Mayur Chaudhary MDS (Oral Pathology and Microbiology)
Senior Lecturer Department of Oral Maxillofacial Pathology SMBT Dental College and Hospital
Sangamner, Maharashtra, India
Shweta Dixit Chaudhary MDS (Pedodontics and Preventive Dentistry)
Senior Lecturer Department of Pedodontics and Preventive Dentistry SMBT Dental College and Hospital
Sangamner, Maharashtra, India
Forewords Asha Singh
Minal Chaudhary
Jaypee Brothers Medical Publishers (P) Ltd
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Essentials of Pediatric Oral Pathology
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2011
9789350253748
Typeset at JPBMP typesetting unit
Printed in India
4Dedicated to
our beloved parents
Shri Bhasker Chaudhary and Smt Maya Chaudhary
Shri Shivendra Dutt Dixit and Smt Manju Dixit and our dearest daughter Tvisha Chaudhary whose constant support and encouragement have been a guiding light for us.
5Contributors
- Amol Gulhane mbbs
- General Practitioner
- Government Medical College
- Nagpur, Maharashtra, India
- Anuraag B Chaudhary mds
- Postgraduate Student
- Department of Oral Medicine
- Diagnosis and Radiology
- Sharad Pawar Dental College and Hospital
- Sawangi, Wardha, Maharashtra, India
- Gauri R Thakre (Chaudhary) mds
- Senior Lecturer
- Department of Oral Pathology and Microbiology
- Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital
- Nagpur, Maharashtra, India
- Iqbal Musani mds
- Professor
- Department of Pedodontics and Preventive Dentistry
- Bharti Vidyapeeth
- Pune, Maharashtra, India
- Manasi Dixit mpt
- Postgraduate Student
- Pediatric Physiotherapy
- Dr DY Patil College of Physiotherapy
- Pune, Maharashtra, India
- Mayur Chaudhary mds
- Senior Lecturer
- Department of Oral Maxillofacial Pathology
- SMBT Dental College and Hospital
- Sangamner, Maharashtra, India
- Prashant Dixit md (Pediatrics)
- Intensivist and Neonatologist
- Mumbai, Maharashtra, India
- Ragini Gulhane mbbs
- General Practitioner
- Government Medical College
- Nagpur, Maharashtra, India
- Sanket Kunte mds
- Senior Lecturer
- Department of Pedodontics and Preventive Dentistry
- Bharti Vidyapeeth
- Pune, Maharashtra, India
- Shweta Dixit Chaudhary mds
- Senior Lecturer
- Department of Pedodontics and Preventive Dentistry
- SMBT Dental College and Hospital
- Sangamner, Maharashtra, India
- Syed Ahmed Taqi mds
- Senior Lecturer
- Department of Oral Pathology and Microbiology
- Government Dental College
- Mumbai, Maharashtra, India
I would like to heartily congratulate Drs Mayur Chaudhary and Shweta Dixit Chaudhary for their timely recognition of the need for a piece of literature dedicated to Essentials of Pediatric Oral Pathology.
This book is the first of its kind and I have felt paucity of a book of this nature while teaching my postgraduate students. The inspiration to write such a book probably stems from one of the countless discussions that I have had with my postgraduate student Shweta Dixit.
The book consists of fifteen chapters including all the common oral pathologies in children. The chapter on Caries includes pathology, prevention and treatment aspects of caries in detail.
I am extremely proud to be a part of the pioneer book on the subject of pediatric oral pathology, and I am sure that the hard work, dedication and sincerity of the authors will be all and transparent to any student reading through this book. I wish the authors all success in this brilliant endeavor of theirs.
Asha Singh
mds (Pedodontics and Preventive Dentistry)
Senior Professor
MGM Dental College
Nasik, Maharashtra, India
7Foreword
It is only in the past couple of decades that pediatric dentistry has come of age. There is an increasing awareness in the minds of parents regarding the importance of deciduous dentition and its associated disease conditions. This has led to an increase in the number of patients in the pediatric age-group seeking treatment.
The distinct environments and requirements of the child patient create a necessity for a book exclusively based on pediatric oral pathology. Thus, there is a definite need for a separate book dealing specifically with the diagnosis and treatment of diseases of the young.
Essentials of Pediatric Oral Pathology by Drs Mayur Chaudhary and Shweta Dixit Chaudhary caters to this particular need. It is an easy-to-refer book with elaborate illustrations, latest treatment modalities as well as lucid elaboration of clinical features.
