizes Hereditary benign
preentat _whiteplaquessadherent; common; alo and eratin 13; extraeal inyoungadulthood intraepithelial
birth symptomatic persistent found on labial sites may be involved dera.
No gender mucosa, ventral reaches full expresion Frictional keratosis
predilection tongue, floor of during adolescence Hyperpastic candidiasis
mouth and soft ‘Syndrome elated
palate Teukoplakia
‘White Surface Material Lesions
Peudomembranous Any age, ‘Widespread, white pots or Any mucoal ate bat Caused by Candida albicans Ang Plaque
candidiasis especially plaques that wipe off ‘common on buccal and other species; medication and Chemical urn
rush) infancy leaving ed base; mild mucosatongue contibuting factors are proper oral Coated tongue
No gender burning and palate antibiotics steroids, hygiene: may recur Mucosal sloughing
preiletion immune suppression; ‘Superficial ip and
infante may have diaper climinated cheek biting

rash; pacifiers orthodontic
appliances and toothbrushes,
may harbor fangus

Koplik spots of rubeola

Continue

soqpuiouy jewaudoprac] Pue LOI] [P10 Jo SPOUBEIC PERUANO Z UaLavn>

a

35. a

E
ER Fl
White Soft Tissue Lesions (See Figure 2-2)—contd El
PEDIATRIC 2
heres aaa Sure Y
oe E rn e O Dito A
Fe ee pan ä
ES “apes A o as Sie
hu Eilean San, per
See en eee cee ee ae
o a ace au Er ee
N ee
en mate
=e ET == ee
en een we ee a
Ea vers en, a
aa asa eee
ellen Jer ES
‘Wie ais one
eee A O A A UELH
‘tat SS ESS Gee See ees en
a ee eee tee
Mac ose Se.
predilection pattern; asymptomatic
A re UESIST
ian ea
a Gees mn en re
a. aa == Een

Q

Kaduse.com

36. on
Iymphoepitheia

Second decade
No gender
predlection

Solitary, sof, pinkish white
nodule with superficial
fine vascular pater;
usually nontender

Posterior lateral
tongue, loo of
mouth soft palate

Mimics an abscess
because it may Muctuate in size
and discharge contents

Excisioal biopsy
does not eu

Sot tse abscess

Lipoma

Siallithiais

Tonsillar concretions

‘yperplasielymphoid
aggregate

Sois

Second decade
No gender
predilection

Salary or maple ard,
‘yellowish white globular
mass episodic pain and
sweling when eating:
obstructive disease ofthe
duct

Usually oor of
mouth within

Wharton duct,
submandibular
sland

‘Occlusal or panoramic
radiograph may assist with
diagnosis circular calcified

Massage of ganá,
surgical removal of
stone and
sometimes the
land: hthotpsy;
stone may recur

Sat ie abscess

Oral lymphoepithelal
ES

Epidermoid ey

CERTES
newbom

okay or multiple, darts
orclstered papales with
‘smooth pearly white
surface; usually 1-3 mm
_insie, asymptomatic

Epstein pearls median
palatal aphe

Bohn nodes hard
palate and soft
palate junction

Spas occur in up to 85% of

None required:
Teran filed cysts
that spontaneously
rupture within ist
month

Sue abies
‘Oral ymphoeptheil
ES

Ginghaleyas of he
newborn (dental
lamina eyss)

No gender
predilection

Salary or multiple, discrete
‘or chstered papules with
‘smooth translucent to
pearly white surface,
usually 1-3 moni size,
asymptomatic

Alveolır mucosa,
especially maxilary

Ops occur in up 0 0% of

None required
rain cats
that spontaneously
rupture within est
3 months

Natalneonatal eth
Sof tissue abcess
Eruption cyst,

[PROD 2 uaLavHo

Srewouy eraudojaaag pur suoR>] [P10 Jo stsoudet

sl

37. 20 Fundamental Pedi Dentistry

1 FIOURE 22 wette. nta ete tro) hc i) fom re
‘reins boleto a ster ur ee Ol, Lcdo o lc br

38. cHapru 2 Differential Disnods o Oral Lesions and Developmental Anomali 21

2 OU 33 cot it u mim a eg Bd sto

39. 2 Fundamentals of Petrie Dentistry

| FIGURE 22, ont hana fon ome lei ett M, Cte une ac no mn beg
A het Deco tena tect be arf fax ganso de marc men O8
Iris cp ponete erage Sle pt pe enbr an bw mr pl RO lp
Sa bent one mans rear mu

40. “TABLE 25

Dark Soft Tissue Lesions (See Figure 2-3)

Peorarnie
Ace
an Pepiaraıc Tararmentano DIFFERENTIAL
Laston Gexpen CurmicanFinpives __Locarion Siontricance Prognosis Diacxosis
Red or Purple-Blue Lesions
Portvine stain Infancy Tocalived wo dise red Pace along ‘Occurs in about 196 of Taser treatments Tiemangiona
(apillry No gender to purple macular diseibution of newborns muy besign of persistent sion Arerial and
vascular prediction lesions: variable trigeminal nerve, Stuge Weberangiomatosis that may become arteriovenous
malformation) anchig bleeds is mostcommon bleeding is complication; darkerincolerand malrmation
Seely: gingival and Siteymayhave lp posibleneucologic disease nodular withage Bechjmasis
bony enlargement and oral mucosa Hereditary
progenic granulosa; movement hemorrhagic
gross with child telangiectasia
Pacha Tint and Locale to diffuse, Buccal macoss, IF muliple lesions, need No treatment; Amalgam graphe 00
ecchymosis, second. pinpoint spots patches lips,lteral ‘exclude child abuse, spontaneously Blue nevus
hematoma decades ‘orswellings with tongue and soft bleeding disorders, resolve Hemangioma
No gender smooth surfacereaiy pale infectious mononucleosis Erythematous candidiasis
predilection lesions are red; late “and other vil infections Blood dyscrasa
lesions are blue-black;
may be tender
Eiythematous——‘Frstand Multiple red maculesto Palate;Buceal ‘Caused by Candida alicars Antifungal medication Contact allergy
candids second ifs ed patches mucosa, dorsal and other species: and proper ors! Traumatic erythema
decades epapiltion of tongue contributing actors are hygiene: may recar Erythema migrane
[No gender tongue; burning antibiotic, if cae is not Thermal burn
prédiction sensation; may have immunostppresson, iminated or Anemia
angular chili xerostomia, pacifer, aná managed
palatal coverage appliances
Median Fan Toxalized red, die posterior Caused by candidal Anal mediation Erythema migrans
rhomboid second <epapilte patch; dorsal tongue infection localized palatal and proper oral Contact allergy
decades ovalt rhombaid in erythema or “kissing hygiene Hemangioma
No gender shape with smooth or lesion’ may be present Lingual thyroid
predilection lobulated surface:
asymptomatic
Eden Tistand otipleoval or Grove Doral andlotenl More common meiden None required, Median hombeid
migans second red patehes with white tongue: rarely at than adults increased risk avoidance ofhotor glosiis
enign decades scaloped border loss other mucosal in aopie children; may spicy foods topial Contact allergy
migratory Female Of filiform papillae sites occur with fsured tongue steroids in Erythematous candidiasis
losis) predilection paternchanges may symptomatic cases Transent lingual papi

burn

Lichen plans,

ind

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41. = TABLE 2-5
Dark Soft Tissue Lesions (See Figure 2-3)—cont’d
Porro
‘Ace
AND Pepiarare TREATMENTAND DIPFERENTIAL
Lesion Gavom CumucaL Fiwincs Locarıon SIGNIFICANCE Prognosis Diacxosis
Eruption Fistand Localited patch or ‘Alveolar mucosa Eruption cyst is soft tissue Notteatmentis Hemangioma
hematoma second ‘swellings amber red, counterpart of dentigerous usualy necessary; Neonaal alveolar
and eyst decades or blue in color; 78; infrequently delays resoves with Iymphangioma
No gender ‘varying an erupting tooth eruption; minimal tooth eruption: Pyogenc granuloma
predilection toothy usually bleeding muy occur at this uncover tooth if Amalgam tattoo
nontender site symptomatic
Brown-Black Lesions
Physiologic Fistand Graybrown,orblack Anylocation but Pigmentation Increases with None required Porter
pigmentation second patches with smooth attached ingiva age of child: common in common variant of pigment
(racial decades surfaces patchy o, most commen dark-complexioned skin normal mucosa. Drugsinduced
Pigmentation) No gender genenlized types Pigmentation
predilection distribution Smoker's melanosis
Lead poisoning
Kmalgam ation Second deade Grayrbue,blackmacule Girgvaalveohr Graphievatioois found on Nonerequred unles _ Melanoticmacule
No gender ‘with smooth surface mucosa buceal palate from self-inflicted melanocytic Graphite tatoo
predilection and well-defined to mucosa ‘wound: imentonal neoplasm cannot | Melanocytie nevus
irregular margins tattooing usally observed be excluded: Va
radiographs may on lower labial mucosa permanent Late ecchymosi
demonstrate opaque “isolation
fragments
Grimenote — Fstand Broven or blackyoval Lowe Bp Most common oral None required unless Amalgami/graphite too
meule second macule with smooth vermilion, buccal pigmentation o ir ‘melanocytic Melanocytic nevus
decades surface, well defined mucosa, gingiva _ complesioned childrens neoplasm cannot Smakers melanosis
Female margins single or multiple lp macule in beexduded: no Lateecchymasis
predilection multiple Peut Jghers syndrome potential for
malignant
transformation
Meinocytie Second dede Brown Blue or Black, Lipvermilion, ‘Grallesions are uncommen Exdonal biopsy: are Amalgam/graphie tattoo
nevus Female el defined nodule or palate, gingiva but head and neck kin is rskof malignant Oral melanotc macule
predilection | macule with smooth frequently involved transformation Melanoma

surface

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42. ‘CHAPTER 2 Diferetl Diagnosis of Oral Lions and Developmental Anomalies 25

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tn cas septa pe on rd ung Amp ne mae poppe cee a rem
‘Cotta mast oor mans gap noua irs ay fl means Me Carp er e ew De
singe

44. = TABLE 24

Ulcerative Lesions (See Figure 2-4)

PaotarRie
AGE AND Peprarnic ‘TrearMent AND DirrerentiAL
Lesion. Genoer _ Cuwicat Frnpives_LocaTion Siawtricance Proanosıs Dinonosıs
‘Aphthous ulcer Fistand Recurrent,painfululers Buca, bial mucosa Occurs in 20% 103096 af _Topicalanestheiks and
second Minor variant LS aremostcommon; children, Tel coating agents for ‘Traumatic ulcer
decades superfcal oval ules occurs on ‘medicated immune symptomatic rei, Secondary herpetic
Female < em: resolves in onkeratinzed reaction; trauma and topical and systemic dete
predicción — 7-10days mucosa. rthodonticappllances steroids chlorhexidine Crohn disease
Major variant multiple, are important factors Oral rinse, laser Behget yndrome
deep ulers>1 cm; in childrem genetic treatment, nutritional atin disease
resolvesin 26 weeks Predisposition; asocated supplements Neutropenie leer
Bee ‘with several systemic Major variant heals with PFAPA syndrome
‘showers of multiple diseases food scarring Gastroesophageal
smaller sensitvtes, nuttional reflux disease
deficiencies
Secondary herpetic Frstand Muliplerecuren, Herpes abil on ip Racvation of herpes ‘Sunscrem for prevention, ‘Traumatic uker
‘leer second smal ulcers painful; vermilionand ‘simplex vicus (HSV), topical anesthetics for Aphthous uler
decades preceded by vesicles; perioral sin; occur in one-third of symptomatic ele “Angular celts
No gender clustered patter: Intraoral herpeñe chien ultraviolet ight, topical antiviral agents, — Imperigo
predilection prodromalbuming ulcerson hard systemicdiseaes, systemic aeydovi, Conte allegy
sensation; heals in palate, attached trauma, stress menses valcydovir, famcilovi,
7-14 days gira herpetic are triggering factors immunocompromied
hilowr on Angers, children shouldbe
specially with treated
‘Rogue deis Fistand Red sure that bleed ‘Caused by Candida species Lubrication of lips ‘Secondary herpetic
second and may ulerate, ‘mouth may be and saphylococs ip antifungal amifingal/ eer
decades sealing and crusted associated with incompetence, licking of steroid or antibiotic Impetigo
No gender surfaces burning coneurent oral lipsand drooling are ointments recuring Exfoliatve chilis.
predilection sensation; may be candidal infection aggnvating fictors may lesionsmayrequireoral Traumatic ulers
current Be caused by contact fungal treatment
allergy
Continue

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45. = TABLE2-4
Ulcerative Lesions (See Figure 2-4)—cont’d
Pepiaratc
‘Ace AND Peptaraic ‘Taearwent AND Dirsenenriat.
Lesion Senor Cuvicar Fiwomos — LocarioN Sinrncancz PRoGNosIS Dracxosts
‘Traumatic der Fir and ‘Usually single ulcer; Laterltongue buccal Most common oral leer; Symptomatic relic Aphihous ulcer
second variable shape with mucosa lipsand mayindiatechild abuse, eliminate cause; facial Mocosal burn
decades irregular margins, ingival Rige-Fede neurologic impairment, ulersarediagnosic Secondary hepatic
No gender shallow or dep diese occurs in or facil injuries when problem: may hel with uler
prediction pain typically infants on ventral persistent and recurrent scarring Contact allergy
ea in 1-3 weeks tongue from
rubbing against
lower incisors
Comactallegy Fistand Focal or widespread Anymucosal ste that Wide variety ofallegena Enano Macon bur
second cexythema, vesicles, comes in contact including foods, dental allergen; patch testing Secondary herpetic
decades andulcers;burning with allergen, materials, oral hygiene helpful in older ‘leer
No gender sensation and pain especially lip, products, topical children; topical steroids Aphthousuleer
prediction buccal mucosa, and medications cosmetic Lo reduce symptoms, Angular celts
sing products lesions recur with Erythema multiforme
reexposur to allergen
ETES Sand dede ‘Onaliesons on lip, Common precipitating Wihdrawal of mediation; Primary herpetic
multiforme Male tongue, buceal factors include herpes Tubrication of lips ingivostomatitis
preilet bullae, and lee; rmucosa,andsoft simplexviras(HSV) and symptomatic elif; Necrotizing wleeratve
blood-crused lesions palate Skinlesons medications; minorand hospilizatin ifsevere; gingivitis,
on lips target sons onextremites and major forms ofthe recurrence are common Aphthous major
om slim acute onset; hend and neck disease it triggered by HSV ‘ers
fever, malaise region Chemical burn
Primaryherpaic Unsally re Fever irritability pain, Widespread onland Caused by HSV: high fever Supportive care includes Necrotizing uleerative
fingivosomatis decade Iymphadenopathy, perioral and dehydration are antipyretics analgesics, gingivitis
No gender rooting, multiple involvement; seriouscomplicaionsin _pallativeoralrinses, Erythema multiforme
prediction vescle and ulers ‘ingival lesions are children digital and hydration; systemic Herpangina
diffuse erythema: sully chief cular lesions may occur acyclovirmay be
sudden onset resolves complaint indicated
in 7-10 days pharyngeal
involvement in
adolescents

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46. CHAPTER 2 Differential Dinenoe of Oral Lesions and Development Anomalies 29

| FIGURE 2-4 correo À ps ine th poser min. Apis ma eet ea
Hepes tof ever ula Sean hp oe ay athe es
Di vine oe emo ep clon wa anata eres net “Smet

48. ‘CHAPTER 2 Difrenil Diagnosis of Oral Lesions and Developmental Anomalies 31

2 FIGURE 2-4, contd Lt 0, Org nes een meme wh wing of es) tem aed eto ec
(co) a eos 0 are ni se (OP ary pe pra Be op UP.
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49. 2 Fundamentals of Petite Dentistry

2 FIGURE 2-4, contd Scoop Uria ew het pause ni ae
beat nonin 41% her apar eb bs rp (pl mts nd an a ee eee
Eimeria teint ph à

50. a TABLE 25

Soft Tissue Enlargements (See Figure 2-5)

Prownic Aor Protarac ‘Tararnanranp DIFFERENTIAL
ston ao Grxorr > Cimicar Finpines — Locamion Sigwiricance Proonosis Diaonosıs.
Papillary Lesions
Squamoss Sonde Sep Anyoralstebır Caused by human Eco Ep Varaca vila
papilles No gender module with nger- predilection fer papilomaviras(HPV) recurrences Condsioma
predlecion Tike projections pink thetongue ip, peclyypes6 ll uncommon no cuite
to white soft and andsoftpate lowvinlenceand evidence of malignant Giant cll broma
entender infectivity rate transformation
‘Veruca vulgaris Firtandsecend — Moltplesesleor Common on tin Caused by HPV, epdally Excioml biopsy of al Squamous papiloma
(common wart) decades präunculatedpapules ofhands and types2.4.6,40rsprad wartslow sik for Condyoma
No gender and nodules with faces infrequemy byzuoinoculation to ecurrence for orl acuminatum
predilection rough, pebbly or found onthe ip oralsitebysuckingon —— lesomsepontancoss Giant cl coma
pillar surface, vermion, bial fingers or mail bing rection may our Mallscum
white nontender mucosa, and forskinlesion:no sk cantayosum
anterior tongue formalignant
ranformatin
Condom “Sond decade Milple discret ele Unalhyanogenial Orallesfons eausedby Exeisonal biopsy, lier Squamous papilloma
acuminatum No gender nodsleswithblnted lesions oa ster HPV 61,16 8; úablaon for wart; Malifcl eii!
(venereal wart) predation papillary surface, include labia oncogenic HPV types highly contagious; pop
pink nontender mucosa, soft 16 18 verkalorsenul eguentyrecumoral _ Inflmmatory
pala, and transmise may HPV 16,18 auodmed papillary
ental tongue indie hd ae vihoropharymgel hyperplasia
carcinoma; vaccine _ Ginteel brome
avale for Fecal dermal
prevention ofeericl ypoplasia
‘Gite Roroma Second decade Salary, sae or ‘itched gingiva, Fbrou Teen of Facsinal op: ‘yams papiloma
Female predlecion pedunelated module doraltongue unknown cus that has recuenceisrare —— Retrcispid papilla
Wh pebly surface, and hard palate a predilection for Train broma
pink: nomender hide
Mali Fra and second life nik, ‘ally ete on Caused by HPV, ypes 13, Excnal payer Veruca voi
epithelial decades papules and nodules Iabaland bucal 32; famialtendene, abiomrecurenceis Condy
hyperplasia Nogender With pink rainyto| mumsand Fern suc Common: spontancous acuminata
(Heck dens) predilection polera tongue Other isk actors include reremion mayoceus, _ Multiple hamartoma
Teens coals, poor era yen, no malignant syndrome
display cobblestone coded ving transformation Malipl endacine
appear; conditions, tional neoplasia
entender deficiencies syndrome, 28

Contin

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51. "TABLE 25
Soft Tissue Enlargements (See Figure 2-5)—cont'd
Pupratnic AGE

Paiaraıc ‘TREATMENT AND LOS
Lesion. AnDGenDeR __CuiNicat Finpincs Locamion Stoxuricanen Prognosis Diacnosıs
Inflammatory ‘Second decade Muliplschusered Hard palatal Caused by continuous Removeand lean ‘Condyloms
papillary No gender papulesand nodules mucosa ‘wear of platal coverage applancerline acuminata
yperplasia predilection with ink to red appliance; other factors appliance if needed; Multifocal epithelia
granular surfaces include mouth antifungal therapy: hyperplasa
cobblestone ‘breathing and high excisional biopsy of Erythematous
appearance; palatl vaut candidal persistent lesions ic
nontender infection may be
_ present
‘Acute Inflammatory Lesions
Soft seve abscess Fistandiccond Soltarypinkish white Gingiva and sales by Pyogeni granulom
(carats) decades Ordeepredmodule alvelarmucos odontogenie infection Onl
No gender nodule with see most or emtrapped foreign Iymphoepithelial
predilection ‘surrounding common ses bodys percorontis is os
‘enjthems; purulent gingival abscess Salolithiasis
drainage Suctuates, associated with erupting infection isnot Tonsiithiss
in ie tender to ‘molars diminated Gingival ey of
il may progres newborn
to cells
Cr Fintandsecond Diffuse erythematous Upper orlower Caused by odontogenic Manage source of Facial hematoma
decades swellingof sudden face and neck. infection, ficial ororal infections antibiotic Plungingranıla
No gender ‘onset soft to lacerations, inset bites, therapy incon and Emphysema
predilection board lke; warm and peritonsilarabeceses, drainage in evere Obstructive
painfltisues fever jaw fractures, ceases Ludvigangina siaadeniis
headache, away. saladentis sinusitis, and emernous sus Angioedema
‘obstruction and and bacteremia thombosismay belie Acute sinusitis
leukocytosis may be ‘threatening ‘Acute lymphadenitis
present
‘angioedema Firtand second Diffoseswellingof Tips tongue, colt Acquired ormis used Allergic formsare Calais
decades sudden onset soft plat and face, byallegicreacionto treated by Emphysema
No gender and nontender;may and other foods plants, dogs, antihistamines, ‘Traumatic edema
predilection be associated with cutaneous tes inst bites, cold, heat, tros, or Contact allergy
respiratory and Latex, pressure, stes, epinephring other Orofical
gasroinestinal and infections; most drugs are wed for the granulomatosis,
problems hereditary forms are hereditary forms, may
caused by CLINH beliferhreatening

deficiency

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52. Mucocele First and cond luidflled nodule Lower labial Mos common ip swelling _ Excidonal biopsy with Lymphangioma
decades a smooth, mucosa buccal in children; may be removal of underlying Hemangioma
No gender tranlucent, red or mucosa, and associnedwithtruuma minorsaivary glands, Hematoma
predilection blue surfaces sudden anteiorvental andorthodontie may recur with Soft roma
‘onset flctuatesin tongue appliances rare cases incomplete removal or Soft tissue abscess
sine tender if are congenital repeated trauma
traumatized;
periodically drains
ET Fesandaond Flid‘illed sweling Foo of mouth, Usually asodated with Excklonalbiopsyef Iymphanglo=
decades ‘with smooth, Iaterlto sublingual glnd; are subligualglandor Hemangioms
No gender ‘translucent t blue midline, ‘eases ae congenital and marsupiatiations Mucoepidermoid
predilection surface of recent plunging variant caused by aplasia of recurencesare carcinoma
onset utuats in resulsin dile submandibular common with Obstructive
sae milly tender; swellingofthe excretory duct ‘marsupiliation siaadenitis
petiodcallydrains sobmandibular Dermoid est
may elevate tongue region and neck
Tumor and Tumorlike Lesions
Irritation fibroma ‘Firstandsecond __Peduncabted or see Common reactive ‘Conservative excisional — Fibrosingmucocele
decades nodule with pink Hyperplsti lesion biopsysmayrecurif Peripheral osfing
No gender smooth surface fm caused by chronic irtation continues broma
predilection and nontender, trauma and mimics à Giant cell froma
limited growth tumor ‘Benign submucosal
potential neoplasm
Peripheral osiiving Second denade Pedunculated orsesile Emanates fom Reaciivelyperplasie ‘Bxcsonal Biopsy down Teration fibroma
broma. Femaleprediletion nodule with pink interdenul lesion that contains to periosteumand Peripheral giant cel
to red surface, papilla of mineralized product remove local granuloma
frequently ueerated; attached gingivs; from cel of periosteum irritation, 16% Giant cll broma
Armand nontender most common orperodomul ligaments recutence rate yogenic granuloma
may resorbalolar siteisamterior may displace teeth Peripheral
bone limited growth region ‘odontogenic
potential Sibroma
Peripher gant Second decade Pedunculatedorsesle Attched gingiva or Rescive yperphle Exit biopsy down Pyogenie granuloma
‘ell granuloms Female predilection nodule with red or scolar mucosa lesion that seaused by to periasteumand eration fibroma
purple blue surfaces irritation; may displaee removelocal Peripheral osifying
may be ulerated: teeth ieitaion 10% fibroma
firm and nontender; recurencerate Hemangioma
may resorb alveolar Foreign body
bone; limited growth ganılma

potential

Contact

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53. = TABLE 2-5

Soft Tissue Enlargements (See Figure 2-5)—cont’d

Pepiaraic AcE Peorarnic ‘TREATMENT AND Dirverenriat
Lesion AxpGanpen __CUNICALFiNpINGs Locarion Sintmcance ProoNosts Diagnosis
Pyogenic Fistand second Pedunculedorsessle — Mostoccuron Reactive hyperplastic ‘Bxcsional biopsy and __ Iration Abroma
ramal decades nodulewithsmooth attachedgingva; lesion eased by remove local Peripheral sing
Femalepredilection to irrgulr red other sites ration and poor oral fibroma
surface usally inelade ip, Hygiene maybe Peripheral gant ell
ulcerated; bleeds tongue, and associated with granuloma
feelysoftand buccal mucosa; pregnancy (pregnany Softisue abscess
‘able; nontender, tho occurson ur) or may develop Hemangioma
limited growth skin ar extraction ste Locle uvenle
potential because of bony spongote gingival
sequestra byperpasa
Gingival Fit and second Localized or generalized Atached gingiva Maybe famifal or Gingivecomy and good Drug-induced
‘beomatoss decades singival and maxillary idiopathic asscited ol hygiene high soga
(herditaryor No gender enlargements pink, tubersiy with several syndromes, recurrence rate overgrowth
idiopathic) ‘prediction smooth to súppled intrferes with eruption Mouth breathing
surfaces fm and ‘of tects displacement ingivitis
nontender acts teeth Chronic hyperplastic
both dentions ingivis
Leskemicgngival
inflar
Samy
Hemangioma fancy Locale dif, re, ocurin bad Hemorragia potendal Tnweuonofleden Vacular
Female predilection blue or purple lesion, amdneck region; compliations may within fist decades malformation
Matormodulr,scht lipstomguesand œuse malocelusion; surgery for select ses Pyogeni granuloma
and compresibe, buccal mucosa sain is common andscar revision, Lymphangioma
blancs bleeds are most with involution. user ablation, Eruption go
ely 20% are common sites conicoseroids hematoma
multiple rarely occurs in propranobl: doesnot Macocle
jaws recur
pmphangioma afan most Tocalzed to difess Up 759 occur Maycamemalocddon, — Sugkalexcióom Hemangioma
detected by tansocenttoredor inheadand dysphagia and recurrences are Squamous papiloma
2 yes purple swellings neck common repiatoryproblems common airway Lingua! pails
No gender smooth o pebbly oral tes include oc ingroma and obstruction anddeath— Mucocele
predilection surfaces soft and thetongus lip, neonatal alveolar may occur with large Plunging ranula
compresiblserpitus and buccal Emphangioma are neck or tongue lesions
maybe palpated mucosa

oe

Anspuag 2tneipag jo sjeiusurepung

54. Congenital epuis Infancy Pedunculatedor see Anterioraleolar May case feeding Surgical excision; Hemangioma
{congenital Femalepredietion node; pink tored ridges sully problems usa season Progenk granulama
anlar el smooth surface may manila reaches maximum ie pontncous Neonatal aheolar
tumor) be uleraed; 10% are abinh regresion; no Yymphangioma

nie recurrence normal Neuroetodermal
tooth development tumor of infancy

‘Newofbrom Semddede Single or maiple Tongue bucal Majano Farin exci Neurikmmoma

No gender nodules with smooth mucos autosomal dominant solitary lesions Mucosal neuroma
predilection surface: discrete or vesibolsand condition with selecive excision Arittion fibroma
dioses soft tom pabte; syndrome meurofbromas, fof syndrome type; Benign submucosal
‘on palpation lesions occur caféau-lat meules, 5% malignant neoplasm
rontender atany ste, axillary freeing and transformation of Savary gland
especialy skin Lich nodules on irs syndrome type neoplasm

Mocoal nearomas — Fes deade ‘Multiple pink papules Labial and bucal Autosomal dominant Surgkalexchionef? Neurfibromatosis
(multiple No gender and nodules sft and mucosajaterior syndrome other neuromas for Focal epithelial
endocrine predilection nontender marnoid tongue gigiva stigmata iodo cames aggresive hyperplasia
neoplasia ‘body type: marrow aloon Pheochromocytoma and thyroid cancer Multiple hamartoma
syndrome, type face wit fu ps conjunctvaand medulry carcinoma of developsin second syndrome
28) eyelid thyroid gland decade

Ficomori Second deade ink, domesaped Parotid glndis Not common bnign _ Surgialexckenwih Newofibroma
adenoma Slight female enlargementwich ‘most common salivary gland neoplasm; adequate margins Neurlemmomu
(Genign mixed predilection smooth surface, site palate is mucoeidermoid recurrence is Mucocpidermoid
tumor) Slowly growing: firm mestcommon _ cereinamais most Low: malignant carcinoma

and nontender orale common malignant transformation ate of Irrtation fibroma
salivary gland tumor in <5%
this age group

Desmoid Fistandsecond Rapidly growing, pink Head andneck Rare, cally aggresive Surgia excision with Large pyogenic
Abromasis decades rm mas with an region; anddesuciveleion wide margins ‘granuloma
(aggresive No gender ireglar surface: my paramandibular that mimiesa adjunctive Fibrosrcoma
Abromatosis) predilection beukertedipainles; softtstesare mlgnancysasocated chemotherapy and Rhabdomyosarcoma

large in ie facil common with fait raditherapymay be Mets diese
disfigurement, inmoral sites adenomates pobposs, indicated: high

destruction of Gardner some recurrence

adjcent bone

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2 FIGURE 25 Sofa enrgement Stars pil last pte Band ec vais e emo) ná
‘esta ip ngs co

56. ‘CHAPTER 2 Diferena Diagnosis of Oral Lesions and Developmental Anomalies 39

* FIGURE 25, contd fons ppt yen le pla co Pr actos nt nt
cr na) más one) lin pr sats ang ran eK socie ie
Bart eg La, ac una un mc) era mr e Jomar)

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58. CHAPTER 2 Diferemia Diagnosis of Oral Lesions and Developmental Anomalis 41

2 FIGURE 25, cont'd M go te veal que eget ep me asic ar cs Y, s
‘ine steno oft putt pie, ne elas aprte manu’ verte má A DDC
a argent mc CO nee
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59. “2 Fundamentals fie Dent.

+ FIGURE 25, con tf, mu ner ns yen ype cu ml emo
A mc haope ee) pa pra

60. = TABLE 2S

Radiolucent Lesions of Bone (See Figure 2-6)

Pepiarmic CLINICAL AND
AGEawD RADIOGRAPHIC Pepraraie TRATMENT AND DivrerentiaL
Lesion Genoa Finis Locarion SigNIFICANCE Proawosis Dinoxosıs
Dentigerouseyn Second decade Welldehned, umloculr, Mandiularand Commonodentegenie _Enuclation; Hyperplastc dental
Slight male radiolucency around maxillary third cyst childrem growth marsupaisation follicle
predilection crown of unerupted molar and canine may berapi may extensive, Periapical est
tooth: may displace regions involve primary or orthodontic Ameloblastic broma.
teeth cause comica supernumerary eth; treatment toast Unieystc
expansion and eruption cys soft tooth eruption; ameloblastoma
root resorption: tissue analogue seldom recur Odontogenic Keratocst
‘symptomatic unless ameloblastoma and Adenomatoid
infected “carcinoma arerare ‘odontogenic tumor
complications Bocca! bifurcation cyt
‘Odontogenie ‘Second decade Wal defined, nilocalar Posterior body pe eye are ‘Surgical excision; may Dentigerus cyst
ertocyst Male or multilocular and ramus of consistent with nevoid include peripheral Ameloblastic broma
(erateystic predilection radilucency with mandible; ‘basal ll carcinoma ostetomy or Odontogenic myxoma
odontogenic corticted margins, macia tied ‘gndmomeand includes chemical cautery; Ameloblastoma
tumor) ‘expanse; 25960 40% molarandcanine ja eysts, basal cell, recurrence rate of Central hemangioma
“associated with regions ‘arcinomas palmar- 30%; malignant (Central gant cell
‘unerupted tooths may plantar pts, bid ribs, changesarerare ‘granuloma
tesorb and displace epidermal cysts, and
teats may be pail alce fal cerebri
Ameloblasie Festand ‘Wel-defined unlocular or Posterior mandible Rare malignant Sugar excision: Dentigerous cyt
broma second ‘multilocular lesion with (70%) ‘counterpart, recurrences are Odontogeni heratocyst
decades sclerotic margins mella commen (18%): Central hemangioma
Sight male expanse; 79% Firosacoma arises long-term follow-up Central giant cell
predilection associated with de novo or fom is recommended ganulma
inerupted10oth preexisting or recurent Amelobasto
Ameloblamoma Second deade Wel-deined, unifocal Mandibular moar Unieystc ameleblastoma le Aggresive odontogenic Denigerous cyt
No gender or multilocular ‘and ramusaress most common variant tumor requires, Odontogenic eratocyst
predlcten radioluceney conical in children; astcinted marginalorenbloc Odontogenie myoma
perforation; expanse with unerupted molar; resection; 90% to Central giant ell
slow growing; oot treatment varie from 90% recurs wth ‘granvloms
displacement and cenucletion to curetagesraely Ameloblasic broma
resorption; usually resection; 30% undergoes malignant
asymptomatic recurtencerate with transformation
enucleation

Continued

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61. = TABLE 26

Radiolucent Lesions of Bone (See Figure 2-6)—cont'd

PRDIATRIC CLINICAL AND
AGeanp — RADIOGRAPMIC Paptaratc ‘Trearwenr AND Durrenextiat
Lesion Genoex Finpinos Locarion Steniricancn Prognosis Diaanosıs
Melanotie Infancy may — Rapidlyexpandingbony Anterior maxilla Lesion mimics malignancy Sargialexcision or Measatk sarcoma
neuroectodermal be present lesions may exhibit with destructive rapid curettage; 20% (Cental hemangioma
tumor ofinfancy atbirth blue-black pigmented growth rate dental recurrence rate: Large eruption et
Slight male surface, illdefined, abnormalities due reportedcasesof Congenitalepuls
predilection unilocular adioluceney to surgery; high metastasis
with deplacement of trina eves of
tooth buds; “Boating vanilyimandelic acid
tooth” appearance
General giant cell Rit and Weildefined,unieulır Mos equently___Aggresive form exits ‘Thorough curettage Pepelqn
‘anvloma second ‘or multilocular in mandible need to rule out ‘experimental Odontogeni kertocyst
decades radiolucency with anterior to first Iyperparayoidiom, treatments inchude Simple bone cyst
Female scalloped border; molar may cross cherubism, and other corticosteroids, Odontogenic myxoma
prediction expanse: may displace midline syndromes, espedally calcitonin, interferon; Central hemangioma
teeth and cause with multiple lesions recurrencerate of Aneurysmal bone cyst
ot resorption; 15% to 20% Ameloblste roma
symptomatic
Cheb Fist decade; Chubby fice appearancs Maxim and Truiment Nevoid baal cel
usuallyby bilateral, symmetric, mandiblesin controversa, carcinoma syndrome
Syeats painless enlargement of particularamgles premature exfoliation spontaneous Hyperparathyreidiem
Male ves extenie, multiple, ofmandible all OF primary teeth; regression with onset Noonan-ike syndrome
predilection well-defined, four quadrants displacement of of pubertyssurgery Ramon syndrome
multilocular frequently tooth buds severe may improve
radiolucencis involved malocclusion, and function aná
malformed teth cosmetics
Simple bone cyst Second decade — Well-defined, unilocular Posterior and. ‘Cause is uncertain, but “Surgical exploration and Central giant cell
(traumaticbone Male radiolucency with thin, anterior body of maybeasocitedwih curettgeperistenee granukma
os) predilection sclerotic border, mandibie and trauma; extensive, and recurrence are Dentigerous cys
scalloping between roots ramus bilateral expansle lesions may rate Periapical est
of teeth; 20% are lesions are ‘cur (Odontogenickeratocyst
cexpanile teeth are vil uncommon Developing tooth bud
Ancurpemalbone Firstand Fais sweling with rapid — Posterior Biood-Aledperudosye; Cuvetage oF Amelobasti fibroma
ost second growth unilocular or mandibalar 20% associated vi enucleation; Amelobastoma
decades ‘multiloclar region preexisting lesion, hemorrhagecontroh Central gant cell
No gender radiolucency with including central giant recurence rate as granaloma
predilection ballooning distention of cellgramaloma, frous ‘high as D Central hemangioma
buceal cortex plais, orig Dentigerous est
froma Simple bone cyst

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62. Periapical abscess First and Nonvtal mobile tooth; Alveolus primary May progres to cellulitis, Endodontic treatment Incomplae
second tender to percussion; denttion is most mayresultinaborted ortoothemmaction — apexifcaionof
decades softtisuesweling with __frequentlyaffected developmentoremamel antibiticsand erupted tooth
No gender purulence painful; in children hypoplaia of analgesics may be Periodontal abcess.
predilection widening of periodontal suecedaneous tooth needed: serious Periapical granuloma
ligament space or poorly complications include or cyst.
defined radioluceney cavernous sinus Buccal bifurcation est
trombosis and Langerhans cell
Ludo angina hisioytoss
Perapiel Fin and ‘Nonvital tooth usally Alvear bone May Endodonticweutment Denigerous cyst
‘granuloma and second asymptomatic unless adjscent to root _ _ succndaneonstcth or tooth extraction Developing tooth bud
ot decades acuteexacerbation of apexand and cause dental and gently curetage.— Solitary bone cy
No gender the lesion; well or poosly bifurcation abnormalities large to avoid disturbing Central gant ell
predilection defined radiolucency at lesions in primary permanent tooth granuloma
the root apex: loss of dentitionresemble a ‘bud if present Langerhans el
lamina dura root demigerous cpt when a histiocytosis
resorption succedaneous tooth is
resent
‘ewe oneomyeliis Fist and Diffie radiolucncy with Porno mandible Mosteases are dueto Inckion and drainage ‘aw facture
second poorly defined margins, in children; dontogeni infecions with culture and Ewing sarcoma
decades ‘sequestrafever sweling, amteriormaxila or aw fractures, sensitivity testing, Burt Iymphoma
Male pain.Iymphadenopathy, in infants occasionally caused by antibotiecoverage; Langerhans cell
prediction leukocytosis, and bactremia may develop nto histiocytosis
raining sinus tracts elvoriceteanyeltis Osteosarcoma
Dose Disseminated Tymphadenopathy, rash, Stall mandible ibs Tadlammatory versus Multagene rc neutropenia
histiocytosis form: fst oral pun, gingivitis, and vertebrae ar neoplastic disease chemotherapy, ‘Barkit lymphoma
(histioeytows x) décade teers, mobile teeth, most often chronic disseminated low-dose Leukemia
Locaized ponched-out involved: jaws form indudes lytic radiotherapy, surgical Aggressive
frm radiolucences with fected in 20% of bone lesions, caretiageand stem periodontitis
second “oating toot” cases fexophthalmos, diabetes celltrnsplantation Perlapialabses or
decade appearance premature insipidos all forms are used, depending granuloma
Male tooth lee ‘mimic periodontal conform of disease Acute osteomyehie
predilection disease and location; children
younger than 2 years
have worst prognosis
Burke lymphoma Fietand Tymphadenopatly facial Posterior mandible Most jawlesions are Treatment includes eae caco
second swelling, tenderness, ‘most common misdiagnosed at ‘multiagent ‘Langerhans cell
decades tooth mobility extrusion stesmay involve odomtogenic infection; chematherapys histiocytosis
Male and premature ls; al four quadrants; associated with ‘aggressive malignancy Periapical abscess or
predilection patchy los of lamina African (endemic) ‘Epstein Barrvirusand with S-yearsurvival grnloma
ra, regular form afetsthe chromosomal rte of 75% to 95% Aciteleukemia
radioluencies,“oating hs in 09% to translocation depending on disease. Aggressive
tooth” appearance TOD of cases sage periodontitis

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63. 4 Fundamental fie Dentistry

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65. 4 Fundamentals of Pads Denis

2 FIGURE 26, conta Nando, nom cn ad ati ven(O) PO QA goma se ue trios
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66. = TABLE 27

Mixed Radiolucent and Radiopaque Lesions of Bone (See Figure 2-7)

Peprarntc
Ace AND CLINICAL AND RADIOGRAPIIC Perra ‘Treatment ann DIFFERENTIAL
Lesion Genoen Fins Location. StoNIFICANCE PROGNOSIS Diagnosis
Calciing Second decade Well defined, unocular Mos: develop in — Inthis age group, this Enucleaion; minimal — Odontoma
‘odontogenic No gender radolucency with regular incisorcanine — odomtogeniceystis — riskofrecurrence Adenomatid odontogenic
eyst(Gorin predilection calcfcations or tooth-ike region of often associated rarely manifests tumor
a structures expanile 33% maxillaand with odontoma Amelobastic
associated with unerupted mandibl Sibro-odontoma
teeth; asymptomatic may occur as Calefyng epithelial
singival lesion ‘odontogenic tumor
‘Adenomatoid’ Second deade _Well-defned, niloculr Anterior mail nucleation; dos mor Dentigerous cyst
‘odontogenic Female radiolucency with fine is most recur Unicystic ameloblatoma
tumor predlecion snowflakecalifcations; most common site, Calefing odontogenic est
associated with unerupted followed by oceurs as gingival Developing odontoma
tooth (canine root divergence; the anterior lesion
symptomatic expansion mandible
doblado stand Wal-defned unibeular ‘Mandibular ‘Odontogenie vumor Conservative Developing odoatoma
fibro- second radioluceney with alifed molar and. is frequently curetage: rarely Calling odontogente cys
odontoma decades material and tooh-like premolar diagnosed because recurs Caefving epithelial
No gender structures expanse; often regions tooth falto erupt ‘odontogenic tumor
predietion associated with unerupted Central osifing fibroma
tooth
Ding Second dede Painlsssweling circular growth Premolarand _Juenileosifing Enodleation or ‘Calving odontogenic ya
fibroma Female Pattern; well-defined, molar region; fibroma is resection; rely Ameloblasic
(eemento- predilection unilocular lesion withsderotic usallyoccum aggresivevarant recus Fbro-odentoma
osifing borders downward bowingof inmandible thatusually oceurs Fibrous dyspasi
fibroma) inferior cortex of mandible, in maxi and Taiopathicostecsclrass
may be radiolucent, mixed, or Frequently recurs Foal cemento-sscous
radiopaque érspasia
Ostcomyalts Rest and Die, poorly define, mised Poser ‘Usually avious molar Endodontic treatment Fibrous dysplasia
with second radiolucent and opaquelesion, mandible is noted; occlusal or tooth extraction; Fracture callos
proliferative decades ‘expanse; comical bone sul radiograph is necessary, Buccal bifureation est
peviostiis No gender <uplication with laminated or invelves fst helpfulfor antibiotic therapy; Ewing sarcoma
(Garré prediletion onion skin patterns mild permanent demonstrating expandedbone Infiil cortical
osteomyelitis) tenderness molar cortical ‘sully remodels yperostsis
laminations without surgical Osteosarcoma
recontouring

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68. = TABLE 28

Radiopaque Lesions of Bone (See Figure 2-8)

Peorarnic
Ace AND Curnicaz ano Peniaraıc TREATMENT ann. Dirsenenerian.
Lesion Gexpen Raptocrariic Finpines Location Prognosis Diacxosis
Odontoma, Fist and second Wal defined radiopaity Compound ype: Local excision; recurrence Eruption sequestrum
compound and decades surrounded by narrow anterior maxilla Ameloblastic
complex No gender radiolucent rim; develop in Comples type ‘odontogenic tumerike fibro odontoms
predilection _pericoronal or radicular posterior lesion; requent cause of Cementoblastoma
reas. ‘mandible isolated delayed toch Caliing
Compound yperesembles Rare ocsursin eruption ‘odontogenic cyst
miniature tet comple ype gingiva Calcfyingepithetal
is amorphous opaque mass ‘odontogenic tumor
Soma Second decade Usually solitary, well-defined, — Body of mandible Gardner palrome, Surgial excision: Toruslecastos
No gender sphericalradiopactyislow andcondyleare — autosomal dominant: Complex cdontoma
predilection growing, maybe expunsile mostcommon characterized by sal lesions no Fibrous dysplasia
and result in facial deformity _sitesjendosteal___osteomas intestinal recurence Condensing osteis
‘or periosteal polyposis, Familial gganiform
location supernumerary teeth, cementoma
‘odontomas and skin pathic
lesions malignant polyps ostescerais
Fibrous dyiplasa Second decade Unilateral, fsform: Mal ismore MeCune Alright pndrome, — Osscousvecontouring fer Chronic sclerosing
No gender enlargementigroundglas frequently includes polyostotc cosmetic and functional osteomyeliis
predileton radipacity with defined affected than ‘brows dysplasia, problems subies Ossifing fibroma
orders: may displace teth mandible buccal after completion of Oteoma
and delay eruption ow and lingual ‘endocrine abnormalities skeletal dewelopments Segmental
growing and asymptomatic; cortical rare malignant ‘odontomaxilary
facial asymmetry expansion ‘transformation érsplasa
Conti

