NEET MDS Lessons
Pedodontics
Natal and neonatal teeth, also known by various synonyms such as congenital teeth, prediciduous teeth, dentition praecox, and foetal teeth. This topic is significant in pediatric dentistry and has implications for both diagnosis and treatment.
Etiology
The etiology of natal and neonatal teeth is multifactorial. Key factors include:
- Superficial Position of Tooth Germs: The positioning of tooth germs can lead to early eruption.
- Infection: Infections during pregnancy may influence tooth development.
- Malnutrition: Nutritional deficiencies can affect dental health.
- Eruption Acceleration: Febrile incidents or hormonal stimulation can hasten the eruption process.
- Genetic Factors: Hereditary transmission of a dominant autosomal gene may play a role.
- Osteoblastic Activities: Bone remodeling phenomena can impact tooth germ development.
- Hypovitaminosis: Deficiencies in vitamins can lead to developmental anomalies.
Associated Genetic Syndromes
Natal and neonatal teeth are often associated with several genetic syndromes, including:
- Ellis-Van Creveld Syndrome
- Riga-Fede Disease
- Pachyonychia Congenital
- Hallemann-Steriff Syndrome
- Sotos Syndrome
- Cleft Palate
Understanding these associations is crucial for comprehensive patient evaluation.
Incidence
The incidence of natal and neonatal teeth varies significantly, ranging from 1 in 6000 to 1 in 800 births. Notably:
- Approximately 90% of these teeth are normal primary teeth.
- In 85% of cases, the teeth are mandibular primary incisors.
- 5% are maxillary incisors and molars.
- The remaining 10% consist of supernumerary calcified structures.
Clinical Features
Clinically, natal and neonatal teeth may present with the following features:
- Morphologically, they can be conical or normal in size and shape.
- The color is typically opaque yellow-brownish.
- Associated symptoms may include dystrophic fingernails and hyperpigmentation.
Radiographic Evaluation
Radiographs are essential for assessing:
- The amount of root development.
- The relationship of prematurely erupted teeth to adjacent teeth.
Most prematurely erupted teeth are hypermobile due to limited root development.
Histological Characteristics
Histological examination reveals:
- Hypoplastic enamel with varying degrees of severity.
- Absence of root formation.
- Ample vascularized pulp.
- Irregular dentin formation.
- Lack of cementum formation.
These characteristics are critical for understanding the structural integrity of natal and neonatal teeth.
Harmful Effects
Natal and neonatal teeth can lead to several complications, including:
- Laceration of the lingual surface of the tongue.
- Difficulties for mothers wishing to breast-feed their infants.
Treatment Options
When considering treatment, extraction may be necessary. However, precautions must be taken:
- Avoid extractions until the 10th day of life to allow for the establishment of commensal flora in the intestine, which is essential for vitamin K production.
- If extractions are planned and the newborn has not been medicated with vitamin K immediately after birth, vitamin K supplements should be administered before the procedure to prevent hemorrhagic disease of the newborn (hypoprothrombinemia).
Use of Nitrous Oxide (N₂O) in Pedodontics
Nitrous oxide, commonly known as "laughing gas," is frequently used in pediatric dentistry for its sedative and analgesic properties. Here’s a detailed overview of its use, effects, dosages, and contraindications:
Dosage and Effects of Nitrous Oxide
-
Common Dosage:
- 40% N₂O + 60% O₂: This combination is commonly used for conscious sedation in pediatric patients.
-
Effects Based on Concentration:
- 5-25% N₂O:
- Effects:
- Moderate sedation
- Diminution of fear and anxiety
- Marked relaxation
- Dissociative sedation and analgesia
- Effects:
- 25-45% N₂O:
- Effects:
- Floating sensation
- Reduced blink rate
- Effects:
- 45-65% N₂O:
- Effects:
- Euphoric state (often referred to as "laughing gas")
- Total anesthesia
- Complete analgesia
- Marked amnesia
- Effects:
- 5-25% N₂O:
Benefits of Nitrous Oxide in Pediatric Dentistry
- Anxiolytic Effects: Helps reduce anxiety and fear, making dental procedures more tolerable for children.
- Analgesic Properties: Provides pain relief, allowing for more comfortable treatment.
- Rapid Onset and Recovery: Nitrous oxide has a quick onset of action and is rapidly eliminated from the body, allowing for a quick recovery after the procedure.
- Control: The level of sedation can be easily adjusted during the procedure, providing flexibility based on the child's response.
Contraindications for Nitrous Oxide Sedation
While nitrous oxide is generally safe, there are specific contraindications where its use should be avoided:
- Chronic Obstructive Pulmonary Disease (COPD): Patients with COPD may have difficulty breathing with nitrous oxide.
- Asthma: Asthmatic patients may experience exacerbation of symptoms.
- Respiratory Infections: Conditions that affect breathing can be worsened by nitrous oxide.
- Sickle Cell Anemia: For general anesthesia, all forms of anemia, including sickle cell anemia, are contraindicated due to the risk of hypoxia.
- Otitis Media: The use of nitrous oxide can increase middle ear pressure, which may be problematic.
- Epilepsy: Patients with a history of seizures may be at risk for seizure activity when using nitrous oxide.