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Clinical Tips for Everyday Pediatric and Adolescent Dental Care

Dr. Reza Nouri is a certified specialist in pediatric dentistry, and has been a Clinical Associate Professor in the Faculty of Dentistry at the University of British Columbia since 1994.

Highlights

Dr. Reza Nouri gives practitioners sage advice about how to help optimize dental health the in the perinatal and infant stages. Good nutrition and its effect on teeth are significant as tooth development starts as early as 5 weeks intrauterine. Similarly, premature birth and low birth weight, as well as smoking and drug abuse by the expecting mother, have detrimental effect on the dentition.

Systemic fluoride has neither a preventive nor cariostatic effect in children whose mothers had fluoride supplements while they were pregnant. On the other hand, topical fluoride application or the use of xylitol is more beneficial for expectant mothers to reduce the risk of caries. Xylitol also helps reduce the transmission of cariogenic bacteria to infants.

It is recommended that the first oral examination be performed by the time a child turns 1 or as soon as the first tooth has erupted in his/her mouth. Unfortunately, studies have shown that <1% of children are examined by the age of 1. Furthermore, 1/3 of hospital day surgeries in Canada are due to early childhood caries (ECC) which is still the most common chronic childhood disease.

Watch the video presentation

 

4 comments

  1. Dear Dr Nouri,

    I have two questions. Is the treatment for deciduous teeth with draining fistulas, still the removal of the diseased tooth?
    What is the current recommended treatment protocol for pulpotomies on deciduous teeth.

    Thank you.

    Bob Kinniburgh

    • Hello Dr. Kinniburgh,

      Thank you for sharing your question. I will forward it to Dr. Nouri. Please check back to read his response on this page.

      CDA Oasis Teacm

    • On behalf of Dr. Reza Nouri:

      Dear Bob, thank you for your interest and these great questions. Although these questions are not directly related to this presentation I will provide a brief response.

      Is the treatment for deciduous teeth with draining fistulas, still the removal of the diseased tooth?

      YES. Extraction of a necrotic primary tooth with draining fistulas is the most predictable treatment, although heroic attempts at endodontic treatment in such teeth may result in occasional successful resolution of signs and symptoms of endodontic lesions. It should be noted that with any endodontic treatment of a primary tooth the short and long term effect of such treatment on the permanent tooth follicle should be considered.

      What is the current recommended treatment protocol for pulpotomies on deciduous teeth?

      VITAL pulpotomy of primary molars has a high success rate. Proper diagnosis and pre-operative radiographic assessment is of paramount importance in the success of VITAL pulpotomy in primary molars. After local anesthetic and rubber dam isolation the following steps should be carried out. 1. Caries removal, 2. Removal of the roof of the pulp chamber, 3. Spoon excavation of the pulpal tissue to the coronal aspect of the root canals, 4. Irrigation of the pulp chamber by water or sodium hypochlorite, 5. Drying of the chamber by cotton pellets, 6. Application of the pulpal medicament (1:5 diluted formocresol, or ferric sulphate, or MTA), 7. Placement of a thick mix of Zinc-oxide Eugenol, 8. Restoration of the tooth with a material that provides optimum seal, such as a Stainless steel crown (SSC).

      Dr. Reza Nouri

  2. I am most curious about Dr. Nouri’s response to the above question as well. I would like to hear also what his recommendation about extracting or leaving cavitated primary teeth when the permanent ones are to follow in a couple of years or less?

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