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69. TABLE 2-8
Radiopaque Lesions of Bone (See Figure 2-8)-cont’d
Peoraraie
‘Ace AND Cunsicat ano Peptarate TREATMENT AND DirrenextiaL
Genoa RaproorarwicFinpines Location Stontricance Prognosis Diacrosis
Firstandsecond Localized radiopacityat root Mostcasesarein — Mostcommon peripical Noueatmenofbony Cementobastoma
decades ‘apices of pulpally involved mandibular radiopaciy; sclerotic lesion; manage Téopathie
skrosing Nogender tooth; margins blendimto premolrand bone may impede ‘odontogenic infection, osteoclrois
oseomyeiis) predilection surroundingbone; ‘molar region eruption of succedaneous may egress fer Complex odontoma
asymptomatic tooth treatment or cause
bone car
‘Gementobistoma Firstand second — Radiopaque mass surrounded Posterior mandible Rarely involve primary Sargialextaction of Condensing reis
decades bythin radiolucent rim; may in molar and teeth tooth with atched Oneoblstoma
No gender be mixed radiolucent- premolar region tumor or endodontic Complex adontoma
predilection radiopaque; fused to root of treatment with root Hypercementosis
amputation
Hope Fist and second Mobrpremobir ‘Rarecass reach? min No wetment necesary Condensing oneids
costesceross decades ‘uniformly radiopaque lesion mandible; size and may interfere tendtostabilizeimsize Residual root tip
(bone seat) Nogender ‘that blendsinto surrounding usually by root wi tooth eruption inyoungadulthood —_‘Empstoss
prediction bonesroundorelliticalin apices Ostcoma

shape adjacent teeth are vital

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70. Kaduse.com

71. Anomalies of the
) Developing Dentition

Cueros O Dux, Ja. ann Samar Tameurassr

dt devdopment pres y here y
emi, nua ar foal lion Nereus gene ve
‘em edo cf etal amaia io wert. Te
ne uid in set capris them In tes f aera
advantage ofthis system is that the categories canbe related
tothe suger tn endo inc he epee
Sonali ae thought Oigan. Thee saps of doa
ento reduced in Chapt 12 The render ia
‘encouraged ei textbooks on desa iso deal
red and coi gees fr mie indepth
Siemon

Anomalies of Number

‘Avert in tooth number ek om problems ding
Abeto dolla seo deal rpm
natn verein utersproducngest or ming
teh php dirpton of the dental amin, race
‘dena min nd fare of det ania dci y
comercia we eed capes ul cil Beto
‘hatte oth umber

HYPERDONTIA
perdi and supere te are terms desig
ca asc aber tt cn coito,
And permanent denon Rpe on Be nid af
Inpro ee vales Rp 9 ith mae bein
affected tc a een s females? Ninety pret wo
permanent deis being more regencia
{owt ithe meiden, which cc in te pl mine
and an asume nerf shapes ad pst ele
0 adhcet teh The mj te ae ala
‘the cent inc

poned Pme 196, sperma teeth,
ax morphloily ed a ier spleen oe
cimentar? Supplemental sperrt Figure
SA) due he yea anatomy of porro ad ae.
ios tet Rudnenay wpernuneany eth te doe
Pie nd can sume cal forms ert forms

Pros

Hrpolas

mas o Su

credo and Macro

aon

Tarot

Dicen

Ena
‘mln tapetes
Erre re pola
{ond Ema Heras

Fancy
atin Din
egal Outre

Comenten

(Fe 3: 8), or shape that dupe mala anto
From clica np babero cree taped,
spears ener the mon seve comptent
‘etree cal roma and aves eles o
hacen wei sch asimpaction or ectopic erp. Ad
thal completions add ih perme
[nda enger ey malen, perkral pace ss
mer on dere re ost te presence fees
{nigh ee tat the morpolgi cancers ot

72. (CHAPTER 3 Anomalies ofthe Developing Denton 55

1 FIGURE 31 Spee eth pme mob Semen tte meting rc mr

compound font ares othr ofspenameray
toon

Ci ip and plate (CLP) compre demonsate an
‘ceo een e poral comple of teh aed
wove ear ample ops upon ae dema
Uinta eg at, Patente eth CLP ave Been
rl ha ar credo ol ypetomta ih
Pots ic an cence fp 0 SH Cae ne
‘mes ino supernumerary teh ae sumaria im
‘Ble 31 dere pls hs the hight action.
seth his dental nom

HYPODONTIA
Hipodonin, or congenital ten asec, define In
too number. Fa beet pte count ar he
lie ciclo cate it pans of poden
Tacón reps Wena range of 156 o 10% xing
rd moles in US populations Te mat fuel}
teciing cogently permanent tot ing
the ind mol tendo be the manda second cui
(3s) flowed by the uy steric 2.28)"

Tree ige tween primary tenth bene
and permanent oth ance!” Eandermal pla (ED)
rer à prop ef cl syiromes arte by
hend or mule cenenitalymisingteth Themas
‘omen à hypobirei ED, owed in descending fe
eng of ocesmenc y halt ED, cosy ED plas
‘Set ip and pune, pp Hohn ED and Ronson type
ED igure 812) Ohe condition lin odon re
main in Te 9-2 ad howe Evang tte ype
en nd hypodoni in Don

Anomalies of Size

MICRODONTIA AND MACRODONTIA

‘oor in tooth ae poi in ice
12 mazodotn, Heirs tpt ore
From hematoma ol estelar during embryolge
are ginge to decent matt op e
‘ce eo he fe nalen © sienne

Syndromes Demonstrating

Supernumerary Teeth

pet mme Sophia oran Hin
‘peau popa

Cid adv Bo
Aria ype rine
née areas ermal a oS
Do Heche en ean
‘paste
indi Croatia
‘Sager Romana afan
ene panne wee
perry
AG pps rar de
“cone
OS
pi

‘SYNDROMES MANIFESTING BOTA

Tonic gta tone pe
ELO
Eden eye

pop and car malomatior less on cursi ts
ler velar evi mle tc fomi se
Peg pe rl nor an example front
conmon in Dour yen Other onions demons.
ine mirodent cde dena dopa snd done.
cera pas These sie normals re pto

73. 56 Fundamentals of Pediatric Demi

FIGURE 32 soda cae dia Ne oy vip

Syndromes Demonstrating Hypodonta

Comin mers

‘edema phe Mori pha of a
paid) cs ná

A Faye mood des

Sonu toe termal risa
Raced Bite de.
maca tol boe
FRE om mi opi
OS
ee

originate during the morpho sage of tooth
een,

‘al hemiparoph ca demente compartivoy
larger teh onthe aci le (Fre 3-3 OF te many
fas hough to cas tis anon, aclaran pr
airada conde most yl de
fon an ces in Ev and rot ae eth
dera verily and eat ere ha où e uni
ve The todentl pde (alo kun steel
plas consisig lio fequeney bung ls and
Be ape fs molar ech ster cenit tht
Fire murodont sted eth with cron can
‘Soret orton bores origine daring
{he obfention stage of tut deepment Fun and
‘aie ae the mon common (wenig shoal,
Edad cobro comme

FUSION
Fuionhaan incidence of 05% andl morecommonintbe
primary dro The cla ein ffs i the
“emia! aan of wo embole devon ect
Alias tt can contin two pue pl cum
‘ees: may pps ge bid own ih one amber,
Sch makes hem cut dings fom pinto
teh

GEMINATION
‘erin sa requmeyo/0.9%, bicis lato a
0 Be and mee common ithe primary den.
Comp. a umi tot repr a ample
‘i of ange oth ol eng ns Wd rw it
nl pa chamber Gemini est eur in a ni.
pen ud prince mar ha on in
Hei condos may ra rad erp te
permanent suceso leal, fon an mino are
‘Sly singed by coming te tinte ae I
theresa deny intherormaleomplement odie
‘WB own the coin fio Pen ith super
read must as conser and raed et bc
vend ot af the ermal umber fet

oncrexene sa timing aroma imobingie aies
ot by cement on, ese is thought be
rsa or adc tc maps, Base ean er
ter rot delopment, ences cha or
depen anomaly

Anomalies of Shape

Aor in shape orgs during the morpho
néon sag 101 dpt and are maid at
rain in rw ad oot rm. Mode of nero
incide ted ame dont and pol pn

74. ‘CHAPTER 3 Anomalies ofthe Developing Denton 57

* FIGURE 3-3 A and, Hora gero, ae lee ie ge) atin enc. €, ea pee eth

‘eles feces pte ern a ero.

2 FIGURE 3-4 Ds agit cop A Vee ene
Cher

DENS EVAGINATUS

ens evga san ext cup, umaly in the cet
‘oon oriol poster tot andin the ingulumaren
‘tthe central and Il noes (gue 34) cts
hee cp pp load ná a apps tela
‘ofthe incl edge This cs portion contains no oly
‘ramet dein andpub sur herr apa ensure
an ele fom dial elation 1 os with a

acc 162.46 andre oo de vagina of
in enue cp cl, which ste he ees of
tite!

DENS IN DENTE

ens in dents condition ssl or ovina of
thelnner name epühelum producing the appenane o
tooth win a oth 197, Rupreche and claus
reported 1 prevalece, ih the iy eral ne
Sor beng mot query aed" The cel ei
ame of this anomly rau fom penal cious
Elemento comico image
pario ofthe pal fc of he teh ithe ote
‘Evtonment The enamel ad det inthe imac
parton can be both cr aná abn lg See
Damas wih hepa.

TAURODONT

“aurdoo eth are race by pican don
{ted pulp ham with short sumed fet and ape
parement of he paul Doe Trodem rl er,
‘he fre ofthe proper ee of tort invagination af
Herwig paro! sath (gate 35), The cece
range fom 05% Pit te permanent molar mor
‘en aii The condition ca De ds cor 10
theese of he pulp cher dngaton*Theconditont

75. se Fundamentals of Pate Deny

Conditions Demonstrating Teurodontism

drome?
Team

Dra ak el

Dona prone Rae sou rear

at iu ie sel are samara in
Abe
DILACERATION

Daten res to an abromal end of the root eras
ns devdopment ad ought o rn fom a tard

episode, usualy othe em dni Figure 3-0. The
rer incidence of dicen has ben tne 6
Fa permanent deine” Epi option and na
Imac jury athe mat common ed ef Sco
‘ns Andres reporter idence
256 ne permanent eth with derogado
Fun second] to primary oth nary Coge
ons Re aly kn and dyed ot ern, lo
Inc rot teren coma! dig

Anomalies of Structure

ENAMEL
‘eh arctereshoraaltietren fom ropa dng
the Bistederetiston, sppostion, andlor minera
tags och development nue dfecsare mantel
pop or hype: Acto Jorge
‘nd Yor they maybe ony ca erate Sect
renal indica dein"

AMELOGENESIS IMPERFECTA,

Andapeneis pec (A) à à asic example of à
Pie ee elec vias a incidence of tht
conti inde 1400) in" nd Din a0

76. [AMELOGENESIS IMPERFECTA

“ype ponte
i type pte toro omit
1 paint ama dat
1 pt oc ma save
1D tori nc atonal emir
E pp emo Xin ort
Y ponen ronaldo

pez Hypomstraton
2Wyomatonton pened toma receive
panier Kind rece

AD Soo pdt tonal dein
Tipe Hypo

pe. Hypanatiration, opi wi ardent
ER ponen pit at urn.
8 Vypoplnichyporatre tarden

Fete hy can lr tin Bon
‘ah lie atone ptes ered So
‘ie fen nec! ach ar MC, vg naan
aks faa an Wer pd ene
Sierra tt ager om ee
‘tis acorn da ey parame meso
ee ann far av Len al
Deo por na Te gie sao
fer alanine dl pane macy Sper
ote my aches reed mr mad
D ee ee fart e.
‘ea cred and o te up ln ee
De a cok ee on Adi
Dre on spor Sn bs tin fom mo
‘creme or

erable enamel dés ocurrio in he stern
fon sagt oth development recap by hehe:
ph pe of al whan iti quant af em
{formed (igure 37). Ti cer ene sm areas of
the enue organ are drid fic eal epic,
ing ceo el fenton nto amos. Bolo
inary and permanent dentin we ae, and on-
‘En inetd romina sa tos dominant
toa depending on de sbgrup pam. Ae tc

‘CHAPTER 5 Anomalies ofthe Developing Denon 59

2 FIGURE 3-8 Ange iger pm y.

peu sal wäh een contact ad rs ofthe dia
Sins cnt ver in o nanestent ene essing it
ig seo thea in

HYPOMATURATION TYPE
‘ThehypomaurdontypeofAlsan example ofaniabeited
lc cmd mat puto I carter by
‘eth vig normal me ee Dt lw ve
raides nd miner conten (iure 3-8 The robe
‘heh eng i poor akon water cet,
aa porous lc tt bees sed

HyPOPLASTIC/HYPOMATURATION
AMELOGENESIS IMPERFECTA

‘wim TAURODONTISM

ypoplusihypamsrtion AL with todo is an
‘aunlcfnheneddteainboth apposition snd
{enon sages of enamel formation The enamel apps
‘td ou ben calor ane pte on he acl
tao, empfing the fer of bth popa and
Erpomatrton previcady desea, Molar eth demon
‘taetearontam ad or components of he denen
Haven pl camber

77. 60 Fundamentals of Petrie Dentistry

1 FIGURE 3:9 Ames gr pocos y

ypocleteton Type The hyaline of AL
Ham ample fn nba dd int cleo tape
nine ratio Quantity he name ar
u qua the ma is pr ls ih el

van cual the nme te Figure 9) The po

(lied name sf nd gie, ey atthe ic
cagon, and à u cr, exposing the undying
‘Eoin ht pods ame spare Ind
‘ls rm and marked dy rot erp we
ent ing The cian meds to decos in
ice cals fen hype enamel parar
in be mandir ater eh

ENVIRONMENTAL ENAMEL HYPOPLASIA
Examples of vicnmentaly induced ene! popa
(an eh om soni or Il aes Bape ol e
rank causes producing pale! cmd yoga
Inch murio dices pricy amine A Cy
Da el a aco and popa Severe ine
‘ion sch e Canteras deme nd fee producing
border pelt darn et arofile dc
Met ble ai reali In ese pri
ua nbropty as a high creation with prem
aml opina in the ein denon Spies
ithe proce Tape alu duce cle pt
tens of pop dpmerpic permanent teeth The
perd and notched ical dps of ater th with
‘cowie shpe ar called Thacinion in andthe
sente cal ters of potes ch kam a m
Br mire che ce Eng for penal pi
incon.

Nestle dec exemple in chien with cere
aa a ge Wer pudre ances
loot of pogresing int erizo enamel pop
tls ich denen nr re
‘ey nd exe adan pote cn drop amelie
‘ems fran or een mica and re

CO!

SYNOROMES DEMONSTRATING

- Downs
+ teen
race

he none
Penn

: Baohporein

1 ose osos aro
2 Morn ended
panama

© Septic stone
Dore

&sndrome ie ame pop a à consent
Faces sion of seni aride cn produce pre
al nd ce ental oo canbe mad
‘eect cion ofthe einer mi
enfant pigmentation ad sma impairment in.
e more ee om Fora ocr when th coer
‘on of gate Aue shove 14 ppm Tee à
ph chance l some ge of etl aoa when the
mount of ingested Dori leete han 6 ppm ou
{be see of marpholje ects cannot he petted
‘fom pce quema mg erie Recent sud
ve sugested ta an nr avons ly Sie
ince bt ma rom recta pred fm
Anita 91 mont scl ih cease
ine kt devoping enamel Moro inthe permanent

Cs of end rota cing indi tech
‘ern eft pte dvr and primary toh event
on Turner poplin use example of ops
de in premi sing, om cl con oF
treat primary rece ge SDL.

{he irn ofthe ogni main enamc ona.
‘on The ame att nr cam yop ala
ae ocacion. The malty of ale oct

(he deca i the case of Tre pop, ae abc
Tran leaked cn nd enema Eres per

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78. can produc genre rove hyped Hons tha
ae th poc pe fA

bent
DENTINOGENESIS IMPERFECTA,

Dentngzness impec ian example fa inert
nal dle ring ring the dienten
Sage of oth desp (Pess SL À and D Ts
orl involve à fect of predentin mai at role
in amo, digas, dub cecempalal
‘ein The mam dni a nrma in contr vid the
resi dese cicumpupal dein, wich high in
‘pant reten and continence Le

2 FIGURE 30 Ture pip Ne a cometan

‘CHAPTER 5 Anomalies of the Developing Denton 61

incidence sabor in 00. Det impetcacan

‘Shel pe 1 ocu with opens peca an
Inked defect in age formato that elo ato.
presi bee tas, bowing of the in, tenor
Being, and ae re Primary tech und ode more
ré} afecte hu permanent ih Pepa radio
‘eres Fallos com citation ol up unbe od
oot facts ar ein (Fur LC An amir ane
Inet tothe common.

‘Sh pe 2k seedy palace det
au ore nage ci bom tage ur
fun thse, beth prima and permanent des
fe equly ated, and de cancers perio
‘Eset for type ie besame Thiscndion sabre
‘Santee oma ie

She pe rare and repens many ofthe ees
decried ae, wth predominance of bel shaped
‘ros spe nthe permanent denon. Ue pes
inde ides teh wi blk appearance

nd mul pal pour hs crud excuse im
{ac ted rupinNarpndknomn asthe Band
‘ne population. ype bat eee propre be ier
pro of te me pe 2 gee?

DENTIN DYSPLASIA

Destin Ayla represents anther group of inked
enn nd rola race tare eng
tte amp dents and root upon 197%
Sis and ascites proposed a user bs on
characterise pates ef dea pas

* FIGURE 351 £0, Denied Inpec erat pest rin.

79. a Fundamental of Piti Dei

Stl typ 1 demenru ni prima tnd per
enter mortis than amer tar igre
TO The rot tendo be sort ad iy conned
Peary the etes ula Ba primar and pe
cie and ben pl chambers Casting le pates
‘ent rm ha normal dent bas el
sc res einer iperet ps and 2
Permanent th sp normal tl agape hey
denote thie be ape pulp char with mu
‘pe ap stones igure 313 No pepe raices

retin oh ewlopmen bog ret fom repr
‘ear developmental anomaly Ace te have tn
fay cd pap chambers an sree, pool dene

* FIGURE 5-12 Da épi ype nts pay

ross Figure-16."Thetetbhneaghaierdogrepie
Se demore in over pps No cme eo
Tei ctr or senc pater as be etd that
‘Sherpa de pond cee

"Aira condos iman dentin sbnormates
alone booms dat ine oral sary
thon and erg ser evo ef lm and ph.
us Verón Dia vet, apache and
aora sel coos denen

NORMAL ABSORPTION AND CIRCULATING
‘SERUM LEVELS oF CALCIUM

ami Restan Rete
1 Deceased skin osa cy nta gem

arte
2 manent tech are pren ected

om mesa o ceeds ore
nada cerco cn opel api
+ rant poi

Psudohpoparahyoen
Enge chen

“= FIGURE 3:18 Dr tye tte ae be ap gerne ce.

80. CEMENTUM
Developmental det iin cent an excluir
coy pr fom ther del Str are uncommon
‘Sexe iia o ent problems comenten
from ate inrobing petodonal men A ne
sing fing m Tur boga ss in atin to
roel mel ds l ac permanent teeth,
Coment i formed ln the corona aro derided ol
seduce cura ithe has on de ered oth
{ale ecumsenchymacelötrenien tocneni-
ia Arn dened enumeal seno

Hiei eve cement cer In te note
very conditions Epia bala open, a
Tabet vals ab balas uae of the akin and
‘poco membranes ees orten of tros pony
cd sclera and overoducion of cela
Cement leer pass ab. ily bilge
te noted that permanent th were devi l cat
mentum, and dad pay hope sclalar

Tiere sa complex condoning the
far of bon o miner prope, whichis socked
ith low stm aline hope vel Ones
Sane ugly and prematue ou of par ces me
‘ase cn tros (igure 3.19) The later dig
‘tered tthe free cementum formation on the ee
frios i the reine primary teh The condition
‘erie ge ec penis ding he et et
‘fife Be and denne feted slong wa cement,
‘othe ny is nat ar a cmenum dee

CHAPTER 3 Anomalies ofthe Developing Denton 6

FIGURE 5-35 pts ote pense etn

‘some eter en ds ua lo nc

Anomalies of Color

Sen cer Changs fom envie nin sio
eee of thee evap sean, ele i-
tine sam ar ered he I 197% Earn eed
erick provided a ete caian of the ces
Sion Gecdornione® Canc of itn sins cn be
ue 1 Mond borne pigments ra adminis, and
opti pal duese ts. Congnal por
pa edu def, anemias ad ann econ
nous amis od borne iments

À si example of dupinfored nine sing
cis fom engine prop of anit Baden
toe can ave severe dalton Im thi ani
‘ten given in concentren of 21026 myo eter
tera rea prod dys igure 16)" eine

81. 2 FIGURE 338 Try got mu un permanent
‘ent anat ton pm tc ma o

storm

echo asthe rs potent o suing among
the teens The get forms an oral os
Pte comple ith dentin and name which où.
fal by uke it. The xao procs rel in
ents ut in de har mc The eel prod or
[ston of primary nl permanent oc sting tat
Sinner derepmen trough yo tag: emo.
‘le sion mus e peal node sing is
tie The Interaina!Acdemy of Dental Tomo
CAD oc recommend stem doo mus ad
{or days or an juries i wich here sed
spe Donji pret gia eco within ne
(Deal ceva fi À ten cay satel in ding
‘Sih patents wher rer mation may ret
coin

Systeme and local enamel opi a resi in
tooth caro. Many fhe enameland enn dpa,
alo test color change snd tos sr
SA the der amies of A and dentro
Empate Exe ore very both the ng noc
tnd bypoplse cago ges espns ttc
colorado. The mare sv om of eal Moros an
Produces rng coran, rm opaque we sos
‘ithe stone to Dun mon.

REFERENCES
St Pest li. a 74 May

Sn Dano be may of pt ne
Steen ta ac ln

ES ses
RS
Beeren.
en

en
ne
ee
Baer
ee
ln or bf nen ad

= ae
See
ee
no
Fe un
preto
ee er
A reenter
Hectares
= ithe antreten,
Er nr trs
SEE
Eee
Be
ee
RER emmener
+ Seer meta
meer
i
a

82. Oral and Dental Care of Local
and Systemic Diseases

Primary Herpetic
Gingivostomatitis

Herpes simplex vrs type 1 SV) ia ge DNA virus
Bat case primary herpete grgvosomalto (A),
arm (en in ee ad in contact or
ma Depa herpes car ofthe bd are, aed
Jrs eget per peto he e mon ee by
HSVa HSV top lt mat common cet ley.
thant mulierme? although FG i y comas
nen, 110% fps nile erp
nal seo eis monly aqui thugs dee in
cote body Bde wich cn rnd ri in sed
‘eg uch a epa center and orphanage The ost
‘rude and cal mantos may vay fom à
ls over oué routing hop amic.
Nonspeciesymptoms ince ceca Imphadenepaty,
ala, ina, oper retry tc fc, and
Tonerdetevo PAG Gacave bot roland extra
elon and oben and Heli poa ur Orales
my sr as vis on tetonas, bucal mucosa, and
ira iy apra 1 became lets 1 3 mm in
ee whch my segeln are ket ra
onze by ali rey membrane" The frien
semi anne 100 a dae ending write.
ing! Cen may pent serre puch ab
ec aca wi Bd and fod ak putng bem
At o eri * se dci, alt ad
tore hat ae egal pesen Compas are te
ut dt wanton my ad wkerconhntvisand
pe wen (ge it hand, rhe sin ico).
ri ac octal adores profesio
Us After the primary econ, he vias may become
rt bt an errant grad neon
‘hata nel les vee

Managment of PAG le ced at promoting leon
bang providing lation promoting adequate sion
‘odio ad preventing rte senda the econ
‘Groh avoid Arc cnt wither pope and o!
eig mc Sens ty, foo nln ur ops,
oes tothe, and towels. Drinks ad foods wh
ph aci or ie coment Should be vied, Cl ems

Marcio A. pa Fonssch

+ ourune
acinar Hayes San irc
normas ies Camus

Sica Ce Desc

Oral an Den Manons
(Ould Deal sent Cancers
Hom

(ra an Del Test Cancers

nié Marfan and Del Care
Cartons

Prorat Carra

Dest and Ora Care Considerations

Pacts Medial History and Hematol Sates
Oral Hygiene, Di, and are even
(rad Deal Temen Cancers
ewaroroiric Crt Tura
Dent and On Care Consens

Ace a Cow Ont Courson oF
Carmen avo Ramornar

suchasceream, popes andi chipscansothe ected
"sues and ep wih pe. Ages pas

dez nd cating pe hel ee pun and cite food
Inthe, wäh autora iplemens added a nected
‘ope metic shuld be wel with extreme aon
enue hy ae pay tordo cr er
Paves sou be eco! o expecta ar u Cr
Bing or prin nenes maya 0 mppesion of
Fe agree pte sito aan. Noah
nicol is may a deceso onda]

83. 66 Fundamentals of Pediatrie Demis

poor ea hygiene

ino ed on tb inca presa and te
ate history Howe pose vil aleteo
‘andar When doings cress shuld be we
Soak pth aan scrape thease of uote ese
‘Toesabisthen ped spel vil por med ad
sent heh Vir ober analy growin tue eure
15 dys itl gan nde eng, op
Joc, done, pemphigus nor! zone non,
ecc leave gigi, and Bebe param +
‘here mea evidence tado (ACY) o decree
‘ome of teeymptms of PG ad the number of bet
eons or len under 6 ers fae! The douge fer
fal ACY sapenina à LS mg wäh a maxima of
Kama per ey to be id vn Baus when se OF
fetes dy fr 10 dys? One o e Inns of he
gina poor unen) aro nd Bra
inet abel and moi were died ith an
‘party ces beara ba hey sre or cr.
‘ey ra as pec pean

Recurrent Herpes
Simplex Infection

Despitetheovenebeiing co ACY andre ra
SV remain major aes probleme La
use of enepali und geal leave die, 4 à
mr fc fo human mode ias ine
than! Ar primary incio, SV etl laten
in e geil els. Duro apro, ber 2
ren of de epica peces und tiger
‘cuts eins sona, matones men.
ration dental eaten, perra) liso vl
cerca, elton In the pro, and val o he
nc mac se’ Aspe held, bh oca
‘gue a mar tk fe Fr tannins Tree
Farms € HOY neon re regie. recent herpes
[ibs (RH tor recent and erence ih
{ng primary Inn Recent esos in immuncn
tet pent may oca te pra sin te of he
ov anda the uncon of bere and be tenes
Spas RL” Inter recaen lens ae sen set
dey on be Keri mus of the rat and
bed gingiva and orasoaly on he dora ofthe
tongue” In patents with cmpromic mane sytem,
Feen HSV okertons may be ge popes. and
posent (gare 41) The ng le Ren Sayed
cause of er ayphal pct, which may lave
ay mr te ng neers”
Pants ho have RL (old sr) experience a pro
deme of islas hing, sens, ado bring I
Towed by formation of a parole tht progress o eles
‘iin Rout and lo leon 08 ring in 72 ©

+ FIGURE 41 Hope one top fn mm

96 hows The highest ea a infec i the fast 28
ours of the appearance ofthe eons Mat ede re
te 0 1 My) nd mi an base lene
‘er or vin hay sets Be teen now is
rotor! Rennes ar arbi Lip al tnd prose.
‘Selon boue wed ine RL son
indu putos hdr maybe rt hol
HG, and palas mungen! te mme Vraie
‘gens veo stared ny fore cal ms of ius
À replace the eat damage o pt
‘els canotbe Propia seo tl agents
feria who experience ne oro mi cie a
‘rar rt recommeded betes ofthe ak of oping
Fene und be poe corde bene? ACT
Bas high ci, or vil feted cl present
inal toy fer other taster, owen, a tro
poor sal cava à a map Son? Sei
iene ages that) Soo 10% ACY nine tse
‘Snot aci ocn Libyan beca
pone penewaton (2) 3h ACY in cream tse may rec
ren ofthe lesions if apie ext nthe prodromal
Pls, at doe ot ay rece ps) pes
homer ver alone epee thos ly
{tenet om epi form be ds 4) ai
an alindammatry agent may eae oil ACY
cn 6) else ACY a 206 40 mg oral)
‘Shen ime dy or ys to treat RL reds beng
Sod pain à LS dap ar wel a bi, epi YE
ar eu, nd 6) srs le (SP io above)
‘edie be incidence of HL Spec poi (20 mg
(Sen hs whe va for 5 y) ma De nate fer
en wäh dt cr more pds al eur IBV per
eat Other aval gets il inde wey,
ce. adore, pen amado Lose
at and dei. Te y an fac of man of tse
ri chien ha pon ets! DoconoL e

84. ‘CHAPTER 4 On and Dental Cate of Local and Systeme Das 67

2 FIGURE 4-2 Parents ca

ly overthecounte dra approve by the Feel Drug
‘ania (FDA) fr the vraiment of RI can de
hed crn ler han eur spl ve
tines daly to the ac aren of he es wp The
medico told bear the ue gn oy
Lo bain masia] ec" Many oe and apts
td acs re Beng teed and deep, icing
ink, reguinod, ndecienie ad yen.
nd muy der otis

aten udergng conce erat hue igh rior
develope! of rerudecnt HOY fection, ths hir
sanagemen toa propyl Ta this grou, eons
"iat do not bel mn 010 aye cl be rected ot
eloped, ad venti testing o ACY be prom
Intro who tare need Dematop en ol
tampa hve shawn the higher rate f ACY rl,
rk wand wih face ets wo be camp
‘sed renal fncton shold have ACY doves reduced o
‘Bout Som Incr oth PHC and eme SV lc
na he dtl profane shoul dre proper nu
$n Bain, optimal or yee lea onal othe
Proc and canes to preven atacan and
end to tere Del amen Bou be ode un
ling ecu

Oropharyngeal Candidiasis

Candida an parie necios cased bythe ov
ont of Cand pec ue to ato ondo cr
‘eri rom derma planes coring.
immune ste The mos common ens in chen ae
pocsdomentranow (gure 42) and erythema ad
ple and path o arouses and shapes rowing in
"radiated concealing unen ema a
Tepic ocu on the bucal mucosa, much fos,
dere tongue, ad copar” The een
op fom ranges om à line pt rin

FIGURE 4-5 og

inv monty he pte and darum ofthe omg
‘Acumelto of si dp fle af the come fe
‘moth als ocio ofan and tacts
lens (nglr ces)” (pre 43). ed, sometime
ete and cased sly ffl and mece ommenin.
ile with spacing hab wich may ead to read
Selon sth et pra ai ae wäh
‘al ani on ape la oath «bring
Feine on ie cu! membres ad tongs drag,
And Steal eating or dio? Dig 4 rbd
through consideration el pent demaraphi and beth
facon nil sas and spams and born ct
À han asen fhe pens ah and eet
nca wal to cure fice cog heu
and 1 desa the feng of rene Clare ae
‘yh inca we testo esac hp
"o portant 1 improve rl gene centre car.
cp par and sppances an and re cta
‘ted cts el ert? Mos mb a
‘gal apn ae resort road activi Candida
‘lou and ote Conde spec, wich re more com
‘only ltd. Unepabed or que reac shold
Prompt an lin for accuse ict condone
ht canada immnenocoromiad ter mate
treatin Deaf inte Agur ele has
‘en desc Condo als ad mon fen sc
vio rm se antena get Top mi
Feng pes dude compounded trl spent
mg) and ayas cl pes (100800 Ui)
Lo ruth for? minster and ewalow or expectante fur
nes a for 2 wei, lowed by ect of the
‘ral ay The pat shuld note dink 30
nut ahnen Alm cn ut net mo pulls
(200,00 U) dom ven the month eines daly”
Nystatin sation cons 30% 1 0% of scr sa
Irene mus be rer. Climate voces (0 mp),
‘lh vey hi ru, an be wed y ll iin
tne voi the oth every 3 ous ve (ve pet
9 for i ay! Syn ge ras are bra
{gous when tet deve means ae adn
Seed concu, They inde Aucnazie Gp.
‘alley 1 024 our fon 107 ap alent can

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85. CT Det

ue à 200g lading ds and ten 101 200 mg once a
oc saute" Recon may al De ed in
‘heat 510 10 mpg rey 1124 hour nd ad
teens 20010 400 mp ve 2 hourafor Sta 7 dep
I a de and ba the avan ol god patient
complice Coma sde ec theme we de
as venin sts naomi coor.
doh, anar] er nio et ad drug induced
pati Ces came 1 an besan
Ab re ad amos we fr maintenance por
ac rang gt Ane
Soda deep orinal mii
‘ole nd ketconnole Fr len so ng chi
panda alone scene 1)
{sth bet choc hen apte ne of the a
Tne feng [sein in cen ate on the rie
ren wih py and secar inmune deen”
‘Thee nein ted to oc in spl stings ad re
‘sly cel by Conia pp. flowed y Aer
"ia e mor common mold néon Pron
Candida nthe ond (aie) eens sc
ed with high mobs and mortal, need eng
‘bp pe und hiper hath are ca" The infec
Sion cn demi 10 end organ, ining bral gs
er nes ye, and sie. Rik es fr anddemin
incadeprolnge ayi nie are nl mano
Styplon pos ee et ye
il extended venom u, Sb, tems and
tol pace! tion e cn be ted wih fon
tae or an chan fr empl therapy ln ble
née Conga be any einen cu.
ty ppved fr wei chen y FDA bt fl
“fein een ove ied lt naa Ces,
and pa patte conven] amet
Ba ban ots However pedal pues need her
dons ofsonzontole the drop hoe fr mare pr.
‘lls and many other ml ness In Doth care
“ce trap for canis" Tee ie current in
‘nthe pen ve of sand pene race ch as
sine, ac, race, and allen
Sc) und ee coca nda, man.
acota be wed in len ba nat
aly ar ay t administer and monitor console”
‘arte svt of ns ama! droge ive Sal
inci inching ho cred y Candida rem
ei peda ton lt rat
Tec. e het of pop reduce
ve dae for ern vio etl males
bene marron er sli opa wanton, a Primary
mue ci ar ce Done re he ba
12 spa randomised. coma wir emba
Sng prphylac in any of thee einge, be routine

te of rophyli aps o commen, xp or
ecu rv int os po:

Sickle Cell Disease

Se cl ne (SCA)sthemest common eet ds
‘of Aan Af Caribe Mile ater Ida, Cal
nd South Amerkan, od Malta acer" SCA
tors sel cll tat wi beg and eel
de SCH) which ia poop of dorées ent
by Bety, demi orn damage, and ample
se complican tht my become Bert th
‘ed ty vast ofthe bin gen ae bone
(bin (MRS) wich ie avd o ener Te
(ntact ech amino ain Behn et,
Val lou HS o plete when det "i
The United Sates te mon promis cre etd
Dr ea ern

The polymerization of dee HS san indie
enableerenintbe bones SCD and dependent
‘nthe HS conten i ed nd als (RDC) he
re of tl dose andthe pH and ner
onen of fel hemo (HB, whch ste.
‘ie sas ing? The proces as à pod of
me cnr fr tute incas plan 0
deem the cl There polymers er ht
Signi tere forming und nd diri be RBC
{eto cape ic een forty
The che cd ar pel mes inthe sow Doing
vel e ofthe mern, bang ti ade
nto de endothe forming heroe preto

dat lado Il yy Inne HS polymer,
nd spend ofthe sci be acen vaut
‘has HIS produces a proble of RBC “Ao” rather
dan nly Si, lading coi ende damage
‘The emuhaly varied el ptr ne a von
nennen ar se vi cong ons ane
Pant D perio of ever un and panne com.
Plane Anemia and Tasa rd al
Fat ofthe diem, with pmptomsapening within the
Fronts > Themen Deal RBC
Haba 20 depto 11 7 dep Mb erst
5 gil (ecm 121018 lly and ebay sunt are
te 15% (normal 0396 15)

Piaf rs cry yes mune as deis hand
foc smérome) and canbe gee y nen, dd
Si creepers yn pc ee
me. ret In mall locations, ing m à
lor mints 1 sever days Splenic eesti cis
e cas y ge suber of RBCS teaming tapped
da de pen and can nce sen and severe an,
‘Hrombocyopeni and on Lie tern

86. ‘CHAPTER 4 Orland Dental Care of Lac and Stemi Diva 69

postie pimi ed by pags
"ie capte acer paraa Sens pes
‘eed y SCD?" Other semi mantas dede
‘arora probemsostomyeltieeoporo growth
hun ono set che same, ero:
‘rican scien ion real for, ad propi.
Fresia complaona inclui mpard paso
al fncinng und dened uty of Me ar not

"The mat importen intervention in SCD à ani
sion of penn V pam 15 mg oly wie iy
string 2 maths of ge presen penca ine:
to. The dos doce tage ys and shoud be ca
incl und age yes shea ala be gin for 2 as
{lowing splenectomy "3 Much earch ig dene o
ad thee rl st the se Iron (HU),
na wed as an anno aun ls achte wi
need evel whic ad o ev sling eisen
fon tome sm andren nic
‘Sine serie nern nd tomb:
ei They avale ie forte dense emaropol
Sem clan which bald be donen ly
te beer ren plain develop" In pearl,
nera has dec, mean oe at eatin the Und
Se A incre (42 yu for men and 4 yas for
comen bomaegous fr HS) and fewer paies de of
eon

ORAL AND DENTAL MANIFESTATIONS
“The orl and detal masitaons of CD are nop
nd may be preset in ely iia wen ose
vih ter tee dnde: Themacans menbranesmay
‘how und ue o hema and por cused y ao
emo. Ai and deed 10 run may ao
Ve app" Radogrpte digs Inde deceased
let in the bones course tesa pate hn
infer trier o be mandible sso abc toe bight
renounced amo ds dent ype ner
but dentin inte pepa ro, laos nthe
lp chamber, nd Iyprceento” rafal ana
ale cade inary proton wih aed incor,
Prominent pr and rp ones Ctomer ul,
Seng ofthe dpe sce with hing the outer
{Shc ofthe lvriomand verte beto ron
apparente ar eso wi ing
lhe appearance napa Ion) =

‘Shing eres within the mio of the fac
sand dent pls may aus orf pn wihoutany
loner ploy” soc ende nea he
‘metal perveframen may rein partent press of
one ip” SCD pet ae ot more frome pe
dena ice tan She general poplin Items nt
Ton em eof eiii propias nes pte re
‘eats the aqui of man eon vein
iu lower ei rt nthe primary den.
Home by 8 yeas of ge, once the popes einen

ns stoped iden prince be see fees as
ste pen

ORAL AND DENTAL
TREATMENT CONCERNS
Indviualcaryngthetraipresentn ens for ena
ran. or pen feed wi e dic 3. Stal
di ry mu bel nding re comp
tng dress ofthe pin ai pas and cent
rial ce rece large rohen carpe
out bene vs rth and event sr mal
‘ats Gncladng ue o pborphonae), alpes ad
‘eit pros profi The pans dea haa
Sold ron nde fey luted aout th ree
pal alba incre quay oe Compute
‘imine teeth mn De taken uty eae tbe
puy opal cion and neces ent ihScD.
Rocco ben rang btp
{nt vasos ol ici mus Berta ir
dy, und dec surges should be aid” Oro.
ee ping bid nde consideration the bony
tte and pag "patent is ig aras
‘Sed Replay mt be fred be
‘kof toporphonste etd nero ofthe =
Towing ¡ova deal procedures A dental exe ca be
sal don in ie enla during once ende
Individuals who have cope posees may eg
rio rope sate del prit
Ifthe tat ing HU, comple od count er
‘ane bene othe ik of ropas nd aoe
ain” Copuitn rs shoul a be ced if be
Herri vale Teen elenco o mpg the ue ol
Lame who rot in pan"
‘icone cn tee etre og een oa
‘yp Ora een cone cnsitrd afer comal
hate he adecco of rs
tt donot hd 1 resp) depresion. An experince
‘esol hold be conse be poceding wth
el ue under gene see im erde domi
‘Bepuen rake Coplas ndto erent pepe
tive problems" Low patents am be ened in note
nt surgery enter Niger ik indi eed fal
‘popped operating rom ins Bsp ey o dun
‘Seal support The Nena nates of Heath ot
‘commend spe rains or den or al gery
pes

Hemophilia A

Hero A isan ined rire dade renting
cine pas acter Veg ac ocur
emo and can be ced a ee lana ano
cable factor VI, modente (nly 1% to 8% a de
orl actor VI level reset nd md (to 25% l
Ub actors pent) In mid aes ere maybe no ory

87. 70... Bundamentas of Pentre Dentistry

fai, which may oly be tere ar ram or
tent pres unos lering with «normal pet
“oun, edge them ine pctv
‘ota ronge achte par drambeplatin me”
Spec cor aa are add to ferent between
Bemopi A an factor dein whch scot
riesen 19m of allenopbiae

"Te lnk hala of Pemoptla A ae jit and
muse bemarhge, ur bg, and eloped and
Sei Bling ter minor ts or lem Hem
rs ar Rat sen wen the ch begin wake
Jothemomeges go ntl seremos moto
con an may lat permanent aby Items
Beats cn compres val sucre and ma} a
re prb, mel vasa ray brin.
lil management o mop A done coro
‘he sv el e contin typeof sd pesen or
Ante and presence of oc Ree
a of ce El de val cs ma tg
fd Mettesein Hering, Vanprnin (demoprea)
se pls ndo tar VI aa ven Wild
(ctor md canbe wed insula noe sof he
À the pet ronds wel to ts os nl
{ered he matt fe ele the sey
rk fe cer in 201 60 mites ha dust of
‘Thurs Less request wed metodo fr management
inde administration of fess een pasa pr
tate and hoped cto VI concent" A cha
‘ening sation ae wien the pie as doped
‘subs fac Vi bh pct up oof
rss Bemophla Ger erp cent
Fig sted forthe mugen hero las

ORAL AND DENTAL TREATMENT
CONCERNS.

(ra and detal traen require ste to ital
nd cls Andi and flow potest and gid
Hea à care evi he palets medal story
Barbie procedures eofpuramosntimperune
0 re he hemowat en 1 à range of paar
heme ner lor ie hemes and o support
conga mi ajuiv editions ad Ica esa.
Review ofthe deal istry sao crcl specially in
tema of previous ig epee inthe cl vi, di
and hpi, ese peeve rad mac o
hy eral iy ae ver importa the pue with
een rat No prevents ls eae epee
ng sang in mid nd moderne cvs hemopi.
Home sbgingl sig nes, some perte
ment old De done lock aerea ad od nn
fas anes severe hemo held na be Soe
‘etl te hemos problem coed bete ay can
(ase dep tue eng nd penal otro:

Vie of rer dm with à ale amp is impor o
rotate sof tues Wedge snd matrices cn be u
‘ih enc handling an plan canbe cement hey
arme othe tes, Atom, pulpcon,
{et eal py sl cn be doe was gr
tien ad avan of inem and ing
‘ond the ars importa, Eodosonte py may be
ok option for manager of deta sb for e
er er igh ssponde iter pent The ged
ige sal beats wih bay fans and
rana te remove and primary dose hl be
mind to prot the Wood dot Ani shoul be
oser when cabe homo an ae ud
refonte Ordo weno rc
Frida, bt pra aso soul Be pl o
es with ar ds and pcement of ands.

"ade wi mode fo severe bang coque
factor Vil concent nun before sl er Te
coocetate an be given irnos, ati a eo
tee wit sever mint andl beat 10%
Eater adninieruien An lenin atodos 0
property und 0% sun 12 bors aer complemented
a hama (pear str gelatin pone cl
alos mater tomb, mixers calle, in
{Use et) andra rare smut
a) The bale factor Ve boar asp,
‘yea er deal exar. Paes undegoing
‘cee rl spa proceures and tho gin
Shouldbeadmitedtothe hyp were cx pope
Front an contigo cto nfs e one

Pediatric Osteoporosis

Lou bone den is affecting Incio numbers of he
ren Bae facture ae th mai on Foc orton
In ehren teers Y and yeas lg and an increase
in tinción of factors chien a ee ep
fer he pst reden Chiba fats seh as
ene, et, hone tne and mañas can have
‘that sem impacto bone heh and along em econ
the achieve of peak tone mas, wi he potest fer
Img in salon” Unmodfule Irinde ce
dera, gc ee) crap deeming
tently angele eine tt (eg it mone,
Hs py activi) mae u agin compone
early inulimaebone mast” Adam
tod Yiamin D intake, and er al acy are
ong the mest import sine fc in gig
‘pal bone mine mar and e
‘neoprene lia! se arce
br o Bone mas aleron of unsre ql e
Bene dsc intrabcar aries nese one
tea prety ruedo is and deesedbone
A]

88. ‘CHAPTER 4 Oral and Dental Car of Local and Stemi Dies 71

‘The primary forms of oops are are inbred candi
on babe secondary farms arebecomig mere commen,
five tat Chacal ren ae suring loge
Pathophiolege mechanisms tat have been implican o
cod] porel oor M rein
nil cri deep andthe ects of medi
Fons on te bad aig inition of one omo.
Ina hoe rs ro, ad dene rentrent

Toe ae often masacqiston in chien and does
ens tends to mir the rat of ge in ght yh ed
Scene af peak bone mans Rens
‘Gis sur he pubertal pr and the oh proces exer
‘than boys bu makes experince «longer duration rom
‘rt and higher grow pak than male” Fur o
‘hee peak bone mas is ace whinerese sk of
le opera nd tres Exes er deine a
ro hormone ri hormone, ant hormone
{id sc ro a alo lend w deed Done mine
ey MD).

