This is an area that many general dentists can find challenging. It can be commonplace for kids to grow up being scared of dentists. Unpleasant experiences can often linger for a long while. I can recall parents recounting stories of their childhood unpleasant dental experiences. In this dentist podcast, Dr Andrew Chang and Dr Diane Tay talk about:

1. Why Connecting with your Pediatric Patient is important and why first impressions count.
2. What are clinical tips and tools to make the initial exam easier for them.
3. What are principles of communicating to a child that can be applied to clinical dental practice.

This is a clinically relevant topic and we go through many clinical situations. For more information, visit our blog.

Lots of advances in the restoration of primary teeth and important to consider as parents are keen for alternative, aesthetic options. We also know the importance of maintaining primary teeth for function, aesthetics and space maintenance. Crowns provide a full coronal coverage restoration to help preserve form and function.

Reasons and indications for placement of crowns

• following a pulpotomy/pulpectomy
• for teeth with developmental defects (enamel hypomineralisation) or large carious lesions involving multiple surfaces where a normal restoration is likely to fail
• high caries risks patients
• where longevity of restoration is required

Types of crowns available and What are zirconia crowns made of

• Stainless steel crowns, composite crowns, Porcelain fused to metal crowns and Zirconia crowns (Pre-fabricated)
• Zirconia crowns are made from zirconium dioxide, a very durable type of metal that's related to titanium. They are still classified under ceramic crowns

Pros and cons of zirconia crowns

• Pros- strength and aesthetics. Research shows similar durability and strength as SSC. Can be used in patients with nickel allergy or who require MRIs (where SSC may cast artefacts in the scan). Ferrule Effect.What colour choices do prefabricated have?
• Cons- extensive prep, technique sensitive, more time consuming, cost. Good colour match but are opaque. Areas of severe crowding? Cannot adjust shape easily. Bond strength where isolation poor?
• contraindications- severe bruxism,

Cementation:

• RMGIC or GIC?

Some tips for dentists interested in trying:

• take a course
• practice, practice, practice
• choose your first case carefully
• Be careful of back-to-back crowns
• Ensure excellent haemostasis

In this part 2, Orthodontist Dr Andrew Chang discusses:

Treatment Options:

1. No treatment
2. Interceptive Treatment now: Functional Appliances with U maxilla expansion + referral to speech therapist.
3. Wait till permanent dentition, then camouflage with upper arch extractions, U expansion is less effective.

Treatment Timing:

1. Is it too early? Primary dentition?
2. 1. If have habits eg: thumb sucking or dummy, best to cease habit first
3. Mixed dentition: best time for maximum orthopedic effect (CVMS 2: Baccetti 2002): Shape of vertebral bodies of C2-4 and inferior borders of C3-4
4. Adult. Is it too late? What happens with functional appliances? Compliance and success rate (due to temporary speech disruptions), greater lower incisor proclination. Jaw surgery and risks of morbidity.
5. Adv & Disadv of Early Treatment- Gingival trauma, Upper incisor trauma, psychosocial.
6. Adv & disadv of Late mixed dentition or Permanent dentition Tx: Orthopedic effects best retained.

What should dentists be looking out for?

1. Age and Dental Status. Mobile D's and E's at 10-11 yrs may be difficult to retain functional appliances.
2. Habits - ask about thumbsucking, dummy, mouth breathing etc.
3. Signs of Risk Factors manifesting as gingival trauma, narrow jaw, Upper Incisor trauma.
4. Assessing risk factors through their lifestyles and habits ie: sports, mouthbreathing
5. >7mm Overjets and referral to orthodontist
6. My experience has been parents would prefer to do a combined functional appliance + teeth alignment that address root causes, rather than orthodontic camouflage and adults are not keen on jaw surgery procedures due to significant risks.