The authors have also included a separate chapter on Pediatric Forensic Odontology, which should be of great help to the reader. I am sure that this well-written book will be of immense help to teachers and students alike.
Minal Chaudhary mds
Professor and Head
Department of Oral Pathology and Microbiology
Sharad Pawar Dental CollegeSawangi, Wardha, Maharashtra, India
8Preface
Pediatric dentistry is amongst the youngest of the branches of dentistry, yet has grown by leaps and bounds to command one of the highest summits in dentistry. This book is a minuscule contribution to this effort.
It has been our dedicated and sincere effort to work within the limits of this book and concentrate on the more relevant topics as far as possible. The topics are covered on the basis of the frequency at which a particular lesion is seen in the pediatric population.
Numerous pathological entities including the commonly occurring ones, e.g. dental caries, infectious diseases, etc. and some rare entities, e.g. salivary glands, bone, skin, etc. have been explained in a simplified manner in context with children.
A chapter on Forensic Odontology in Children has been included which also deals with the currently relevant topics of child abuse and neglect. Each chapter has been provided with adequate and to-the-point references for greater exploration of the topic by young enthusiastic minds.
To distinguish between normal and pathology, one must be well-versed with the physiology. Keeping this fact in mind, comprehensive appendices defining the normal values of various aspects in children have been included.
We hope that this piece of work occupies the vacant niche for a comprehensive book on Pediatric Oral Pathology.
To err is human, to forgive is divine
With these words, we wish to admit that no one is ever perfect just as we are not. There might be some shortcomings despite our most sincere efforts. The reader's suggestions for further improvements shall be greatly encouraged and acknowledged.
Mayur Chaudhary
Shweta Dixit Chaudhary
9Acknowledgments
We stand with our heads bowed to the almighty God for giving us the opportunity to undertake the writing of this book and carry to its successful completion.
The writing of a book is an arduous undertaking and is impossible without the timely and sequential involvement of an entire team. We wish to express our sincere gratitude to all the contributors whose inputs have added character to the book.
Our respected teachers Dr Asha Singh, Dr Meena Kulkarni and Dr Rajeev Desai have provided us the basic understanding and knowledge of the subject and have always stood us in good stead.
The skilled technicians, artists, reviewers and the entire panel of M/s Jaypee Brothers Medical Publishers (P) Ltd deserves a standing ovation for their tireless efforts in designing and refining the vast host of minute details in the book.
A special thanks to Shri Vijay Gulhane and Shri Vipin Sharma who have been a reassuring buttress in all our times of doubt and hesitation.
We sincerely wish to acknowledge the overwhelming support provided to us by the staff and students, especially Dr Ashok Patil, Dean, SMBT Dental College and Hospital, Sangamner, Maharashtra, India and Dr Anil Ghom, Professor and Head, Department of Oral Medicine and Radiology, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India.
Thanks to all those who have directly or indirectly helped us in this venture and last but not least, we would like to thank our parents and family members for their ever-extended arms of support.
21Introduction
As Bruno Bettelheim once remarked, “Raising children is a creative endeavor, an art rather than a science”, all of us who know about the advent of dentistry right from the ages of the tooth worm theory to the present scenario where dentistry is brimming with new techniques and newer materials would agree with him. Dentistry started from a single department in various schools and universities to branch into various specialties, with post graduate and diploma courses in individual specialties. At this juncture in the steep development curve of dentistry, this book aims to explore yet another aspect of dentistry, i.e. pediatric oral pathology.
DEFINITION OF PEDIATRIC DENTISTRY
According to the American Academy of Pediatric Dentistry (AAPD), Pediatric dentistry is an age-defined specialty that provides primary and comprehensive, preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
This gives us answers for the following questions:
- Who are the objects of pediatric dentistry?
- Infants and children through adolescence.
- Including those with special health care needs.
- What does pediatric dentistry provide?
- Provides both primary and comprehensive preventive oral health care.
- Provides both primary and comprehensive therapeutic oral health care.
- What are the key elements of this definition that make it so unique?
- Age-defined: Most specialties are procedure-defined (endodontics, periodontics, etc.). Pediatric dentists provide care for their specific age group of patients. There is no limitation to what type of treatment they provide.
- Primary and comprehensive care: Pediatric dentists are primary providers. There is no need for a referral of patients. Parents can choose to have their children evaluated and treated by a pediatric dentist just like they can choose to have their child treated by a pediatrician.