Déni edu osteoporosis is calengng because
peine BMD values conmanly change wth age und
end om any ar such por y pb
{a mage lel matrtio, bomen ación be se,
by complete matter muy eae ofl
[NUD pelissip ar scondary to gay vr
Pulg condions and anomalies tht att eg
She and purl derdopmet and may even af
Sone ses of he sl more than others Pedi
MD send y te bs rene population
ne o ley gender und ae mata com, aa
Ft aan ied The Zor i the ier
tact teen the moral BMD ae en the reece
‘al, croi in sandro dean (SD) ane The
core dos ot scan o some ofthe vues pe
‘uly mentioned Gender, body sie perl sage sal
mato, boone acon bond dehy) ok
se problem of ga cac bce veil me
rene ia dinge td say be dat ep
‘Thus the dioss of pi copes shoud ot
te made based on denso lone Ze vals
Vito =? ae general med & serios waning for
espro bt mos pels d nt make a ie
Sat ast oe fly cure hs been bred
rence of croic ba pain andlor eaigapic ev
thes of raced bone in then cd bs ps
opera The ter ow fon ma for hole
te Soul be ed e Zee 2 ower he em.
see soul ot aper pac bone repr
Sine gay cir consti be dial ale of
opera te fc ses For low BMD 1 came
rond bone tenth phasing tiber fc
Fares ded o complex actors ad not oly» pe
umi mestre À noe apro t De Gl
St pic oteperss lcd on the sli
Baena DAD or bone miner contr (BMC) ad
sue mas becas aio musa werk cn one

incre egin BMD ris he dios paran
o pei oe à Er

the mot wily ied and the prince ol or ipods
nd management fault opera sul ere 9
borne (DEXA)* pois low alten do,
10 pein, and god ero, bt It des no
‘mesure volume Bon density and dos at dish
‘lay are when don a growing mb bene
‘Reanundereiatthe tor deny ae lor alerones
el over o gr oc" Ts bone mil
{parent denaty (BMAD) seen tobe the mar acumte
Fersen of one deny within he peña popu

on bee of ls aby 10 great volume rare
met do DEXA css wt he prefered method for
‘suing BMC ad areal EMD." The mon apre
nd eee ses for densitometry incre re he
steele sie and a body ls head Our
‘tha fr mening IMD noe quant comput

‘ned tomography, qui lrasund ad agate
‘omnes nage,

Anita guidance reading hey Key ait,
suchas regulary el oy alnced di and eo
rer ft al, and droga rc peti
{ince to preven bine lo an hal art fm y
‘pe Tiss an ren hat the det profesional ean mean
pct onthe palets hand ths ld be aed
every real i In at ee euer of dc IND,
oveing yor nition and eam ond vita intake
log vi proto, cin pal activity
‘rove bends with minima Te pe quin.
{End quay of pal cy mat bee othe pede,
a dal saa ofthe patent, bese guet
‘ntonemay ape ara otitis
ie fr example Lae tania Dvds
an case incre stn l party hormone
tion” Sof dik consumption negativ Ines one
nina accrual in aan gb mee an bop
‘Growth tration perl db, on mat
Decora pri orar Ante
sare aen sc as Bisphspboaen sow Done rece
{on whe allowing bone fermion 1 ca, Te
shoul be conde ely in pda ptes whoa
‘aor estan “2 pec when raue cur ser
‘nial tas nd afer all priminug mesos (eg,
“det urn) fal to re Done ne" The Seg rng
indoor yards bene sr
aii cl facia and nding ace uc:
lst death pc in aber one and bone with a
ie trover te Alone secc and say in
‘ia hs become cri cd There ocn
vas reading optimal Diploma ge in cen
optimal dovge und duration ff Ses ie
Se ind uch as a, oops ad

89. «soap ee rl crios are rar he te
Pot, evince dc nt spot ue of ipborbones
As sudar therapy pode cn wh cody

ORAL AND DENTAL
TREATMENT CONCERNS

Pete patents dag with owe BMD and stop
ricino being ete drs at yee
‘peal cr in the deer fol and dst are Dental
Profa haver be malo tbn th medal
Bon of cred ne wth sec Ra ce
eed ec many may ve hina fw BMD and
or rio o ple bo

1. Mowatt MD Taringa om
hc othe ental al py ret ad
‘Secon espec pren moy hd
ne ct ae aly

2 Wht i the cue of te ent low BMD or

3 Warme ng provide fer te bene canin
Me po opérer
‘areca ofthe jor RONDS Bae may e
mind ery for wech or mot par nd
rakes my at rember hey ok ey rem
iy al part o 2 sec qe.
‘Sout me ry m an eae
{he dag porn ln terol campos Gre
‘tie de mye se ye

locaton ofthat ad cars about he impor
tano ole ad the seal long ar side ic
te dog wih nae etal procedures a as Bi
on o AN pal acs of ooo and cn
Infection ma be done ee he patent rep ui
pbospontes Aig ral anal pecdares pe
‘iyi pen who ave had rae bg gen tare
as IV) Bophphentes (BI, cal dere Be
"kof BRON Inia reg the eal frm ef he
ru met comiera or rk of RON ha he
‘whore IV fan Tere rinse deceo
Suggest at ipl placement tooth craton ander
urbaines hol be ruine ave opten
teca oral or e ra albo dran fe
therapy (ener thn yea) may cet wi ee
‘pment and severity of BRON One cn pect Bat
cin of primary teh may ot pue «ak ee be
“open of BRON given the ive eal woud as
Sr tthe increase port and wast of the je
Tene punga compared ott fwd Aber
‘enon maybe th sar dn pen tere Putas
der 0 the lc al ocunen of BRON) ln pede
patients present many ds as (eg, mal numbers of
rent co deletion thet lwp peri
ing das and deed, ch mat contre when
Interpret he eta Hosen, more ales ad

young adultare rrr fer orthoses seed xo
‘es elo npc eth nd id mols een
tl ser and toe opie the ko BRON coud
nee Hr rca vivas procedures it
Populi the pede er mus colt de pte
fica and obtain el named coser fom ie
‘Great hat unbe petty of compl.
The pub, danois and ment BRON
Pa Ben der in deal acute

phonons cas ht ont movement poda à
robe fer then therapy which depend oso
‘ie al to move et us ten gested tht
thon ramas be ein patent ib ghd
ig eel faste inten sch as tbs who are
ere one rod IV BR The ding pa
fo be aa wih dyed wol ep in en
ih Onogeess impera (00

Fetal Alcohol Spectrum Disorders

Feta putin disorder FASD) i pendagrer
‘met tern idad à rn spect of stra
stores and marocaine and Lil dis
‘eng rom eget te doping no bel
‘Therein wide rng of xro beten ec
bol ea cha seem (AS) ng ms
erre fm of FASD Caters fr lagos Ia à
itor of muera! cto ingestion ad some componen
in each fte flowing ars canoa dance.
Pi, pen ná portal grnth cardio, ná
Servos sem CNS) dancin (ena er.
fen, larme bien an Deal ests)”
‘he American Academy of Pela recomiendo a=
ec om aha fr women who a ru pla
ing came rg bc tr posts e
Schal comempúen during peganey The of in
‘onal ingles inh fring of women ig fe
a mare inks pr ocaso et once awe incre
yoo five ines when the mother le 30 Jar ge
pére

Fetal cobol nome à the lading cate of mesa
sudo inthe Units Thee ecu
‘one from uns files and pet ma pacos!
robles and eng adsense Schal c
ong simp wi a arr deft amie
ha reece pent tree ci ocio
sh ste ná gc aná case and effect They ave
euky gering fo one station fo ane Ts
pps 1 be central t hl ey ve independent
Ing poe jdgment and gene opcion
CRANIOFACIAL MANIFESTATIONS AND
DENTAL CARE CONSIDERATIONS
‘Themen common fus AS dude miohalni,

‘hort palpebral Sse poly deve trum, thn
vel hdr, sn tng of the malay ar

90. [CHAPTER 4 Orland Deal Car of Leland Systemic Diseases 73

ron paires

2 FIOURE 4-4 Once of ol y ron Pr, Se D Coen orto eta

Er

(Figure 4.4) Patents ih AS can be discimiaed
from sample gop wi 00% acc yon
dificil mesures bed drena tnd igen
ech gta fal mag increible in
oe detnston” cid ehren mya presen
St late ct ip with or without del palo. Short
ture and micha ae the mat pone pro
chenden the ice et cd. However, mon of e
‘iy phenotype changes ith he far Becoming or.
Titled In lee Vi of hein othe le
rum ges aniones of he os and cia No
‘dir have dco e ate of dental rr it
Porn. In be etal otic, e st cheng factor
ET chide wih eal acolyte magia

Pediatric Cancer

Canc the second mot common use of ata in
‘renin the Une So eran Theincdence
‘sf chdhoodmalyaney eres inthe Sit yar fe
ra second paa Yes of ae. Tere ot ld
Tet algae fas eed etry content ih
apps 30 chen beer Dand U yarı age
“rod with cancer anal in be Usted Ses Aste
Temas Irmphomas tan tumor, at ae tumor,
‘iden Edy ga nd advan meine ae ig
ris improved ouéomes of weten, ring m
‘opens as ge inden over idea ore
arsine arc is cant tei ae u

The mulinoal reten aprach us surgery and
date coto lua ete and cect wo
(dine tren dea Chery incita de
‘prea o funtion of he otal mudo aie el,

sehr ro therapy damages DNA cancer cl
{hina armo acer ens (eal in pie
ten)" Rap dng co ae more sete and
‘Bow ue eds yat gen ihe
sein one being see tration Ratha
‘tgs overs de of meo aser peal aed
rc anal pce y 24 Baus alow for ea of
‘heared ses and 1 poste at he dro
Siena of tamer" Aug improvement ie chem
‘heap adnan ration have ll lest ade an
les mln sul even, augerp may be
rear fr lui of temor Bop ct,
an o rd ck Imre ello
mmol anode and potins o mor desu
‘th the porn fr tra pci, wich may pure
Chien on the majoria acid ear
col emp.

cae pd edema (AL) acom or abot 75%
of ll chad aera wi eh idence a ae 4
ns and symptoms we snore ety, etary,
‘emi Heng. phi, fer phadenpah, ie
name. and hejtomepy. Bone pin and atras
ray be as ce y bee fon of the per
‘honda bone o jim or by leukemic espeso ofthe
‘dual to vale? The mos common hed nck nd
‘ral anions of ALL atthe tine a don are
Ipmpaderoatiy, sor thet aye fin, igi
Bici. ad md ia? Pat win i dog
Bemaopiei sen cel wanglntten (SCT) Mange
mac ALL a o cal kan iy ved
ie ur pas

stem den eg, ee pam el

91. 74 Fundamentals of Piti Dent

apart) wih 998 sce ate. Achievement
‘of emis 1a own peel for pond
ev

2 CNS event aprecie the CNS can ac ot
ancre fr estem ater sue only
initrd cemorbrpeuie us amt con te
‘onan Br. ral radiation ander we
inc injection of cemeterapeatiagent ly
‘threaten be wed Tas proympiomat eat
mem can be done in eel.

à Omen wish deine to nie
the cape of drug rs resistance tough ten
Sd tests na tempo sy remain In
eme.

4 Mince med a sppresing levee growth
‘trop eins admita à meto nd
‘ineeptoparne The optimal length of pi hs
Beben eablibedye but asl ats 25103 yee

The patents od cunts normaly st ali $07
das ae te begining of exh eae eee they Say
Tow frappocnately to 2 daysefore ring ai.

DENTAL AND ORAL CARE
CONSIDERATIONS

retnent with chemotherapy andor radiation therapy
Testo many ete ndlong terme ef bona
(Gon 1), Onl ad deal fio my comple Be
enc nent a wel a diy sito meti
dior guay offerte chs Aa or qe
regen in cin En nd alcaldesa es.
th ec the problem, mining de rk for wa
td sie ten pet (ips #5 1047).
‘Tame sted wth ol Eton and amg 0 de
‘mac, chan pt incon, nen he ik ef
Being. Tiere be dena contain on ey dg
‘cl patent sdb dane tones that enc ies
vato creo completed berth cancer ey
‘Sars Bey pen should e weed scoring to ind
Sloe an repeat th pant and
‘ter eal pce shuld be sr fre el re
Cire

PATIENTS MEDICAL HISTORY
AND HEMATOLOGIC STATUS
A thorugh revu hold noe information about he
eg dise, ie of gms, modales ler
mate aient at ced due the ago (Chee
thea. alar, rei, ic) and complication,
[needing rele Hopton emergency rom ii,
infor (oth orl and meme arent hemstlege
ans ales medicas nd view sens be
Inge Kepa te) shuld ete.
epa given entraine bch an nel
lng air ited nto e ih ao of the he
weil for dig God arms md antag
‘hemotberapeatie agents, À cnt ine ca be partly

CZ

2

ORAL ANO CRANIOFACIAL COMPLICATIONS.
SF CANCER THERAPY

Acute Compleatios rom Chaman

tnd adore

Say ind onen

Sanders (at

Tate ncn

etl pesen

Bergmann

gora cis a angst bs)

Len erm Compas ladera to te Face

‘eal ra

Tate dsc

gs abate ect

ona anol open rss (wth
ersteren

FIGURE 4:5 redentor ey tot
A ar a in ae go en.

Implanted (eg, ro, Hickman catheters) or bcutane-
‘uly Input (eg. Medion, BudPo, Para Ca),
Te inn sie eines the med of ec
opin Poe raie Sel precedes for pte
tve ml no

Proknged ledig in tod cancer may be cased
y chemother induced yesos, some medi
hak nd dere f ting an ptt red to the
une die Gal ican: si wy ©
(eer ths tele oun peter thn D Ihe

Kaduse.com

92. ‘CHAPTER 4 Oral and Dental Cate of Local and Systemic Dieses 75

+ FIGURE 4-6 Are enn pe yl
Dane

+ FIGURE 4-7 tement mot ine

ace ofthe coming actors Dental procuran
core ent pi count sr an 00 MI,
with tegen pa mere for contri prolonged
ing" Oter caption tess maybe spproriste
for pete with vr iment snl cil
Cases.

Nespas re he boy fr ie a defense hr
the idence und severity linen se ver td
{other number When that neuropb cout (ANC)
‘dened eae the rk for dewlopment of infos
Inenas gr. However, many oncologo live
ie deal war be competed an ANC sve
‘arm

ORAL HYGIENE, DIET, AND,
CARIES PREVENTION

Rare ofthe di hematlg sus inerte oa
ee sgh! entre oly eaten impor
tant decree orl complica” Montois
‘ould noel toman orales pants

‘Blood Count Normal Reference Valus
‘uo Couronne _ Noms Vato

Meme) Me 1638 omen 8
Nor 1617 106
Mier 5 fomi 7-07

ie ce
A teers

sealer tush vb eig iy rent pate
amt" The ls viene thet pent ho do ie
cane rod of drain modes
‘moc it cing an re sete and
nen inter a3 A reser hr
fran ci rah wie ent ie ly the mot
et mean torbellino cd
Infection nthe mir Sponge foam ries and
pen bras aot provide deve mesial
‘eng beac of thir ses rie thy shld
not lee arg br Brahe soul be
“red enema ad otr withthe mein,
‘Sens ob codec eau cage am ate
er During top prio tbe ott
Pcksand watering devs shou be ole
they may beak he pi a the ses ring pets of
ty for mirra coeiaion an eng Uhr:
‘om be and etl lot an Be nd the peti
repair une" Pte who late oor rl es or
event ewe can we Nori ae ay wot
ho gs af th ina ps of macs A that pot,
‘uc cating ltl and Bering age shel be
inocua dere ad re the mom,
Frodo infections major conc becas colonia.

Teck ih cancer may beat high ordenar
ci of ia es arthemore many ral peti
lions conn high smoot of mern an they
cad te uc ina manne ht mins thee ak
er example ren sald o! be sowed fl ep
vi amp oon or with time woche hat

93. 762 amena

‘ot gar ft Dept th fact at tin i ßen pre
eed ei nt ee at eventing Candida tons
In inmuanaderees patents and sald not be recom
ended" Vering 3 am a ie tet ofthe cancer
‘hep. 0 the patent shoal ine fer ements ces
‘sth tap wate or any Bad slate o remove the psc
hhh rang tthe ral dr and may case
‘amd deck. ii suplemento ad metal
aie rs o els ae inca fo palets ir

ORAL AND DENTAL
TREATMENT CONCERNS
The pate dal stay hole review and thor.
‘ig examination aten, ceo, anor sat
{nd hed ue shold be performed, complemented by
{adopts wie inated Some pts may cat
‘of pues cane y kee ala peri
ave Oben muy repr dera pan mimi e
See alps the done of à alerte
icon Tis an bea sie cc of vinnie a vi,
sine, wo commonly wed chemotherpeatie age
Tn hs eae the pte sb vd tos at cr
Vit the dic (wet ce), and snl cu Le
‘esd for pin canto The Pin una appears
Shin afew dy asma ae ecc of the cu
Ive cemethenpy. Patents may ao comp o dra
penita mente à nt we deta ad
ca be managed vas top Hude ora denn
cal

“he pants Boo com ally stent normal
ae the chematrup pe Whe me emi for
etal cae ore he orgia! therapy arts infection,
Seien, perdental cr, and sources of ii
Should be gen higher sit psy than cot
teh ot canal therapy or permanent eth and rele
‘met of Ey vert Tek or pull tn
{bd pain told determine carios os are to be
‘raed As, bee a pl feos ding ino.
upon cold lod o à Metetning eaten”
‘Temporary retro can be peed, nd nace dal
tenant canbe ded un the psn? eth lo sub
id Pe tuner toad be conser re
‘peavey and 24 ours property whe the ve! i
‘een 4020 an 90.0 mu When the pt vel
‘low 19000, desl ve had dd During
manon, ll drive dental pocedares shal
Beide cae 0f emp, he pyc mus be
ntact before any dental temen inated, este
ree rau abit coverage beyond endo
Fi prevention, an hop ae maybe cesar a
ema management
heap, deal say ad propa sb be ome,
hei reves sh be replied, and teh ih
Sharp edges soul be pled Alca the har been
no di o date tha adres the fer of Pam,

lp therapy in pay te eer he inition of che
math ndlr othenpr is prudent to worden
‘more radial ame inthe form of src má
‘ie the rik fr nl and sem complications of fed
ip ler deine nrmroycaón poo wich
Lan ue nia: impact on ener temen Teh
tha hive aa ten play tested ad ae cil
‘nd graph sound prt no thee Sper
‘Se oneal ermanat wc lé eee fot can
bay lt ck Bere non of cnc rap
eh u poule, nets indie loved y
bo then for sot edo Eade tat
teat of permanent eth with asymm pal
nahmen cn be dyed ifthe patent neurone"
During inmnenuppresonnedng ná pure eure
may ot be prec making ome fe ca Sof
dote infection ving them cial dette”
tn tis union, radiata alto deine ea
loc facto paces

aed ebodente applancs and ce mans
shouldbe removed if the ptet has por oral ype 0
eteatmentprica cars ik forthe depto
mode 0 ae mc Th pecado fos oat
Sont ap planer standandiope an re
‘owe ling ah” Appian can harbor fod dir
compromiso iene ad et at mechani tant
Increasing kor seconarynecton Remo pp
cesar wal may beeen song sto
‘ol by the potent who shows goad al ce Y Sand
‘emo int posible mouth prof orale wax
‘Boal be ued Ares ne rao”

Partly erp mors can came socie
case «per, so the ota ir!
Send be ceed ifthe net tes ve penal
AK Looe primary teh hold ele line ao
‘ayant prevent cere he pet ul om
Sd mo pay wi hm epic cnt ogy
‘ith he recommend oe teh shuld bere
mp teh ot tp partly ered thd molar,
‘eth parlar aci reer an mm eh th
‘eu to and resort shold te rene
At 4107 dae aly 2 eh) foe acer Bear
‘arto alow adequate bang I+ permanent ooh
not be exa fr medial res at ne, de
dine dent can comas amparo
{ove the ging, (bed by ata oo can tren
‘ih cctencobal meh stdin the oot cl
‘hater Ati ve fr 7100 doo ser
Verd, withthe xtc muet done hen the
ents hea ats aw" area anio
Should be gent exact of manent teh pens
Noire our eed radon tote aha
tthe ri of ordner Srpel road mar
eas au a posite, wih no sharp bony gs
‘emaning and say doute af the wound
Teal meses to conto dig sch preste uds.
street pone topa rombo, r merit

94. ‘CHAPTER 4 Onl and Dental Cr of Loca and Sytem Diseases 77.

colin shoud bernie fo menes abe
ran mas be cone’ imme.

"When the ae in de minenance pe of ete
‘ment onthe over pogoss pod, sky ht he
mst tr co normal Dental procesa
e dre ri bt not eee checking te lod cout
odon temenmay store compe
rl By ten te ik fps I dated und he
patas oo longer wing immunospprshe du
However nic mits ny dent depen
strbncs cuy hecncer erp especie
ente depot (ge), Dal
and asc del the ring teo provide
‘thon cre fr patents dena ona 0 we
Spice at mini the ake rot exp) ws
lighter re) terminate reiten eier than norma,
(@ che de simplenmeodlo the este edad
(9 donot ret the ero However specie des
for orthotic mangement indi optima foe and
pace remin une, These of gow humor in he
Seripment of the calc structures in plie
‘ce ptes has ot ben filly abled, Pda
tet with ance uy develop estore and many
Fee kiphepanse, which ds to none

‘he vay of cel and dental are. Thee ies we
‘evened a more el eee

Hematopoietic Stem Cell
‘Transplantation

SCT hasbeen ed replete maso of pes with
ema dorer congenial imnnodefcencs Up
dims an inborn corso metal ar wel fr mare
‘Roper to low the amination of Hiper ds of
‘hemethgapy andor athepy opens with od
Samora Fhe em cli uud I HOCH can be obtained
from mule airs of tone marron fm the se
‘stand the Bones for the ripe! oad and om
the cet er mba rd Bd. The lca be cl
Tsd om the paie wn mar toos want
land, om «donor ree wo the recent or fs
Fine pron (logs plan), oo an Meta
‘i (page wann), and rom à lern species
nop transplant Human kate antigen
LA eying one ten anges on te ot
tum of chomevee 6 of potential donar o match a
Soy a pone tow of the recipient ler pr
‘math few do loe ration the pent
ited 1 rece highdosechemthrpy soe or in
Combination wah leiden Bence feng
‘mens aly event between dys 20 an amies
‘ler by nera wit can patel counts
Its sandy tbe presence of door cls on atten
capte

DENTAL AND ORAL CARE
CONSIDERATIONS
Mot ofthe princes of dental and oa are for pe
patient der HSCT ae carte ced
Inte seien on peda cancer The momajr faces
res flow (1) SCT, three no eee fee.
‘contr return ermal hich oes he management
ff nontranspnt pte and (2 he wl be protege
inronompec falo tanıplntaden, wis mos
ima fois eb ayer yr vente
bocas e Gr Ober compile mit
Present There era tester man de co
Ped doce the pas nm order t ate
es thet could edt comptons ding nd er
Erin

"belong terme equeny af oaxamintione il
vary depending on the several potes compl
aye an error
Reg el examinations wit gras cn doe
rove, bt ie deal wor, sli propia
‘ould beveled patent with prooand impairment ol
Immun union" y deal ene wc ing
"het period the pat psc mn eones
y etmen insted. Orthadente retest ai
(arena re de ane dic nthe previous tn

‘Acute and Chronic Oral
Complications of Chemotherapy
and Radiotherapy

ancrtberppean en aloe morbiityin the orale
(Ge Bar &1ycompreniing the Gus qty of ie and
Ineeing rien ete Among al complica mac
‘is ee Rise 1) senos common au of pln
In ent vent end the mos common comple ia
SCT The gen ed inte propre rene
in ep alec os ofthe gti mucam,
Inking tal hon © rep the sper cle
lego geral co afanation, The or
ene ted seo ma ho peat inl va
in wi ane changes noticas between 4 and 7 do
ter the aio of therapy and el ating oa 10
to dae managment ete a palin of
pin and reno a non nd wa Maco
ind all ther ct and lng tercios oh
ner aran elec exten ened
Pe

À longterm ine of pata intrest for piste
esis ib development of dental anio cnc
normales ee gre 4) The younger the hd at
‘he begining ef hemp (opel efor 6 eus o go,
‘hegre bere eat an enlistees,
‘neh sooth gens complete or pra aa of rot

95. 78 Fundamentals of Pedi Deity

e

,

FUE 4-8 Lorem es nda Seven Hero by cated wth ee nd y aan

loans wth hin tapered rot yaa sure,
or an conil romo, denn and enamel paies
‘Su def, merdont, ered pelp chamber, tor
onen, and anormal oc" Delayed erp
permanente can eos toughsome ren
one da o! hav bres in dena mati o rp
in of hee permanent enon Verka growth of he
‘dylan these und mehr Bight ae avery
cel y SCH coin

an ar for magna tramlrmatios a de an
ms and th shoul e food ds "Crema
toring of rai mom td eral fat ver bet
eue ar very important sues.

REFERENCES.

1 Dag A ek pt mug
en

2 Üben tree ne
nenne Sarah it

a fei Rina Ba Aa o
‘nue ese Sa a
a ei Gun

7 nS Pl Hei md pr ns

eh roma On tee

der ng ml
ete ro ote dns ce
fs put Drug ese Up aha
MA ire Pe Wh is he sl
lca uy OS Sha se
secant ri

(Gein Sica ae
AE ne
> St petal ed

Tonite

er ne
en dto

xe

96. ‘CHAPTER 4 Ora and Dental Cate of Local and Stemi Dies 79

2, Gat Lr Wide op a
Sas e

Fes me

sx Dad al Ore
‘dpm tel en eM

pr Mei ec mene pee
‘gene er tesa os D

rc ella en

en “
Hen aci oda

Rn ru Sa gts ns
oc da oc bcn
Er RIA
ES

rpm
Pcs e
So md ae

a Honk hg ee m

© Dec innate im

o See accep le dl

10 y Dorf Empate Cola po a
‘raat Mago ame repito ren
as aa ere

ca N pn rhe dd nl
‘Se eu inh de

sa fat fen Mee Cin fee ned
E al

date sf
‘ett Dn o oe
in oer

can AN oi Bets mi
Spoon put eB

pn

ip a pat a
Em ey a coca (SD en DA
EEE ES

14 Sop Do Yop D een ee ety
Inept pin QI

EAS plata ol

ee er

cad Roe ht rt ds.
cosido inn Gays ae ehren
SET ETES

A ea papa

mn ects rt on
ss Reg a pco
‘ner oe

‘Regu bone aL a Aman eco

da Sey pul pr

ppt ann e 20,
a

Je E acta
Pe

1 Zo Byrne ecc
Pe een

a Kane ai One Deer ot
‘Shogo ct rts tr tye
Ernie

a aan Bh dde.
pre Perte

1 Ba ange ws git
‘ees in tenes ae

19 Bie tea tl be ds q
A En.

a Sotho ete deta tn ong
Senna ero
‘Semin ed alee
Saeed an

Nowe it Rion Late Meee
Nocera rar

ed tie CA nr

4 Ta Gén rt oo I
ng fc ce Pf dp ple
ne ws,

1 Hal u a Ghat an
[efter cs mice Spee gate
ei Pann espace esa Wan

a
E
een

Eee,
RS eee
em

ans

Er

ten

ee:
o

Sea
Ba eon
nn

Sr
NS ne

enter
NES mes

SE .

97. nn ann
re our oO

se Dr nse D On cone
on Mn oa ad Moma
a Ma

1 ta nen pl ri ei
‘renee pes ch

2 Bate Wiis rata
Pe een

Dalle Omi rre cr

a m
Sh Rn Dicer Ma tb rin

‘gen nan pi hte,

ee

an

heute here ateos
EEE TER
D dr a dene an
LEER

o in men m ci
‘pt in at

‘GG Game dango dn op

‘Ra ani cea
AS

98. Topics in Pediatric Physiology 5)

Treuen len presents paraa changes
ot hlcareeofsnal Thebodyfthe pate
aten not mp a miii veo of so er
dt counterpart, hd pyslgy and anatomy sn
ant il on ht of dl Pd
‘Ser use nes when ri eps cies
tout youn pera especial when went ices
gt Rate andre of dg adminis, dongs,
ese and dation ef cto, and posi of wcll
ae enc be unig pyslogy cool
Thu chapter wil ew Bane pipes of parie
io incuing humane characte
Ind ty Pre sae of amp be mel ibe
seedy organ en cae compense evi
tha st beyond be opel be cae een
rues on the prince dt der candy fon
‘hone ofthe al pen ire publ cll pp
{tos ope denise are made

Respiratory System (Figure 5-1)

ANATOMY

Several anatomic fetes fte pei etry ac
prados the youn patito brute ad cls ef
oh ge and mal iways Ach upper toto]
(ci prone 10 obtain a several tes The ron
mal pause ungen corny dipopertiny td
ered away dametr chante of fats und
Yung ren pros tis pate ppal opa
comple upper say sucio (gare 82.3 Ad
‘el may be pre by rove lc procedures à
ply dared mask oer te nares outs ack eres
lg ca ent on oF seais pose displacing
the tng all my rene the hood of upper iy
ruin The rein nd edema sci mh upper
rep nenn alo cn compromi the pete
ina shold be hep in mind when a ae ch
reports fe an dene procedure Bronchapum. rygo-
pm. ete ji edema with stir nop
pen hp sica, nd portate
Croup ae anion de compas of nba tt se

sere ch rep ines cen

¡ELO

Due M. MeBanx.

Restos Stree
Ann

Paray.

Drag Costa
CCassovascinan Sert

Drag Canero
scores Sere
Rea Sri

con ano Bow Fam

Temicoogy

"eo Body ss
Pine Pre Ps

oor Hasmos wo Demzomunr

pricing ibn ade pa mor ns
Fecommendsporonement of an ive rear un
the lud ben fe ol symptoms for I week. Abc
ein cornu incas o ana andere
procedure witout endorach tation, Irse e
es that sn and symptoms of lower tc met
cha ev a C1004" or ge, har, pda
vecu uba, o uch pain ado o story
asma, e more comely are wäh are

ee morbid. Snir bacterial ntc e ss
‘ected pate shold be pace on aiii eya
{he pei ponponed fo at eat 4 mec” ale
eh way nales par of encadre ad
Be appcacic mit sec coat ae 31). Cen
wih history of probe edoiachal nba muy
Be pde enon und ns may be roe to may
(ren In addon, trendy these chien (nd
ms index higher than 40) map av sway pens
‘ested re eck ne

a
Kaduse.com

99. 2 Fandamemtals of Pediatric Dentistry

—
Door
= =|
a
E
=i) :-

2 FIGURES negro tematicas
en eG: tees mr à pss ai à
cin Sones)

Anatomic dfeence in he cits cet age can alo
conti espe) probe The chi ches vals
toe ers tan thea na, lc men a ower
‘elton reses ar ese to ed de longs Te
‘Seu es il whch men hat bs an ines
‘uc ba ppor Inthe apie pore the ct
‘bare more bars place asf he sls
ui ice mas terms mae reaction
Toei Thsthe ptr andabdominl mace
‘igo wisely gud Aloma inma ce dt
an inde movement of thse mines eying and og:
‘nuk vento an lado nach nat and incre
the rk of apro. Anything a nits dpi
canin held be see, incide sin onto,
id promotes psi organ peste onthe apa.
Instead a 20 0 30 dere dav poston i een
‘endl by many authors 1 peint sch per und
ey minimize rik of rain and aon

Ting ects I lla in de plis pal
sion abl The majo fac ar fred oer ts
nd the ad ember fea ge pr oly
boat th hh yr fie Ad albo tn fang
Volume 1 boy eater troughs the He po.
heaves reste prepat afro rat
Er

1 FIGURE $2 Deus pri sy tar (rom Sade: A EMT mie tek fr Pana

Cees es 02 Moy)

100. ‘CHAPTERS Topics in Pediatric Physiology 83

‘Congenital Conditions and Associated Cal Features Pertaining to Away

ero eg arp mero ton et hp pine

‘Tee Cal tee Aura nd een an nds ori ria EO

menden) lao alo a np ae

AS ‘rl sss tome veia pai Bead o
‘hed put nd mc gan pa. ci veel ns

Fine ra rn mea opin prop ple creta

arcs rin oma meet et

Galea dre Tri nd de rpc und unr opin abn oa

emia sn)

eter ed ron pl ace a

ng

Fa ph ng on a I ca pol dedo
eof tn ml pc pa cand los rm
‘mown but ted or sry

‘ail pene

Conga inf ile met ea ER TR
‘ese

‘prone fre
es)

cen POT Er BE

tan i oa
np)

is da
tonne pane

Get compa
pad)
Gt tone on
Spain

capote een Tarai alone pl
ee

egal rm lo i ar pr
De

Ti Regis dae
res

Fa ma cr lr lw we wan cea eA
ters rom émerge

ise sarone
cacao)

ae ces eed nae RP NE D
ri eto at phd sacra tec cg

Shane pone
(copa

Foie Green see
Er)

aga maces m u

Fae Wik ae

SS aes pen

Oran pees

one one ne ri hr ne ihren wre aa
“pn of oper cera e

“tis drone ng
peros)

Tei ng nd mani pe nil roo iho el pl
pr eee des

‘Sete Css dase Gruss aa ney any pi arm BT aed ae
alte ceva vert an
hen ne Fa rang ved ple cop aaa ding
map typen. pte cole tury al
oa “ep dee rent ray ions ered ap ii
mas e Lange Tai art me mi pl pr phos ión
sn

101. CRT sei

PHYSIOLOGY
Bee of his ate ine in ses sure ar,
‘ten es gee ef erecta vena (A) pot
“nit of (proportion pre exchange of sacs
(he abe, However, he tt lume ofp exchanged à
ethan o al, be area rl copa
(FRC) FRC did the some operen in
Tang atthe endo normal expt

DRUG CONSIDERATIONS
‘he AVRC rt Rls to determine the ete at which
Change in pied gue eoncnaton set cinc
opens’ Wie AV supports tempor ef inked gat
‘ough the dream and othe brain FRC termine
evr nc ge inthe bg ing oral cath
ine Than the AVR ao ices the Body reas
rte qt change in inhald ps concen

“Goeth nd gh A ndo RC be un eet
AYER rao, for example is alo ve ümes dut ofan
“dale Young chien cn be aden aves with
Aimer a Sonnen tan bee qed fr dat
Pen Foro reo and so beca el some une
pect pd hn diced erin sp,
en ste ie kof ordre om nal
irchng hipo, Dar, nd porron.
Gef montoring of al signs ero ese

"en undoing inst aer for ena
pro,

Cardiovascular System (gue 5-3)

PHYSIOLOGY
mes ar Bi, he infant's edna sytem
gin ar emperehngethatwilconimefr he
ft decade, Mer Unica rd ping md the fet
raster bets pulmonary uc petanca and
hehe el under serra changes nding ste
‘the dicts trent sa oran ae

(Other phsloichargscntnoethouphotinany
and ehidood The heat te hich aaa boo 10
at per mine inthe senor decos tugboat
oot by à ya la men ts rs han 109
teat permite adhe ts ar general td by
10 o per age Be D

Cards pt, dled the prod of hn ton
rara he tol ood pampedbyonecortee
tn ofthe leven) none by sre vibes
Int Tina hare ii denne
nd opi huge she volume Ts ea e
mc mor importan determinant fer out in.
ina und young chien than sin dl apa
opin hee are in er rs optan
open. Atte spe tine, pnsmputbee tores

FIGURE 53 Crash tem peri put.
e ma St

uo mado teint evo pe ich nan
ic ae group ismore prone sigla bayas
viva subio Examples of mansos producing
vaga man include deuten, badder Stein,
sur o te aly aplican of het pack and
ai bacon Bert ol Be potential lor may
Induced radars wth nun, ren dei
Meilen of the ainay se Bom renee
‘th apie or smi paras pate cing aer

bd pres, in comas fo ear st, end te
"rocio chend Neen sytbeblod prams now.
Born ages fom 751 85mm Hg there ba 51 Mm
Hg ince ver te Sever weeks fe. A oot
pres als ae general che by el adlecenee
Tbe 52 dpa verge a peu fr cen”

Care put ao canes th ge Card opa
gram of boy weg a Bighn In nono a
ray eins ne rt aa eco ol Tee
‘Sly ponompil inn myeardum sept pao o
‘olden change in aro ld ont nd emi
biennn pudre cards laremore guion
ee

DRUG CONSIDERATIONS

Changes in ac opaca have drama imp on
‘Reape ia ae pets À sodden rue
ia bent te ein del ere expt ch a

102. ital Signs by Age:

CHAPTER S Topics in Paie Physiology 85

ann Passsont (04 Mo)
(oor Peace BP ox sor

Hears Rune asno Ramet racers Hes)
for (ua e name) Cs rea) ion. Gms
Fern o pe te E]
a Go al ii Si

‘Pham eo roe pre

‘snmp nia hm
tum incre the rtf inhaled ae pate Beca
{OW ofa chs are pat ef heb res
{niall anette ap act with dered oe
are ompr an signet depre centra evs
System The dees! ec can nude end rl Pre
on in vasomotor en nd porra) vasodinton which ‘te ee
(an waren the hypotension asa wi sian
brad. oe

Braue of hs ptet ave ets nhl ans M
thetic sould wed arf in he pei population E
Te sents ac more py in len thn als am ac. >

hen ate deol sedated ower gas coments
"han hoe rege forks?

To miii the hypenve response scat with
poten drops in bet te, pelt pent shal be
Frey relie rares rearing ined et
Esso een Retro vomiting ares, e poor
ral ab nthe as Bee the rca ae propre
Indo o sociale

Gastrointestinal System
Figure 5-4)

“There are sever important hygiene in the
hls part sytem Tho flows

arcaica not rachedant te 2 yee
ae Beer me, how iy of he ano gt
avr absorption ef weal ac rps sah as pn

Fins nd cplospori whereas hesborptino! wey
‘droge ch te Doris eyed.

2 FIGURE 54 Cowon ste là pda on
Martie endear) aa

+ Abed mil Gat emptying ines ae pican
Janer daring cn ina Antgeempping esa he
Youn aan can reach E oars and on ts aut
V2 loutre Gand 8 men cape
Tenge py ines amined ie regu pe
abi la) peel rt nome ui sg
also

1 Aired hepatic mein. Many drag ae mtb
phe ter pe eyes may o dy dro

103. 86 Fundamental of Pedi Dennis
o]
foun ie ur ca der ers
Bere korean dada) Lor
te ame nein iz mont
ere td wi daa tin lc,
hen ad pci esas al De
dio un vel cnc cari ben

Green, which coger res ine
crabe om, lala eet eat rs
Gites ar the ft month of Be Morphin ac
Fica seri and sl apts lr ge
came und the see cto a
denne

"Te nun veri dient in pedo
eye are 0% of alts dre it several
‘moths oK Even when cleat on an due by
gt val ihn os donot ech aut er
tl afer 2 yeas foe The eco scheine te
ere exaggerated nthe infant. Deve ben
reported asc th soci mine.
tween with dr mat nd ote
‘te eno enger nommndel Seine therfore
‘inured wih cain to fact pue who may
repond prolonged apes

Renal System ¢gure)

‘Thagh rugs can be creta bya number of physi

Kee
mer

FUE nel sptenota rept Attn

lel Grea num deters

andorra excel. Beat of matar pci,
the youn ke Les competent fo exce mg Most
Fes reed dus a dre by lomera Ett
or transport, ort cis ofboth process

"The ame Sean ne (OF Ihe volume af
‘ero valo by 2 months o a oul eves ae ol
frets the norton ll swe apache 8
1 ment cf ge GFR parts the extn of
ch commonly wed pdt drum the ping,
Bor acingburbiute an levar conned
apes of thse aun fr infant and tds ae al

Tuba anpoı doris rou of mechanisms hat
tente ro a dog melts ees real bol ep
‘lm Drain cabal ap poemes
rue nad morphine apie ad sl abia Mary
toch dove deca bla amor ns youn
‘tran us ave much mower mang of iy
va pc populate, Tar sport meca ge
erly mature by mont of ape

Blood and Body Fluids

TERMINOLOGY
Drag mea and ein ar profoud feed by
tet aos bad id comparmens Pd dat
‘on among es compartments signet ent in
[nfs nd od, wc in am aer he an ef

"A review of aly anomia may beep
sis point The wal body water ce canst of nr
‘sl CH) and err Ba (EC) compar
‘men The volume ora (Va that vam o
Nha du ube tbody quito Albo
Vai ema mewoed in par (he vole of plasma
{Gren ng concert hat rue acto era
gn the bp many gs tbe int ty es
Plane same.

PHYSIOLOGY
ALTERATIONS IN BODY FLUIDS

‘sth child ows, changes body mas ae companies
by huge in body Hat computer Whe ul body
ner ol 0% ofthe infants cg mes up ely
SELTEN formal ad Sod weight Much he
Volume lo me rem the EC comparen eee m
mc na ee ver ay tale ig mos
Le émise tige er pe nt of ty wog
‘Stun herpes ocean ge np

PLASMA PROTEIN DIFFERENCES

A number of lama pct fc to Bird dug in
beba Poe potas both topo dog td

104. ‘ender it kes Pyle ace whe oud Seve of
"hese poten ning serum lui and plasma obo
gs tat ae hy pros bound (eg, vii ad
ei) ms be pen at evel el pe ni of
Sy wight in ths pnts

Body Habitus and Integument

Chidrenarcobvouysalethanadattmekesinaive
Ses ht they ned le ro ds otal hers
peste dr concentran at srl dons at nee
{5 produce today. Te mama sale dosel Sa
ar drag reference mana suey enough 10 oe
ove pdt paren waht ted formas we much
[afer inthe pe poplin and are appropriate all
‘tthe mal neon

‘Not nly isthe pal pat sma, bat is propor
tims to ken nthe ofthe ale Bee à
ag re om batho dana th mi
incre tel daring ut ame pel, many pl
als fel that body ace ae (HSA isa ore cute
parameter om which % tse ro dose Mere in
ae meter BSA eat ting he chs ght
a ue on anomogam The SA med shou ot be
sl pens wen es than 1g. The aio of ESA.
Lo body wege ght i the este and alo sb!
‘neath of hi vl bn dal proportion are ace
Jus er par, We SA lara edi the ia
eig 1 convie Ge anil 0
setas ben shown tobe proportional o maple y
og vale achat Ba requirements, on con
“amp metabolite ad rd ete.

Te se compone fans and len fers as
we depending o Stopes tape Fa mai up 10%
15 159 offer menden weight ines to 261.
25h dto eva mnt alle ad hn deine
ringe Wider ad poo ee the comes
me se Some comal wel dental ative (emo.
spin ad rat) ae idole andare een
Sey bound by any tue ts decreasing serum drug
Here lle hr hen wi lower cep of
‘oly a maybe more sente osea

Chil anatomy and phy ie icant from ta
of dal À working wedge of the erences ls

(CHAPTER'S Topic in Pedic Phsology 87

cn or the pda dental proies, who ans
fd tes crn at every devant sage Gara
serie thug rc opa popa
il promote sí nd ais, del care. Ros
be the pela det [side reference hs
ica the Har Lae Hank tera and ter
con sauces and pis the commu

1. Chand SM je td an
‘Sitges ar
den

ee
Re cee none
ur Te
Pas So 11993-19130.
Se
EN patio
rene
oe
Barum asi en
a
AE ng a
Seemann,
Re
AA
ener rta
rra
— ne

105. Nonpharmacologic Issues in
Pain Perception and Control

Sremtes Wnson

he pi word pun is derived rm an ancient Grek

‘word mening “perl” ad à in word mening
phone” wel a “ply” Whe he en pan it
din nal dens e eine pny ns vis
Soong disco Is portant to rl at ete he
nu perp ad near fc, Pan gas
rel or parent tue damage be energie the
equim ke cn im reberig or eng pre
hee In hs see, is deste experience for maa
Fand gung he cies Be

Ais lope wo undntnd at pao mer than
ur ein consequential reponse hy
Fono mufa incion of yee chen
mor, aie (emia) coa, perito
vial and scl ment Corsa, termine
ef ow an ni interes and ef pan ae oot
‘ey undemtond Howe the body of kale e
Found the understand of pi eel as bps 1
‘Go and cero ply it cien nd wehl
pie.

An een and ina rn pal experience
curl fem hein pence Tee e cope
easy refe o ses” and Ye” Chien and
teen Begrofundy inne he ree ten
Log many evens pre as arm, ssf or bth
inci various demal procure For example, he
2yearold child mb pn pat abc man
lay anterior tech da o nung hate ars ad pot
ares the jeton flo ana and extant
Vine resrainedinapepoos bordillos ay develop
Soong dape and ein avis Sch Ebano
may dde gi or witht eae placing ans er
e mos refsng pen the mouth ln star,
Shaking the en, ping, an ig, Tee may mans
(ring segur! den oponen.

ike, at patent hn fe bn but ciber as
lor san al by a dent wo ws ot comet
‘Sr emp muy five ditty mang and hen

eT

Dernananor Pane
“Faso e aon Pencemon War ao How I
Es

Sr

Gt Contd Theory

Meet

‘CenrtaLNetvous Sem Emerson Pan

Conroe Euan or Fax Pesca
somos Exe or Pat Penco
Cuna ano Pano

Buon Mana Tecmiquts

Suokr ato Lane Te Cowsgunncns oF Button

Definition of Pain

Pi ar perl ant acing Go dem
ihr rl (eg sn ain) or pptet Co
faces Bol disen) asa rt ofan aeqat elo
Under nrma rame, the sate of ps ples at
rei à mulet abraten of cor, ematical
Anderen mau at pons te ton
da ren tat.

Pinca Btn nest and qualit sa conse
quence ofthe page a me Tis my es sit
‘bein serial France inch
‘arp ost pain inthe er back of pere
per eiiqu may ange oer ine
‘Gd trap wa mite den, leche at
y nant ies with routine ele

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106. (CHAPTER 6 Nonpharmacoloic sus in Pain Perception and Control 69

Payday pin ince ner sgn hat ae
transite over ltd of pans nto eons
{hate pad in pce, chemise, ad pe.
ico sb loca rapes te
‘ome organi in a erry fem vaig por.
onofthecensalnervoussyem (CRS) Ath loi
Ten some of thee responses ine Farber ansmson
feat gas andthe wee neue and
sony sv chemi (eg, aminobutyric ni and
endogenau opi). Oter sens within ts reponse
archi hos ht ace motor acts rp
Poel eeapestloter el emotions ad cie
eatin ofthe pain pee
exar showing th ematoaland opte le.
mets he pin proces have cite ls inte dere
pln arenes ans psy more import in e
Indias sy once seen! whe ending
the sui es consequences! For tance, copie
‘medi (eg, cove disco) that reduce he
peeved culty and gay of den ca be ee
fray ght oa pa fore th parie cl or
lara pin Chen trough the proces of
ago, un be ugh (vying degre) 1 or or
16 abi pannes ul ma ding cancer
pis

‘Theories of Pain Perception:
Why and How It Is Experienced

SPECIFICITY
enc ves mery union of sang» parr of
Fesronstharenke mes parlg peak. in a ni.
‘tthe a a higher Ic ofthe OS signing dito
fort The neal eee (Le, re nerve endings) and
proce of pin Jus as be ents and pathways wer
ot doe rang er en loma

"arios of his theory ae rob acute dei
nerd er ra prominent nour andere
‘ofthe pn mechani, but the inp of the eo
ds iadequte expan the male nature of the
pu xe hte ain eine a

PATTERN

A gy more solito mode of pin means
rosea onsen ofthe chlo ayo record
Simolandaced sty wien earl pato Nev
‘vty carded ad apie on an clope aol
ome pco ofthe changes in tng an poping
‘fee actin potent at a cmsoqoence of mann
in simalas parameters ght sling aos pth of
‘lin may proa ce or treated cin pol m

large meter neurons sevi the ae, eras aho
mir erming element) my cu an ind bast
Fame y end ich fc otra im ae.

ovas rie tthe rcogstonf pif stil by
‘tendon bu rayon he ter of eve
cin ut entered CNS. pth hor as nde
ae 1 xl the compe dl e pin pence bat
Besntbreipiantyt te ancement oie
ao pun chan
GATE CONTROL THEORY
‘The gue cono hor pain gue 61) ws developed
Dy Mec and Wal 165 and as ben he mst in
hi compense, ad aapve conception of
fal an coseguenest dea These o eo
proposes tt arcs "ue? online kel of out
Top vi sl her nus Be spa cod unbe md.
lite by eter sena ger neuron higher CNS
Input or bth Posted pecans fre qu nde
ae inition ees on secondary anio
el the spinal ear Im sence simples a ge
‘her (eg seer toc) can ae pra delito
‘ofthe nee termi of mal ers fg, pa) at
net ame clin the inal or. Tis ree
{nthe tle of fee “pocket of ewotansater ole
ler and à deed load at nm cel wi
fumed ie

À mp example wold be the meri init
sory aol theparentrbbing amp ar eke
Inne fig a ters fall The Itrabo,

ES atc ar

FIGURE 6 the pe crible de 2
sega it es od pe o 20,

107. 20 lo rio |

proportion ates greater numbers o ar ers
ii psico cated rl Sher. det a
ing ip dur nene di and deb
al anestesia comal ebd y manto det

Trance etica neve mation TENS) or
he uc lm ney li mation at pre
‘ey fs ben on orev psn” Aug the mec
ti fer TENSeedated pin reif not ow at
been ses tt eral cs may be det at
‘ison fo dant primary ers Bt nun
init sma ter umo a pei y the gre
"ior. ia mechan may scout the et of
pe TENS hs bra pce pra el
{ein to cecil tnt pl simon in shel aged
irn

‚Property more emplas has ben paco! an the
ree and dene of higher CNS moda a pan pre
‘eon nd ea. The errant the
na ol mere opiate sin the ed fr
{nore competen espanto copie evi
nd motor inne in pun ection ad conte”
corre of edogenas pd vides ron of
‘poi ceptor throghoa the CS, snd erature (ey
‘ker sima of ONS real in pa e
‘i devon abo have sued renewed nr In pin

In adi animal tale have documented the pres
ocean nee of desen Spas eh
on modulating pall pat level? the sale
Interesting 4 hemomenen ald ina produced
alge SPA) ha ee demonstrated in ot human
Animal. SA nis In Speci ibi of pui or anid-
nca dongle acer
‘ies (gs pue gray area themed) and has

Fax cet SP ofthe eras rayareahasben
Shown at opening ves due to 10 Pulp

NEUROMATRIX
In more recent yrs be CNS and moe sei te
components the CNS perl re gerer
CAS factoring Ge ton e md hs become
‘pope fc ol pi rere In one y. à BE
‘plex nero entr mati perp rad
led to sde prometi gue 62) The nr

mare Hong tie ame rete ts bt ande
inten byte ern ad seal even The
sus of the gene makeup of the neonate and
{inate fan entity may i o diri
‘ch nd tds ei ough our
{Bat eal pong ad this of ners avi
fare Ms ben terized hat ners can Bp
Spin compete sats pl I taa o expe

ene» pred set pts terme
tata or te ins medios (oto).
‘Ths act model unde sil mule à sof
fare rach ad in dugg, andereandg and
pig ary inkl condo.

Central Nervous System Effects
on Pain Perception and Control

An endogenosoii sytem a htc fe
‘hon and iret toros he mamma CAS at
en party care and Serie" Edogrost
pie ar pepe tat ate earl bei the
‘hay aod celts ear we th of opm (eee

‘ton mean uni, e

a

108. ‘CHAPTER 6 Nonpharmacologic les in Pin Perception and Control 91

morphine. Endorphin one of the mot potent pes
{hd hs a N mi em o tha mece,
veni vane oe rs pi pepe ltd

cac apo pep ere kom er pre
sor and at vario CNS pil receptor stes incl
A]
Ane Data by moore à ati Ego and sc
ray Comte lo sete ad special michunens
eig the pin perception proce

“Comes er ave ben a lea four opiate
receptora racer € ad nee) hugo
{he ENS Hower de cotton of ech produ
‘alesse not ler Opi ian at ind to report
produ poten anal en md inthe parie.
nca PAG) reihe mella Other ten extend
‘fom the bps othe sa vermeil
inline PAG peace anal when opty ima
teeta ory opine Cnet lee
is ae we bale tbe pray meted by
fodogenus op and, or alt deel atte
pe reper”

Tree thi sytem cold mediate change in the
«precia motivan and ce poses of une
cep sige ees the CS I ion al or
nes in terms of eter supe eee or ur.
les ar pose.

The tence to sags that his sem ders
‘aly inthe CNS and ths shold be facta in youre
‘Bille, Th erent ale ne and the con oo
‘ary fre ran ae not derstood. ate ute
role il under the meas and afl oc
‘ing te ein art ced pla e

Cognitive Elements of
Pain Perception

tod fen sbsguent eaglion of pote
a faction of ting Kung volves à multado
Ine ng meaning, ening and opening,

“Coin plie an avr fete an external
cnvimenal ice on of ea inte
‘hat pa cn be taken fone to qui contro ovr hoe
Fans end we te cl wahrend rapoue (eg
‘oping For sance, one may Le experiencing some dir
Comfer but can paul imi he dere of dicot
br pneichg mental process (eg, imaging ples
her comia lesa acia teh

‘Apron can cape have o condi nding
rca enormen depending en his or her perception
tf esti actor sch as ane and eer
‘los ofthe stati, ir ad nial rares
{ppt ae important he oncom o coping nie
1 Coping wheter reed or nt. a temen of et
{onal ect that e mos rearing

oping ater may idad ypna and con
tee mue, model, dan. end cence

on pic, therapesic copio segs ol pa
geneve number forma mens ning
Ganasessment of be poem, 2) nein of
the patents point, 0) derlpment of apogee
(68, beating ad reat) () genen and
rin ofthe ls apre rap, and (9)
‘arremen of apesta

idee sppa he natn das coping lin the
conte of in any cn be ght event chee,
ind th fetes a copii ing can be etd
‘ough apor, logie or Behaworl mene In.
ne hy chest wer undegingrenortne poe.
res were taught deci and apport tiques
Begin enlpeuedurr and smut.
pare tha op o chen wo were rend ar Sl
Feat ande for speci procedure (ge inte)
rin os who acted the cope rang an
Thee bo dl not” Th ede crees t Be stat
‘che aged ilrensbo hve ad partner ci
ficar ln any prova drcumsunces ma do
Beer if they kaw th they ae ete a ji a
par of he ween et tan to proceed witht sy
cr be own percale coping sl in prepara o
Dern

However Loing ahead of tine aout impenda dir
comfort an ave einen ft nde ean onde
Se Fortunes hele nc etre fin youn
‘hid sn coping e Inapabie of agnlanı coping
Sete (Ley 3 Yeas fle) a procedural eed
inl mas (ncn and dang teow ore
{ponding le tinea efec ears w a ie
Sen pale tha the gi of otra outburst tre
Sn flog the procure may be ed under hese
comes.

Som ds indie taal wh rd ove
Ata hey have some cnt oe impeding com do
bte lance o if ml However ato
fn ay paí slate apreni a
"peta ac in moda be dae of comfort
‘Those who ack his ality may pla more ra im br
(epica) nd “at e” under here

gate developmen nd turin are hes w the
sce copie ates Thre leiden ht ande
rain ae tina he meal dental ern.
nenas ction of pein so apd coors The eset
o whch hae arten ca e cl apple pre
serie edit Homer Jorge chien
Are ap spat pin malen ro proces
Feeling pie reis none, ly tera
vi medien und dal Deore venpuctre re in &
een mare rp vet of ert ate and le ty
‘movement win § minster of Hood drin compared
ith conte. This ding was espe as idee of

109. > Fundamentals of Pe

Emotional Elements
of Pain Perception

Although pin ad th anticipo fpf ial Ge,
amie vee à perse emotion experience most
mans he Granos andeaoding ofthe senda
tothe of nich ep Ca, me we eg st
coping sober sing und only in ber
Ina oprime pen tl of
ante

“Ta epenion e emotions cnten ding ox rc
inl experiences most iy compe came
partly inertes yet lenin tempered phenomenon
are in fe Anlfanfssprenien of comfort
rating rm nc anges with ping ram a more
ih eig andere to oe o spon,
des toward he ox object and sometimes
Dore

"An red ced ma ot be vey pet ml sh ore
ocean emeenaleupauingererheroriscn:
Aion Ti i an important comiera sehen ang
parents to observe injections exacts ad ther tet
nt precedes Cell ect by the prin ol
‘he prety coce an kl repose mode it mat
Inporantoneanipesthat he pret wl bee
Stepper fhe procedure, may Le ava fr he
ae te the rave thee pe ay
witht ut

"The sol reset pln can be a commanding and
ten ping ey” Fr example he kr who
‘Bis ohne during fl iy may pets ifn pln
nt thepret scandy reset de jr
hope be hl my but it tithe
rent ks upset or ouphen up wich the spp of he
Facts veal engen.

"Albo one mht cone of the motora ents
14 pun being end othe pl sl be emotional
reiner may sc in concert ote puna exper
‘hers ne nd anecdotal evidence gr cern
Frame opens eg rs onde ad bend
Fines) cn are lb CNS response fr emelal
nen. À pen eo he pln bot st partial
stooped it

In cots emotional dite in npn of com
forts knowns owe pin resol and eras rc
Ay. Cope sate depre tc posite eatin
sates can e elie neg eat and the degree
repars pal sm

Children and Pain

‘Spiny ite ion about chen end pa Sadia
suggest tat de developmental charges in repone
fel sen oer ein tac, I ac, naar
Fee of sharp jeta be sen in dren nd et

cf ap Aa hd mares drop broder catar
Andes avai of mimo or her sh
Commute flags teams rat opted
Paring and being the chil copie delo
‘se gor manifesting the evo of oping ale In
{er the pan shld ends decir a the sl
Rene lpn become re deceo ieee
et Sars management ends sr owe nthe
young deal pue, This phenomenon andante
‘el fom the tracks of maple cr di
(beta of coping il pectin ol cra
‘del noc,

"The pun aut wih deal or ber media
ings procedures might be instrumental voi
opportunity forthe derdopmen und tigre
onl and coping machin” Many Chen ae ce
‘Sent with ei ping sil und oleate md conne
‘witht ove apres A ech going and
pay era avis (eg, exter par, seaming,
‘nd sui) in amic pao ar during mine cam
ar. Coque, any ame of chs bear
‘5d cgi reposo 1 the desl eniromen shuld
e consider in igh ageaprpeine expresion, po
e redes and the we ol cogne prob

1 may apps cl o mare dee of pin or
condor à youn il especialy pechol ken,
case of th eve of corre ad agur dera.
‘ent Sever tes have ee developed er hs ores,
Ang mover sl sp cine Thar he ie.
siya pu ma represented tember poker spa
‘sical the ing of vrai een on bpp
fx he rag alg à pan rat ae an e
Le

An comio of evidence nde ht he via
analog she (VAS) oe of the mos rela ad vai
nera nk for report of pn chien Typ
{ps VAS i ne apps 10mm in eng ith
(Sch end anche y cure depo (eg, 0 ps
‘eur "worst pin ago) or Rapp nd fee The
tet nes the dere prev in by malo à
‘uk on then. The ag of he ine om ee aod
Bar tthe mark deines te made of pin or
{ha inal (gue 63). Certain phys mer.
‘nents cycler ste in conto wi lego
comiera hoght mad rather impor den
Sn tobe crc repas to Pl

Family and ultra lemon apparent te media
nl preted espesor ná hr ft An fats
cry may et poet md indulging per of bhai
‘ly abe obvios ak oc Pay membre
ay raped diferent 1a hd pil pens,
‘th females being more partie nds sales
‘orcas and cn Some cer he
‘het fat dies mehr osa et

lo summary many factors may conte ow child
pee of pain MéGr and cales have ed

110. ‘HAPTER 6 Nonpharmaolgi ses in Pin Perception and Control 93

2 FIGURE 65 An arde a ang that co bso mena hedge fc nce Noth ot

Icom bgt mat he andy ay hehe ed ya The to ae one
tre ot con pa o ag ntc Mn lens Lor mat oy hse ment

FACTORS EXACERBATING CHLDRENS PAIN

lotic actor

Scope dere, amet depen ane

Pres ete ib made anal p hs
Teel cone)

ns rete mercantes

‘rl cas

Any near anes

Ra papas

mens e venenos

Perl relate server oder (acom)
arr opa

idee u management ce that cota

ange ae apr ocn

fates that tend to exact the pi in een with

cancer nd ge developmental considerations for quae
‘etn ofp (ox 61 and le 1)

Behavior Management Techniques

A vai of echiqus cn be wed o mame te avi
Fl inthe dema envenment The estaban
‘st commaniaton combined with» cing ande ae
y bling tock for derdping sound rapport ih any
tet Coque be pe muy € de er
Encima maragement ea ter un roger
ton on what igang happen (eg, el bw anda. An
impartan caveat stat ee chil responde tbs or ber
annales ie Peon mst
be pace und ce wi the ue of ht management
aigue und opio the Blond of seca
‘counter by mating he len fs hat
ie patente iento.

"Te mean Aden of Peli Dette” pa
eed puller om teca mamgementof rend

= ‘orate perce

Tee peaked enr ou

Yes depen sten impor
more et

special pent That pub ichude denn ro
il and decipiens of techigus tht are com
ed o manage te thar ol thee pans (te 62),
‘The hs of ques Is ot exe but represent
the major body of emp and scene dered
wedge psy avala np mamıgemen ts
probo dat ever tenues well a remets
[tte preety exes wl be derdope withthe
il of providing both a pent experience nd pose
Tein Some thes tig se ice frer in

Chap 3.

Faria ad psi Ending sages hat etre
most dr ae producing mul in be dera ope
stay einen aa anesthesia aplican of he
er dam ed ination of oth proper with the
Bighapeed handle" Kane of thar And
‘howd pep te dent andor marge
‘rope favors at my company these pede
Fer arc, the etl gas sol arr lc hi
or her rm gy ave th tro and arms of te par
ig einen. a this sion, stat ae peered
do ire the cls unde she or he tempo ab.
‘he dents hd Otherwise the pet may dre

111. = TABLE 6-2
American Academy of Pediatric Dentistry's Standards of Care for Behavior Management
MANAGEMENT
Tem Descauprion Onscrives InpreaTions CONTRAINDICATIONS
Basic Communication and Communicative Guidance
(a) Tilshow-do Explanations led to 3. Teach patent ‘Al patiens who can communiate None
gite level followed by b. Shape patent responses regarles of communication
demonstration; followed by b. Giveexpectains of behavior
actual procedure
TD Nonverbal “Guidance of behavior through. Enhance effectiveness of other ‘May be weed with any patient Nowe
‘communication appropriate contact, techniques
posturing, and body language — b. Gain or maintain patients attention
and compliance
(O VWoeecontrol Modulation invoke volume, à Gainpatientsatention May Be used with any patent Patients who are heating
tone or paceto influence and — b, Avert negative or avoidance behaviors impaired
direct patients behavior €. Extablsh adult-child roles
CEST Process of shaping patients ‘Reinforce desired behavior ‘May be wed wih any patent None
‘reinforcement behavior through
appropriately timed feedback
(eg. praise, facial expression)
© Distraction Divertng patients attention a. Decrease perception of unpleasantness May be used with any patient Nene
from percived umplesant D. Avert ngatvelaoidance behavior
procedure
GET Presence or absence fpurentto à Parcipate in infnt examinations May be used with any patient Parents who are unwilling or
presence id in gaiing cooperation of treatment unable to extend efecive

child. Involvement of parent
in ils ora heath are

Offer physical or prychological support

©. Observe reality of chil’ treatment

4. Gain patents attention and
compliance

+. Avert negative or avoidance behaviors

E. Esablih child deni relationship

8: Pacitate rapid informed consent for
treatment

support

vs

Ansi aunerp>a jo sere

112. (@ Nivousoxide Safe inhalation agent with

Reduce or eliminate anxiety

a. A fearful, anxious or ostreperous

a. Some chronic obstructive

required limited stabilization

‘onemergent treatment

anale scie and some, Reduce untoward movement and pent pulmonary dieses
must properties to reduce rection to dental tete 5. Cerin patients with special heath b, Severe emainal
Ansetyandenhaneeefehe Enhance communion and patient care neds disurbancesor dra
comminiction, cooperation & Apaic whose gagreeximrers elated dependences
Raise tb pa ection theo ih dena are € Fisttrimenerof
€. Increase tolerance for longer 4A pent for whom profound cal pregnancy
sppoinmens anche cannot be obtained & Treatment with
f. Aid in teatment ofthe mentally? A caopertive child undergoing à ema slate
physical abled or medically lengthy dental procedure € Mehyleterahydroflte
compromised patent reduce deficiency
ge Reduce patine
À Potentst the ef of sedatives
‘Advanced Behavior Guidance
1. Sedation" Preopeive oF pente à Contalansety minnie “ay ASK css ov pans who à Paint wth minimal 2
séminisadon of slave perchologaltauma,and maximize cannot copente dueto kof dental needs 5
agents potential or ames Psroogicalemotioralmatriy doper patentwih Y
Reduce untoward movementación a. ef anxious patient for whom minimaldenalnesds 5
© Guard patient fr and wre her techniques ae not suceso! €, Unadvinbledueto a
&. Minimize discomfort and pain . Camotcoopeate due emotional, predisposing medical Zz
e een aes E
Gaby É
€: Protect developing psyche or reduce El
rei ik E
Toma Tazo gene ante 1 Provide fein and afecve Pens cera pista mena, Helly, cooperative E
anesthesia? revenons intramuscular, det are ot medially compromising patent i minima A
inhalation) for intraoperative «ondo lol ansias dental needs E
are ineectve because o acute inecion, Medical ent E
allergysextremely uncooperati to general anesthesia E
fer ansias, or uncommunictiv 3
il or adolescent in whom dental z
care cannot be deferred: extensive 3
«sofa trauma; protection
of deveopingpayche El
hace Festin of pate feedom «Reduce or climate unoward Cannot cooperate dueto mmatarg Cooperaive pint those
sablistion® to decrease ko injury movement mental or physical ab; failure who have medical or 4
Protect patient fom injury of ther mangement techniques, __sstemicconitons El
€ Flat delivery of are stay ofpenypacttione would contrindiatngrestaing, 0)
be at ri sedated patents moy nonsedatd patients wth À
El

forlengthy appointment

8
Kaduse.com

113. caret themes rh elf (Ser Chapter
Due 2 fran ample of ha precede)

"Stu fers of ight ight lvl obs nen move.
menta and range coenmers ar aly aro in and
rot the mos overt espesos fame daring the
fryers chile These il found roy
‘eal operon! Consequet the dein ad aan
‘ould pat dera bwin in vey young ck
(en. Taking tine for devopmen a apor and vu,
‘givens du re fea o ae pts ge
or) and allowing a id 1 we them tal à
+ Ai sacral mehnd for pining à young chs
onen

tout rio (VO, ca beleive or
en wo sre ly madera ami an repond to
tie and no medial conraidinostoNO/O,
‘Sinisa In slave concentrations (0% o 49).
the tet can dere rom NIDO, bo a caming tet
nd some wage (lg Il ene is sal
eed) Key lent improve th cien NO!
‘On incide proper poet ction, maxing nal
becas, mining orl shang fir daring eying
‘pode soe fte aa hood overt nose af See
aber ha tht adapt tothe young ch ce, ute
tation aden mentoring

is idea ot thea paris Ras o abort
tory dis a wel as pompe connus nal
‘ponte o enero bue ave Ben autel wich
int sueo, fading bone marrow drain:
teen muni and roger ponte.
salis and neropaties™

meas alana ga pl i y
sil management tenue eto ri open
‘expres poste or he an al de dee
‘indigo the tment and mien of youve
re ia, al promot a te Mong ete
Ling and preven evi Hence he dentists at
‘ital the evelopment o postive aitu aout den.
‘tryin toe pene

Short- and Long-Term
Consequences of
Behavior Management

nonumy foe web coral audi ave acne
the inpect e esa management cues md in
nod on vor Iter iin Geh pret,
‘Racy, ha ero ood that some age eh

‘gue donner pets tare
{spec ithe hd wa rely young whe he ech

‘sap in childhood fave ren imped a bing
minero the caro of ae a wäh.
‘el phobia, Fay, rel ot enag information

abet fac dee this se ut andes
oF Resp, peony derdopnen and extern Ge
‘oman shoul be ar Dry An
‘Ses a ram

Alford els podtverdnfrcements been
ox to produce dere diga bave iin a
Arai min in cen wh lave able lvl ol
ne pen pra, thes or cken, and preyed
‘cy ated evens (lg opprunyto ach
ing rind undergo deta nen)

"Timeout (ey acing he ld fon esi env
ronment os rc tht prove dupe bain)
‘Spe dere pte rupee In accede
‘hedge of cen often ou ar ad cas sch at
the cut prod and he quency ol api meo
oes are Import cur Ayer, te
als to belive shoud be shor and ol use oe
roe inanenpato nthe bio, Longer
Kg fare

‘aber ch a paring sy, peony, pen
set and sity ve not bers ed spas
Ronan itis mind dat ach child uno a
“ow” he or she respondo and has distinguida tack
‘Bound tu forester vn deb pe eine.
Er ofthese arses inte cas bla

shoul cmpbusaed atthe ps mit of ed
ste dental patents an be mange with mpl rong
[Desveteiqos Howe even the se of teow,
‘eich is pera asthe mst cious tcl mo
rats hat he tien wil ot Dome dent phobie
parent won et ony ts us on thr cd
IC deste aa che 1 ewe ad compete
prie who Knows chess vi and paren!
Sections

"Guyer 2 dues behave management tems of
eal and novel tique pects of ld mise
vor and reed heer

REFERENCES

e
en
mms
3
a RP app A do en eo 6
a
ie na ch
2, Wal Ne Ra Dt Et arg
ee

114. ‘CHAPTER 6 Nonpharmacalogc sus in Pain Perception and Control 97

an ae eagle ee
See Cap

ote init an Pa pee pi
‘cline ayaa oh

a LE ni md sr
EEE

Gt Panne ea at
Sen anton EM
DT D Gral Le

1 Gnade O D a erent
Se A

1 PT a Een pice ei la
(Ratna cer nn fan eek
Eten

2 er M al er. D Bd,

1 er re
ms

eg tems eng ee
Speci tay ene Canon

A pe pa Ce Cr

1 Sart rn Did rg
incesto ead

38 lc esrb ao BR ecto eo
Per tre

Evene

2 a Pain en WPD Mn Tai
iS

1 RE One ai dome ei
Sn par pa rl
rat ate

24 ite est ter an

A
A
es
ee
Er ue
En
Bee
asien
nn
Enten
een
» SERRE pra
ES
=a
Re
een
EE qt
en

115. |
171 Pain Perception Control

Semen Watson ano Sreven I. Ganzenne

ini compis moldeo phenome med

cd by Mpschemial proces in de pupa * OUTENE
sd eta ners ster CNS) Perception o pan cn ie
sind mod by any of aho of mens, CER

iso rguenrrnmenlleimlhcoweandemo. Loc Arteta
re Anda abc ció tems Mec of Aton
Ses ama heit ac aa nm A
(See wes boundeia enue y rhe ir ach ine
init On he wer end ft con be pin inte

pan ded The pain pepo het can be Athi Propre

ie rl
en EE
Saas ae
sn ae
Ds er
mn nee Mn

dido bowser, more inn simon on

Otter Fetes
Mca
"The ornrheiming mi of pharmacege agents
toed dey ae administered coe ame und Tot
is Gn he tin of pi ation nthe Cm Sem Room
al set reus ching a an perception el Hp
Pete in local anthony mind O
eres Anny cota, ur or comple, dy ST
‘ng sedition lr may inv humour ANALG
road chris or bath Any ad paiacotolin Nonna Anges
‘ual neal pace oe to icant eee 3
“Thaciobentechiueforeatcloeseyend pain “ID
Arte me) ave Y fre cen bolo a
mars deal paces oline Te Actas
rent nd vis demi hs won knee ofen Dome
Fier and ci, on a anal bas, ie me tat Nour Ant Dros
spears e mo apeopi fora arica pt. Op Arles
Ione cs ma neces reer a
Da

General Anesthesia

Groenland the pen ncn hh
ro ofthe CNS, ths cmiting pa opero
à Tate Thee ae age of patents in when the
aly rane anche aerate forse tenet à

116. nel ante Examples muy inde very young pee
operative chien ad ehren with etal odor
‘prea di who re unbe 1 certe dung,
epica orme de pecans

“General sera hold be admired under e
ection or per of ningun a compel
1 Camis o Dental credo (CODA) or Ace
‘ate Coun on Graduate Meal Elsa (ACGME)
Accede ring popu, ois equiva, whieh pr.
vids comprebeve an appropriate Yang necesa
to manage peer area cue Den wicht
ing mus Se end by the set admite pera
teres.

Local Anesthesia

MECHANISMS OF ACTION
Pin perception may be ee atthe pei ee by
king propepstin of eve impulses sng ocalanete.
sia The ia proces o pin perception ales produ
Fin of neve Impulse by noia malos that cates
‘pce eve br em cept nd lid
‘Reet and bers hat ans pla noma a the
(SNS The nerve pales travel o the eve bra vias
pinche! pos nang on trampor os the
Serra entras. The primary effet of ol ae
ents ib opener eve al membrane und Dick
‘epost at oto then of vam ans asec
fed with menden del: Current inking
aid tht he eqn of vent nove in ser
‘het ck onto) intra pen le
local anesthe and sbent dg tos repo de
lr cts an the side fhe cel membeane, (2) Wocade
tf he sou cha though wc the sodium ln
read normal eme dering depron (3) dere in
Sodium condctanc (4) depen of the ate of ect
porn, (8) fae 1 active rab pote,
nd (6) Ink of deve of propagated ston poten
{hand ths blockade condone the nerve ipl!
In gene, um eve Aber are mor ceptible he
‘nut of con ofa anne an reer Acard
ingl the sat of pus ne ofthe ft modal
‘lacked bowed by cl, warmth, tach, ands Hines,
eal aretes ar weak chemical ues and re
supplied gene salt sch Mise doce.
‘heals may ee ito forme ihe encargo
lr bs e 4 ao whose cargos determined byt ir
‘con con (pK) The ce form, wich i ip
‘ole ape of pene e nerve cell membrane.
ent fhe teme an al membrane cc or
the lal anesthe 1 ha an effet beaut the reper
‘tes re ned o te iio of he cal membre Ti
plas ar by lol rc opts ments
te when ied nas ofa ac afec whee the

CHAPTER 7 Pin Perception Control 99

ces rec nce tee ba a pete
croquis ad ao cp th ms
‘hat then mec ih Be repos preven Sodi

LOCAL ANESTHETIC AGENTS
esters

Diner In 180, caine ss theft alae
‘ecu ofthe number of dense econ wth
enn temps were made 10 devdop armies tt
‘ined the bed weh pope of coc ile
mining thee fet Sever eben cd et
saine wer depa ding beats, pro
(Sora), rca Porton), and loreprocine
(esc) The major protien wih he eect
nent be ropes 1 produce leer,

AMIDES
‘The aries we nr wh the mb of one
in 1943 Thee compounds ar mide denso ey
inact u. Thy ae sey fe fom ses
reins Sine cin as the lib heal
cie hve ben nr for data we. Al we
Amies and incide mepivacaine (Cabane, ic),
prise (Canes) pic (ree, chaine
(Duran) and arian Septcsioe

LOCAL ANESTHETIC PROPERTIES

Individual bal nett pnts fe fm exch tein
‘th parma proto (Te 7). They ayia her
tery tiny ot tine nd rt Ache hare
fea may e lel Important, andl ary à fae
ths of the ie ropes fhe anesthe aer ce
and the repeal anette procedure employed: are
‘rth rc maybe modi b he sii
rte.

POTENCY
Their poten of ao ane he consent
in eg cr he dred nerve aca nd à
test ected by slp sity, Proc Ts he west
ini por Klean pocas, mepivacaine, and
ario ave made pte, ad bupivacaine and
aise have pen porn I importen ne
{hat tae ype of al pais da mt near
omen te ame concent: enc an lee to
ern teeing oie dee lol ana especia
‘hen ud a conne wih er eget acting de
‘arbor nd central eve en (eg sare

‘ONSET TIME
Onsetineishetine rie fo the ases a
"ontopenetats there ber anda compltcondu
tion Mckde. The pi the most import fc à
that conducien Bockade requis inet eco ek,

117. TABLE 7-1

Properties of Common Dental Local Anesthetics

Generic. Max Rec. Ansorure Av. Duration Av. Dunarıon
Nae Brawo Name Tres Concenraarron Vasoconsraicron Dose (mg/kg) Max. (mg) __Purat Tissue (min) _Sorr Tissue (hr)
Proporyeaine — Ravocine Ester 0% 1:20000 levonordefrin 66 0 23
vith Novocain Ester 2 ‘Weo-Cobetrin)
procaine
Tidocaine _ Xplaraine Ame EJ 7100000 epinephrine 44 EC] 3
Mepivacaine _ Carbocaine Amide 3 44 EN 23
Mepivacaine — Carbocaine Amide ES T2000 Tevonordefin 44 m 600 35
(Neo-Cabetrin)
Pilocaine Gina “amide # © 200 Toni ha
60 (block) 24
Frlecine Clanet Forte Amie = 2000 epinephrine 60 3 600 EN
Bupivaaine _ Marcaine Amide 0% 120,0 epinephrine 13 5090-180 LEE
Biidocaine _ Duranes Amide 1% En 40030180 45
Aricaine® UltracaineD-S Amide + 79 day 300 Tall 20 dal NA
50 (child) 150 (hi)
Block: 270 (adult)
225 (child)
Ariane Uliacane DS Amide ry 1100,000 epinephrine 7. dul) 30 Taf: 180 adult NA
Forte 50 ch) 150 (child)
Block: 285 (adult)
230 (ei)
NA noria

able in European Cada.

oo!

Asus mepea Jo seusuepung

118. th, mé pis ye ns epg à
Procedure toon

DURATION
Duron ane iron of emos import nk
ropeie considere when chosing a apropia local
nei aen o given procedure and ei die
ty protein Binding rar. local neste wi
Inu pri no pa ana mocos wi
cloruro un age wih dene poten
indie and no menmeatiast Goal, prose end
oriol, vate wed primary for pase:
SS, e coser of hort duration ieee ep
Cno, proue, ad rice have an mate
Sua bres apace und cda har lo
oros

REGIONAL TECHNIQUE
A jor far Uat determine ra characteris se
pr of renal (oe) ae procedure employed
Bepening o ser opi inn, or à major oe
izo nave Hock employed ne and dualen el e
Varios ges wl ry. Por oo ee

a anes fhe of sus by he inane
sigue cc abs imme wth al the cl ans
thes As more te pene Becomes nc, he
‘Bric ley net grey eter
‘ol Generali et oy ven drag heat
‘eyed srt ha alton sk loge wi à
Feigen (minor) nee Nac, and logo fr pil
he

DURATION
uration area ve ea with therein tech
ue pedernal Ts pole may die ore pent
“depending on tintin pharma proper or
ample oca (16) wi epi (120000) hs
nar erw lock, 156 mites with epidural anesthesia, and
‘mines with pin od For dental nio a he
‘mus or erat nerve (AN) Back in de man
‘Bie, 2% doce wich 110000 epinephrine hs an
ee ae nee rio of 1801 308 minuten
{nd ppl anche time of 40068 minute Ur of 3%
replace ponies apre 20 minute pulp
‘ethene wih ner nato, ht proves
6 mins for AN Wk Sof tate rca wi
iter ehe 1200 180 min!

OTHER FACTORS.
Dose

‘The qui, ott ing and dain of cl aer
Bock may be improved y inrenäng te dos lean
ng ge concen or pester vue Incest

‘cuapren 7 Pain Perception Control. 101

in dong mus be Kine by anesthe om.
Towers for asien ec ol aca eck ab
equ concentration and vhume max be sintered
dost the rg nel) as posible.

(nse ine, dro and qty of ch esi ated
Bei olin soon agents sch as cie,
drew the rt of tete ds all y dci
lee lod on ad thus mania «her snes
concerto athe injection te This general pas
Abed oca ara produced ad incase Be
Frey with wich degree stained Toe
fos of lo nesses ar educ rc apo
no te semi latin eyed. Ost Sine of

In pedir deta puerta viscoso is grey
inde beca sp of pela pio (sce
In) ted to incre emi pil, thas prod à
‘horerdunton of scion and a mare pd aumen
tales in the no. ny, msaconaricon produce
‘cel hematin flowing cl niet inion int
‘he opering el Ti an poroertve more
cra bang he menage cl young rn
Sndeoig dl cios

Viacom a al smpatominet agents thet
‘any tr wn ain te eats Thre ide acy
{lh dret headache ne, vr aah
‘Sint us been shown tt 2 Ada contig à
«ocean of 12800 epinephrine i a cie in
icrsing the depth and dun ca asien lock
higher concentatony of eine, ch at: 100000
151150000 To pee ion tain
en à concentre of 1100800 pape should
‘tbe came The phamacloge pipers old lol
ehe common red in deny sre summa in
nern

Toxiaty

‘hee of lea snr io common in emi that
‘he potest forty th hese ea cn bcn oe
looks bento wea ches old sabe min
saa ant toy Toe rain oa act
ie muy be ue to die, acetal nova in
tion poc rape ale rc rien
sa id ab agen (sai)

The dental pracitone shoud de fair with the
min recommended dove fr lo nen sens,
rent dos per toy wet (eg iis er.
am. Simply Ano + ttl milan 6e the sere
‘Se snot deg and may lad vedo in pda
ates

‘One mst bee milo the pharmacokinetics be
lea testis sed a den Bere of the ie
rc output, higher bua meh te and hier

119. eye of tae prs in cin, the agent en
orbe mor mpl fom he iu The mun
ver cie tera very young chen may ds
tha oma ets ower fc hn nde len ad
dt Al be inmate etal ero and crio
ce probably mon sep to oxy alone
rage thsi os Forts non, a gesehen
Yasconsicor i pren inated, and à bou
nice of th inti propres of al nee.
ene Been

bee a the meramente masala du d bel
snes ald be ele pry ah paies and
tt ee bed Mad ae defor ae
‘Gerard in Tae

CENTRAL NERVOUS
SYSTEM REACTIONS,

Laca unse pnts cae ita inthe CNS
1 Hed les inca Alhogh al anette
dera ec in pene they oop to see
dee nto son italy pompe eo
(NS excitation Sue sis and sa ol cat
secte ind crconoralnumbnes tng,
‘Sinan (ten duce sbumingorhomming
‘ound, ope (italy i fcsing ey, and dl
siena Dres eles may be iden imei
nee in may nade uc hig venons,
redee, ant Mg lowed ren eue ace.
iy Genenlaed CNS depresion chances be cond
phase offal aneshe on, companied sois
Epica depen.

CARDIOVASCULAR.
SYSTEM REACTIONS

The cnrs reponse o lo acabe iy
ao bit During e pel of CNS stilton e
et re and lod pe y inem When pla
leeds of the ante ice motion ed
A mc depen ocr wih acen A
oad pre ran, doc cape and
arc at moy ost gl of the gens Most
Sealant wein den cause it cone
ne oa acid ec sry The
“pes ee one mca e senta propor
‘onal ote ere porno of he cl ae wi
proce big lent tos eco and epica have
Enemy and topico andere
Dépenses

SUMMARY

Theueeflcal ns pede ee bas changes
‘he qual ad quart procedure pose ar mach st
Any ber adresse Bel thre wo ie pe

prepara praia hiéh-qualiy loa asta i
Fay at nca mint pin comply.

ES

Analgesics

‘Orasonyphamaclogi ef of xn may be essay
fer thc deta pate The apt ar pla it
treme nae Heat up Sol ee
eaters perl dad cy bd
‘ina cor oot Nas ung hop 0
Dm athe CNS. None malo, mh à
omer entamer went be Aufn et
15 ic natn in God de perpen and OS
de ne pin nio Te gen my mal
pis ee pots ce mage ung niert
hen den oft geet pac of pen:
in pin and meet one ipo bre Sad
{Stan at younger he ads may de nd.
tread fr pun flowing ceria dial pres
Co

NONNARCOTIC ANALGESICS
Gemey. he nonaro ales are wel or dw
‘moderate pn wich indes the vast jr deal
etl procedur pin The sonnet alps
le or the naco in the te und meca of
‘con the ave fe prof and het ape ing
he doe sch macia pa eel cas
testi Mondeo er ann ammatar
rary attend. The sandr pro
{ype drag in io ds spin, camper nd
‘sono anti drags (NSAID).

ASPIRIN

Sine imroducin in 189 pa, sate (ey
Slee ac), as found wierd efor sami
nvr ep nd ninmatry proper
Deptt ae of my ewer dep spin ma à
sandr dg for comparo other alg.

he mo ga sd ccs ol sia nde shee:
sins of coplas by ieee inhibin of pl
gran ge dires and pepo lod,
and errar entity rescindir io
ert edema ath, or ana The aca
proper of apn re er problem chien
Er cms agé do ani am area:
ine im ap shold be ode dre ro if pon
epi shuld be avoid inpatients wi Meng or
tt erde nd eg warn (Cosmin)
rd

‘The gate’ efi of ai we the mon
‘he dog wit od or by aig autre a encod
preparo though absorption may belle The more
ee aer pes fractions ave bee show occur
‘nove fin in pes with pening ash, ap, oF
unl pie und pio shld probly be ame sn
Pers wih sach a tome The pasible simon of

Kaduse.com

120. HADTER 7 Pin Perception Control 105

‘Commonly Used Analgesics for Citron
Davo Cum (Grue Nue Tape Not Dose
ese Sie api Pos op id
eee
ne SAID)
RU
CS Teen APACHE IR mpg eur om ay
rer es
AS
‘ae ‘maim dove mps
Fan ot mecenas CS
Fe min dove sorge

pin with ein vel ses and he dope of
eyed has ee in man pacto opting it
spin sb pre chen.

posace
"The recommend sag fr mss andes pur
pas a ren 101015 mg gen at hour ners op
{0 atta of 4080 mg per ay wth amen ico
Auto.
ACETAMINOPHEN
‘Acanisophen (eg Tel Tempra, Dai i th most
common ange wed in pet In the United Sates
{olay Is an fective anal and antipyretic ht es
tents apr ormangenen of mil modest pá.
Valse np, actaminphen does not nk pe
non. ao cases ls ge ua and has ot been
epic in Ree re: Te py bung
camina tat ha o ay aca nin
amena proper

“oy ares ovrosnge may est in acter
fate wi sro or tl heat nt is med
ut gofaccumiophenrequedinanadato rode
rer damage or mare tan 3 for» cal nde? er of

ge Alpe rss we vey rate Actamisphen à à

Pod ehe nlp tens bdo mee an
Samar ec

DOSAGE

“The recommended dopo fr actamiophen are the
longe

ee en
lado (naciona 1
cory

Adal 301 50m ery ous
Chen: 101015 mese y 4106 hours
imal ove Donat xed Ss Ahaus

NONSTEROIDAL ANTIINFLAMMATORY
DRUGS

The NSAIDS, pupa eats of Peano ci.
‘eth ans fleas by it prota sn
‘hese the perpen and CNS. Thee ans poses ana
escandalo arma, properties tha ae apro
fe fai cpa o ois an are clive or
the munapemn of cut pain foi ms sen or
tema TheNSAIDs produce fewer ei probem han
es beans ce ition of plate apa à
‘ere afer men by te body. Oder side es
repre inde utes pe, rt ha di
es peus bepatidfonaon dren nc
on Fer ae rc fn nal dg i hating
[NSAIDs in cren, bu comen spent approved bythe
Food and Drag Adminis (FDA) fr chien we I
prof (eaten, Cte Ab) 4 10 10 mg every
Soar mp proa) 5 107 mp wo © tree
ine pr dy and oi (etn) Sto? mg eso
oar tins per day oth profe and marcan ae
ab ino penas fr

‘OPIOID ANALGESICS

The opi amg, gu need o a mem
ave ee thaw 1 inter with op receptor la the
(CRS? The naciona ent pharmacien fete

121. cancer ofthe aot ning ase tion
And cough sppreon. Nara are sgnheandy more
centre ad ate pan ha he ont
Amen nd day twig cfr els
Home ey can produce serous adver fects such as
sedan, espeor) deren, and, with prlonged we,
dependen snd the poly faction Compa
a ao bea olen een i shorter se There ae
‘many arate anos bl ining moi,
nep (Dene eta codeine hy dcodoe (eg,
Nove Vicodin, Lora), podar (cg. Percocet nd
Iydemortone (Dadi). Many of th des cy
era pre regates Irons,
And onodone are able or ral us. Oi odie wil
alce in iin

CODEINE
Codeine is the sndardol comparo fororal opildand
ls he mos commonly preted du fr mode 12
Bere pin in pen patent I sine wel hen
{en ral and proa in mu be convened o
ee om, morphine ah may be de mor
‘Sri un hat ot espns o acctaminoph oF
[NSAIDs Cade much les otr thant tre, moe
Pine. Side finde nee ston, die, con
Sion cape When gen nw oc ns
‘fet mate a por dug lor be management of
oh en ip dso owe ln ed,
{ory depen nd depend mn ith te oh more
ponent

“Codie may be gen alone as a Drug Enforcement
Admin (DEA) Shel deg or combination
‘rth another aac onal actaminophn eg Peal
‘ih Codeine No) à DEA Shel Gop

Dosace
is mammended tht codo be in in combination

‘eth tertumiophen when minita ol o pete
The The recommended dager seu fore

Chien: 051010 mp cae gen er 0 hou

Tae rime alloble dee of scumicphen with
(deine, hove, bel st codeine tomponan
‘tte temp imponen For ten de
ren dos in 24 hore

hs bee pred at cides ender iv
ca quart]
‘When coating an nal gs, tie hate eco
‘endl doef acominopbenor NSAID wi tetra
‘otal pin Shou hs sion oct code incom
on wi ccuinophe may provide teed rail
Inthe nenn fusion a ch dena pui ra
tor to thee motte, psy because de pat hat
‘ier eye ars ae unbe 10 conver code 1
‘morphine, à mere poten age chas drone or
Snyndane maybe wed The duran of sch dog pe
‘tou eel be be and à prolnge pred ned
forages shoul pomelo r Fie on
tanto determine he cor of pete repare pa.