- Infants and children through adolescence: Pediatric dentists see patients at any age from birth up to their late teens.
- Special health care needs: Pediatric dentists have the training and experience to evaluate and treat patients, that are medically compromised. This includes patients with hemophilia, leukemia, congenital syndromes, etc. No other dental specialty, other than oral and maxillofacial surgery is more involved in hospital care of patients.
We have talked about the four key elements in the definition that make the pediatric dentists so unique, and most of all it is treatment provided with tender, loving care.
The primary focus of most dental specialties is a particular area of dental, oral, or maxillofacial expertise. Pediatric dentistry encompasses a variety of disciplines, techniques, procedures and skills that share a common basis with other specialties, but are modified and adapted to the unique requirements of infants, children, adolescents and those with special health care needs. By being an age specific specialty, pediatric dentistry encompasses disciplines such as behavior guidance, care of the medically and developmentally compromised and disabled patient, supervision of orofacial growth and development, caries prevention, pharmacological management and hospital dentistry as well as other traditional fields of dentistry. These skills are applied to the needs of children throughout their ever changing stages of development and to treat conditions and diseases unique to growing individuals.
The AAPD founded in 1947, is the membership organization representing the specialty of pediatric dentistry. The membership provides care to millions of infants, children, adolescents and persons with oral health care needs. They are primary contributors to professional education programs and publications on pediatric oral health.22
Oral Pathology
HISTORY
Oral pathology appears to have had its origin during the first Golden Age of Dentistry, from 1835 through the organization of the American Dental Association in 1860. This era saw the establishment of organized, education-based dentistry and was integrally associated with an obvious fascination for pathologic processes and an inherent wish to share scientific and clinical knowledge with others in the dental profession. It encompassed the creation of the professorship of “Dental Pathology.”
In the practice of medicine, three main questions are given utmost consideration:
- What is wrong? (Diagnosis)
- What is going to happen? (Prognosis)
- What can be done? (Treatment)
To this, two more questions should be added:
- How did this happen? (Etiology)
- Why did this happen? (Pathogenesis)
- Most of the times, diagnosis of a specific lesion depends upon the histopathologic examination of the same under the microscope.
- Secondly, the cause and effect of the disease can be better understood (extent of the lesion).
DEFINITION
Basically, oral pathology is a science of dentistry that deals with the etiology, pathogenesis, management and prognosis of various diseases affecting oral and paraoral structures as well as local and systemic effects of various diseases as reflected in the oral cavity, diagnosis of various diseases, disorders and lesions under the microscope.
PEDIATRIC ORAL PATHOLOGY
The Pediatric Oral Pathology (POP) seminars began in 1977 as a joint, interstate effort between the Department of Dentistry, Pittsburgh Children's Hospital, Pittsburgh, Pennsylvania (USA) and the Department of Oral Pathology, West Virginia University School of Dentistry, Morgantown, West Virginia. They were intended to provide hands-on discussion opportunities for pediatric dentistry residents interested in lesions of the orofacial region in children and young adults. Weekly afternoon seminars were offered during the Fall Semester in Children's Hospital of Pittsburgh, with Dr Jerry Bouquot, Chairman of the WVU Department of Oral Pathology, presiding as monitor and discussion leader.
The seminars are participation discussions of clinical cases, with participants being provided “notebook cases” a week ahead of time, with appropriate photos, historical and clinical information provided. Participants are expected to come to the next seminar with a differential diagnosis, a diagnostic work-up plan and a management plan for each case. They are called upon individually to treat the cases, as best as they can within the limits of the format, as their own patients. Each seminar encompasses lesions which can be included in a similar differential diagnosis category. From time to time, special topics are provided in a more traditional lecture format, and these may carry over several seminars. As of June, 2000, there had been discussion of more than 960 clinical cases.
DEFINITION
Pediatric Oral Pathology is an art and science of dentistry that deals with the etiology, pathogenesis, management and prognosis of various diseases and developmental anomalies affecting oral and paraoral structures of infants, children through adolescence and encompass primary and comprehensive, preventive and therapeutic oral health care through variety of disciplines, techniques, procedures, and skills that are modified and adapted to the unique requirements of infants, children, adolescents, and those with special health care needs.23
These are one of the few milestones in the journey of the art and science of pediatric oral pathology, a subject which should be read and comprehended by:
- Pediatric dentists
- Oral pathologists
- Students of dentistry
- General dental practitioners and other dental specialists
- Government agencies and health care policymakers
- Individuals interested in the health of children.