REFERENCES

1. ern 6m HL mein mdi of i nt

À em AE DE 10
2 B90 arm lp aC
EB map tnd

> Santer epee na de

122. Pain Reaction Control:

he majo of parie dental patent an be trated
in rt delenit ebbing
od appr with he pent nd pret nd by eng ot
‘Sand Behr mangement hie (ne Chap 20,
‘he amy and pan of mary pei mal pats an
Se mans ef wang online noxe
len bo re nal (te eal pores com
Foray pe gene encouragement an aut lea
ee any ad pain cnt wil ne go beyond
SmmunkatieBehrirlmodiesenanäphpuchencl
UNoladeoftheaneomicpatep Parmaclos manage
mei nie ren v cana be mitad vi
{dina behavioral mangement tique and local
“he primary purpose of pharmacologie mangement of
young pent 41 ini orci ney Genera
Trenza ly dits re and doute de paa
Feen test. Shan, Gpe on eth pro.
nes à re reden In any etn ) an
ine oportnty for he pent owe kam cine
‘hills and) eduction tcs piel sim
ever sedan snd general nea are nt tot
‘se gain wich the Dene of thee cs mus be
‘rege The dereof sen depen ona ow of es
‘sel bt the dg) mitreden se
tet ef he pat Promise do cto ine doe,
fous and rat of nina, eed impor ptt
ee are ae, general he, sae and mol ate
"pora ed represents conto nose es
‘ey fom minimal sao (peony terme "a
59 to madera eatin (pro teed "mn
Sela’ 0 dep sao and genera aser be
raros of his took the new termini e minimal
"male sedation vil be spiel nd tele on
‘Sous sedation, ico ls sed pros eos Mary
‘eal boo ta some frm minimal sedan oe
“competence ee, uly nitrous ou gen alien
Sedation und por ra minima on When moder
Ae sean e gh 1 empeine etal schoo
‘tly an ete se senor dent stents and
most as focus on techies or ad pen. pe
lcd pe ains igh deber the pn
Sing on ning modera: seat o pedí pa.
tiny those 12 jus and joue Fes nin

Sedation

x Watson AND Sravex L Ganznrno

sounune
Minas avo Moorea Sasamo

rte Staion

Gana Arama

Monat ano Moomara Verse Dar Separe
Amia Question

Resa on ra Guineas at mu Sax oF
(Case ox Moat a Monanar Sari
bain Route

Arts

Dates
Praca len Italo Sedation Tenia
Ora Rote

‘cee

Dice
Invasor

‘hanes

re
Sabet Rose

no

pa

as

pra
Pragseacotocic Actors rx Soano
Seve Hyper,
Annie Apts
Opioids
Pare Once
Prod Seco
Du oro

10

123. ‘ond dnt choot formal acre ie Co
mision of Dev Acta (CODA) i teil for
he pri ep station ad peer ances

in 10%, the American Aden of Pedic (AAP)
“and he Amekan Any of Pei Density (MD)
sy endorsed “Caen or de Bective Ue of Can.
‘oat Slaton, Dep Seton and General Are in

ene Paes" The gs s te crest
ed arr seno pace hse ean tig
fer odie pt The mast rece pond pile.
lnc ing the dina of minimal, moder and dep
cados speed in 208 and an betray eco?
(abies

"The gies empacar gs of sedation ae
to D guard the patents ey and were; (2) minima
‘yal domo und par) or aby, mine
Pernia! tums, and mimo de pte for
Fiese‘) cont bear andre whch
Slows the mie complain of the peedure ad (9)
eur the patent o à stein which fe charge om
‘medal apro, as determined by recedes
ble

The purpose fs chaperis to oat on minima and
moet sedan an ou arn gun othe manage:
nen of amdey and pain coma in pedate pat.
Bese of he pet vea of minimal etn th
modems sedan sod moderi sedan with es na.
‘inand rl nahen hei mode mse deine
“nd modern duo a and more importa. hat hey

‘Minimal and Moderate Sedation

Minimal scion is « Quince ste dig which
tens respond normal to etal command. Ang
opel cis end crios beige vr
‘itor and car con ae ufos

Male station dando depre on
couse dig wich paño royo para to
Verbal command (eg. "open your ees ser abn oF
{companied y lg cl lio gap on the
‘oar oc, ota ml rb). The vet tt ou of
‘onsciuesshould bunt apart importan
spect ofthe dentin of moler sedation The digs
and ehnique ed soul arya agin of sy wide
ough 1 ener unintended hs of consonnes My
‘ey.

Por the ry young ptt or torpe wäh inc
ga or phykainpamene whose cpa a ing
heul peed veal pons. minimal depre
lee of canne for that dda shuld be man
tied Uno, the way costae Be
‘en acid wih so patient, pco Seer
He sodio or en cba Nte that mode

sedation sages ata may ein ae wherein e
Le tempora dacs however, hd robe
Toning 2 vet prompt Ce, pen his or her ye) oF
responds tthe Sage at witha ond ening ocur
ating ly pa silos, sch as n jection of
loc ant. idem rm inl ml deg
te prominente of ston, bere eee in
ct may rest oy in ex wea Frees
anal and nos cy ras as decibel pe
ly ds not oc, pec flowing epee mod
‘rey pil snl (eg, pena mule pinch) a
el sin tte fin and mus be mame
and monitored acera

‘Caen, e min monitora, qee fr
mue lan me

+ Pe meter fr montorngorpeion and pls
(guetta)

+ Blood preste cf for monitoring ciclos (Fur
enn

+ Pedal hope er capograp 1 monitor en
an (goes 2, aod D} Oberon of des
‘movements and clics veel coa ur
‘copa for mode sao, ata comimos
‘eal ommanienton may e under or he ld
Pen, precodlscoscope or upnagrph ily
{eq for moderne slain and shay eid fo
dep salto

Ei pen nes a per ke of sedation than the
ets quali 1 prove, the denis mat stop the
‘ental procdre ut the ptt runs othe intended
ri

Deep Sedation

Dry selon in cone vate of dene necios.
‘et or nconcioune fom which te patente not
Eu ca Dep elas nay beacon by à
Fal or compe sof proce reflexes ining the
{iy main pr wy Independent and to
respond. pups 10 pysal simon or verb
mad Wang pis ho ae i dc station may
span wit ya ee ww oan tee pun
‘tin fat all Monti requirements or dp seda
Segle ici fa pul oximeter apap oF
proordal eos, decencia, ad nd pes
pira

General Anesthesia

(Genet een econo te of unamedeumen
‘companied by à ls of proce ref eg he
isa to msn a any indepen and spend
Pepe pic simulation or vete coran.

124. CHAPTER 8 Pin Reaction Control: Sedation 107

Definition and Character for Levels of Sedation

Mos Sepan Mapua Seon Dur Sepa
Delain Dregne og Dg nac dren ct rind prin
Semone Sees ES
= Ten an e]
asia eme Pape pat
bey paca etorri ann
pan
neo
Bent
em pyle
Ge pen Ts ES
me tonos o ‘soar
Par ie reir SA eee
Erandio ramón
same mamie aq
ends Emsa nn md
= Teen Pen
mm pr mon net esol pal eo nnd
a Mim ear
per Peers ver eer rr
ee Fey ee
cio a pomos te
iio ein orme ry mp
pararme ende dor do]
simi da nd mal eg pin pad
no ño tite annee
Dates rt ee
Selen cea Ait de becados,
= ‘operons er
itp nthe
corn

Minimal and Moderate Versus
Deep Sedation: A Critical Question

“The din been minimal and moderate vers
cp sedan à concept that ut be comprehended

org y tor ho sedate pedir dental patient.
Pres mas sl tb ol of nial and od
ere on see fan at dee tender de
‘teat uconsowsorunespnse oval poping.
the mes, to mini piel inal À reflex with
eva respon alone ro eet minimal or madera

125. 108 Fundamentals of Pie Denise

<a

—

e o

@°2mD

ra he, nada cr near A cy nn Sib Mn)

fl mal ot pop for minimaland moderate
Sedan and indice f deeper rl of sedan. The
‘tent under minimal nd moderne sedan ca repo
propre to veal commands or miimaly noes
‘lan ble to mini tet sins a a ines,
Ie dein techniques ae paced fn this mann, Be
patents carac nd roy functions shuld
‘tea

‘Why sit probe forte patine ome om tbe
‘tril minimal nd mente sin dex ea.
os? The aver spe The patent as à much more
frequent and srs tik of rein or cardos
(mpg drin der lee of ain. When he
Ed eno main ay independent, hype,
lannéspusn, pulmonary spin, ad apa may be
serous retro comes eco espurio

‘een mode and dep sein cn someimesbe it
Seat to dcr, isthe se patton ho chin
ope ring in monitoring ubique ad manie
‘thio er ting pumpe mungemen fort
phone oud be sufi tral to rca” the
A ou he or sb enter a dee ee of slo han
ut endormi Albo
ri pren to wie Emergency Mate Sens
(ENS: 1 in an emerger, the prcaner mus ot
ray soy ether ad Iran of the ENS pe
‘one or wor ace interven ing ba or
vanced le apr mus be ccomplaed by he rc
‘me and his or ber af wide ang an the
‘oly de mon cited ec © mont end mans
‘thle wing the EMS team Since the depth of seen
Teves ot alae price cali rl otro

126. Fo ese dudo entes der le of edt an
Sein intended os lane or the procedure

tin fr pe pues, e pling ar sect
ropero thir inde prom ng vd
gr ongle o ment the prensa
‘ge aná lev of dao, They splot rarement for
personne he opening li, ravenous cc mon
Fern procedure and cover ee at cary a er
of expaton and taining tans the cs ih the we of
‘tho chao tose dep sedation the andar a xe se
in be guidelines ingl than singen and
doué at many genen raciones or peda ene
tie caret have the aig or fc andere
ep slo nan ice stig

Reliance on the Guidelines as
the Standard of Care for Minimal
and Moderate Sedation

‘The AAPIAAPD pides esla a sandrd of ar for
‘aiid od moder sein of palate pet a
Casetas predation event, te giddiness on
{cheat and pinilenioston Ben. din
Intensify the prsda airis wäh «hen ee tor
lining the potty edo complices Thy
‘lao fo documentation and coding of even rng
tevin! (ey al in medicos gen and patent
spon)

"he three andara the plis hat ive mst da
rately changed the manner in wich pda sao
it prac! Inthe ofc sin rele f (1) persone
(a) pue monta and) peproedul pressions
Rive persona be idles se ht an sistant
‘te than he dental operator must parate nh sea.
‘on procure and ht thant mt Be aed to
mentor appropri plo prices and as in.
{oy spot en mes re. Rte
the pie spy continus muii by à wind
indé A por mesero ond prey a,
tn ple once a considered the mini equipment
rie ate

epoca precios reer to the praciner
ing wren precipi tothe arent anand
minis the sense agent) uni of the traer
fei Prepac resptin oreo ande (eg
“pam Ni) fr ole den who ae extrema
cn may ehopta stheughaostongerdence sea
‘let pr thi nia, Fr younger ere (Le pe
‘choo age we of pres osteo the wees

L298]

OMAPTER Fain Recon Conta: Sedation 109

‘uty and without posi spero ot apr
ri Drap faded for seais pur in Bn
as cena ght ote to mae he cl eus
‘Mouse of poeta lose onesies, sod nee be
istered hom by pense gas on he ght
efor ar during th dy of ton bebe tapering a
ht acy when procedure wile peones (0
orte mepañdie [Dame orp dose bem
Spin. Aga chiral bre oF meee an
‘onset mior vaneless or anne get and
thor held not be sds 0 à hd oie the
Pr

Tn sms e gehn hve had major impacto
‘hve ae 29 tomase clans ofthe input of he
ein y pi los bono on
impr ety ofecaionin de etal fice
ronment Una pat mri nd moral
ine acca bower de ave oral oot
Aie when te godt: hae een fy o
anal D the practioner

Routes of Administration

‘The priary rots adnan {or iia and mat
cre eatin a (D) ian (2) eter (ga or
Fecal and 6) purer (napus, sean
some rana, rines) ring
"escenico the pinaryadunagesané dad
tages beds

INHALATIONAL ROUTE (NITROUS OXIDE)
‘trou ene nd ona deiner it ue dental
er sens (Figure 2) pode minimal eatin or

= FIGURE 8:2 ret rc nen sao. (hem
Er

Kaduse.com

127. 2 FIGURE 8 sneer shan tn. ron Mane Sn ua pi maine SL 200 May)

ght moderate sedation. Las of conose ander he
‘sabi o mats patent vay ae simon imposi
{adhe Tepriar admis after
on in pelle deny ae deed inthe flowing

Beaute nitro aid has vey ow lod: au it
tensa hrpet lee inthe blood api comer
ood Nerds decene apy when mirom ode à
mind,

EASE OF DOSE CONTROL CTITRATION)
‘here ae to vaso ly mnie nas xd o
‘ten One lee standard ten tique sid on
dl, and the tr the pd dci techs.
For the sanar an techie, ns oxide should
te sored at 10% corta and ince in ce
‘ene ranging om 5610 10%, nl he pat Becomes
contarle and dial sig of optimal sedation ae
‘ote The eof pina slo at may be bared
nca sight raten of the limbs and jw mude
sf the ee Dank ste aif ong up ate a
fied evening sy pal open warm, and gy mots
‘ght change inthe ch of he patent vo «weed
het rt and pent reports of bang comfortable and
‘eae Bach ine the din bene be coment,
or be od vas 30 060 sds whe king
sth ld ad watehng fr hs iat of pial ea

ide unuly sou ot exceed 30% or chien. Mos
‘Gen ve cofre und demona puma gs
Sl sedation inthe cent range of 39% no 50%
ten ide. The vandard Seton chaque pany
‘hed for my lo modestly amis Dt compere
ir.

À second opos 1o the soda don techiqne
of niet oxide amino i he rap “dación”

technique? hs tique u inde fr he
15 mode anios postal cooperative cd who
maybe onthe ee oli coping bites and edo
‘conta quik yh nica: The ecg mobs
nier 0 ns xe eda the patent
out ey ttn step,

Teer technique raie hold continues
ice dar or ner esther
he iv nid ood Cu Bow dl a be tere
HF bears nase or emir bth A god
ios oie biene is aha Indie anne De
{ae ofa avenging system (te 23) ge operator,
‘apd room al exchanges sppleneatl movement oat
(Eaten and sonal hod at alata othe ose
cold fe

LACK OF SERIOUS ADVERSE EFFECTS
Atos oe is considered o be physiol safe or
the pant when edited wi eat er. The
‘mot commonly encountered adverse des ase wich
‘tol be vn re anes igh concretos of ous
ride ate ue Poor thumb igh cocer
‘maya ein an ectement ph inwbieh ie pent
y become confond, compare, and dus
‘evening tna age peral aerea.

DISADVANTAGES

“The we of tos oie ln pedi dense alo as
cali

temps o incre the concentran of tros od in
der to onto modern rs ans pus wl
sgh ares ml epa fr pora
tarot ptet.

athens ths no mg kd oe

te ped
a

128. [LACK OF PATIENT ACCEPTANCE
‘Thee ae some pens (das and chen) who do no
od he fs froide want These pts ay
came overt nancmplant reevig te nu mus or
‘coming beni copes

Im some aren rach the mir anterior eth ese
felts sd msl mad may hinder expose of te
re This may bea poten, peal in sal een

CCONTRAINDICATIONS
Acute ts meade earnfction) primary co
‘eit osos ein chien nse
iy enter the caved tympani pce and rope the
tarde Children wih ade plan fechen se ot
oo die fr is eat al re early ot
een in e deal fico Astro amas ot ct
Taken e vs ere Older ren wath eas
rent eth ones may espond naprpeh © he
bones vou od tar te mayor
ee

POTENTIAL CHRONIC TOXICITY
Rerorecive vey sie of ent fice penne he
ver poro ce kvl our oxide gg apo.
anna dde
Sorin, congenital enorme cin m

‘Eun Eloy dara, and oops Gens The
els decae the net of evening ein)
re ques adenely fom he deal operator. which,
‘then propery provide rsa mnie ol
nthe ude stood be ne at tea be ct
toser tous oe ag i the whoopee
‘hid bese gues that ae exe though Be mouth
nme beserenged eee

POTENTIATION
‘tough nitrous ie weak and vey fe get when
‘hed wth omen a se nat ge, dp etn or
‘er ans may bees produced os oe
edt de ec of ter eine dsp gven y anar
‘out sch sly o navn. Te comica of
‘oso with ater dro ss mon beurre
ri extreme care and yan dvi who hs the pope
(iin and aparece

EQUPMENT

quien mat be pre, mal, teed fr proper
Retard.

PRACTICAL UTILIZATION OF INHALATION
SEDATION TECHNIQUES.

‘trou onde nln iret and ce for be

Testo ren inthe den lie Ite wel fo
esca minimal level el any sod dtd or

{CHAPTER © Pain Recon Control: Sedation IM

ten who have he cac be apt and low
6 hare cal oberon or are unenperuße when
ice ete hrs the noe are por canter
res ae ada Te cms Pers ef
‘tus oxide ep 1 ae the ui hel and maybe
ed ene cafe ding. al ant pe.
oe However, tou ei wil ot te the ned or
naar pain roman len xe fr ery
‘loo eal radars (eg, al chs repunte,

"Nr ae change the patents pesapion of he
virent and be puso of me and ttre
ia managing chen nth short atentos sar. Ths
‘minal disco may be ered same in as
{past in mich se eee fes xe one
talon “bold be deren or the mint

"allies Bone permit of quer shuld be sa.
ed es wih 00% oxygen. An ad wail gure 5 to
2 Una whereas 3104 yr llega 310 Lin
"Wide sin be contr ent one heel
howd" chaque with terminology appropriate fr the
ele oft ch (eg, “ml e bappy a) The nose
ice shuld be indices wäh insrerns to bree
ly Minimal ger pesar under de Ler lp to
Produce on oral rá gente png ofthe nice can
‘ep encourage mal beth he young ci.

After suiza the psp and every ar 10%
xen er oS mine heirs oe eve should
messe 039% andadnnsteedfor3 o Sante:
for theindacon prod Whe administering te rw
ide te dentist sold ak geo A rome
in and ré cooperate behav Alo
‘Slog ler den and sk Y ty fs ging una
aon ges and o sopera
cs it etal nervous pen (CNS) dc rom e
ites ide these gee questo e young child
ay hd to undeniable body momen An indication of
nic ds reddbe amie coil morenens
‘the Ange ad toa inthe young id

Mt dents pret nes the vel of res aide
100 (010 minutes provide mmm ager
the al anette jc; homer, concerto of
‘Stour oie cm cS ar may ot nated for
‘ental fice seston, When the dera! jection com.
ltd tour oxide lee hou be reduced o 30% to
Soe or» maintenance dos rin he deal aiment,
nase, 1098 oxygen may de ministro when the
Divot odes only needed for behavior management
etd the dena ion.

‘Upon termino fas oie arian, ine
Inn of 10% yen fr not a tan $ mue
recommended to prevent Gun posa. Ti ows
rapid difusion of ros oe fom tr venas cd ino
the avo while manning gent, cube he
pacto ear ih nen rennt aci
Trndyute genen may produc such posopeatie

129. 2019 dame Ped Denis

Side dies as nase, ight eadednes dines,
A of which can be evened wth cid ao

Tis importa forte det 1 reo tn
id ned soul ot be ua sb or the
(rin tira apro o ld manager abe
Jemen dental o Nros onde on conil
Aja din management of mima aby Be

ORAL ROUTE
À rot of admiran wed comme fr niza
fad modeate wien in ed deny e erat
remediation

Many ss pow ree a special seo permit o oral
‘eve yout sates alta ral seat of een.

Oral dre adios pme a nd covet
‘pec he medtn tm poda conde diver
{now vta Usa is best o adi rl seve
medicacion in pure, qe oom a the fice where
‘Slam of etn can ciel bythe pret int
code cien

ECONOMY
To admi rl ste medicos, no spc ce
pen eds 1 e purchue or mai Moser,
level of sao pce e ine

erp do ae cleat fr ach pin (ping.
the previo dain on phare in mind) and
ind dapat edi singe doves, te oral ete of
{isi omo ae Home 1 Aug combinados are
‘ied rio route ae coined (gor remain
floues bsenos o balon! medios,
‘hace of reside lee src ire.

“The Mes dndvanageof oral remain ithe at
ely onwei ori bt fet impec

ah hued on aly ace aren nda of eae
wei home, may spond que dle de ame
eof dog depending on many variables Absorption of
real to mb he pre fond autonomic
far and oy nota elo igi ects,

nd ur mpg time The patent may ot compere
Iningesing te meat or may om ling pos

be eat the ro ot eae In am ae à
parado rom maybe sen which may De due o
Fret ee or os of eatin ains his ee,
‘he ptt may become ail and mare unoperaine
‘aloe of edition last pelea fr sa

tiny of lets cocer A nd ds of rl medi

tin tata resus dete ds shoud ere be
{re Tan no pose af with el meca,
Hr iso of the tl doe hs ben dyed fr any
remo and à stand dove sn ren the
asumponthatte fist dose since bth deel
‘ental dean, psy ring à ser
of the CNS der dro, dig o posible sai
one sc topo en, cosa a

aa nd da

Oral rg admira hs be age ti of ce of
oy die route wed fr slo Te lg ie
Yates 151099 minutes depending en th dog athe
rer ie ul ea oh tne eis

‘ral pra very wein pda demi
bus rations mus be ar undentnd An adequate
ae must be give, and eng ie mus be lowed >
‘ge or abortion o ae pace before the dies eet
ara.

INTRAMUSCULAR ROUTE
Theater route of rsdn gare)
‘nue aes eran advange und inane
hen u pd det,

po

MGURES-4 name e asie rom
nf hse gen ape dni € a
Era

130. ‘Absorption rm an non dep into + ge muscle it
‘och fate andmoredependabe than aber om ie
nie

TECHNICAL ADVANTAGES.
Tel betta dr rot faisant
Le cond ut of a rot eq no a
ment except sine ad ed Patent cooperation
Scores for bee ote of admin amies
making very fc o ve fl dee o ie tar,
meinen to uncocpera cl When traca
maca ar mire il er no pe coopers
on rege andthe fal ltd due en ih
eh depre Even when ach reger
‘rama eon ae ae to scampi chi
(dan piconet of an teur mul Cte a
rete mar wh as oe of admiration cen
Fm be moment pes

DISADVANTAGES.

conser

‘Absrptin ofthe ited drug can be dered or dae
ya factors A pent old every ama
parce phone) monsiian inthe mer of de
infection, sendy dcedg the rte of soon
Perhaps he bigs var in net elated whee he
rags actly ponte the rua Speed de a
‘age muxle ma te igh ere of very the wll
‘Mowulterpidupae however someortheente dog
dados ina or tec mund or (al atin po

es in mal str ng en) boron may be
‘qe ump

errect
Assit he oa rou a dad dos i py a:
ie ted nthe patents ph Dro ef anne be
tata oy by admite aml dos for much
he same erat der fr th or at hat,
‘hepsi amule verve A and dos may
Nave te or pot in some Alten, wheres may
de es bay

Trauma
Into sites that ae derodoflrgenrvesand vs ae
‘el fr amuse tons à em dela
ego vu ale mud ofthe igh ee que
5, td the tens metus made Proper sen l
(beine ste and proper che shuld mii e
po of ae tute A hematoma may cer ay
tonte

LACK OF INTRAVENOUS ACCESS

“The potential fr more raid ie efec and toy
Is Mer wi de lame route dun wh e

‘CHAPTER Pain Reston Control: Sedation 18

incor or rl ote. Compare with the narco
‘outa mor drang of eames route the
ka pte ia cc (a tros te.
a terested elie mega.

Mac insurance ais gener charge à higher
premium ods wo sir area in
the dental fe In aon ms ste det pace os
Ive cala egrets for perfor det wh
miner preter mediana.

SUBCUTANEOUS ROUTE
‘caso te mbcuınes route of amination i
ein pe der or sea, ni ston, he
opis st common needa a nara abe.
ac ot tos te autant ar at wed be
‘dor tube ir for example Genel inst
ant and ddrantges api hi ote so de
Fara route ath de bowing xeon

Fer detal procedures some drug may bined bm
oul within te al ar, aly to the bc es
le This may be es object ose ptt and
ret than das numer rnb ie
Son tes andthe ens may itor comfortable and
vino pat

DISADVANTAGES.
TECHNICAL DISADVANTAGES

“Thee farine the banane
‘han ve er purent rots lod spl oe
bas se ae is pase compared with mus
Hower sobs jet inthe aa iy ave à
rea pi de because De scr borden

ISSUE sLovon
Besse the drgis deposed set be ace sin
mac the poney of ase ohne pet or
‘his enon, oly ning bas sould be gen
ane large vals lla ol tte
met

Lagury costs

Ann parer mein incre tect

cl males overage and may De abet fo ste etal
ns at require pm rhe we of peste ai.

INTRAVENOUS ROUTE

“he items oe the optimal and erate for
intron a ae ae

131. De Fundamente Den

ADVANTAGES
‘TRATION

Among he free oe, ony the Iran rote
‘lows ec aon to deed ng fect Because the
Fie caper pap pepe
o factor ad he tne ops drug fe icone
Wii few culate tines, the noves ag wll
exer iy main fet Sl, rome ses muy be
{Bren over reel shor period ntl the dese ee
Sai shee tha avi under er oer
ring wi andre mg ts ge Els dose
ds cesary with oa tamer or bte
ingens.

rest pose
Verse route ey slit es dose can
te administre, anda rt tne à allowed pst
‘here fora leg sion ce ox pte ty
ote

INTRAVENOUS ACCESS

ln the eve of a medal emergency, admiran of
ten dl et aca ou e
emergency ha acre can be da ad an come
reds im.

Theron rome won be ied feral pen rg
Ing etn it i oti some diante

TECHNICAL DISADVANTAGES
able of intravenous ce (espn) itech
rica mos diel sb lt mt mastered inthe
rate of minimal and moderne sao and wegen
Son e patea cooperation Pacing and malting
A cent ct Inchldren an e ives ot
easel linen The poeureregue both ting
fad ete practice TH para tae of Younger
Shino cy pr pen of es

POTENTIAL COMPLICATIONS
ecu pote drs are nece et iat the oo
seam tons roster ances poet
for complican Evan of dog ino the dames
hematoma rmac, and inneren ral ing:
on we pie copains ol mae Inrena
‘athe de mention lija o iy, ge
ed lcs may le produced inedito amp
er recon may become He estra mere iy
{tint deta a venous Els la droga i doe
‘oan rl or msc dt Ale te opc
‘Boule svt by ing at du and prope rel
technique Thvombopbl re complican ht

suite ray othe intatenout nous aiii
Arena mella

PATIENT MONITORING.

case ofthe previa cu ices pte of
Lie sets ny De pe ree

LABILITY costs
‘he at co ae conde higher than Lor et
‘Sineatn With the additonal monton and De
Grmamentaru equ, inavenou sation an be
Cony bt thes cs ave deren the we of mentos
vers equipment hs become more common.

Pharmacologic Agents for Sedation

‘lage number of dus arava or eins má
‘rete In i tert india Ang or change wl
ar} group l dogs ae wed for sai pete
‘ety nadie onivosonde de dave hype,
he ama aer, ad the ac amp Cale
12) Each grp spit in a irn rs af he
bin and shuld be expected o produce tice
primary ec The wi potine il understand which
‘pec eco expe rom a gen droga wäl u the
pri e tt ec

SEDATIVE-HYPNOTICS
The sde ypc ae drags wha pal diets
Sedo pie A the ds of Slate pate
rg i cad, the put wil bee incre
roy un ep (hype) i produce, Farber nern
ing dedo can rode perra essa, cm, anderen
e pont e a the prima col
rg omo dcr or toro e pin nel
darle ln fac a scarey wed aos may
lomera ection ral meer bp remain

Minima and Moderate Sedation:
Pharmacologie Agents
‘Srreor Patan

Go Enr Emer
are “Retraining Stee

ks e

Fo Tie Devan

i ‘ey

_————

132. lohbitonsandtinadeqne dempsey simpy produce
+ pan nha mere rapes o pin mulato, The
principal cn of the sae pon en fom e
lel rary let of these ras o he Feta ca
in system an res ofthe bra ne à maining
comicas Farber Inc In dove vil ft thet

"The sat hypose droge al et tree categorie:
ea bring val be due inthe
ie io mor ae och chor ht
td pede

"Or or yde alone or in combination ter

ate seat oi ca ave opp ee, podig à
‘ive and ad patents cers wa trate
Sedation in chen. ger does 00 10 50 mg ee
‘ily in combinan wither meen ach a
Fire (Au or tal) meine can proce
per eee of see therefore pan ia ig
devel of consumes mus be monitor chy sad
coria the glas bese te crues of
‘epimtorydepreson ad on of concours” Chor
ide er tring, hich can produce manage
problema ring admiran. dana tt
‘oral hate can ince na and vomling secondary
Do

‘he mot commonly wed ral art o pede
cios pnl This commonly sá ty ed
e medical is bt bs o! end much ve vith
polar den

ANTIANXIETY AGENTS
Thesedrgsbaveibe prima elect of rmovig odres
ing any The primary to ocn a tha gets i be
a do ere chaman agen
le decreed without producing cat ston A
(es we ner, weer there acting tm
fd thes the corer ae fred, producing sea mal
‘ep. Thur som Drain rect rie
Iypooties as me, Because ae ote the primary
probe in people with dental Pda, primary elt
pis any appa 10 be esate cal reno

‘hy cope ada tamb] deg poses ater
ose ssp carve pamaco; na many a he
sv hypaai (special battre, lowing for
‘Sferthropestiinder Threat formor anti
‘eas gs dear) redee ents between the
eset wil produce los of concen han the
‘ae with ary acting sete poate (eg, meto
ox Bera) wich bas a ep os age carve
the ig the dence Den a minmahy ing Sse
tnd genera anette dose salle, Drugs sch

CHAPTER Pain Reaction Control Sedtion 16

mies shold ot be ed fr sedan orth ren.
“Thana agents pose no ages

"Fhe ans ge cna prima ofthe benzo
sep sch dispo, misa eii), and wi
‘alm Gaon Ts prop ofogentss the one pr
‘ee for minimal and dete ation da sde D
om the ol an that hs ben enter od
ln che and isthe man equ sed aer for pd
‘te orl eon ln edie and deny. Masa
nes some pve carters sch 2 ap ont
od decreased elon! of ining o coin
ower idea hs some characters at ar ot
a nel Bertone fr me pet pro
“eres meh a br rato of can ad he potent
ira pent tabl primary fe del fel
ete émission Phmapnd à à enzdieine
rai nd a rene he ees of boot.
Ru slain and oneroso As wh many ee
pen he paces mu be wae thatthe ron
ton e real agent may nt lt a lng he
ffs medie bythe drug being ee Cent
the reves ao muy a wo be given pre in
eps dee

Some of the names such a irán and
Aptcopicamine (endo, poses ot ney and
ire npn ropert Pyare cen aed wth
Be ann agente The dogo ot ey ah fr
‘dion be ed oe bar como
(her dap ac a hol de or meperidine (ds
‘Sed ner a potentiating agen nd a th an
‘netic proper.

‘opioios
Opis commonly ree 10 sara, war dicos
reno in Chapter? Tse dog we ao ud in ea:
Fan or hee primary acon am, The te of acon
ff the ars the pil receptor of the CNS Thee
ups med the inepto fhe pu ss in he
{CNS and herr rate the pin read As the dc of
‘hemos neue ob eco uch a cc el
sc sould coped san pei he
pricipal end pit sought fom a arca. aac
Gage cre 10 achieve sea, serios aer
as wil be encountered he met common ae
Fey depresion and open which an ead hypoxia
{hd dah Icon deste, e arte hu econ
cod an adn dr hat produce sedation as
rar e

irc may produce anses and vomiting, opel
shen sed lm. In igh does marcas may lo nde
Sroruclr drones Narco sony pe
ie CS depen drugs Therefore he pra u of
‘hrf sim and mode etn nk bo
gen the ac he eave hypo or nay
ens ado conte seme degre of anal atte
ents do ot prove told be ted homer, ha

133. he ares chaine ih acc cannot be wed sa
ste for age rebasar
ed that rs cate spade repre depres
onen combined with seat yar atansety
gras This mans Battery dps fet Ù
(e combinados oct mich rer en tre
por Sp cs weal ep

"The marco mos commenly se in peda eon
tecnic meperidine When con he we of pa.
‘over ingen tee rm be dl
‘ln ofl and mode sao wld oat in
"been Torre theca ation o corno.
slo er ecu moderation or be oly
Imre ston ae pray impor pare of he
eos ofthe slave levels Fur fr moderate
nda, the dag und tiques ed shold cay à
‘apn of ey wide eng 1 ede uniera os
conne Narotishavestey e sopor
ores Thymus Deu with xn ction ernie
nd modern seston bc thy cary igh kof
producing restr depression an lso! conscious
‘Speci Bey ao combed a ber gent ch a
‘rus oi loan a opi ng ad an be
minted preterit revere te adverse ec of
‘poi ated sedation eg, rapie deren.

KETAMINE

The ice pet taie hs ad proa popular
sin ped deta racic produces clept te
ve round aa ad very nena depending où
os Because tame ss primary o de talas and
te nt on ral aeg ase he tent
es rot part be ary blather dace he
Eur. Repo sl ae ot Sere ih
[rope dos Sima crias change way
fe pole, tached and eed Hood prete
Entre ptas aná read bc acabo
laid ara general neste bathe patent under
uitenee pale malig appropri repens
‘eral commands mili fen np
Urine and set in som pas wel a diam
ld loci Renae ul be deny by mac

‘ner lied to adie general scr

MoNrroRs
‘cr ents! The mor common ae Pl exit,
‘Spmopapinsutmated ood premure cif precordial
stores tocadas temperate probe and
‘erates The mio motors eget ay sedan
‘depend on thea depth orina Thema common
‘Bente for minimal and mest selten ae ple
tte, ed tabs and tome Blood
pre car ee Figure BI) These wi e bey
Sine

2 FIGURE 85 Pme lec once te munter
Donne

PULSE OXIMETER
A pe oximeter eco inrument at in.
‘ally monies de dpe of expen trat of the
Paint hemogoia and te patients ple at On
Fos placed acest persed se eds a vih ae
ine deed (eg, ego) determi ype.
‘ion y mening dientes in be stron rl ad
Inept dt emi bythe sen, Normal. the
empl artes oy ras ad lit 978
19997 strte (ts Geely ead a 100% by pe
mets. The pus oxic gener que acne
ut ame eter such patent morement cs cold
‘hue bed, pou person e tne bel and ei may
ase abe dar that cre hate low eae
ee

PRECORDIAL STETHOSCOPE
record those are cs sesos whose
Vols temp tache he cet sal ade wed fer
monitoring enla iure) y tig though the
poco be can tan determin he oia te
{td gay ot movement ring rein wel e
‘ac sound The cach bal ofthe chape placed
‘othe peel tc ne se ae ined
ty bone the mabe ofthe es) de oe ae the

und quals Icod when, io, and cong
‘Toe ra chape opel nave 1 compa
Ing pet mund (de ph of he igh peed aná
ce arder sty guy oe se
Sens (eg che eur) or pie monitor (e
‘Sogn determine the by and conn de

‘The Future

‘heel of tii regidor dentist 1 adminis
den ornato carey under ette

Kaduse.com

134. changing tonghout be Une Sates Invites
‘pec prise rege to pace prne ete
nie Many see have ie pemi for al
dla peu oracion we

Deep sin and goal aca are grouped
‘opt for train requrement mal east ad
purposes of marc Insurance. The can sould
ener ha ation ige fm wich pte à
easy roused andy oon purposed
onan a a ine, by dio, dep sedation The
said cata erements fer admin of
ep seien or gene neti 1 completion of à
CODA scr een traning program at prod
compra tin in general re A tates ave
‘opted requirements the administration of dex ea
Fo ad porras det,

summary a pharmaco apecch to managing te
chair uncooperative cen inthe desta fie with
Sedan 1 ver complex and requis sin ining
Beyond he ope of th tuto. unter hid
a pue mange pl, rt
erence dental oc.

REFERENCES

‘CHABTER 8 Pin Reaction Control: Slation 17.

(ic cs eign eran or pen
‘Severo Petr 26.
a LM hrs ont eg pte
‘Siete rn cepa aro O
ie Reva mono nd meting rg ei th
CC ne tac eee arr

awison aoc hose

D al
1 OD Mat aa ty
‘menor cons nen apa hic

O ie
dc me gn de
ait rtm i Der cad ehe

135. Antimicrobials in
_ Pediatric Dentistry

Wan Stavanran

he cond mos commonly pressed group of drugs
for we in den ar the nal ante ae te
ante Infection th nore ca
Become quese anderen resto! propery
‘aged The mungenen of fects al aes à
ive delo ges procedure ado reee
Sr ante Anibal are mete un or
Sipps the gow or mallas af mierorguses,
(Ser tr rues Sng or pass: Anis ae
trance produc! y miccorganiems o by nie
‘hemi tod bt can be nd wo wen nt
feo unida ead for Ana vic pe
uns ey cased by cta get and a ue à
sing mese ina srry potent. Prep we
‘fans indio in some pie une chat
Props agit ral enced for pens eh
penal bet diese Ani ben, & msi
‘Sew if he cute ban ed y cre
rol texting and the herpetic age a see
Sn page onrnedty sept ting
innere in ppp Ses

Antimicrobial Classification

À ge number of aniicbi get ae vaa for
tie o pede dewey. There are mule sien
‘chee er thes peat cng dietas bec
al tra, mode of an, and eft on the acer

pathogen,

MICROBIAL TARGET
pS
Itoi ge group The princpl emphasis
sr on air agent be anti At.
de cored 1 be iter aro or wie pcm.
Namonapeciom abe ae face prima su.
cite ose gang ni Bo
Bas ales)

ao specrun drugs cy agan parar mico.
‘epi cy eine y ening de nupubähy
fhe ata cate pathogen (biie by ete) 1
ciao Urrtunaeg tae a sept

Aron Camaro
ca
Me ot
el rs Baco Amos
‘erm Rana
‘hormone hone
ess

een ha pe
e
Macs rho inn an
pre
arin
Summary
rason rors
Dress
‘plc Ober igh Uk Pts
Natio
imac
Fc dO ok
Agen Band Capa

Aniberpei gs

en may tke 24 our srl day and nd day
Inn eFanimirob rap Ti equi at a bet
ec De made fr spec Gn! tans at wich
og is ost Bly be ae age and which nt
‘mbit of anit ae neue and sea
de rss ae avi Dental end periodontal cor
ae mos comal ened by hc ha normaly el
tite he mou then nd upper alimentary anal fr

136. CHAPTER 9 Animicrbials in Pic Demisry 19

“Antimicrobial Spectrum and Prefered Therapeutic Agents

Mictonat Cuassor Poemas
recen Armanonat Bars
CET lis la VE
ches Peace perio Ou ll eii doc

espe ‘lin sms

Mobic Sr cac aoa

Grise ann

ps Gé pain cpl der

Fr Gens

Sans pri opin

uns tac mp
CRE Cam rame ana
a Emde peer oi ‘icin etc pp

Apte patin Ges tela

Nate Fee

Capes {nips nep

ages Be u
Fragen Tine aan pen een anne dine ean ae SP
or cams Bam Ace alae

‘aan nae
Pela tac

selon Cain od tac ic

Ep Imp a, pee
I ende eres

plaga Costa ein

Cm nenn chi rpm

press) latin

a] perl
A fe Reo

pes maca oe

Ps Cart

na ge rt inn mis ate
Traicion abs as ei cen ome aan

nr an

ample, sob and anti arc, Miss
‘pecs anar pram nga bates Entre Puso.
Bern, nd Vell speci und ocanaly spy
ner inches Man al agas reste
open bene penne roman the sl st uch
la ol nba for den nd periodontal icons.
raid en fe ed by aero a
eve uti Aromen or fg In hse cu tr
Simnirbals ny ane for open apy
“Content be Ling ater etiment com
seed for aos medial and ental nal roms
st ont ae bled plated pray
‘elon Poca Boofers: Amiri Therapy und

he Sar Gto inicia Trap ro pia.
Fins coming such pidele Dat rm local ia
obi batas can be consid oc information
A pater Of common
MODE OF ACTION

Antica muy alo be ct acordig 1 hei
mode rie lan? Common mode of action fr st
nico! agents are exe In Bot. and lows
tibio omic ofthe bc cal val am
are for cea viva (2) into apa
‘mts, cui a ne a even posse ep 0)

137. ANTIMICROBIAL: MODE OF ACTION

Iron of Cea a Site
onen
Cape

ni of rote sys
Chore
Spas

ind Rome
minga

Temes

Annette
Senor

teren fl Membrane Permet
Po

Corse (nt)

Foye mt

ni of Nac cid y
men
Gratin

Toposomers nis

rares

Inno of Oyocrome Ste
Moser)

interes with o id mtb, they nin
Facil pro (4) interface wih cel mentes
Fermat (5) ihn of mle cd subas (6)
Tolkien. Dreier nme nd 7) ni
‘on of same Pa tea By thse means of
‘eo, the amic pnts produce xi effets that
‘sate erre the Me of the mca opent
‘rhe miming arca ration inthe ele of te

BACTERICIDAL VERSUS
BACTERIOSTATIC ANTIBIOTICS
‘Anis mu ote sie as cera or cei

Sate cea nos stay kl he minor
‘tn, ee cert tinal nh teal

BACTERICIDAL AND
ctr Brit
Pech Mees
ce Tees
ia na
Annegret Ana
Cane Ordres
Sam

rot or mailen and depend on the normal ht
‘tee mehanins Comun sten) o dim de
‘coogi, The me soba be ctl or
‘ome pathogens bt cr fo ibn othe iy
may te concentration dependen. octal apse
feeble in om stato Bco ae shold
Beide pute in imunocampromise patent,
cae a copromid immune stm may be mal to
‘esate ace fe ending microns Boe 2
Core

Antibiotic Resistance

ant changin the mensgeen of infections ent e
Pas en cette by wiped incriminate we
tic vain medial and dental pletion.

‘Corer ier in terial sic nse icon
tance of tape to peli rent pic
ins (eg, metil, ail, eisunc of puma
to pels by aeration bacterial pri ini
rota res of ecc 10 erage ete
Kr es van), and moldy rearance among
rice beter deu sad modi ent
{ndesendd scr $ lctamaes The or Bora cn
‘al and pont tfeion may e feed by the
roi problem of ne race (de 9-2)

The development of reinan tal aras may be
‘eine by conte wing a aprte bt
‘dmg for an aden prio of tine For rege
Inns eps Palomas eins infections
enter ment with ont of antes
des. Binion nd aminoglycoside) may a prevent
the merece orita Sr Ait combination
may a be me fr infor vi miel er of
‘etre When plang combination ra therapy
portant racer pen at eve sec

138. Mechanisms of Boctorial Resistance

Avrione——Connow Menus

cas Rares

Fo rare Pico

SN byenend pen
Banane

a ier ftps ve te

Ara Rano oe macnn by
clon

rita Nation a be

on vdd ing
Fe Fe len aa
mean pue

0 adie ach Un of drug at are amonio
Sohlen may ren à open desl mes
dan ad Ib) of the emergence of reat

In most unis incl sea, the ue of
spots snag ened by mar commit
ter and ais indi programs Maple pide
Tes have been develope 10 provide recommendations
forthe appropri u, and dice appropiate u,
‘ofan in var cl stos Hope such
‘lors pemotennereeintbe ronal al ppp
(See of aint minis red of aca

Antibiotic Agents
Tecan ha ud on comme a pe

a deste nade pco idem, merle,
adeptos.

PENICILLINS

ln 192% Sr Aeande Fleming covered tht penn
‘led gram puse micas Ti eran.
84 ot gain el ees uni the 19404, when he
Ente en ba. Te pein arca grup ati
{cr hat ile inthe pamaco propre They re
mary ace pls rom postive roc and mere
ct atthe serum of coverage ca wary. AS à
ou eye mos are band ON
oler

eli vas te prototype of his group of abi
‘ens apd contin beth def bie o manito
ons I coege is Ami primary 1 gramo

CHAPTER Antimicrobial in Paie Dentistry 21

‘rns and deve ga nee cc. Pein Gas
two primary anne pere Ft, ie pos
‘ried nh owing desmucion y eta
‘Batt bt pen bythe inane remous
rou, Second i it realy desole
rc mcr Sent plans bs
ren developed sand overage nd 1 rene ome
ihe daran

‘The primary adeno opel Y ea beat
st ph orig or much improved bitin when
Frise oy I cru of coverage e ane
efor pilin except ly lew ceive spit
ise gros nd ane anerbe Howes
al nace by enclin Peni Vis the primary
tease ud o mana dental infections

Ampli has reader poctramofcovenge ha pei
Bin Got coving more pague organi nd:
ing mestre Ehrich Ha fase
and Salmonella I home, as eet aaa ame
gra pose ergnins Alb ampli abad
Kr ely then pain guint depredation
‘eer in he qu. Dre or guinea pet i
‘enon and 3% 10 10% of hen ero a mac:

par hater receiving ampli. Amin hat
fhe sine spectrum of coverage ss ampli, but
Ford beer ray ad cu hs dh Dept be
“eles o these drugs in panes. ey ae wot ind
td opr pnl o pein V fr mangement of
‘ental nation Devlopment of race o hs sento,
‘specially by He fae, 18 Becoming incase)
probleme

Mor sri of plococ reduce an ease, ec
Tne, whch des pei, rung ln ra ed
tance. Seve pening have Den devied tha ae
restant dran by penile nding rain,
reci, naci dancin, and dou Tae
(rage should be reserved for infections ivan,
elise producing pbococ and ae ot indian
{common deal ion.

CLINDAMYCIN
Cindampein as comino ai for a wel ani

‘tein the management of detal nens. poses
rad acy aa mon gram gst acer ar wel at
Tt mer ci pes asc with orl ne

toot The despelote cnn ot
Ben a common rn 1 he macro ad ther
(ds of anio Garten qe inci dr
‘het ac with Coti dde il on.
Aly associ with his deg However, the pect of
li as we sr avait of rl nd torna

139. formant madeclndanyins ond optonforman-
Amen fl fc

MACROLIDES: ERYTHROMYCIN,
AZITHROMYCIN, AND CLARITHROMYCIN

rer ia mace nie tht as true
In 982 spectrum coverage silo a open
nt don ef sme pole product
cc clas Leire yaa endo e
[wel aborted ey Howeve the eu foc soma:
Beate sit ssdmnnedwihaneneecening
or lo (note o te) Caine put
isthe fem ol rena major didrange eno:
rn. Aábrompán and nico ie scr)
nier oferty pora evade iu
‘foci singrovel Bowley Tb impercdlr.
y. sc with legate wet, as
end grater una hae re se compr th
hey Malis se erly crore der
then ber natn ocre reine 1 me
‘olde as been cocer snd pret anther dc

‘CEPHALOSPORINS
The please varied pou of tact a
os tht are chenal rated opel They re
‘and set in coverage ad ae died int "go

caca by rer Many cells at sr to
is In iy apt raros cani
(Grey Spaces Extras fc) and se rt
(Spez Pr peris calpe
Aci aa rr ire robot hr he eet
sharing ga he et ect
let pan, The eal epson nud cep
ie clon ead nd male or ana They
ave ewe dure dies an penis and res iter
tating when gen oral. The calais ae aci
int cal phone but they perry ha stanarbic
‘vy than picas and tbe hve sar ty
‘Seat serie oral Three ephakpor gene.

yefernosdvanageoner pein fr mar elec.
esa ae usally moc expensive Cepsa od
Be rare fr eve ints lali panda
Spam er nd ins.

SUMMARY
ost ental ná prota! bce infections ar ud
ram postive robes cae sete an, cee

cm rie: Other orton peop cade
ane ob ramener sacha ale, Val
denia, Fcc, rar eve ser and her
‘ois Pics dame and pepsi re
nude god cher a ll epic bp, Owing
te Ec! cn and ero spectrum ci
Peskin V (orl) pein trame) à en
commended the primey du of cae for del and

print infections Reine taie get pe
‘tsa crio he dre management of ee
Fa ons Cercos of palcos uc a
Dri mation ande für Dewar andthe Amer
Aal of Pare Den Reece Mana an be
adorer on pal erp
ine inte on any

Antibiotic Prophylaxis
ENDOCARDITIS PROPHYLAXIS
(Soon (ra pref eed mudo Conga
Sah cm ter dose er aca hat ave et
lie high be arde scot fs
FE à mapas cc © wind an
‘he td ene cream go te cal o
a dae boat
Sn Resol opa men men wc
E ir dl o ep leah,
ad cnc of ce ns pr
Site mon comp og vil cra
nS al ve ou pad e
‘Tamer a tte nas poi pe re
dae mios ntl por oft
Sica Tr ande cis mich atte
ea
entre proc rae pel
Sauce regret pr.
teed trod me intel pc Sages
‘poor edn dou tr np ao
ed
in ei
drone fr natn men
comet cael by tem pt Meet
opi yay ec pi hae ri.
Citer drap ete
dae ol toser El Sal Id pri
tare du Re pat ee pea
{eset tng he Been fa pe
“Theda crear eich ti pf
den md aies a Tica
il
en be D
“al uss hea bee prove ng

PROPHYLAXIS FOR OTHER
HIGH-RISK PATIENTS

Chen with a comprend immune sytem may be at
Ince i of der oa seme net a
lowing ami Econ aut with deal proce.
ies: There abi roby may be coser

140. ‘CHAPTER 9 Antimicrobial in Peditie Det 123

CARDIAC CONDITIONS ASSOCIATED DENTAL PROCEDURES AND

TH eNoocaRorns ENDOCARDITIS PROPHYLAXIS

nda ret Recommended Ener Frephybsh Endcri Sgt

rennen er rete mater fr Recommended Noteconmendes
“asda so ocios Does

revo de eco Feros proces a]

Congo eat ia Treg pecan prostate or
repare cogent ea dase ‘Raven rng ping. min eran cot
(cng pl an aca, re asar pees
+ Conley repaed cogent lect wth Detling piconet (rigen)
ste mates wtb pco y euro manne
Bray ed etter mere ng ets res rest
Conte ar tc todoo (est) Pacem! bin
+ Regtedcongent ar dee fects rd
o vecino A Page

‘cece lanas ers mo dese rc opa care comen free
naty matos pote

doc rg Not Recommended

cn alte

Sr par ata pl dt verre
(ec, o pate xs an (uba se
Bernd mans)

reins ran toy ys ti

tre prop malo regates

pap oon cet Neat mom

‘row ove de then ar con

reo ema or itu er con

(hic puma rar andara nd
impresos

ere

fee paies with giant primary or age immune
ner Brtentin cen han rn lin.
ing beware lang var sn, venta But,
‘ental wens nevus stop dere, an thee,
‘may alo provide ame of fc o the ae
“dono conan guelne rds ory
Ten, conti withthe cd phycn I ecmmend
fox opting patent sen

Antifungal Agents

Candia sees and spec Candid aies, anale
und on the aby coor membrane of he body.
wer lic be Conde soci andren
fhe tae rey or une Ihe many of he bo
‘compromised Candis common In che ec
ing only resent pry during parado ave

2)

im eon planen
dedos bot Tigo el msi
beets Fen rene

omnia io Toradora
nations One pie

Dre sumer
Techorinantenere Sheng payee
Bree ete

‘See me et nn ett

immanosppresion and neutrpeia. The tee we
of bra amb, Ari, Chem
Soc immunnsppreden sin egate one
{nd meen are bane ofthe al misas and
he cen ak for uni

The ii mangement of ul adidas chien
ev ai ah and en pic of an
gl age Sue Candia nen ll be con.
famed y coke nd poso dre ne befre
nio prompt und aggresive erp in immunosp-
pese patients: The median and out of ads
‘Ste drain byte seventy ofthe fc, Orla
Sopbege endet ul resehwih opialsuen-
ons or woche ol antun pent sch as san oF
risa Several antun agents mat fo or
{epee contain men wich cn remote cies
cher extended prod. Dady uo! opal ores
Ronnie reir cr pots

NYSTATIN

Nystatin i the mst common topic get wed fr at
inem o ral cocida cde, Te gis erates

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141. 124 Fundamentals of Pest Denny

Prophylals Regimens for Dental, Oral,
Respiratory Trct or Esophageal Procedures

Sono Awe Rea
Soma he
pur

= ‘ire 5s,

sine or tor

Cáñamos "Aline mus
Mo Gaya lb me
polar hie 3 mee
pein or
pila Adal
om
street 0 mg
pr sms,
ce
Ale Cp Mate Dg
re aan Dg)
pin oe Mer
ae Catan! ada ber,
ocn = te nung
noces Gene Diem

eae

‘Sepa rd ct oe
‘pine hada ned pr ii
‘oman cr
rosin

orl ssension (10000 Um ad tbe (500000 U.
‘dor of 6000 24 millon nts per do in far
‘ied doves or a ea 48 ou afer per pts
ape:

CLOTRIMAZOLE
Goins fang apn ti able ona
10m woche fr incr apaon Howe, a of
suspenso can be ompounded rm the vaginal bles
Te recomendados à ene voce eae doy in
a]
ren The aid mt be af ae and mataro 9
Comprend und follow Intracins to we the woche
SE Lie txt ts been por in ale ng
time, ad ie sais or ot ban contes

abi be try the dogo ren pogo us

ADDITIONAL GUIDELINES FOR

À intecaseot dyed beg rot arcade
res Wd tam i nes labia

2 rel st prefered anote
{ter tures De promet ea
rons he and mse stared seu es

a. pl rocio long em bio
som ren (eg. hematite previo eet
‘it fenton sh rodar sn.
‘hetero an of ie er peste ger
ae trame ep

A Fate eg paar tha poset
va has martes ghee” ford et rl
ve gl may din et
one atra parc egin Hone,
‘ime pi mays pele pra ant
nto se ph poten eps
Pinion ou be cute rng dente
Feng init Canam sp
Reeder panel emana nds
on belge on amp

FLUCONAZOLE AND OTHER AZOLES
Systemic angl hey in or candida is way
reared for dren eer not testing or ai topic
tretmetor ths rk of stone lion Mao
[Ss men ud ae inthe cumstances The drag
{arate fron or Ivar amination and à
er high vs nl as rove eco fr
te management e a varity of cil pci ang
some speci ae estan othe rg, Finale ige.
{ly eter oer tocas wich as «et sk
of suited hepsi. acoso, pocorn
normale re dona ol wah ee si
iy ast Cane and may ely hve à men the
mager of infections sone with moe reine

AMPHOTERICIN B AND CASPOFUNGIN
photic as log ben the primary dsc Fer
ae management of were ona neon acy of
mot aren demons infcion cased by
the majo offnplpuhopens Adve efect sha
Rare meto diner, nd Ever má admin
‘Son reno common. Capofungn. à note Amal
ll itor, a à rower pec of cy but
ense cae in seve dese cated by eran
furl pub Tagen wl ey have nines,
nite gan af rs

142. Antiviral Agents

Pinar ere ginörstom is the mo commanly
recoge mie fhe ep pet vise
{HSV san au es fen ith concomitant ee,
ab rial ceva mphadeopa opere
‘he charters rl and pra rie leon mae
lng te gg and cous membranes of the math HSV
ptosis aby chadren elves ponen
Ivan 100 M dye nd rue nly spore py
Hower, primary or roca Int SV into
Immunompprenel ens require more seve
‘herp. Uber here line muy Depot fer ac
tea fogosa Inte,

ANTIMERPETIC AGENTS

eve agent fr the management of HSV infection in
nana patent inca oo o
vi, and famili, Drags fen ed fo management
gameplay eicacna or HSV btext
‘norton. Te ote of herp eer vermin
"ous ci) rentes the bt and at and sr

fy of cue. Prophet therapy maybe considered o
patin rope tb HSV and a igh ako rene
ran. Ag doi ned for ptes alow i fo
‘lnk giant dine rra. Adkene ec
‘the central ron yer or nee moy nomme

(CHAPTER 9 Antimicrobial in Politic Det 125

sen wi tenons ag dvi wheres orate
‘on may be united vi ac aus, rep
is (he er i ent The Blood of

tance 0 ey isto bat mre a man
rei ora

REFERENCES

pa
SS
omer
qe
Sms,
Dr is
a
paneer ECO

Ey
esse
1 cn it nce ee e

Sein ef nt ws
nn Ds Eevee eyo

143. 1 (0) Medical Emergencies

Sraven I Ganzuuno,

iy e oa socia dt cen auch

rth high Teves of patent ay. The cts
combina prods sumisa ny become tote
econ of teal emergen ep those hat
Are luce or gate ty tes. Ado, thy
te drap bal nee and van.
reform a dena rer A os thr
Tee sete, arts, slave, e me ao
Cry the penal for producing ai Meeting
‘ston om ony o alg.

"Appelt mos ter ra of dental ecke the
‘Mergen and and vers when cd ih
‘tea car in th deal efi sald e peated
tha the mai re ofthe dent in he management of
‘medial emergence ose he pte un tans
to Emergmcy Medal Serves (EMS persone fran
esto propre ma y ls ee ng
{and textment The score dignos ofthe medal
‘endo tenn et gie hous to est determine
inthe apa ing, Id premio of medal ere
‘oc is peered Te primary responses of the
‘stn hese media emergence lo
‘Beare prevention preparation bas e spp ae
cern made procedure nd prcurement of lp
Sed ampara

Prevention of Medical Emergencies

Arabe mon importa ape of desing ih medial
Emergencies à preventing ther gruen Prrenion
medal emergendes can general be scoped, as
‘noch pole gh an arpropte mel hr
‘td physalemnination medi ona (hen nd.
ed) a pint pate montane

HISTORY AND PHYSICAL EXAMINATION
À sup hood of al ing medal condon,
paar prole, ht may predispone e pue o
Selena mal complete il ip preven
va my of emergency santos. Tis Lodge à
ane hugh the mei Mary and phy xa
onan a an amant ft ptt ocho

- ourune
Pasvenvion or Manica Beca
ior and Phys Frame
Meal Corti

ent Mentoring

Paeranarıo vor Enenonscas
Pro Preparan

Sul rection

Backup Medial Asiste

ice reparation

Boaco Bovine

ler (oven Venti Others)
supi
Dame

gcc Nitro ring Pump Sen
en)

tw Supe

Sates
Asia ip Brads)

Septet

a

144. Diptera (Bed)

ow oped
Siete

duc (end)
ve

Ton Sart

a

la
sop
‘Other Option Medion,
Mae oF Mica Bueno
Poston
rein Ai, Breathing and Deve Care

pel

A

lil

Dee Then CO")

oko dental stent Themed ery
‘Shine va vete goin wich carpeted by
{be patient or part Many standard re vete,
ut hey may eure medicas fe pde dtl pc:
"ke The forms sl ice questions erasing oy
present pas medical condones aves ro
Feen, Bios und rei medication and
Fo, Questions repr dental concerns a wel put
‘esa ment ae fequnyecade The dei ere
‘Reform ups fading mé cndac sift
‘ew withthe pen fo li any ose spss an
and o te quon mt be empbaie hat
ricas and farther expertas of pote Andings
hou a be wien bythe dni he record docs.
‘ent ht tho quesos were throughly montse Far
Fnac rent tent cds asta on the pa
mein ior the dent needs igen moe ner
‘nation thane mee Bet at e pue een a or
Ius had asa the pst The deal ter dace
sent the een ad seve fhe asta atch mat
‘thom bow Gey te aged ar or na at
ride we ner so srr tat reset was emergent
‘Steed in he oral or emergency fom, when the st
‘ek curd, and ly wheter th pt rest
sy tony. Bed cn thease of the docmented
‘linen he denny fed cfr provide
‘ded nal retin hat spine moy decide
15 petpon ren une pen ie edly opt
aed hel pn

CHATER 10 Medical Emergencies 127

‘The pial examination sl nude acne il
sig (od pear ple cad yt ein) me
{nd dance) athena hd nd ck camilo, ad
bat of gener opera (gl, mental tata
tone und car, te) Fate pal ern ould be
Acted the denis ningun per a pacte
ter end 1 ue mode tu eckig nt may
pres be patent rica repo encom
in recommended pati pases supplemen
ta lo pel examination ch ng art
15 nos br Bci norma a well ar array
A erg hor an pl examination vil ep
sake he e are any pening cms ht
y poi nos me ener ne ie
‘tons toting th ere pulmonar, and deine
remar of gre concern Ku pens mai
Chernin Patents a ery face ale warnt
‘pec comideron. Thi once sold aw the
esten of een pote fr the patent at wi
craie cod of «ous medical event The moy
Inve teu of ina or modent eto for ca
Indeed cons (eg. crac aryrhmias asic
‘tact ples) proper mig of appointments
fee ead propiyds atacan oe.
Based dental or mel anche during he pros.
ore rate al persan room. ine

MEDICAL CONSULTATION

any questions at eng the management ofa med
cal comprometo, sgl delo consi
{he puente yan for ft infomation 10 a he
‘dent in forming a ai management pla and nome
ss for ace Aer einig ll the pret
‘neil inem fom e primary oe pisan ná]
oF medial specs, ln mos stances de nn
Concept of eklig mel ane from à medical
const befor nit of «dena proce hs nom
ten sapereded by requesting the comnts stent
Ah he pte in optima conden forthe pinned
octane”
PATIENT MONITORING
“Thee of monitoring ht necesa 1 teat a edle
eal aient fey ll ary, depending onthe pce
tobe povided te patent undying mde onion
te Pant

Dec foes pte dango sation dope
‘Te dents shold see monitor (obere) the gener
‘pene ofthe putt, acing tev of const.
ey evel of comfort muse tone, cl ofthe sin and
co, and reiner pate F0 maj of ty
int bang tested witha nas ae 0r wi
ini mis des bythe America Det Ais
tio, sica he monitoring tht ects

145. When modera eon is ed, and expec cle
denia mu roer mpi fey oe ci
ut of sale des rep and carre
‘ere in mano rater employed
‘Tis ine comin! moni of lod pene,
‘ou vie an autom ood pesar af, contaras
rang of pete snd pve ev ple sit
nd contour monitoring of rent, either sts a
Fpetacbelpecodl setbscope Figure 11 ve abo
Fares) orscapogragh Them mear reprtcaary
ip for ai th whem comia eal cont
ill or under. (ce Cope or deed de.
‘anon of mentoring during ition) Prenton and
are il sas ncn pl u, st ms,
‘toed pesar hold ahs be ote le pre
‘ented the ac paient corri

enter dep ston of feel anes i wed
mortier motoring ese! Thevas maja
tf pedro dent ae nt rnd in the aan pain
nd ay control dique wich soul ny be ed
opa ad ic bs

Preparation For Emergencies

Despite perensremere, metal meme ocasion:
Ay cc, The del prior, ad lie mus be
Ma prepared fr ch een

PERSONAL PREPARATION

An eri ate. camote expected hat the pace:
ing dentin wil be alt dag nd manage every os
bleed eee, Hower spt pte
‘rit ome ou which acte) aos are mot
lye aren th deal ceo we set ave
fe rat potential to epee or mera
Handheld dd wth them Bxmpescile
more, operen, senor is ae
‘Sth tac, ei ction and ny obra,
ra een tn Bari pal acer

det ve of mains or high u
‘at not any be anat nd well under e
et mu ab be peared qu ay eta cn
A manage the Sutton ample nde ka an
The tm scons an inte depresion send.
no san. Personal preparation fr he denia sald
inde a minimum, wong hos of th ag,
rms, cour, and bp fü common ete come
‘ane Tag be fe spat at he Ba ere
rider el BLS, clog refered sc.
mar rection (CPR) shuld be come he
ande of nergy el management nthe den
tie rears of wher hi que fo dental Bn
‘re orale 030) in techniques wil be the
‘mat common mtd of mage ds dry. when

ede Te deli ein 0 the upper arm ad he ass
tras region ofthe thigh are commonly employed ster
‘Wen nde ect of lk of et cooperation e
sin can be performed though he pte tes mos
suppor PALS ot avance cara ie spp (IS)
tia may be deb Home à ppt ut
‘net titine pdt dt a geal oot
pere and compte in emerge bing
enous o as cs, ing leaves med
ou or pefrmig endercial inten Thee à
ure oa on emergency ana manage, och ar
American Beta Ansa Resta Manage
‘et of Compas During Mama sod Moderne
Sr couse hey mor bee,

STAFF PREPARATION
Ofic persone old be fie wih hei rl inthe
ecoponsnd management l common miam

‘Se If moderate sen provide, ti eae und
‘Sten regued al die dia a members te co
fed in BESO À tam spout o mei ners
vel provide for opi margen ergo uz.
Teo Eich all member ul ave ape len
red anemery poema quen media:
Fons, and onygen wl be brought (ad maine) by
sc panda vero aa pe
id face, Forum, beaute medial emerges
cu rely rely the dena fe. det to
regala un mod dad emergency ils to Beep he
{etm prota ring oot and ec parla a

BACKUP MEDICAL ASSISTANCE
Ana eat component of office prepa fr
‘nei mere mo curingbckup med a
Ueeinadvance This ive having the caren telecos
mer for acting EMS, wich sual OU he
ein ia rural eta doc no re azn EMS
"heaps he demi soul ve retiene numbers
‘ofthe eres recu quads and emergen room es
rich oplyed wwe they wil be inci

146. able The dni shold arange in advance to have
Parumedi veras bie emergeny mal teins
repond to deal o: medial cena whee
alte When feaslearangent sald be mde with

yan whe fees ey fried asc
Nola emergency arb Sach ario pmustbepre
amd ot asumed

OFFICE PREPARATION
er dental ac ons a gre de of equipment and
pes The i a minimum of adel oque
thers sen fr nay ceo be propery pearl fr
mesial emergen Ths exerts nb dv into
enr pet und engen dp

Emergency Equipment

Rein abs sopportunlEMS anport aves
hands of med management in mt stators,
to dei mal emergencies When cg pre
nce of any emerency ups wire pale pens
fe tobe vse, boa be speed dat apro
Site equipment weil Be neces ptet for tan o
decent ad pret he dent repaso
«norte coralinos able Ogee
‘She primey emergen dog ne deal fee, wich
eure scale aqui! fre admin. A
yen pate even rs than 90% oe
{ows of 10 Linn ors minimum ol hour el Pt
means tht an “E nde i the minima te eed,
‘She pic den patente oly very rely fr mo
ri icon nd cr urnas Deli el
‘est atan ru induced erry epson and.
los ofapuentareny ring wees much more
halt oc, tena rary pf base espe
je lines ead matos of pops sopor
funcion. Hypnenia ow augen cam in the ae
Had) ihe Anl common aay fading mori
nd mot inthe may of severe pbc ea
Smereny stos. Adegteoxpemons more ely
‘owed Oy de mind of element en Y
the pat aqu beni sonne; sere
‘yb drá ty ry ofa em nl ma, o al
aula prong ally» non sete aemad shold
be alae as Ds even the hist concerts of
‘oxygen tothe spontane beg patent fr be ost
Sows medial emerenei However shold the patent
ame trating dig an emerge dto, pu
esr emos wil neces. Atop meto:
‘ath vrai, er preety mosto maven,
1 poste, is versely aut 10% augen fom de
rung an ns cal Day er ann
ton in à pent who ot beating Three à
Pte presure gen ale stem (bg lve mk
‘eve ut cn he canned high ow open sore

‘CHAPTER 10 Medical Emergencies 129

2 FIGURE 10:2 pudre apa tods pte
rer nie Prag pl

a man ande ne

costed een equipment to deer oa to
capo pt gre 0.2) Aa tomate fer tose
{tind in ox Robert demand vale deve or
e penis
ras, ad one ender ou al e tor one
penis

"A gala scion Svcs amer pic of equipe
me tht come em for De mangent Of
mal emergenes Emerge ston ep hoe
{volgen rade pate, ten nce vote The
‘Spite of vont cla be dose Ts cn om be
mn or prevented by rope ae ping and
cion, OF cora, mon dental fe ent ih
une ston equipe for retorne des Par.
eh AlinkaerypetacSonconiguredtabeconneed
De dent gt lame esca dental cn ait
‘olde det sucio he mouth and paras igre
ion

147. Ober emergency quiet ms that re eed
ina ige ad cds o nam und
‘eaten, Öephryngel and narophange sway re
ie dele Fr thse desire essa
ng the aveanenarhe fr sg internets
ces nd advanced any equipment, such saga
‘vk anys and eter nena away devices can be
emplea avala ol nome eel e
its (ABD) capable of cil be dry fr
ech chen anda y recommended

Emergency Drugs

the we of rap. The proctione'sthoaght pres shuld
Le pay Sci Base mppon mere and
‘aultumtodagtbeapyonywhendeyndated The
cometan apropia mere rghit may be que
‘fren for vita dni, depending on De res
‘bedi the ofthe dents viel evel ling
{ely vale expect ta parma pets be
‘rate o Lay manage any medial emergency tht
a be erected to area ct rt any eg ht
‘Sted 1o eu patents. Ti indes the we fol ae
‘hei wh may pode toi orge rats.

"Te dent shoud every mir wi ech agi the
emergeneyki Most emery vale eres ki
reo où very expen bt regen ona inode
‘heoptinal per ind pce purpose
‘On ofthe ge nes o owning comer ma
‘Sleemereney ts ging fae sense of city ml
pars he reine does ot Lo he we,
dongs and probable ne ec of ech ngin thei ad
es tp them up o at th tay be mere dung
cos thn pra Dep À quod opt should
‘enti nthe needed ras and held be ingle eat
‘Sh ad sale The denis shal te amir wth
‘ery dug in hit e er ki ind I recommended
ange nenn ad ide ct

“he felling st the str recmendato for
rs that might be ined in a eeepc des ar
forthe deta bo ent re Vaio oe esas
«rei fusta od mit be pedale at
coneended rey.

EPINEPHRINE
pirepvine ie rut the cond mot imparten dap
ther nen, in de emergency armenio. I. be
wesent ol his fr neto apte eee
(er nd for er unbe ande inca ©
tr nd san ely advanced eda fe support

2 FIGURE 10-4 Eger tec. rom Hans 5
teenie St 207, Hoy)

rg or cad ars. In gener, epi i nly
‘tated the dent bere he atti pe
‘ening tren mel emegeg a dent
mien any dag to pen, goa ne
ei pie must be vaa ee of aer,

senos
pme mas
ee
a
SE

12100 gi enlampule Figure 104 or 110000
(a mg lr venous pen pres 10
ringe Epia. 0. melo, und Hin I, 015 gine
(Dey Parma LE) e gore 109) may ao be abad
Loc IM admitan: Repro wich preparan e
ose mat essa peces to aveo hands he
carol epnephrinecan ag andre din be
Dosace

‘The polie do 1001 mag. IM up oa maxima of
03 plone Thales er DE A, 202 mg
ne woul iy be aiid. Ts may need 1 be
eps fer 5109 mines a ee The al ee
(Spine Admin of tan get fr eel
meer à de nr or pda nal fc pene
{Sly yt nascar ete

Side ets of einen ince hypertension year
il

ALBUTEROL (PROVENTIL,
VENTOLIN, OTHERS)

use
Trent of cue hm stack encore),
ACTION

Braden reco agonist cg bronco.

Kaduse.com

148. | FIGURE 105 Ar ner: Ven pu: Rove
ph rons rata ere DR M toi
pba tore

How SUPPLIED
Mare dot inter gre 105)

2 peach silane with des np. May
Tey ai,

NITROGLYCERIN (NITROMIST,
NITROLINGUAL PUMP SPRAY, OTHERS)

use
Treatment hes pain os reo co unsube
gin pci rain cada scion Although
‘hs ris unl De ete y he pei pende
to bee out fo the dental tice D als mb may
Vier. Vue month muse rant via nie
one

Sang gray (ige 10.6)

Le mg S minutes ntl chet pan bites
où ple Blood pare Baw about 100 mm He.
se errecrs

Hypotension headache

‘CHAPTER 0 Medial Emergencies 181

a

230 90
CE im

FIGURE 10-6 hop pu a py eta
(coat Asma mea ee)

[ASPIRIN (MULTIPLE BRANDS)
use

ment of aspect moc nro Alou hi
og lly be needy he pet a, be ar
‘ol rough tothe etal ic by dal who may mute
emergency mi margen

Anti pet bbs hemborane ches
HOW suppLieo

Cheat al

2 pretty cd Bf allowing wih war.
sos EFFECTS

Dyspepsia iy,

DIPHENHYDRAMINE (BENADRYL)
use

Diphnhydamine is wed or aller reactions of dower
ase es severity han py ad a an aie 1
est nm loci

ACTION

Dipheshdramine e itamin (8) expr antag
ha ca the reponse of the reper same

0 min Ll vil (gue 107)
Dosace
1102 malig M upto aproxima 5 mg.

149. 2 RGURE 07 Oprima anton (rom
easter poetes o end La,
AS

2 FIGURE 10-8 Mao er to Cs A
‘rene Company Sn

SIE errecrs
Sedation ey oath

MIDAZOLAM (VERSED)
Midland an none er mange of
sts epics (e or susie sere) rs
‘ares bm ol menor

ACTION

Articomalant.Enbancesamipobayrc ach (GABA) A
re ai.

"mg nd Spin 10 vil Oe vi ech sa
ested igure 100.

posace
The pad de foraine grand maire 15 mg
fu mat 10 grieta ds estr,
fora IP or 2g ch amg dove would be nah
émise Foraulson SOKE D mg usa di,
Str Seplenetl dos may be considered sears
havent rated within St Titer,

SIDE EFFECTS
Sedation espinoy depresion
SUGAR

Tn aon to thee Aug a source of simple spr as
‘oppor to comple aby det shoud be sae fr
Ingestion in cu of spec bpogjemie ck. This
tite gar pocket empate nd sds op
saving andes sch se Severs Comme av
thle acre parts NOT aint abord muss.
{ayn apd i he cl ete, ba re eee
ehe salat. raven deso can bavi fr
‘hose compren cai renos ces.

OTHER OPTIONAL MEDICATIONS
‘The pei sto medicion contes he bac eme
cy means dat de pool denia or pede
Sens na have ovale The deis may año coser
having ola repito sea sch a mona
Sahat rable Gpe which ae commonly fod in
el ais ped to ainsi the oprtry to hp
es pte with ancora secondary o u
ed ae

Ober mine to coir in the energy Ht
inches cricnteri sch metro (a.
Media) o hyteartsane Sl Cae) fr act deal
ion un san ae to argo management. If
aio wth sed nd pid eed,
Home (Romana) and nenne (Nara), roc
‘dy mtb able Th apne withthe ern
arsenal agote by the US Fond and Drag
Admin o Y incio

‘ter agent tat may be wed for crias ora
ce or emergencia, auch ar po, pen,
‘een und brand, at we at ACLS and PALS
Sra aby be salable for we y dent th
‘svcd ig who ar well ved i th we

Management of
Medical Emergencies

‘The management of eset all medial emerged,
spec Bavaria ange in bett cia
fers al be prod in à ir Son, ering
‘ein pores i mid (Bor 101). Not oly wl ts
Span make ptt management more «Bit and

150. MANAGEMENT OF MEDICAL EMERGENCIES

CHAPTER 10 Medical Emergencies 133

A paie pret then the net prie manage
‘pet fll melkal eme ening» pet and
‘ction uperiayandaneing vtr be pet

beating
Creston
Dette ey

Poser à god fit tw bic He sper
arcs aac We spot udn me o deck or
Scans nd 2 cfs pus. ee o
ules wth 90 che congener
‘hen opethe say adi ees andren ere
82 pe open De ny and ner wieder ra
beeing tong puc. Y hen sr en rn

civ but tl roots any and confio
doce dent and |

POSITION
For emergence involving ofconscousessorhyoten
‘othe bs poston or managing the ston st place
"heating at on is her back with he et aed
Sigh above the lev of he ert Ti wl miii de
tk ft ar nr turn of pled bd em he
emi and ine via! Bend How he ain Fr
tira thi poston Is ey acomplia the dental
Chair For medal emerger inthe cnn pent
Invobig reprory dies (eg, shat ata way
‘hart whe conic) or che pun (ania), he
‘Sino sem rechne postions peel peered ye
sen

CIRCULATION, AIRWAY, BREATHING,
AND DEFINITE CARE

‘CIRCULATION cc)

‘The 2010 Bai Life Support Gaiden ofthe American
Hear Acc emp he po o enaring data
le resent whe watching fori of I sch as
rein nthe concious pent apes ot pees,
then cht omens hold medal bested
1 ate af teat Linse. Th compres ref
lowed by opening ie array and providing two arc!
velan ina repeating e The mat pd nene
ad cute metod for engen ls upton of
‘hero ue The carter sould 1 ot der
the semcicidomancid mue im the neck, One shold
eer plate bath ral at mln eae
reste onthe bores ofthe cod snes may
Free es besa The guy. tad hyn
pales shoal ented te pl aber fie
recur uncerln, EMS sould be ato ad chest
‘open shold beine nei

Los

AIRWAY CAD)
then one othe ans iinet or xn
ot per opel in a el, rapid prog a
rar deren an ee eating ri il
amago ic vers nd death Thx oper sy may e
‘steed by popsive sling tar, eg dy,
rather fc ht may hve cata helo e cms
ss deis an ec pleut no respirations oly
“itr gap, enue cai bude te
ifthe ay ln! obtraced Fors ch ere te
ds 210 20th pr minute (I rey So scan),
fd fr e sul he tes 101012 bens per mie
(traes o 6 seconds

‘hemos common aus of vay baca, aer
‘cous tbe mace pp mundi ad moque
cams red lag he be o tongo al
sain the puc pargeil ome, us Docking he
ey betwee he rl and nal oie ad Be tcs,
‘Ghent enge tonal para valero
Bye okay obran: Tiling he ead tk hed
A meer Ger ren) nd hating the a
eyed (Chin or re tr scare aa et
fran e Ban open thes hat
‘obsrced bytetongbe An rar ns my dere
‘may bus à kein be tongue award in encon
‘Sis dep atunes patent. Homer, hae den
‘ince aging and vomiting

I he ay osreb a foreign by sacha a
ten rol or dental deze management depends on he
tents condone paint somos sd fhe an
‘gh or vole allo hm to ten (were the bet
‘ih hrm elo ae or perk ine hi
y nece rif theca wes the unver aking
‘Spr of plang be ando round the ack, the nl sep
‘Boul bet diver bol rt ci mane.
‘er Inthe siting or mae common heading pu
ton, the operator pus him behind he ue,
hs End hip rca oe thd pet
omen len with he ter and nd pall pad
‘ck cy Th manever pushes eds and
produces mre ruined an feline init.
Fade pesr sei ito ra nd opa
ding the braco. Abdominal russ te ger
forma o al suceso ul saco owt he cd
Joa cocinar Thesblenina fran may be meted
foc pate nn dom in eden) m
‘hate rece dee tn with hee ar
‘om the side o font ofthe patent

The performance ef abdomisal or cet) thst e
pated cco acest edge ort

151. 154 Fundamentals Pda: Demi

tet oes once. the bj it expe the
Fate wl venta se conan and sos he
Regent glad Bo EMS soa cat soon
ss pone Start CPR wih een compresion (o no
ao pe check atts fe Jochen compr.
Sons open the ina are bey serre
td nt porn ind Sager apa bse they my
Ph big bs ahr to be par ad may
‘imate Decora Aneto ge Zbrats ad on
ince with ll cht compresas and veras
‘he the abet xp Aer? minute fr be one
cu fan char dy done, atte eemergeney
‘pee sytem Fer dhe de ao och core
ino serios bold 30:2 with on eo 1:
hwo recone
ftheuppe away Strife red hasbeen
“loge or cold be sen ná seme lena re
el Paire pese vento inthe hens
hr patin may e mc nn if he bt a ot
‘en dodged The aba thst sould mot be pre
‘red in nan tan year ld bcs of the rl
tiny ge abdominal organ (poly We Av wich
oul e damage. Inte eso het host mauve
‘Boal be deter ined th the el of he band pose
(ned over he cream would the poston
forces compresions during CPR. Chet tras are ao
‘edith prepa els ad bee ils,
Tale oreposteduntla patria robe,
ExSanivesand tle over management or ntlan ave
Ser tina à deemed pco. Denda it
‘vcd eng may per lr gscopy adenda.
‘hea matin, jt vento, or chy
Foods tng: Fallowing advanced
‘Soy cst compressa te ol te of estr hn
At sol not be tera, bt tar beth
shouldbe Gren smut bythe scan ese ever
(toa end to provid 110 beta po mit.

BREATHING C8")
‘One ptt erway seul, the not pity in
eng with mei emerges lo nr ta segue
ein (being) presen. The chest sold be
ic for an and the psa moth che
For dung resis y feto nd ening the
sea. oyen shal be tee and ere
‘sory rt aie rt ad lol prete shuld be mon
ar or beating rescue reg soul be ts
immediately with beth every 3103 sods ocre
(121020 per inte) a Wreath ay to 6 seconds (10
ta 12 pr mint) fo ll un postres retin

Ree bet may be compl bythe moto
moi monto mad, or agvabe mas equ or
ihr specie deve Most mou or mph
omas vette sometimes nec the energy

on. butts icy sever nied bythe at that
air alo rm the sce Tangs and ever the
‘prs patents Ings ely cotas aproimady 10%

‘ic of à poste proue bento sem (eg, ba
‘beh device) hh deliver se 10% sg,
‘Shy perl e Re 10-2 A ma at py
‘ove the patents moth nd ae pr. The mai
‘tached 18 ame tae wich allows on entr
‘he ps hen retoque fc, The
mps bag then rel th cen on The che
sta saine a Wht mak e on the pt ce and
Sperre he ey with ne hand and compresing the og,
sth ther fring on by poste pres mo Be
[tents lang Exton is pare. Ts tee of
oes tein le mach moe efit thn monto.
‘mouth r mono mask cacon and shld be ms.
teed by al dentine Dg ral us ster, such a
bug cal e mer at a
‘Sey dali

DEFINITIVE THERAPY 0")
(Onraterthe "CA" ad “of emergency management
fave ben atid sould one omar dine ig
"rap Wheber the dentist shold air sea
mins depend on eer, indi his bet
traning ad pers, the saab mei an.
nd om ai shan the mery rate
nd hi reten, pel ithe el dar oF was
prep y à wem dr minis, de
{hetherpy maybe indice und exes Some common
media emergence whch die tony nd
dvi ely dsl

smcope
‘alee yc, or pe ft ebay e
‘met men em lt lomo la the etl
‘ice ti amen, ach conan nen nin
Yemen or young ads. cope a ldap res
con tas sly were by an As the ptt
‘reas ans, ie ho igh resem fhe pe
Serre gd nd ee
“Tis reponse lv re nese In Dod Hor othe
mules of heboy themes recon. Would
beca fie indie runing, norma od om
1 mintined. However, in the dental ei eo o
‘mute conracion cf. hh Bead pco inthe
mc, el dese the re Bod vee
ale tothe el cretion and orth brain,
‘The ee stay ice ina ate mais
the Mood presure, but a enc ling dares
case of yor vou tan ver mechan sb the
heart to improve lg ofthe veis Ths pst
esto poten and tadyarda, Cv person
1 then compromis, cig ss lomos, or

152. ig yin the proce Nod Baw the bein
lens the paies lily fc dy ov igh beaded.
‘hsp of Be condition cated preyacope ande
aten ay se normal colon he ce nd Pre

open bn py.

1 resaca recognized in a asc pt nd
eat ith uty lo of communes ma be reve
engement om of poston be patent apne ow
in che andre pare Debut augment
¡lod flow woth rai by ai This ru bel
incre lod pre nd pro nice nr
‘bod ow. Administ o eye is apropri in any
en involving decree ain partos.

ithe proce of scope conti homer be sympa.
Jet nerraus system wil age ad e paras
‘nervous ye il del become dominant Ts vag
and bloodpressure onto starting} low eves, Blood fw
Toter decreased and nee lot rain
come eu, Be popes dat, ad convie more
mens may beste. As any concisa, the
consis paient in he den fie cd ere BLS
Theron are proa fa panne hey
Should be opened, and he sal pen shold sil be
‘cred o de resting a e pol, let pen the
‘Say and matin elton aly lead orale
‘overs legen to cereal base Hwee
‘hepatitis qu placed the spine pet pos
ton ofconcoume fom score mal guy
Fehr lb ven 30 second lucas may
Ue dune to the dent or mas wit the une
sors ait. Oxygen held bearer
Tang ad nln stot hte once
‘thing oral and via pe montre. The we of
fn ammonia ihr to imate the patent my be
De

thong conciousness maybe epi y ui.
recy of bat rte und Dvd pie may be ge sow
Irre of conne dyed bed men r
is comple ate 5 » 29 minutes, mal ace
tol be suet. Drager say ot ined with
cope une the bart cor oad rare emai dan
(rou depre ar oso In such acu atone
{Ete drag of choke 1 incre her rt and improve
Cauda output, but avo ot come avala in
gene or pete dnl fc

“The patent may be icharged a pod ath
ang andre of vil ito cepa rs The ik
‘trepeatopcopeiowere rater fer sanetine afer the
‘pl and he Sent at ocre shout
‘he pe wil tarot cepa fonction
the patents «ola shouldbe cl to
pent ome and her wee ice pat tr time
or adolescents, his i nt an sue baie they were
‘ay ramon vo etal by anal ay the

‘CHAPTER 10 Medical Emergencies 185

ALLERGIC REACTION
Als reactions nov pee responses ty he
{mane sto to tios hte coin sf,
and ae asocted wih sahen andy formation
‘Tecate sever diferent yes alec respon tatthe
‘ype! Gimme) hypesenstity cion wl be die
‘hued here ye pedal ection cn ange cn
‘i dyed res o ever ude tin an
Pylci Bock The primary agents employed pedi
‘Entry tat might prove an are recto re de
penis ná pos theese pe of oe anses
(Sed fr thee tpl anette flee Comm pete
leg resis albo uf asiatica
‘het cong vaccine may oul prove ae
Allegation

“The plc resto is tne primary bythe
awe of ita fom end mat cl ang
‘te indmaary medat lay a tle Hist sa
ent enges oi agent pole irn.
nd vascular et The dy yes primary mad
{Gala recon are the si rep sem.
fd ears sien. Sn ave Ihe ment
common action snd may nage om mi yemas
‘ht rar (hive). to pened sein

‘Aa ener he mor rp the ost and he more
tae de symptoms tere severe the poeta eve
on ane expel ee Edema that nv efor
tod neck my be rapidly popes, leading to aay
ración wed death Te respiro), ue e uy
Evolved aba te in ection rin ered apt
luis The primary proben i consi of neh
act mc bat oder reper dimos cael by
nay obra, primary ext nature The pi
‘ia recone gn lbn since ring
‘Sand acid boncocuricionand dar tan
tm tack Aste echo morse pate at
Escena in cnn lege vom la,
‘Sly bcs pied whieh woes ttn and
porel ds er hypanras test cles
3 contac and may produce symptoms of abil
‘ramps nasa and vio, or Innen As ampli
ine prosa the roma te ed m
may popes o anphplc sho Mypteon i po-
‘heed bythe vaodlaing fect of Mamie ad ober
tains oe reponse Reflex tached ati
Ad ey crac ars may fellow

sement of aleje recon pends en de me
ours and seve of the ampioms Ir mps ar
mme, seva, o reply poet, nde dent.
fe they may ele sei ch wr punt
play enn ig and dy eating epi
epics. mpg tos maximum nal seo mg
al à admire inramosclaly fem ampul
‘1000 epinephrine. Alea, 6 En (03 ra)
Se Ein Je (015 ma) can be ud, ih De her du

153. 2 FIGURE 109 re 03 mle aan) ad En.
‘bmp os) Aulas gone arg ae st
densa estan Coste e ema Ba ge.)

chosen fe the sueco apli paient who mito
una 16 and 29h (gre 109). EMS bold be a
tel Repo dos of pin wi aos rey be
rede andor some co apn high dose ee
Sy admire temo y wand persone re
sure Epinetrin pipe comedo mos of
thes of histamine I role rocio ous
tering bondhecontiction and ss lod presi ys
(Capon fet als conter hira wari ot
ot an eine st rducin mel edema.

(Ouen das be abris pray any
espro sponse pret The pent who ss
from scree any hub transporte hot
tl eer soplete with erat and
mie cn be provide he dent ar injectate
“rrr ad ambinamies sable, the an be
miel IN bot te sanitation bons dey
«inepto, one therapy. and BLS if Methven
‘apes spec

For mie lero echo chas hia sh oe sal
number of hie, a hitamine receptor Hor sich as
eden cn Beamter Mor calado
hg for len 2550 mg fr dul Than
‘amie il general revee malecon
rah and ting. À roi can alo be ner
‘The patient dond be etre for à nt pro of
me ensure atthe rcs does ot ogres ph
ce tock À presion or an ond antaras, or
by coter sch asa mehren dose
Fock proprio perdia Dipbenhdramine
à ne of gh fr hie or om oral,
an be preste oral at Ehour interval fr 2410

hour ling nya rection

(Of the mule yes of eure, the nie coi (gu
mal ypeisbemon High ond theonetat mon fen
Fey reine Only ths type il be conser bere
‘Gand malins ae med four Pas te po
rom phase ur te ale Gt) he a he
postal ps.

"Te prodromal pase cons of able changes that
uy tr oe mint are aval ot ely

iden tothe pain ce pain The aa e
‘loge pere that tem pos ru rec
{afore hectare ic ted o he ger sae
‘the bai in which he aie sty bine my
ens of ste sel lus, mote ay ot
‘ter symptme À pivenpatn au en same or
tuer fs the CNS Scary become eerie tbe
‘eal pe begins The at es conne e
eo anti salta sde conection es.
[Ave chen val musas concu a le xed
trough the arya, producing clio edhe pep
ay. Gone movement hen begin producing ped
feng ofthe ernie an mue Being may Be
ocd ring hs eri und pens mare tee
‘sve Thi ck pas vt to 1 03 mites tbe
oie hu nda de mes rela ad ovement ps A
Simca dee af CNS dere is wal pre
hing ths pn phase nd map el pta
depresion The pate ha ames fom the RO
ple ruht he etre see

Managemen of ir conto prestan
posting of he patent presen! sry easing,
unen adopte cr ainda athe
portal ph, epa sway mansgement Sole 2.
Its d pr rege dog py becas hey sa ae
tag. Sol the il ps As longer then 5
nee thom, à conden aed nat plc bat
deep. Ts may bea Hethrnening tet ent
{poy ce the ema mu sy en rest in
Epia, need oxygen consti, tye,
person parcs and ac amb
In deal fice here ace aaa, th coh
on is bet mange vi namas mic,
35 agg Me aia of 1 mg forthe ta ds
ns way acer flowin miel amie
‘ion cel EMS ho be stated ad espn
bei sald be arnes.

HYPERVENTILATION
Hyperion drame be syncope, «maladaptive
ans ration that primary ca apena
‘Eales batt de te any mac et
ero als dae oun ren. The
rome ong ya en poling eet sch
28 he local ancien. The pun usa
re fhe ct ds einig 1 peine
be resp ste may nr o 231 3 Bat er
rin, than ice al vom sue, The pent
may ampli of ey in catching hr teeth The
‘ten dese mth od The decree ote te
vil pal pre of cen id COs) reer fo
hype, cts apli eons ofthe
en sopping the bala is à cent decree
{i ood foto the brain The ant ml gi fd
ap ad ight bade, whch eter enbncs de ande

154. ros he condition id Othe emptns
‘Gat may sur née nambreo md aging l be
in sates nd los o concise.

argent ol hype ves uy recent
sion he ent samrieyand diag open withie
un. Resume, pet rapper ná clay coc.
the ptt obren on may beset o so e
prose Oxygen sémiitaton ie np to e tencia,
{hd home mato canal may rer hen e
Pent nse fhe plano! be broken, eps shold
Beten vo ice the Oy Ti cn be scoped
‘Spl by sng te pti eet itn ape tp ich
‘tes bai ef call Core an, ds
‘ing the FCO, and rn the peces Of os ht
Bu nt be doe fra ended pari Hecate of te
res producing poa Breathing eater
‘copped anda may a ep whe bing» pope ag.
D fit ot sangre for genen snr
‘subsequent aptes propre
‘Thprimary pe ofan that cs incense
e coria cm vid l miel y inert
ER) antes Ths ype of sana I fogueo
pow y thet tens rey mente The ma at
Ss cue à al gud by see aleron sch
poles, das and mol The nitro! te
Espere aba and coins rd amount of
tencion seo During a steam tache con.
cio ofthe oath mu athe bench au
‘onchepes td the date being Ticker:
ins re rode wich ean pag the anal wy and
‘ron wal muy devhprapiiy ad fuer com
Sine and symptoms on mid vr nd ong o
‘ever pre, roda sn eat

a ace the pinay ye of tna i termed nie
sth With ini tims stc muy Prec
y econ, cold wath ec ad print, se
Some reg inte ain ype ray cr With
ny ae aie a Dorso try shoul be dec
rated inthe reed nado how oe sc ca,
ow seve e have Become (f ps
‘at or bein at Den eed), ge
‘tac and what med se bang ken Al temps
‘hold de mude to wld prep cr he pen
ds ing mein, be o be ou e inset 0
“tie ling them ace e deta ppinumen Te
aten told be tact Big ti aber ler
‘ny be wig oer bars ahs corer als,
Elche portant rec ae ht hey shoud
ig

1 pase with ah bein o whee and dep
say répit ives inthe del ee, they shold
À Slowed to at pri whee hey ae way

CHAPTER 10 Medical Emergencies 187

moe comfortable Heorshe bs tie tw pu fo he
er al, and the he ot eee the
‘ens an eth patent ine one le se
sy He Ine vas major o cs uber ible
‘beste to abet anata tack hi leo
the dnt feo the attack may be Be threatnig ind
e]
ll des, 03 mp) leia (1:100) IM sald e
ici ande EMS oral Epi lee
‘fl within o mint in mon ce ty admin
too oa cocos IM ay a be bel in seve
‘ad ag dx onset rater den.

DIABETES MELLITUS
abs melts a disorder involving yoo illa ro
cine adi aire Ths to dien ol
“rbot and porn metabolism snd nr
‘cl compro wih subeguen orga Scion
ofthe kan aire pe, peer neo
em an ter dy sens ls character by po
¡cami te, Dates meli oca fn Ca
en mu comas y ina dependen dts
Freitas nd ea m os of peat el faction
Th lade wo the egin fr dy preter mai
intron Hood cose rs muy be ery eto
“al peri in young dre.

"The principal emergence ht deep are
ue to er Byepyeemia se hyperemia pms
ins rl ema ow ow efor prong eid
‘ood cee ker wll become extremly lated
Rowers: de gros comet be tel by ext dam
casco beca niin nds are he lamenb-
inthe production al bes ad abr metal ac À
‘dion known s diabetes (DEN) occur.
SA may ed 10 com td deb ld pat nt
Troe e import o sl tht eri egies
Seal dp o devon during wih te the pate
pp docs ot oc ly in a previa let
A wel pte Therefore thi dir sl gay not
ied wan sate emereny in the dental ce Regardless,
ithe dabei pai do no Tok wes pricy
the ban hs an acto odor, he or ae shoul! he
ind ek mei aten tamed.

a be pn who appa wel ba dle de
co de contin i fr mare ely tobe de sate
gen, or aa shock, The ul sea ves
forest eta mal o a inge induite be
latin aná re teed cs concentrations Cae
doxygen re primary metab sourcesfor brinca
[the serum gcse level begins dere rl
opens may app. Mat dee patents ae wel

Kaduse.com

155. tuned to this phenomenen an cary a chante
Source to beige othe cent tb ot
ingested and te od lou concentration continue to
e]
se Te patent may Eco ha ave sage
me acne or pond app questo
ng rents ints condo maybe conse with hse
nin hd enter aha nen. The mate
eros atom Becomes sce in an ate fo re
od gion evel produce sponsor.
permi, any ad io The pen depa
‘red sec, uso mental cardio nd evenly
ior omic Srs may eu

‘agement of ypopycema volves te admin.
tion icon Tea rs le wed any pal
conclus and separen ety ymptoms Sapı de
red jo empre wh Siok marc,
Simple soasare more plated thn complex a
byes Shoal he pent Become conc, BLS
‘shold ested The ost importan emergen mans
met contains ae misa à ptt sy and
cng EMS. Genel ety nthe ep of econ
ome retro und clon se maintained. ES
ramet wi geerbt IV cc and aime
50% dene, wich apy rings about zum o,

‘Blond theresa delay EMS aan he pen
de dee, eaters el ini 001 ph
msnm da 03 mg) és 151000 sation Mc e
‘nerd ted on the pent uring carioca
‘tana The dent shoud never anept to. mii
Bucneonty oa diam mental obudedor unan
‘ou potent

Tet veraneo tht the dental raconte
pur co ths mata becoming ar wäh aber
‘meal emergency stn that may or in de det
tlic, pel thse dra red emergence at moy
‘elt fam pamaco apn being ied in day

156. Dental Public Health Issues

in Pediatric Dentistry

Jowarnan D, Sii ano Howa Asst

eig, ne oft inary challenge tin he dna

[profesio sens at a en nd adults de
‘snes of ood el al Though weatment fen
{a ofc ein ibe comertone of peutic dent
cie, amo! ies all the weeds fal cen
Ecol ned cc etl ur and Med cpu
‘Th, opine the oa fl chen community
‘nse, pal hl aprons ar neces This per
idea mie dental pbc a and ens
‘pin which he ol ea fee i nace by
‘vos pale ath ce

Definition of Dental Public Health

Dental publi eth ie doe a the cece ad ar of
evening and conoling ental dieses and prom
nai bath hough ae community ee” À
common micoception stout dental pac bah at
de im or edle of den ae 1 ow
income pron Anh hi impor, esca dev.
yo denle noe pe of el pb hal
ete majo cre nts of pubis dented
Up the Tot inte of Mate sly ar nase,
oly development and sance} The mar site of
‘en pb al cn be ii ne te ame tg
Fi. Bamps of cre dna pub eth ae at
Mf the ora hea of ele genio Ha

Role of the Individual Practitioner

important othe individual practioner to understand
tha rl eth ate ad et ren pc
(Sein pate pracice eng ay ot eps heats
nd ned ofa denn commit Te age
For ens therefore sto ok beyond envi etal
‘fice and ake road nement of thc
eats vie seg ter own fle in eshancing de ora
sith ofthe ene comm,

"The Ain 0 Set nd Teal esl Dect
(ASTDD) devoped sod dismi a ned acest
ol a revised in 03, designed to ep communis
defy nd adres thiol eth neds" Tis li

+ ourune
Roınor rue sorna: Paco
censo Cane

Dental Paria in Medic
Federal Quai Heth Centers
monas yo Deer Poni rat

aries aro fat and Toller om Love
ce Fae

Propet Head Sart
Sebo ed Dental re
‘The Challenge of Adeeeence

non a the ASTDD Seven Step Mode Figure 11)
rides aora apro for eying te rl
ah needs af community and for desing program
to met ie nets bated tae pus Te
nee ace ne re où ndings on ae
Seal examinations wich are pay expe and ine
Consuming to conduc. The ASTOD mode provide an
mate for asen neds tats mare eon
fd iles exito roouces and dat when eae
caray baad med se ldo pri
‘cst opporenty à ect à commit tout he
prince a rl eas

adios puriptingin nes asset cic,
einen ae ken no arpateinother pac
eh acti cling adoring ura oem
many ate spp parting nod and corn.
y bah pomos nei, avatar pins
oberer fo e aplica of Borie vanish fr.
ike ad bin poy aerea dental
Cire progama inca Medes Support and gine
ot ivi practioner bc erben desta
ube ath acti cn be sgh om # ay of
Forza lncldngiheoralteth component lt ab

19

157. "EXAMPLES OF DENTAL PUBLIC HEALTH ACTIVITES AFFECTING CHILDREN

cen or sto tc
gine

2 Kaige pan iy oo et

2, aang he tt later Raton comunes

À Jong De net o Gn fer wah
sentence

5. gr o et ces

4 Seno nto eter co

Palle Devebpment

Dore pol an aca rept ston
Ko rre cs real sees fica
ner hotes nd ne chin

2 Devon rama a fc en pinay ans
Sony even

3 Dog programs prove dental eto lr
ec est nnd orto esate

à ting at ns mang chat ring
CREER

‘suranga cent ers to roe ord
ath eon nd emotion shoo in
onan tings nd chert

2 ignores ew deal c see,
Ox epson

5. Ding romain atve by e Sete Heth
cmd ptet

4 Tring tpl tee (ce roams totes
refina

on

rg a al compet schol ath

6 aig choc ad prevent proa
Compre of comprenne ol heath

7. Esc roma o med feta an
estr votar cris ol eth
Pera og eo occ

dera al es ar to sprite tes,
Sen socal eve egos eg. Mate
dca eat natn VC ha rot
pete

Beni gece county ber of el medal cite,
{vais commun Barsa raisons

One important ie eines end eme
na ear scent den ue fermes
ftir commons pied bn

Access to Care

‘ough regular deu ce nut santa to
Bes mosto malls ren a api! number
(ehren and ad tous robes ecg the
‘ee they nea. These chen ae mus ales fom a
income or minty fares and uno} serons
{endo experience moe ora des tan other Cre
Sete ofthe cst cana acest dental ce for
‘hse cen a (1) ak of Sans Gling ck of
‘hed pry coverage), (2 lack of ranıporaien snd geo
rap on (5) suspenda barra and)
Saab of dental provides vo accept Medic
“Ath major a th ie dental vi
luck pace need for care ool ath Hey
Aout Aroca ct, ava, and Bop

str ae among the major determinants of ea eh
ery shir ype core oa ath
ae Or eh ray dene a the dees to
ic india ave he pay 1 ob process ant
néant bai nl bath infra ad eres
le o make appepete el eins India
Put ilk the provide ly commune fl
Brand accua nd informational demand ped
‘on pts ty Bal ae ares Impact Beats ey
eat ath rc arc Ine poor bath ost
lower we of preventive srl, need we of bapa
‘cron room a per hah cae

DENTAL PARTICIPATION IN MEDICAID
Fisica, Sandals have been mange mat
forma bata or Income ae ln ering
ral In 1965, te eel goverment atente.
reduce thee Baal bares bp creating the Medias
eam (Tie 19, which py for mil nd dental are
foe Sil loveincame chien Ads dental enge
vole Medias opin rd orde vary wie
rom ateo st Honeve, coverage er child deal e
‘ies manivory ec of 196 amendment 1 de
Mateaidprogamesagtbe Bund Pood Senne,

158. ‘CHAPTER M Dental Public Health ses in Pediatrie Dentistry 141

Sp sty
EEE

=) =

y
= |
— =

2 FIGURE Y cn of tan Tr De Dec Sn ec semen oc otero!
{ete et Det Or eng rd ei me 100 Set (nt) nen aa ana

Sede een VON)

Digs and Teen (EPSDT) propa? The purpose
tthe EPSDT propa o ident ie hah pode of
len say pun and o provide compen
rein and Feil are

"Sic 19 the Med progam hasbeen he primacy
podi sera program fete finn! dna eres
Feel coe ce inthe Une Sts Mo hen
lniowthepovertlevewhorecvedent edo trou
{he Med (Tite 19) program" In 197, he State Ci
(er Heath Insurance Progam (SCHIP) was sated o
and pad une lei am ith income
dao to ua fr Media e program now Simpy
non he CHIP propa. Af 206 ses arecosen
Lo ve cen il CHD program iter through
Spanien of Bar exiting Mend popa (0 ates) 3
are leah progam (18 ssh ra combaten
ero sat)"

‘show’ Melia and CHIP have ben suceda in
mproig acces to del series fe som, 196 à
‘report the Inspector Genel f the US Department

of He and Human Services indice tht ely on in
he Mei ee heen reve ny del services
analy.” One ofthe Den barr o dental ae he
ao dent wing cp Media ele dren
Rae of papa vay by at a y te definition of
artigo. Since ie Impacto Genes repr 1996
Forme inthe ron of dena care wo bre
vale in Maui Cave cure. The ms sl
improvement ce beten 001 and 200%. Je
2001, 27h a den acoso dal servis hee le
200, 308 of Meai-ewoled cher saad etal
‘Serves Though ths wa sabi nee a mens
Fou two ds of Medias ddr di not cc
den serves in 2008. One Conce thovgh i that à
mins cod tome Medi! mama cry rl
crc nes. De Goverment Acosmabily Ofi
Separa at at vá Meld Manage Car a po
(bees have much oe vc in cis da
‘vc tantes ht comin with inal ee
Free Mead"

159. ‘The mst amen reson ed y deso te ack
of partion in Mele we he low rémburenent
Fate Oe nonfnanl tees wer, er impart
{Swe er example in a stad oro oh des
tere more ka to uk lo fs as mot important.
oben mor dei id it rake pannes ro
Ere impotent poem In th pace than ow fs +
Dents who wer les ay ad hve who belied that
etashaveanetcalehipton os Mei calles
‘rere mot ely be cet lin Mic patents
In ther practice À number of tat have neal rim
remem tes to ty and improve det scene of
Medicaid cl Serra ie ne have ben rc
‘ee Mai ranbanenen the big monday
{fer sproch and improved dei prat in
Medic by carving ou ee dest prin of hed
nor the signa tt Med har among. deni and
ira rimbursement aes y 207 there hd bea 27
min 2 pais snc prime

Fonera 021 ate ca cw change base
ofthe wohl US. cor: Combined vincia
calles in Mei end dein fea mung
nr to tes many e sites ae racing rei
Pet esr dental sfr drenan it
Si dena servi fo tance sate bee Tse fet
‘eduction rere may sol in decode pr
{Epon Casey in he 30 ste and he Dirt of
Colombo, 7 Mate progama fer no dental eve ot
dl, 1 fr emerges dental ae ole tes
enge, nd the remaining H fer coches
‘es Rod or dit den seis fr alls
vray rot ina nese in malig of pos tir or
[Eto imac hat of ter hen” o el 20 the
‘bara nario dd th sate in opposing Le.
‘apn ct in Medi rt at cd rel a
Far redactions in ssa o cen and th pent
ord”

FEDERALLY QUALIFIED
HEALTH CENTERS

Aspar of his "Great Sot” plan to amine por
rien Lyndon Jhon Honda ight aphorhood
ath ner in 168 This narco eh centr
ner as contd to desa ad eg hough Be
Yeu nd hs eevee raide std of oughly
Tato federal aed hath enters FON mi
indes Conmaniy Hk Center, Mast Heth
eme Heh Care or te Home rege and pie
Fring primary arepogums Themisionofhsecntes
devo les seas fo Merde hes cae src or
Tomine fame. RQHC ae lated brought the
‘uty narterbrebrrlini ce tpn as
dre fr pica prion of the pote Thee

rer can be economic, geographic andlor al
ONCE provide inary and preventa cae series
‘nig den rin man enter.

cal er (FY) 2010 colons or FQHCS woe 9,5
len Progr setts from the 200 Uni Da
‘Shem (UDS) fort ames were foe

+ we 195 lien
2 al palets bn ered dental erie 35 ion
+ ol pidas 992

1 Toul nue pacte php sans 584

1 oa dentine 261

o genie

‘The ol of FQHOs inthe provision of rl beth ae
fornido wo woud otherwise ec ot
rd evil aly incesto come.

Children and Dental Public Health

‘This took in rind by irn derdopmenul
ge I werke wl fo dica dal pb al os
within hire developmen enter The reiner of
This capri do to indi sme dena pie
Feb ro ren lernt ge oor

BARRIERS TO CARE FOR INFANTS AND
TODDLERS FROM LOW-INCOME FAMILIES
Del ae fifa ad tol fe once
es preis lea or several eases, These len
sen (ck Banc acces to care. 2) hve egies
Se fal to recone the imporane of cuy det
du, G) ve dey Sige dent who sep Med
dei (ve dey Anding dott bowel wat
Chen ponga a ya and (9) arent we bye
uns primary ae can Sek ental ee a an
rote see

Tr ae der in htt dtl ae Fc cr
shoud begin inc. Ti spec nr fe we
income cen who ae at Her for dee Aug
ie wu that mn ehren en experince decai it
Primary denon others epee iver dc or young
‘Shen prs bee de age yah rerest
‘ten res hopin and perl neta To,
{er lowtncme den with sr dc te om la:
mem can vrighandpresnt amajr arr ptt
ents an peine

Dei ESD program requirements at pi cl
ren dents age ya (rpaungerin some state.
A we of demal rs y how coros ops ©
Sy remains Guen lo? Cain lor se
eal 10 convey e importance of et dena vids or
nd eontlg shuld be apr of exiting publi ath
progres whe young chen ape fr ar serves
Sere iron of oral bith cites icing

160. ‘CHAPTER 1 Dental Public Health ein Pari Dentity 143

prevention, educan an cer, has aed cure
‘many publ ath programa nding Mera Cl
Heth Gr and Ware, an, ad Cen WIC)
Cr

‘Although dental components ar fn tal pat of
patch propane arepab bat ad.
Tied sly 10 met the nen of ine fat
weve let oe neo model xs ay dni
eign ecc fer he cl hl ae of ts In
ata sate sponsored infant ol bah cl ar nt

PROJECT HEAD START
efor ein hate oi rad many een
inthe Unie Stes price In formal proc pro
Scant el a Sal
{po andorra sforloincame
Es.

Th het pro pra in cout s Had
sur, wi pm save eden fom Join
is and len with ten Hed Sr, ea
Hei 1965 ait the Department of Hito
An Haman Si (DHS). ad Sota comprehen
ve ch developmen rogram at serves ¿rn om
lito a ya peut women, ad he ami.
‘They ae cid ocd progra dh real ga a
{bean the chal eds of young ches nw

For oye Medir gore evito pros
(0105 yea y. 194 Congreso de
Ineo! Ey Head ar, eig prepa ment,
(rates carom sng Dy Hew Sor may seve
pur worn, ifn ad tos tough wey
Re vit 07% mines ech forthe ence ay

Tl in 194, Hea Stand Bay Head Sar ep
rowing sevi ro community hd xe enters
ne 1-2) many gates nw have frm pre
Aemet tht ated Head San progam Poeme
‘Zonta o dec commen ope.

Tn 01th al Sgr fe Head St and Ent Head
Sar wa 72 blo andthe number of hen el
puse Y milo: aly Head Sart programs seed mae
{htm 13200 iden under the age ot years”

Thar pets inl sate De Dstt of Cals
bia ero Rc Vig and and Outer Pa and a
ton He at roves hl eee evo
pat cen an mies and idan aon,
ead Sat is raid by “pants in 2010 thre wee
ire coher right sre aan as coun aro

ied Sat a iria mín song com
seat e el fee and the eben
IS programe Ths commimen eect De dosmencd
conection beeen school readies and god beth

2 FIGURE 112 nal Ass pci eut 1 Hed
Sarre (ran runs Con dede tear
Pop tat 202 Sunes)

‘can podoratbah"Ealytonthloscausedby deel
‘hay can ein far 0 he impair ch Seve
‘pment aloe omar hal o concentre sc
dred -ten”(UCH Fc She Oral aa
Lang Hen Sr and Kr Head Seat haves mn
tery dental composentrequig al cold dire to
ee del examination complete with propi so
‘el as ono ae for ne toca ment.
ead Sat program estaba nd maintain en recado
force ello nt program, bat Be near
tal ete ls anal povided by dental profesional
in be coma o wi publ beth dc Hed Sat
progama ar the par al a rest or nee det
Soma becerro et
‘gle fr funding fom Med ar ober sores Tit
Sn pub pet rte hs ee ramet in
pin recu roro come pro! chi
ex noni One ofthe sated pas of Hand Sst sto
‘tempt to amo a gang ele pe o
are thatthe eld const ee comprame
Ne ae eve er ving te Hed Sut pope”

A Hea Sur rates hve à hal seis mane,
who must ensure tat fis, stl and comma
Foo u cute far te der of qual bal
‘evict che Th work made ing far and
att cond enlevant spot gal bea
problems ining be techniques (gre 1-3)
The eh serves manager anda rer and be re
ein rap wäh commit hu and dental
profesional to work toward gon hell fr al en.

161. 44 Fundamentals of Petite Dentistry

I IGURE 13 Hob se e Wann et
ur ma say rons torn he
‘el ing Sic Sonde

‘SCHOOL-BASED DENTAL CARE
copportuaty fr ehandng the onl hes of dite.
Soda lg sor remar arg
canal an prevention programs ad debi dental
‘eves touche ad crea ey pri igh
Scenic fen st the mec The Utd
‘Stes hs enel lng tration of sacs imp
meting cal bath ais in scho eins The US.
(Ctr fa Die Conta and Prevention stb
filo or shold detal rss hough Cord
Pat ol Heathens wich mee pto prov
Pat he comes scho ed ela? Epes
faerie that an be pois ins he sti inde
‘alah education, ord mouth nag ein pce
‘met ol hath seing and real, and compr
Mere cre

Heath education, india oral bath eect, as
Hong been cmd an important part of choo curia
‘nthe Une Sates Dott and other dealer
orale cen have the opprtniy o cont te
Aci by vin caters and pring beth
fs o oer el ee Oral ath noemi pe.
‘ened in se forums cn geet mr ad male
‘angen noes und ets However singin
forthe ol ha profesional fo andertnd tht thee
‘hangs ae comely sort ved and dut dese ba
Joa changes eure rep, en tem flow"

Schooled ore mot fg popes inthe
Une Str ad bcn a cum pul helo prevent
tte fr 30 years In 196, a em 325 ml
len wer ari i schoo bed Borie mouth
Fila (EMR) programs in 109 school, by 209, the
‘number of chien parting in FMR program was

A

(9

dwn sts 80900 Hct aed uo
‘ide mouth sng programs bre De mo corner
{ue at choos ite the ey of ees donot
ves 1 cred king o pri te
thera te among chen fas aed e o
incre propecia
Tose inh lage deine ot a oa Te po
(as ar mot 1 be cof when reds.
dan enlace as ica nt ick
‘cn pn er pa pal
‘ksh mle sam foe mn Most
ang aci e ea spree by a ram
tech ch un. o oe Pons wth pot

‘tok ts seat programs heal
pora na m rg he pens sets
ER mom chen" Aka pd oe
ehe ben Kant cn prender
ar Fo mx than 3 pari 1989 ol 1 of US.
ee ea rt one Mos
Sade eme pores bd ben stad athe
{oot cet NHANES mame (1999-2000, wih of
‘Sen va + det san. Die same pr
mentor pement de fren
‘Eom me fol eid Gang a
‘Sle m ai vacila 10 he
(ee poverty on In Zu. ho adc
ed deta a progama were epi in te
104 vice ban 50030 cen” These prog
‘Strath witha igh porta foam
‘See done forced te con me
progama Crain Bas ae ul ist parió,
Boston the cup put a he permanent mal
Be le tig of eran ffs permanent les,
second grade ia common seo ie sea ropa
apor ith caco poe proving es 10
{ei lens dy gue a

Oral heal en ar cri ot in schol une à
mb lie as Ofte are
ing re pr apart al a fa or combi
ib other datos ase The purpose
Wise secs ef ety pos robes
nd re crn dale Amina Senay
ent med or hel ag a eng ad
{me in anne with cheb an program
a pre saves peng once ale as
of ra. te rr and expre cain ote
Sore apie

Flog ho Basel rl ath reis real
fu alan e ely made too dr fdo
$y Quit Heath eme e hooked se Ony
tata hoa ue resin examinations ited

Kaduse.com

162. RATER 1 Dental Publi Heath Ic in Pedi Det

URE 14 Owns ice srta esto potash

‘ine sted penance eee

to etico of compet del ramitas ets
‘ute the schol Thi Informati oud be commun
‘edo rent and guards of hen where
sao crean inion o ero
dures provided (no do).

Copie hot tse dental re ot common
inthe Uned Sas although ome bl hs programs
{han @ yess In Vii, comprenne schooled
‘el rogers were it eed ia 192, with gang
progra actions eer nce” Alough examples of
[hol ued progam: lin compense care an be
found in the United tts perhaps te best known mode
for compehenve schol ase entity isthe Shoal
Dent Service of Ne Za which hs een insiste
hor more tan 6 yer” Dept unver aces ander
‘Grete New Zend hol based deal service baled
to rece des prove and uty fre dae
eu Zand cn tae tg rl ath parts
{fom cond throughout aulboos The bly ean
thet san ae wi miga the dental en proces
ina al ing on th ey prevenon of esa
Sees

"tooled dental cae can nene haces ands
‘Gee the pre str. Sho ued dal program
‘etd of cope ld be planed carey pe
‘ances for uc The mo fundamental spe ol
Bing lea Crta asst ol he need er cea
Based den serves and onping eatin of sch
program Schooled progr should not ate ©
Teplice ie provided in the rate sector ae shld
they compte or patents bo, me say ved
ty eng emu À proud pee ising fom

uy M5,

cb bs dent ini tat parents ae ot arto be
decimal compa th via the log em hs
ne a the mos sant sic fa peeve eta
Vi Bere mie sation for fal o prov
‘nl bl noe In whoa te tings when como
Pd th coca stale to dua tong ue
to nica drinn of pn bb

THE CHALLENGE OF ADOLESCENCE
Proving ol eth tet adlecentcnbes reso
perno de practicos. Ths geal ave
‘egy vá mou eects ety eal br
appear andthe bea Fr allen. home
dales y mae dal ave on pe
Alan a prod of We play act wi
Increased fs i the aes of beh and een",
weve oer he pst wo decade de otra bath of

+ 1 199,26 feng didnot wera sete vbs
in 209 ny 1 i oe

+ De 191,2 of eng had smoked a prete at east

+ An 1991, 51% oftenagershada las one rinkof alcohol
de ps 2 das bat 200 a

+ 19199, 19% fur ad er merce vit ur
or more persa bras 209 es a 10 a

(ne as bre me bae wet dein in heh
among ace has ben the sige in obey ater
ee 1980 a 2008 the percentage of alce aged
1320 years ho wre he nerd fom S610 18"

Needs to, he rl ath neds faeces te
often ovo by pesan concer
describe people in ol nds on ud 10 core
Solace ho ae o at sce in cr ie
ae of ne or mor eter air hr on li m
dolce may inde bt reno! intel che
Ga depender enge rgnane, prey, econ
oo ad emotional and py abe py

Many fe same toe ean fc an alee ral
a and ability or wings sc dental are. Lo
een and dsc ith rk air of poverty,
teenage pega ow rade flection with coal
te tes ely se or reve dena cr tha oe
Mae”

Ari ter ae group ok of Faces siii
Pur to rl hath cae for tk ale Ie
‘nate dt one tres ctm ip
tnd 20% a a ter arnot covered Banane
Noam terre cae so a od may ico I)
Jaw pri gen orl rth 2) no peed ned or.
deal ee, 9) nie far gro de dent (ak ef

163. ent ce hours ta do or ine cho and
‘ther sii a (5 ck of anor.

"cin the oth ned sk emis ro
‘ely ey recognised problem, aná stes fr daa
‘rh hs protien hove not een a wel deropd sor
‘eta inepto rl a vac compran
els el entering srening nd ee
programs in comment sets quel 07 sand
‘ating che prion of see in he EISDT
Progam

REFERENCES

eee

Ea agi ug my
Secon marietta
eee

ar ÓN
See cranes

a

A
Ben
Fe ee

+ SEN rent em el
rn

bis
ende,

un

Be
eg

nn
Een
18 RA Sra ran faa

‘J hese Andy oer.
een

Fee ee socal

17 fee ei nm id
Le am Ap De tr nn.
N

pai ga Des 108 rt
o
ne ee
En
ar a
Soe
en
Me
(ren Maik Rn N
a nn an aa
BEREIT A
tos
este hans re trata
ee
re a ea
a ern ey
ee
nn ea ins
een
er
a
SRE
sae La
ee
eater ee ana
A
een
EN
29 Comté Catane Sah gran fe
ER rentes
ee
os
fe re
ee
ee
BE
a
a mm
a Sa Recs sd ofl 6
cos
re
Bee

Bere

164. ‘CHAPTER 1 Dental Public Health ies in Polaire Dentistry 147

‘isi NS hago Br Con

ae
eee ee
40. Nah DA Developed e nt ea ep
Pen
Soe eres
Teale ne OCR x
Sec,
a

nn
Be
rn ann
ee
ee,
eine,
en
ee
MN
a
A
ern
Seam
ee

166. PART TWO

Conception to Age Three

12 The Dynamics of Change 15. Introduction to Dental Traum.
= x Trauma juries nthe
‘Phin team and Ter

ion
14 Por Der Da 16 conga Gin Done ad

Without question, the development of a child from conception to age 3
years the most drama rm o growth and develement. Data, the ade
‘ulus neonate wi have a comet primary denen consti of 20 tot y the
290 of 3 years

The importance of these years detaly cannot be overemphasized Dental
condtions such as elt pale, itunes Clean, anual numbers of
ern, ral habits, aries and he development of maloecslons start during these
year The profession of dent hs long recognizesthe importance of hese years.
yt infant oa heath and care ofthe chia younger than age 3 has largely been
spprosched actes and not cll. H more can be done to enhance dent
aan with tete proven strategie implement nfs yer en
vy Pot deter Ben ding 07 The answer to th question i adresse inthis
section

wo

167. 12 The Dynamics of Change

Aron J-Nowax

Physical Changes

Boy
‘Thepetatonofahumanbenglassaproximael 9 months
and De moment motor vam le ered by
cle eee Ath mom of ponce of he
‘rum wal he sperm rue 2 chromosome no he
‘ram sh ao cue roms dog ace 2 chee
iros os nn Th man fbi hese
{Gcbvemosome The rel al begs to pan tbe
Proceso mito The rt in fh tied on
Eso ls uly takes ple 241 hours

“The ine fom conception wo bth fen described
in tre phases Te fet pase, period of he vam a
eased fon feito 1 inp Tis perio
tube hdingovum orto becomes act
tothe walla tras Ths per or aproximtay
1010 days The nx prod 20 wes enced
the prod ofthe ebro. This pels mat imprint
ec of the cal reino lt cc daring ht
Sets during is prada map sg rs.
under aroma 40 wes ced the period
tthe as This period cence ration of
‘he nel fomes eran.

gure: 1 Bon the diferencia th proportions the
{una and month thenetora by and eclangs
‘hatte made rng maturation No years more dramatic
ns from tha he fe Jer of Me ura mich
‘at chen undergo o cease eh en mst
30 ices in weight. wa thee fhe fs ya
‘eth prow tes Aer het ray he
rhythm tic
ent ofthe hid ema rt rei al he way
scene

‘Theresrenosccurteprdiorto ec nal gt
Bale age 3 ers At age mr, carton temen
the cls hp ond pt may are y seme
“Toe pcs af newborn charging toon ast ae
orton hc lg rer than he tr, ome
Kage Alte eg the hl ask compre wh
Nr ber bres, ecos code bi gree

‘he rey Dont Age as
‘he Penn Deon pus

(Goes Cnancas

Bomanaı Cue

Soc Guess

Tie ina eer

‘he cond Yar

‘The The ar

Enomuctocrano Mucous of Der Disease

Cunt Concepts af the Caries Peces

Mico ol Dental aes

anno Mu ecc
Dates

Hisopablogy e Sot Sure Lesions
Diet

‘Sir and ibe Hot Fair

arly lon Cars

‘eth aly changes and at the nat i rd
Incense sopas postural ad lomo actos
Tale 12 shows ame ofthe bal and cognitive dvd
‘pm farma of ch rng iro er frst
TS mona a Me (iger pnl) as val a objet

168. ‘CHAPTER 1 The Dyramics of Change 151

80»

®

ca

Li

FIGURE 12: The ges parts De una yom 2 mot utero asd Gem jme Neon Ani}
hartge pmo oe Sos, A Suede

permanency and causality i cused in this capes
Secon copie depen

Dre yea chi as the ros moor sls ran,
lin walk op ad down sea and Ak al Hi Be
motor ls low hm stuck lock (apt ax, make
ll yo es and turn the ue of os oe
ages im ible 122 over land
‘Betmcanege et wich ey ee opi.

“Thenerour stem of th ld gros drama rom
‘inh unge Spare In fit by the end ofthe scan or
‘he chi bin ar atin 79 of dl wo!

CRANIOFACIAL CHANGES
INTRAUTERINE GROWTH AND DEVELOPMENT
‘The rare and complexity of own and deco
‘entero more ann chungen a ke
fee in the had an face (Ta 123) The hana ee
is St chara poh uring te oth eck o
inte ive opt of thebracha ape
‘at The bani appear rt en à er of
gesonettrl seco becepalicedof eembro.
A prieta the thd wech of nati Me À
Fem ol embryo has a eal facet the ey prime.
ave aay began aber Tess mins Gps
sons, and hen then rpiy under à sete of
mere rent and elagemen hat ano
them rom à er of separate muss to ae gue
ia

‘Sperber described the reste sage of devdeprent
(21031 dap daring wich e mm embryo devas
srl end re ech eos or process The
re meena data cose al etre el
the ce Tht inde the fome! proceso ma
Hey proce nd we mandibula aci Tee proc

2)

pow deren, and by obeting the cadet
Bois ere he ey vet ono be fetes
eae

‘The eral eat of he mbr is toundd y be te
ul procesan he aan nd mundi proces
te fet banal arch (are 129. Bach mary
Proc more wowed the mii und oe wth he tra
‘hall fronton) procs AS ss happening à
like proces (he pala proces) dels on terme
de of ch marily proce. Ths two ph proce
‘move ward the mine whee they fe Th pst
sn i oral completed y the dinars
‘eat The mandar proces ue a the mine sone
the the malay and num proce gare 12-4)
‘The pare grows more rp in wilh thn in Legh
ling he fel pared a et of mip er
pod, and agp growth of the bil abel
‘pine Aare inthe tno the proc per to
‘aor fal cs orteth Inthemande te crags
‘Seton ofthe fst ranch ar Known as Medel eat
Inge rories orm or he development of he mantle

"The maxes of marica, rl he tempora Be
mater und the medal and Mal legado nd the
‘igi nerve ao ate dere fom the fat banc
ch At approsmsely 6 ys of getan, the enr
À sue al of 1 tse marpologe chances

race delos thecal portion a they
Compared wäh is cal poro. The difieren ates of
forro peros enbryoni ik wih te
ed sen forming the exuded potion of the pe.
ea of thay development ofthe cran en of he
me, the had cones ey hal of the ttl aly

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169. = TABLE 124

Cognition, Play, and Language

PiacEriAN

Expressive

Stace Aor Osyect Penstanence _Cavsaurry Pray Recerrive LANGUAGE Lancvace

1 Birth to Shifting images (Generalization of reines “Ture to voice Range of cies

1 month (hunger, pain)

a TA months Stars at spot where object Primary circular reactions ‘Searches for speaker with eyes Cooing
disappeared looks at (thumb sucking) Vocal contagion
hand afer yarn drops)

i #8 months Visaly follows dropped — Secondary circular reactions Same behavioral Responds to own name andto ‘Babbling
‘object through vertical (recreate accidenaly repertoire forall tone of vice Four distinc eylable
trajectory (tracks discovered environmental objects (bangs shakes,
éropped yam tofloor) effecis.eg.kicksmattress _putsin mouth, drops)

to shake mobile)
w 57 Findsan object ater Coordination of secondary Viswalmotor inspection Listensseectvdy to familar Prt val word
months vatchingithidden circular reactions of objects words Jargoning
Peek-a-boo Respondsto no" and other Symbolic gestures,
verbal requests (shakes head no)
v He Recover hidden abject Terry dreilr reactions Awarenes of och Can bing familiar object rom _ Many single
‘monthe afermulipleviable (deliberately varies function o objects another room words us words
changes of postion behavior tocreate novel Symboliephy centered on Points to parts of body to expres needs
ees) ‘ovn body drinks fom, Acquires 10 words by
toyeup) 18 months

w 18 monihs — Recover hidden objet Spontaneoudlyusesnondivect Symbolic phy directed Fallwsserieseftwoorthre —Telegraphic two"

to2yeurs afer invisile changes causal mechanisms (uses towarddall(givesdoll commands word sentences

in postion

key 10 move wind-up ty)

a drink)

Points to pictures when named

From heu BS FDA I vie MD, Cry WB Cor AT adr Dev dope evn paies Pinel, 8 Sd

170. (CHAPTER 12 The Dynamics of Change 153

Medion Age and Range in Acquistion Developing Structures ofthe Head and Face
‘of Motor Ski en
‘Ace m Movs Devon Sraocromns (Wises Urs)
Moron Sus Moun Ranch? Nes A
Tue bado ss «6 papis 7
Pre SE Mant ohio y
Autom back som 1 EI 5
Fe peep DE Medien pc a
Ménage us 5
coms LU a
‘Wai pe a a

ES

Fra andren
Semen ange Cto oe
‘kaon abn y lab y NA cet
ng

ae during the pm embryonic pein (ur 10
ren

The dominance of Hed growth and derdopment in be
bye period snot mainte in theft perio
‘cringe proportions ofthe hea reduced fom
‘oat one hi ofthe ete body length athe end ofthe
moni prod o bout ne id he 685 mont

Daring e fel per hera owing nel
sternal ont, tly row ray Ti cote
{he widening of he face Interesting. he nal vty and
the nasal sept re ebene to ve coser
ce in determining cl rm, Dacigeter aa ma
{er deveopment or one temp

“The growth ofthe mpl ren conto on.
‘eos, Fonts, forja appa
masia std hanes The epson a he eel,
the ku, und the bosco erage
‘lo asin separa he fc tees The vel elec of
‘hae vere fre of expan er ldap on e
Posterior race othe al bones

‘ale the embeponeperid daring the pero the
ss ofthe masia rav tote mundi ara wi.
Throughout the embryni sage. the mands cone
shiver than he mana sot nthe el ag at
‘the mai is mote developed thin the mance, Sub.
queno ts he ande pronta greterpace an qu
thee ofthe mas by E we in ra Between he th
the 20 weds in ter, uni rv a a
eset he mas A ith the mane tends oe
Feroe to the moa During the remade 0
Intrauterine exite the fs under à rec of

pont and martin nd a ron

Rapid and ete growth chances the eng
7 month of le An ene of the cam oc
ring this fel periodate ret combina of
¡or process nung ines, endochondral and
Futura er wann growth The cage remnants of
he honda cranium tat persist Eten he ones are
Komme menée

a don he cal base undergoes ler app
sin emodengb roro and app Tiss
Je medi by sei ou the pr fe bone ring
cal (soda) as well as by banesto cols
For.

The mae reodeing of early cl ken that
ci route reader ol he fel ped pie
{the fe at about 4 mena Bre this ie the Bones
«ein al director fe the repr ston
Cenes. Remodeling, row that acompa growth
‘Eats when the etn form of exh ofthe indo
nes fc and rain tad (gee 123"

GROWTH AND DEVELOPMENT AFTER BIRTH
Ar, he bony ae and al show te deren
from did oct Newtons have ny uh má vit
fy no hn. Tel as ae anal, loop the ee in
omparizon with the smal ac ae exce lp. The
Ford andtop ofthe bed eg eu o Imagine
the verity finda lak hat wi deep over e

son of he at

171. FIGURE 12-2 Semi lon micros! mese entry es, nic soma) wich esenblebumanenbiyosat compete
gero ent. A, ge sonnel ye lor cnn the hanna ows te lon oe et acl rc
‘ote mu nd mente he you ac ron ayn human he med an Lira nnd proce eget
re ie aa pt, on oe meds a era aa nthe airy pres ome Depp o Fas many
‘Pi nt pocene cathe te fe mah (pron Mae Rehm) DAT hp pron ha ee
eee fasion has ten ce, an the mut and ewe may een. SU US Sap part map fe penal ef ses mst
‘Gomory tered na drop (Cote D SA AE rom LR ae WH: Cote ans lt
Eire

ys

2 FIGURE 125 Swing con miso pt o movi entayessecnedin etal eA fr ln Depa shes
‘ong ti mares eden the slo he terre the eg Belong rin fp shes (Costes OK

172. (CHAPTER 12 The Dynamics of Change 155

2 FIGURE 12-4 te ang dc mere thorn cies (et ith sa mae pee sow ewe |
pate re om 319 dp accept Comic! ray peon Pat nes iy even Eo
ctf meer, rar palio alo orte eS am Po WE, ee Copo oO

rer

eure of dhbood ad ads from nach ima
‘ant es gue 120.

‘At bith the ml ver lv fet and etry
may 9 mont the es become comely wide
nd higher, Th al arman man.
day aime At inh the bans dt ops cria we
et sed and ar separated se membrane led aps
‘ale fran (igure 12). Tach of thee wen com
ty sed by oca wii 2 yeas of Beth

ee rl om the ack of etal pont whch
il came. The baston dimensions are more ney
dul. The upper anti ae hes arent even af
opie birth According 1 Ray? they ar 43% and
om respect, whch means that he most ing and
‘ample growth of chan sante withthe ce Aer
“ini spr during ef 3 ya, the eof cree
‘thse imei dows It emi dy ol eat
ei eche. The rn s repre yeni With

deg oe a eu ny bre e
‘ead esca be play depen feb.
stich by he pth month ol nena sd
Bere cs weer have The gow he can vat
clac tat the alin ad sry por
Us complet before mundi roch Ths san ame
the cepa gowh grd. which ist
the cna race ate dor othr a se rng
Infancy and hood than other body par Spy
‘pow increas the wih of the mane Bye cond
she sms closed and gromih becas bale!
Tre mundi we in benmenalley cop An
cm meimerpbnde bare pc at many mes
‘ge eda cure te dl apa
ve

DENTAL CHANGES

The pape of is sin ito ddr be rot dre
ne and pina ch tun oc hen
{© compice euption BY denon, growth Sigo an

173. Pein 28 nn uote one
Since ree
Pen
ee
et
ne
ee
Sea
er
BEER En
ci
een
ee
men
Be
SEAN

inne, expansion, or exten of np gen He For
caplet ross moras dep y a
Ili Dept ados de prepare li
a ane A tooth den a he ame dsp
From e pei them Soe ad dermis
der tom aspel mesoderm,
em and mesoderm, Ataxia 6 eds of a the
sale ef te ol ete of us hs ares
‘reed act and nage ears ofthe tre
‘Goal che Ti ine and epson pe it the
‘eal min of he fare tc pr As the fot od
Couns dede it rs pot et whch tp
‘nd th ap sage Ar me ll ep tr.
Rein cir Tero eto domine
tcp inital formed om tor but er era
hear of ase on the ep border repre:
sens the einig le Mt e lt, Te eo
‘erm wal cre response or for nae nd the
‘meander wil come primary expose fr pl nd
See Tt gy acute e

1. Dentarg ital)
À Denali

The ech es demonstrate 10st piba
sy tec Gof a) border fhe ee
Woche nd ity pc the postion fhe
ere pinay techn ba email ande monte
(eu 120)

Ta sin o developing 20 primary et, uch unit

FIGURE 12-6 The sm on as rs, ne ced arg yg be Bs a nl pp We

(pentose ese res marys tbe sten nic nde cps

174. ‘CHAPTER 12 The Dynamic of Change 157,

mes gero gana
8 ue

A

2 FIGURE 2-7 Perote tae De tn re tech ren Fr So TE Capi dp

een

FO.
erates

ERE 129 Det bl pity rl

esse of four permanent ih There e
primary cel rl nd csi poda à dl
Limia forthe ure permanent central, ata, and
The fs und second primary mars produce à
‘eal lamina fer he are Se snd second permanent
renal The uncoated or permanent ols ee
mand one ane Lotions on ne dl mim
‘tending dal ram ech ofthe cond primary molar
Gaur 229.7

“nas of he scene prods of oh of he
tooth germ as be rai! y the ling sages the
Le af

Growth
min

Dont
Gar

Pomanen om

ra a

Lire
FIGURE 12: me deu gs and ea um nan
Contes

crowns
INmATION

“he nition stages fr ote inthe wee fs
(gure 12-10, As he word nition supe sage
coat bythe iil formation a an expansion ote
allay eet imei abc tbs
mere Teas yer row e razed cals ined
“pon the bent membrane, ic tae dion
Ie en ern (epihum) and the sade
Cigar 1-1). Thecelsf aller wetheinerman
ha the ol eit (ide) aduce thease
here

1 ec ntemitent con slong he ment
smembeae the clothe layer may ach
se te an he src els" Ti dsp

175. ud aed ie epee fr teal growth of tat oth
(gare 121,

ean be nae ht e times finan fhe varias
tether" Thi prod of ch developers e
‘opine bag Sch dern asin aly
desing de dome rs he immatre
oth

2 FIGURE 12-10 Trenton sag fle rf Beth
Costes

PROLIFERATION
Proton sel ny uber mulation o be
af eiii sage und an exon of Be ot
‘od ching in he formation of de Wei som (ige
123). The oo gem are ofthe pe pita
al forming» cate appearance withthe ment
meistern ow sn ihn cp preside

"The moencyme (modern) mrounäing be dnt
run and nal alas ttl fer te etal
SSE The dena sc ait es 21 the spying
‘race of the tooth, The Arche ae the coment
‘tl pron game

"Ah tout gr conne re en ier
ution produces pl apps Ti ge e
‘be ap suge because he ace tas on he form dl
(ap gare 1214), Like he bd stage 0 rec
or nico, oe ap bai to fc, he me
che hangs wii heap nte he dan
fede pp

‘The det pil cvs fom te merce in
ating he ner dent epson and spa to rm
‘help an enn The dental coment Big
{tural endeten the moe sowing

eS

2 FIGURE 12-1 intent decorar eto mg thnk A Sat cn op don a
‘tap mapa a eta frm Oban Cora Ra nat eo ew VB coe

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176. ‘CHAPTER 12 The Dynamics of Change 150.

* FIGURE 12:2 ut ge of th een eet sig) Haman nb % m sh ned A Yt et
‘sume nn ton rohan toe Pr gh apn ow a
Bene one eta ba age Dt anal 2 hn Yo, BR ea)

2 FIGURE 1245 ne preto spel ee yf etch an pont 1 one

177. ma)

‘he del gan and dental papi. Te else (are)
‘elu (or) e an panza of es within the
descending potion ofthe dental onan tht enamel
forming tor and cad the ese pulp There be
suso embrac the development of hab pr
dent game

In summary he oth gm cons of a the nec
lene forth devdepnn a the complet tot The
ferns conpoted of de fons thee dite! parte
{0 deat oran, dent papa 9) dena se The
dealer pode bere The dental pop gene
ts the denn and pulp The dental se gis ie to he
Cement and ponla”
HISTODIFFERENTIATION
‘The hisailfenttion sage i masked by de hile
ieee in the apeuane ofthe els ofthe oot gem
case they ar sow being speciale gare 121)
‘Te cop cones toro end be t ok more a
tell Theimge oa legit tease the on
ithe cp row der into the mesoderm. Tas par of
Seran propi cl the tl ag a he
Fe atin thee gies be the dental pep.

"The er on now cmt sroande bythe
Damon membrane and e Sided a ner ad tr

2 FIGURE 12:14 Cage fat ven Human eb Dm ka hed A, scene thee go
Lo ar cs, Bb con Ur) te sane non Oo Do Al dema) ew er BUS,

eal epitlium. The dena ran uit becomes
une,

“The condenan of he ae (ender) den to
be do ofthe bel espai forthe el a The
eal cml gesto the cee mii he
‘oveingof betta ando prod pme,
taches tbe oot othe one ound he oth oat

"The deta acon ower at
el more ke coed Te deal lamina rhe per:
nice chosen mio the era
Imi fte primary oh. The bs her connus 1
‘ud stow died toa ner and an out ental
incorpore more ince Ba in prepara fr Be
Firman of enamel (gus 1215101218)

‘The morphine athe ame imple ithe
Suge at which te ls nd on arungemen ht ie

as thei ead sap eh oth (ge 12.10)
Tags cale anal age Ge Fe 121)
he al of he inner deal ep become he meo
at bic produc te eel mat Ate amc
‘agin the formation thee fe deel plane
dany an othe uement membrane bros 0 di

eet o dot ures 1229 snd 1221). e

178. biscotti oem con Kanpur D aay one od ro.

179. doo andthe ame ar pone forthe or
Suton of dat end exh repro

"Ag de dedo fein tay unde
sted am have been ened tht chow rere
‘anges The ft hang in det formation 10 be sens
‘hthenigof te buemeat membrane ofthe ne deta

«ibllumand he pulp esop y hed pp The
‘membrane fom theme ofthe pl costo e
‘clr rca of goth noted ba o
ran 8 eur nn Be fom dep in he pl
range with dera rro de mont
‘ofthe pa Ths long pling bers ae known as Kr

180. XAPTER 12 The Dynamics of Change 168

HOURE 1-20 Tonge owe nc) shan us hon) erigen root reee
te eed ics Xd ee Pg 2) Oran Dan Ap E recio PR.
vst and es Da Ba)

‘is and ist e ca perf te developing ep for he deta lamina proper mme acento
dei gure 1222" (he deci primary tot

“The specie cl fe previous ug no range "The dental amin proper amines proie 1 te.
home in manner ht gives ch othe reed ling the primary tata bn he pont.
and dupe Thee à diaprarunceofthedenalumia permanent oth The primary tooth gem now beams a

181. (Re EEE

Ae fa

1 FIGURE 1-2 get eel bd lan on rae pre 220 cerco e dt
‘edt termes be tt a cee Say e oar ec ne pa dans Pa
‘age nor ote cn ean ht dx omen eam ron Damen. op Te ee

apna con Ore AOL PA

cc organ? The seed clk found dung he
Chad els arg hemorphdierenabon sage rete
‘he tt for he development of ais ues ol ac
‘ein pal cementum ad peo lamen

‘Wheres the morpbodienion ge tts these
and ape of the tot esposo! age ca wien
the none or are mati fhe wo mal Fae
12523), Ces tha ve the potent or the dean of

182. ‘CHAPTER 12 The Dynamics of Change 165

FIGURE 12-22 han!
Ber ron One a

2 FIGURE 12-25 the porte stg ct fe

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183. ce ma fi be ln of the woth germ estab
Ite by pros age The roch appeal, a
re rg Tecos for Deir ol
ae and dentin” The orante spec sues nom
epotinrmenta layers name and dent mar The
cs cr amd rs dodo bah om
Lion centr slog the dentinoenume nd den.

Dear)
AH
(

‘CALCIFICATION
Cala er with an in of mine hin
rg dened tine mui e 1228
5 fp mer sd spony ee
‘mate nd Tora pron compe qu

ani of clam and phosphorus wih «sl portion
my ter compos td mens mc cos

NR

1 FOUR 12.24 net fun mt. emt ows a erat ptr mat epi 0 ae
‘coma pes cen tata tn pe, ede Non Bose sh er Oreos hy ens
Entrer)

Drei Web tte umo ete nah iy mad rama estaba coe
CS er)

184. Caen begins with he recita of enue in
‘the up pan ical ee of he et and com
‘hte prior a more person mal pts of
te cup tip nales ad the new name at

‘crv egin Ge Figures 1224 ad 12-290

"The laine mn und dein evry ie
proce ds takes ple oer ng perio. Therefore ee
‘ean ners ced an fl developed oth a
en be equated wth» pete meme dance In
‘he erento othe cl cow tn Bt
beenpreparedorhitlp er te ryan sor
Sande wich ae cad he cement cr of Res
(gare 12-2) Depenng on how the secon ered
(eier Login abona he crete et
of Ritos may appar at ns or res (igure 1228)
‘Thornes rl eps the developmental pater
the deroga th

"Thee of variation any neuen
on toa change in ie pipe pas of rowland
‘evelopment fhe tat Fr imac, inte pray et
there ian arent ln of Rei eld he neta
In or mont ing gue 1229). Ti neonatal ie à
rub t he abat angen cert body process
‘tthe fu when Ben A at inte ea of
‘ehangeorinltathenentrn yema to cases growth
ange as eed deny as ental ing TS ig
‘Eccl the vent of daran inthe ont anda
‘atin ofthe tah

In summary. the abet of enumel maturation cle
ca males the Benin of the sendy previ
med max be precipitation of miel ts Ger
poke eum sat) Tis Gian à slow, dee
recess begining ae cs tp ov inci geo te oth
‘ee Figure 122)

‘CHAPTER 12 The Dynamics of Change 167.

(chemical Content of Enamel, Dentin,
Cementum, and Bone
Com,
Conner

Error
NEVA Ouse

Baten Rie coi alia na

Ae SB aT

185. * FIGURE 12-28 A, ronal te of Re Ver rad een seed cnc), Dci palin cl

(lem (12 ne rm km reine mre oe epee erg
ftom Ri poe dt pco rma anna Ins no veta oe fhe tae ace ro.
ses ra ne eme St Loa Mo)

186. ‘CHAPTER 12 The Dynamics of Change 169.

uses pará scion of py cpl Sv |The 0

Caiman na e Rann Sanur ne permet ma Be OH E ayy eee et

‘cain Raped pearson

ERUPTION

Ataca met on deren rare
ing opi (gue 12.30) The deren proces of
E oral ooo many ori proce a
(etme Th ame tre fr ro, ot ei
Ps caro with erption When rien fe sl:
rom of oth Bas been alte he nner and
‘iter pts spear fo ld over a the cemented
neon and canine ther gown witout any tise
Bate them. Preval. sie cl wes thre. The
om om ale Heri eit rc sheath eich
enable for th sean shape of the on and espn
ofthe tooth gure 1231."

Eruption ca be categorie int three irn pase
(0) prep ps. E) rtve ph (etary,
and 0) rapie phase (anton. The pee phase
État per dig wich the tothe! es o formas
‘onandteinstomovetomatd ve suff he only
rom ts bony wut The penetra eo pase co
ft pato devdpmentof et rot ro
nal emergence. Mos erp abs repr he tne
Fit an het een nthe mon gues 1232

nn

un — (etm)

De at

a rest

ore

FIGURE 1230 Tonta goleo ett

187. |

2 FIGURE 1231 ue sage rt rent A, Secon
I nom ong esti Soap ates
ine of pu Hp rap ve le ach
‘ean of AG ray ge Sono e rg ben.
‘Sill had Eee da ad ae cmenosara
[tetera don
sens ne ere nd pesa fein
Suey come tne cts af cons
(cd ont eter O rai on
Seed Ste eo

a 12-39) The tot ot sally post co a
tee thirds of & Ba ln athe tine of gingival

Ar tots erptdin the olay andes
is antagonist (ppg fot the opt eh) Is
cadera 1 be I facial cope pase. Toth
‘erin «ami nt in that some pe of overt, o
‘ater how it bay tng pce Te conte 19
‘ove and pt a cesar th by contesto ng

roce
"Theres ben comiera pecan bos he cases

oftotheapinn Some mp esc of th erp.
‘on fen ed re) roa formation proton of
erg epithe ot sheath (9) riferden of the con.
active se ofthe dental ppl, 0) growth ofthe
(6) reses fom masala an, and (6) postin und

cryin ef or Be of id of rcs a
it ie fran ts dl to ge tay
ne pres Be primary cause the.

heroes of in of primary cs case y
ecrire reste of theperent scsi pe
Se primary woth and made The pve
re mites the deepen loe À pro.
(peste roro of het ros det endeemertum
wells ae oe compta by te an ef he
ci

arramion
Ains the wearing of hte uring fenton igre
1234) his the noel wearing of he eth ring amt
ah opposing thin Scant. ie fo und
iy ean type a fod ant ascitis my cn
marc or wee, depending.n he nid The ees
Sion om oia re djs fry at ae.
any

igre 1238 sumas eee fhe oth fo
nn ogg ation.

‘THE PRIMARY DENTITION TO AGE 3 YEARS
Tale 125 demonstrate hevar ao of develpent
ofthe ei om cocon 1 ale” The ary
‘eth begin ofr 7 we tr and e eel
‘ofthe primary eth say copy the i yee
‘tage A ofthe primary seth geal ve tot u
T2 ooh nie are the 20 pray eth and et
‘een mals gres12-36and 12-37.

The An primary tot to pt the mandir
inary ici, The Toth only ets in a ver
‘ih poston" As ar primary teeth ep, hey may
espe part om ech othr, parley in he cae
ren pce quen corn in the primary denon
tre the prima spaces (pure 1238). Primate qu ae
(he gece betwee the mania primary cape an he
fs primary molar, ad between the mala, prima
Iter inte and the primary capi. The prima den
‘hon remain rtve aa online y he
focas o erp permanent dsc

THE PERMANENT DENTITION TO AGE 3 YEARS

“The fist permanent mar the et otha show gem
Formation tage 3% 1 month in ir owed by
the cnr and tera nor wich deme fr
ovat SoS mont wer The clapton ter
permanent oth ha gis fain fore th at
Sito months inate Te fend cond esla
second und rd mols demon pm mon
in

“Auth the ny tl ht boe teo had Hse
formation ae the fst. permanent mols? Wh the
‘een ofthe hd ll permanen th denon
‘Seated tse formation by 3 years of ap (e Tale
Ena

Se Box 12+ fra gsr terms from hs schen.

188. * FIGURE 12:32 Tee ec polea De ns er aga nes we fm uch 0 amp
Cas on den me te a ma Aaa) stein Bl o

_—
a

ga deat cy got pn to ns a Redan
‘rar gy an enn ens OL)

189. Fens gant

FIGURE 234 Tease better ot

Cognitive Changes

ve eae recent humaninfanas be eed
cas frere cogne compe:
Let care Many pros non gie at re
‘Seagate ty entorn, fact re src
‘hat Bebe ca xr sno ofp ooh and
‘angi patin iso known tat ans
fom the et ay ff se lh Cope
meine espns how and why om fa exes à
ring mote fingers and dir ce

In 196 Men nd corr noted tt here refor
nj ae f copie development during the E ja
a fe The fs be ar of perception Bren very
ang nfs ve the ably to pce moves, i
stoi, ad cl Ge Te

“Th cond prominent cogne ares rca
oline I now known that an an reo
‘ata vias ica end on eros td
‘feet seta ape Inu eis contended
ha Al rene developed menta sen rer.
Fons of things encountered inher cones an Bat

2 FIGURE 12:35 teehee Reden ect Mase States net pen pont atera
AE Am De RDA PB ean era Ana ees Peso)

5)

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190. ‘CHAPTER 12 The Dynamics of Change 173

Chronology ofthe Human Denton

Moose AnowwrorEunn Ev
‘Toor Fonastiow eons _Fonumaräiam _ Cowantp _Eaurman Root Ener
Primary Deen
Mery
(Cod eter sin tes ives ime wire
calco Uf nmin eo Te Dm E
E EI ‘tied 5 En
ae Corus em Ef
lm tain ‘Gop sce me Sy
Cord moine Tief m im um
Frac ame Dh = Fe ihr
Cd Emo ve nei Sie ‘mek
Fm nee ose ‘Sino ene Dr
Send oe 6 ‘Copp EE Pme Dm Dm
eer To? = «sy a
Son E = en Tage
Fobia EN = EN Ir
Scent eo aan; = er star
Fa ai Same #5 om
inna ET = ELA ra
Cons 24m & es soy ow
Bam = Sy ET Re)
Gone Em = cr COTA
ed yea = Ena ety eB
Second iD = Cr Dee
Fee Ab Sens m ern sm
Send mai asp = Fam or lege
rl mE Eon. cha pre be dc uo Am ma

EEE ee Cro rn Da oct

191. Sct cap 0 De band pony mr Gam Meet Jo Wi SC dni Pos

enn a omc aS ine oe ogee

‘hese scheme contain some bt ot al ofthe cui ee
‘eamlarty ofnewobjetcamparedwithoionerbece
Of ably to ener en thse cc ment

hancement of memory ei ur copie dep
sent ofthe at year ol Ue Even ey osa atan e
Shown ohvesome menor At months abdole he
thay real ut experince apar obo Ah a
Be mn gale ram tat even to ep then rn

192. (GLOSSARY

mtb Or cla yop of ana ton de
tern on wh hea eu cg
clero co pote

Apps ein grosso oe
te Seco rw bye don

ln Di 1 ng itn deny beten
font mid weg ay ofthe ate fe
Sooner Des mc

‘satura mdf man prog or
“ated este e di bs
tyra tine theta of e tm 8

‘atnentenbrane The delat agent mere
Tor de De ette mio
enr md cp e cont

anse na pond de toda
e docena Medea dee

Cale he pce y nor Une a
ny saan scm slam

capote Te gta me afte eb
{Pott cara De edge
‘sei ae ct

ne cone let aro

enema e jr y ts coo oto
“oom hater nsvodactr ara to by
raies rte robe Sopa ee
‘Suey te)

nat À age Hey eat ented
fit pit oft ope

exec: eer comet tnt pt of
"remera mind amos De cc ens
Sad wie he Bed wee nde
se.

dem Te éd le yee pink

co

orphan: Age fhe Me ye of tet
ides sat parc fm sap.

(nicht On af ie octetos ct
ntm the ae suce le el pul ac o
Se et Tey we comes y pom pc
oracion e ing ese proces, et
‘Sear fer of ane whch exten rage
tal nde tothe enteran nen.

mods: On th aa naht so the ott
epi e y ci be he ina ee
de ring eminent eth

ed me Persea or ocur
"und ton pring oe persona mentre
at hao taba on

enana: Dreaming torte
Tenors tiniest at lso mb
me de he
Sian song te ong ob ponte emg,
Trance ean rm bray Sree

mereces tete
Ten pore eo pt ooh re)
ane coje

iad pr ro do de
pap acted

Be As ne meets ere
he dealer et peo so e
ou an peo geet e or

Dente held ont papal te oth
im noes Wom am

coder retreat pee wot
‘rij omo he span a nee re
es

Emma: sc mute om vice enteran
Tonnes

rio Tc ren où, per ob
“ebe on rete pce rose het
restraint cy

cig sist rot A mei sa
‘Stic mc crest moe

exertion: Asap ei yo ah
nt y ne e erty re been
{prise pl es coe
D pos nn in ce

Dede marae oc ne copy he
‘eating stm comecion be oot

tere Teen or apte tsar
Fan asp ccf eto bai ae
min mg

mps ore Cartan be cong e tn
Tri och
‘Gant ran oreo ct er phe
‘reg ee emt am be prat
reli

taa ret lord a ot
ao na era pare no
Se omg ees up Dede

“ott re ta eto fe evito
ent es wb ie be
teo tr).

‘esp he se fh ong al et
Ta bang ir dts pp ceo
Den

193. ‘ect things pre gig en Two theres a of
interest the td of opin nat The ia
ing br The concep of codi the mot iger
tan ene die om at toy ofthat. Ter are oo
per fcomátioning clase and pet lal cond
Ang crore when ona ped oar For
instan sacking the nipped fen enough with
ewig alla, evenly leds the ini to nate
cin when be hs he lala emma e pros
“omo ear whens dan ere ot
asbl Ti kndofkarin posible in he parents
Sin pont tou cl chris al pui the
‘mater Bes er cing by coke qu ho bet
‘dwn, i comende odd beaver Behar
‘hat ty to car a.

"Te cole development theory of Jan Paget is the
she tery of brat athe stent eran na
cogio: Acond to Paget! much the talca
Seren ofthe cil ram tht the age 2 ous
‘ene the scar ofthe ch with ein the ev
ronment Abogh Pages tery sos wi seme
ones teeing ts aun) ts xr weil
cesar en pret and oberon ars
esse Ppt ued cocos un bras ot
‘un clr bir, The beavers be mate common
hen.

In 1934 Paga dsd eyo fea period
‘of tensrinoterSevlopment, ic he Sil ot ae
cet tages Page cootended dut during th ine
the cid must deo Knowle in te fling hee

1. Ober permanence Object coin on even when

hey ae not prea yh ci
2 Canale Objet ve wen andern have cases
nese te emcee rary cory
nd vera) 10 dese ages ht or in ths
ra. A primary cer ration dcr recreating
An Arad Ann sang action sch a thumb
Seng A sendy crear rc I here
nn donen ce and et Teac
‘li rections Inle experimenta, and a one
Sigh guess mc btu en engere hd

pure
2 Spray: One ie can represen ana

‘The ngage development ofthe int a fs very
sto The men agree voy ln I mantel
Istowerds UNS iv, he epi wenn he cll
‘considerate than the exprese caba Tverd
the end ofthe acd ya, he expre vba of
ile devs exter qui. In 1983, Laine

clap ted that eus of he man vea
‘lyf hid i 00 mor.

“le 1-3 connate the vc age fhe semi
stage of dedopment with open, pe and lapse
depen

Emotional Changes

‘Thee ar many human ento, sich a shame, lt,
ge. fet ud ne Emons an be Sere DY
dr Blair nections (in), menso pi
leg respons (erben tele scr pero
‘Sgr and radins Cm depend)

In ing de enol ste of young cn the
later wo med f drama ae of He noe
‘Asa powell inthe fester of che ali
ares emo they ble at the ch shoul fe a
panal ain Ts y vi range linen
it When an 16mont cdi pl má on pret
Fay ines be ch rings station overseer
{oaths acer as put for he make nd aer
Sr or sas at having nothing dl

"isa evident hatin older een adds tre
cion ol metio ery much lance y hom
{pron rec 1 aa. suis is hr own
dao Too e sm le ee pen ay Isha
tether may a. In very young doen cra uch
ba eis na posible The sc big oa
mont lich pres bs o, may mor po.
rate cl ey acen

a AS
vin te ch ems 4 monde and mn fo
T1984, Musen and colegas” ord nt nfs ve
capa of plying earl belie a wea ange or
tation At à approches sor be Bt thy
‘Snes separan fm pet oy en rs, a
any pa obligo ne able dings.

nt and lo fare ar merca o ice
oh ea chen ad must be taken o sc en
Farming are for deg ih he ch Ua
nd erat esp of lent that emege y in
[any anda ado ar or ck le. Festa
‘het ime the ka ih bonus uit
bec e hl may a out ner wen Be
cogs t wat pr of the te the ck el jap ou
Kong stone impartan ining hen
‘actin ew envionment sexton

Fat of ranger almost» une Siding afer 70
12 mn lag abi ito ees ec
Another vay common fan rope o fer sl
pre rn e porn Toe trond mont
ga peaks tc 13 ad 8 months off, and then
cie The bas forthe ome hs fee pohly he
elf doping remembrance the preteen wen
patio present tts bet permanence Bese
‘of ts mental proces parao eames te Io
1974 Gain DEC” mese hat fa witha tne
‘nl ro wh er mates dsp perrera
uch er to one motes ve ern content
Ad afionte.

“The ones nd pas separan amity appear be
crane in hen ons y dcr ough

194. at mine ofthe ar aie ry" shuld e
‘ted that he probe of eatin sie aly we
ntl by met chen by 60 2 mon a ag and
by many le y 32 26 monthrofae In 196, Ai
‘orth nd ut chien wo hve ong reo
penita parres trato
à plc om which to venture to wider oc re
by export Comer, chien with pot dope
‘ladon with hi creer ae ot eo onder
‘Suh espoation bese ed a ens a cry.

Social Changes

THE FIRST YEAR

the est year of Me he ds uy ad comple
dependen than Molero even por,
tothe chide rime Inthe ftv owt he hd
ties ot ou à ear erento among pope The
aby may co où eme at pens aswel an sages

Norco mile cece 2 t 3 mont and hit
cps teat mac fhe eet
th ying Wits hsm, e begins under
‘hat hise tan ein ca dto end his or
Furio in he hom.

The mes important bppeings ily during the et
ea fi are the dep Seng and secu atch
mento o mutig nd ring ale ode sted
thn congo sv ehren who arsed
fay Le In hip qual dae eicamens do ot
Selle deepens cal eomeqorcs Compare th
‘len aed solely by the motes at ome

‘THE SECOND YEAR
The turca child capable of pet scl progres
aña the second per of developmen The ave fa
gels ao he ch a and to elt the
Fa Soci chen sek to ener wl A eed 0
tet dependence arts ce Eee sd comet
Peeing ae become ery importan

ie mada Serato becomes port a thi ge
ad ems so o perso cane Rc male ho sy
‘cot bev ae te mo ef Chen eho
Share nunggesie ys handling sation re ely
laser dat apr Ufone crn ho ser
Vil seve behavior cna e Ju nik
to sp that apprnch

Thé mine of fen between parent nd child
od renting vera rol nd daaproal re impor
tenth age Dice nd De enon ot pu
the Poets oul be read that 1 ad Anna
‘hdres are not spe inter one ad tat en
tener tantrums ar normal ad re best left unc
Fa pnhmenteyondan tenon getig tenue
ty parent e ne pine thump the tc i
‘seal conte and an ey be «rae

‘CHAPTER 12 The Dinamic of Change 177,

THE THIRD YEAR

epening on he indivi, in be cond yar
ri bei yar he la oct dependently
‘tthe pret The hd year when pot ig en
‘Sy sat Thi shoul ot be sated foo an held
ever ame à roue of cont betwen he ld ne
Fret Pres shuld wat wl he ld i ra

"he thd yar demanding one x arene The pee
fox cen between the second and td bits as
Beca bed etre tos” Chenin he ed yar
say ase the wed “nl” nie they wat 0 rei Che
‘en ae offen an embara! 1 er pres ca
they do nt best ut th observations fest of
‘Sree (ut ne tt) Ge manipulation not
‘Suncom rc ba und la may Be og
pre an

Byte end of he hed ey, the aking on™
snd Shy ue. The is unique dry begin.
‘ing tc, and he eh canada of
‘tert ior er own fe Beach nd bene
crue commutation sly the ch by the tate
thy scape fs varity of eal echanges with
tbe rope Ser el th sity to comme fr
Yu the hed tty mh the ente ae or many
"hen ints progam of de are OF ear ee he
rm of hr ebook rt fom a ern sand
et ge 3 jes much too It forthe est dea

Epidemiology and Mechanisms
of Dental Disease

ac poss as een made in recat decade in ude
Sanding the complex icon ofthe del cares
Proc However bene oh mula! str thee
Fa mach wo besa read he iin prog
om and prevention of dena de The raton o
ero de mais ia os sponsor sad
er ce cements the dect rene
heraenon und hr factors al require arte ei
on However, we understand the proces mic to
‘blest den with cesto Senter ro up
fre of care, à dice tht was on ende In De
pates.

Dentistry hs developed a hs of aves prevnive re
poems de spied on enna or publ hath
ie Appian af thee reine in prác he o.
on of ple water supe, has ed to sia
ducs eased dental cre among res
Inthe Used Sea A crete tcp ga à
vary but ets go the dental rin tbe
{orm chad patients e practice. Thi pray
tee fr chen whose present programs re its
pie

195. CURRENT CONCEPTS OF
‘THE CARIES PROCESS
Dental ais e a comple, multi! deu whose
my aß made of bs mor sla
‘opines À deed dictan of cure kriege
rond the scope of hs caper tr the loa Ei
revo hold aqui therener wi a tas understand
"el ai a diary erbte mais te.
Ye ee in ih ln fin cc ee,
In as dein, the er neo we in mon
even meaning colono of ter any y ce
teria Dental care à diese of the dental hand sis
rca ty y the decision he moran
pans af th oth Low le mine one ls hen
oe by breakdown Ue ore mar sde.
ne prces rent for be mtb nearby
rt rl micoorgaions Inf pls termo, he
proces cn be sub by Vea dara stig be
{aowigreguzemens (1) nur tot (2) prenne
tact ($ ace rin, erent cbt
nd (time Pare 12-39 stots he ts lacio
tenis er emirato of detal ar. hs
‘st widely scape mode, tater we raed dir
stes pra scree a esate fr cd
pod The roulant adr begin the pros of
Eminent,

MICROBIOLOGY OF DENTAL CARIES

‘The presence of miei in detal plaque as een
kamen sine van Lacvenhock ead tho under i
‘miconcop in 68 I 1904 Bes pics. Crh,
ted an of Snptccu fom ara on in à

LIGUE 1239 mc at De nd

ch Henamedi Specs mutans lhe 1s Koes
a be demoted Bite nido a etal
Sri ia Emile, cis diene These
pais repas assed dental cinto
DT tied td in mn we ls à de
“ts septa Aare members avides sp
tocas gp The oo specs repose the it
tif mal rs in man ae mato an Sica
Sabrina. Matan seta ve been carted wäh
ein namen ros seal epenidope modes
‘Tey ae caret pres lave the map ro in he
Ineo fee ee huge remo he to
‘enn the tooth sere Maa spiel ar os.
‘elt be esta tt nar sal sli lor the pro.
Seen of dema cs Escrits acia und
Tacuba ctl so have ben sited with dena
ar Tee spec iia avd ni
Se Baar belehren oe inthe exer propesion
Inca tenien In recent og recur being
veo cbc and try and bs cor whch
ill rent ators wi seve pees
ista Sand gue and bis ex ing
a i advanced cane

hem o fac in tbe date procs. They ae ater
toy pode ede atop) and they ave
nd aci hin the acd rm oe ar)

TRANSMISSION OF MUTANS STREPTOCOCCI
Matan epica have eva log with man 106
the ecg ne in he ham rl ai They ave
oe ben eel partes competing ih pa
‘nce har pcs fr he einen end proton
prod by the eal vi Hower, wien ham es
Egin o inde sco ad ober ened cto
mean repos bp o exert Bel ec the
form of id pectin and the tin denle.

Cac die one tnemion of mans pi
cc suggest tht tens Sr ave cal à nk
ie cle e ol cai, and tht they ra a
ud op despsmatig fac sch that provid by
sd fer clan Beca ter clogs che
‘athe toth ace mut proc mer ps od
«be monto aut ne gol pay oth
‘option Sobseguey was shown tt mese monte
‘Tanmisin of mtan srepncci les place between
‘mothe td the ren Sc implanta no
{hein al eed in pr o sie ofthe ncaa,
be eqeny tl dose Incl anda nial ne
forn ec dove” Lans pp 1 cq gy
ofS mutans ti dm te ter sigh
‘nots harbor à more errant poplin ef 5
mnt and enfant ine acon Ti
real amin” spec to ve pinay de
eter ice testis lined yh ea sh her
‘ley with a he mes (mean 300) compared
‘othe be: Tamil may cur in wo ways Dect

196. ‘raison ales the coming ofthe parents and
diras durngksing Inte ramon nes
the placement of ejects (soon ui, infants er)
nt ie pret mas, thn into he fat mouth tat
th bee eee hats window of afc” opens or
‘ome prod fine ing he dsp fhe primary
im Could and coworker etd man ep
cc In 29% ft ample of inns y ae 19 monts
‘din 75% by 3 monte The pee width of he window
fe individ infants may vary and wat ot determine in

“Tansmision of mans sreptocch an be dey,
perhaps even prevent by nig itemise eet
Progr dre orar number af mu ep
Foca in made a br fama eth Dpto ropa
Reduction he bod oralen and he eee
crains re bere denis res netics er
teed with forge, corer o yo containing
eng um.

Heron trnemision of mans spore
tought to ocu Matos Grier ad coque ted
‘mutans sepa fom muay shel ehren aged
1210 30 months and reported that many children wre
cond wih mune epoca tas of etc
‘types Van Loven und mode" denoted à
Hethendorhorzstal anne when achicomes
colonized with mutastrpncciaferage pas Ai
‘oy Ds sg rental ea mar 15
month od eldren ey nuse stings”

Recent suis ao get ht $ matan maybe ant
te atan eer ape earth pin of tet, ner
nd cobeague ing DNA probe technology repone the
presence of motas set in 55% of lagu samples
nd 70% of tongue sraping om sample o 37 dren
get 6 to 18 month Was and muni? valo 60
eter and 19 fll em fat lage 3 mont The
tere were ae o ae Sato 34% of the
term fat and 20% ofthe pcm nat (OM
‘vel prevalence). Thre wat a Apia! lao
tween the presence ofS mean and deren
(Geha) nodules In a subsquet sty, Wan adc
league” dete . mt SO of eter ande of
rm infant pe moths Factors sect with clo
izan ined ceed frequency of sugar nk,
Escocia ato tht love! the wane fa
from mother cd Nonlin war ced wih

Oo

ace

‘CHAPTER 12 The Dynamic of Change 179

maple cour af amic Ina flow sp ay ofthe
Sine Ian Wan and comer” dem tht the
{bat by 24 months af ae 80% ofthe fans rte tbe
ea Fassel wheat fa I dy
vere ester uds teo bd regen oa expo.
Sig ring ds vial and teal an
Herd renter than 10 olor oring unit és
mike crane fait The man age Stans
lat nent ya 17 moni One.
‘ht om Wan and ace ba the pre al
Stanton 2 monde of ge Tex dese
nabs abot the tne thats ard, one urn
raie for mutans eos cloro. Te faros
tthe tongurepat tote animporunt cola ee oe
comen ofthe pede

FORMATION OF PLAQUE
The tal bce coin of ch pat bains
vith eran ter dan man repos which do
have peat a o adhere o eth The chains
Final ceniza fade () adherence of bce o
ali the enue ue) adbeson between ber
te me r dere pc, and) misc pont
toc om aval ear tcs and rom els tay
‘Stace otoath cur Plague drop cine
‘th the formation of each yer cans e
rade lr in two mal components pce
and fc (gue 12-4), The polymer ae need
‘om cachet these component Chis of Poco and fc
tes termed gicas and cans respect, ar sc,
‘ious substances Bat fuer chan the tates
yo aro tot and o uch eter Glens and
run aso sec he ie a wich a can eter the
Hoge to butler the aid and revere he Jene

pros
Tocca matali of arche lea y the
produce of cd, hey ace aci a cn dpe
bq pi un arg lve af abut 6 o à al 4
"rin minutes o conta wth mena cay te
Fran wd re mere sll than pcan, may so
serve asa eo yo elechne fr
e acia 0 o wien uber bart ae ot raat
Waster era challenge, the png pl
ree abut 2 miter to tr oH ing valo

a

2 FIGURE 12-40 rota tay mac wn gen ct

À
4

Kaduse.com

197. HISTOPATHOLOGY OF SMOOTH
SURFACE LESIONS
‘The eures dine gn of he ees roces on smooch
nae surfaces se white spo lesion an ae of whe,
‘tally opague enamel pc sen under a yer plague
ike ginal margin of ot uf ca a beeen
‘nth proximal tooth mac that Become expe’ ser
bon of an sécu primary wth gue 1240,
e mit pot lona nico ta the undeing
cenas dl In croarston the eon cola,
‘eh ap toward the den, Daring heey sae of
eones, the in may not be isle on a Ming
cp

“Te enamel ion us een vided by Seton and
evr into stg sones tat coment 1 the
‘hag produced a the enamel (gre 2-42) The sra
Sones tert une spec enamel at ac
fon radin lowing mine oc acm,
spate tote fon) pus mand ot ofthe eae
‘Ons to 10 ofthe mil content tom te
‘ales pe Bow thr one te body ofthe oe
Principal rc of Gemma esti about 60%

+ FIGURE 12-41 weston en si siena
In sen nd or cot ee Seely ing
rana era ll mol Carty D
Bem Men

w |

1 FIGURE 12-42 an sy name on ut) tre
pe rant ra nd pene) tt stare
jetsam) soe nace 7

‘nines In developed eons hs re oul cor
ondo tothe range mage sc o eng m
‘The ind on, cale det sone bei of ape
nce under ed light microscopy. represa ae
‘tinea inemedite to be Ovo petting une
here font ofthe les, the ande ne as
‘ind mir! ou im tht ofthe sce one
(Ge 10m) les pr ar ken Wo aes ad et
en, As aproches the deninsenameljncin, he
feo apcdo nel, and ie ein nn ace
ir bres down, rating cally dette ciation

The itopteiogie meh opt nd fare as
À mat dern om tet of moth ataco
ose apres the prevention the wo es
‘tater a cre Te me el Sore in i vas
forma improved ar yes and ery cnt re ri
ar een combat soc sre sts Fand
Fer seats and proie ean resorts cigs
re und conte pt and Sante lions. The toas
ingle acer and presen of pi and reso re
cad in Clap,

(One ofthe mos important camps at have ered in
‘logy inthe pst even ees ithe deinen
a reinen of enamel The cies proce o
longer thoght of ln, bepning with ac demie

Vd kt dane pert ort ads lan
eth sue enamel nciening as à focos marie
Bd copain ral arcada by
1 ener rt ii mat at ecules 10% 10 196 of
‘het aun Ths mari previ reihe une
‘through wich a mine ridad rn
‘my pas in ot econ

‘Under tral ora condos equim sess
tv mie ss and minera gn. The hee un be
loud, hover, by endonmentl on in the rl
‘arty me as plage Hal pt andthe pre race
Monde Acá pda by plaque cres an eon
‘ent with lowered pl ste cpm ace ening 20
le of mire enamel eyo. acom, hor
loa and ober nner di ut ugh theca

"The presence of orien he eral environment even
ery low comenta, can at the uri of he
Pre the oppose manne ning rent.
‘Ts Mande moy come rm tl, he png Bl o
fom ie demi ename Bang tomer:
tn Aue air he ifuson claman ps
loas eck ito the leon bere paraly dived
Erratas arre into Perico
pat Tas ar autre snow more run 1 ad
coo an were he rin cals” Moe ep of
sia er lin es pce

198. ‘Thos derdopmen of dent re mat be viewed a.
ami proces in pe on all page core.
‘slong the sufaceayer remis intact eran
eos pose ad restr muy be ve.
Te ihn mut cape importance le fc
yer he white spot eso and std he temptation o
peat wit br explorer. Doing wl rate me
bi tat mat pre Th e a any
Tages may no be dette on 2 nadia However
tay sll lona ae raogrphka ll
‘amd canbe mange nina with oie THs
resonant rc permanent eth wich aves mach
"cer nme ayer than rary eth The inician mus
o bar in mind ta car lens ate rer clay
than the appear on ngrp Clay videos
may o undergo reminerazatin sch ais he ae wih
ome chose aos lens, but rotor ri
‘aot be avi ns station

bier
‘Theda components inl repose forthe dee
opment of dent ara reread (fm carbo
pte inci varios spar Refined ché
an be broken dow inthe eal avy y vay aye
Into simple pr tan be met by mun ep
toco and oer acidgei ct. Cage bce
mettais tee Gemenabke aka md proce
‘rn ads principal ces ich caer tele of
ner ote om th oth race (“Etapa
701 Sot Saro Lon er.

rs as bee inpiated more han any ter catho
Irae cis process Theron beten he
mern conten of e dt and ema dental air
Gere à moi uve that ics pl hen roe
id fondo ar one frequent. The cre pseu a
ieh rel of were te init dt the serie
conten ofthe dt bs become strated ada ices
in mern content beyond da lee dona ice ares
econ à ant extent

Tatton htm dry Cobol and aber
cars ik air are complex. The fee of refined
Clyde ine is importan, or pops more
Epoca han the amt of ttl arta in the
‘de. Oder footed cos cn ence or eaten à
ec aspen, such ssp cio in main
‘Sv reins or ene flanc ft ante ná
cepa to metab by metas sepa I
ha then, v0 rank foods on the Dad al thee
roger

M mt wel sou it nd care vs died
‘om te Vipin sc, conducted among station
‘aed dle Sweden in 5.1952. The mao ding of
‘tat tu wees ale (1) gar consumption a meals
an ne à gt nee in rs sci) pa cm
Spin betwen mas at defense aies
‘ctv Ori oem produces martd rs
Encanto) cue sei eer ong india

‘CHAPTER 2 The Dynamics of Change 181

with the same det, and (5) cares cry deines when
Spa wir fo e de,

"A recent comparto ofthe mur epoca of
en in Alte, Boop and North Aerie er at
ay cont of these mirorpnens sre comple
inthe tree polen cen hgh he oe lee of
dentaria shanty Dit doesnot have aso
{nfm on he lvls of mus seca ed bo
oe satan determine bee dent cri Ths
‘he tay cond that erences i the cars es
mong the tee pops are moe leed det
than ve of mone proc

‘SALIVA AND OTHER HOST FACTORS
Human avai rc reali cr in tb cis
process I's speared th lam snd phar
{hosted martin proces of normal ramal an
promots emision of dencre ea cm
‘ns eons ad other ble and so striate the
ec of aid padocin by page cera Salva a
ets rc immun compet andante
a compounde I crane lw level of Boe tht
Bee cncentted in dena laque. Te ring pH of
la normal arc 70, ho mayan roman 55
1060 Shan fw my bereuceinchlirn with cree
‘less by medications and y radio eaten nl
fap the had und oc vary ow my ested by
unity ant me mio, Jeder eth
re gums and candi.

‘Others fc nl the qual of these the
dea fs and ur, ad the individuals expe
lo cri. Enamel opi, een a sein vel,
ner the cep of eae to cy. There re
‘ee that pematre very ow bith weght chien ae at
incre ik fr e pop.

EARLY CHILDHOOD CARIES

y cho cis (EC) ie a specie om of vee
‘en cesta aes as an Young hen eb
‘ned athe presence of mae than ne day (noe

ae o cv eon) mis (due 1 decay oiled
‘oath sae in any pinay th ac 71 maths or
Younger, This pest 8 dena ae war foray
Tee ab be ch dc and rn tle ar
‘ay apne oath arses ine Coens tas 3
ara die of vere EOC Beten he ager and
Biar sere EOC deed as one or more caste,
sing (de 1 care), ied snot soe pm
AA
face (m soe rat an à ag 3 y) pre
tans ps ye gree an. (ge yr). lr
[ECC no pic int etn e pal pd
progreso ofthe dc.

TOC bret die intercen el te at mote
inher pes of dal cris epee ctra, ened
‘tbe und hos far) igure 12.3). oem,
(Ge Sur Gates aos inde fest corps of

199. 2 FIGURE 12-45 the copar te ysl seo eat em pect oy din

(ey ened Sh nest Cay Aba Co)

Ti contain frente cardo, parir
"rg a nung ttle tale tines Jl nds ct
formal ad reed bevenge have ben implied in
OC Wen tale vi mug tte wi te fat epa
ee pds pl around the many incio und Ga
ue ap progres, eve deren ot th rc
tar Figure 248). The socio eee cow kad
EOS ls meet comvovenal Many sede report
Inveipletedmihasantlgi actor for ECC However
arte sc have en it mak ot cree
and may even pote tooth fas beca of igh
‘au content Human bet mk y De peed
[EOC among cren who engage in probnge te
{eked nung However, ith Rumana have ot
Indeed that human mlb i cargene® There muy de
‘te fc at wrk in fae ha engage in plone
"incaico dut promote he dant
pereza

The Amerkan Academy of Pete Denny team
nens tinta ot be ptt slp rot a at
Uetekted nocumıl Based be ade aer he
(open ofthe Bs pray tot Pate should encour
ethnies dank om ap the hd pones
de hs iia ni om hs be done
120014 month of ge Bone ral py) caps
vd ot be ud fr rte consumption lua
‘onlin krmentabe arte Oral ire me
es shoal im pe the tie of he np of he

2 FIGURE 12-44 Et hen as Gomes se
lets CeO Des) Ne)

etc. Techn re conan should
tcc tin 6 math fer the eruption of he rt th
‘tno lier han months of ge

REFERENCES

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