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📖 Pedodontics

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Psychoanalytical theory
Pedodontics

The psychoanalytical theory, primarily developed by Sigmund Freud, provides a framework for understanding human behavior and personality through two key models: the Topographic Model and the Psychic Model (or Triad). Here’s a detailed explanation of these concepts:

1. Topographic Model

  • Overview: Freud's Topographic Model describes the structure of the human mind in three distinct layers: the conscious, preconscious, and unconscious mind.

    • Conscious Mind:
      • This is the part of the mind that contains thoughts, feelings, and perceptions that we are currently aware of. It is the "tip of the iceberg" and represents about 10% of the total mind.
    • Preconscious Mind:
      • This layer contains thoughts and memories that are not currently in conscious awareness but can be easily brought to consciousness. It acts as a bridge between the conscious and unconscious mind.
    • Unconscious Mind:
      • The unconscious mind holds thoughts, memories, and desires that are not accessible to conscious awareness. It is much larger than the conscious mind, representing about 90% of the total mind. This part of the mind is believed to influence behavior and emotions significantly, often without the individual's awareness.

  • Iceberg Analogy:

    • Freud often likened the mind to an iceberg, where the visible part above the water represents the conscious mind, while the much larger part submerged beneath the surface represents the unconscious mind.

2. Psychic Model (Triad)

The Psychic Model consists of three components that interact to shape personality and behavior:

A. Id:

  • Description: The Id is the most primitive part of the personality and is present from birth. It operates entirely in the unconscious and is driven by the pleasure principle, seeking immediate gratification of basic instincts and desires (e.g., hunger, thirst, sexual urges).
  • Characteristics: The Id is impulsive and does not consider reality or the consequences of actions. It is the source of instinctual drives and desires.

B. Ego:

  • Description: The Ego develops from the Id during the second to sixth month of life. It operates primarily in the conscious and preconscious mind and is governed by the reality principle.
  • Function: The Ego mediates between the desires of the Id and the constraints of reality. It helps individuals understand that not all impulses can be immediately satisfied and that some delay is necessary. The Ego employs defense mechanisms to manage conflicts between the Id and the external world.

C. Superego:

  • Description: The Superego develops later in childhood, typically around the age of 3 to 6 years, as children internalize the moral standards and values of their parents and society.
  • Function: The Superego represents the ethical component of personality and strives for perfection. It consists of two parts: the conscience, which punishes the ego with feelings of guilt for wrongdoing, and the ideal self, which rewards the ego with feelings of pride for adhering to moral standards.
  • Characteristics: The Superego can be seen as the internalized voice of authority, guiding behavior according to societal norms and values.
Separation-Individualization
Pedodontics

Characteristics of the Separation-Individualization Subphases

The separation-individualization phase, as described by Margaret S. Mahler, is crucial for a child's emotional and psychological development. This phase is divided into four subphases: Differentiation, Practicing Period, Rapprochement, and Consolidation and Object Constancy. Each subphase has distinct characteristics that contribute to the child's growing sense of self and independence.

1. Differentiation (5 – 10 Months)

  • Cognitive and Neurological Maturation:
    • The infant becomes more alert as cognitive and neurological development progresses.
  • Stranger Anxiety:
    • Characteristic anxiety during this period includes stranger anxiety, as the infant begins to differentiate between familiar and unfamiliar people.
  • Self and Other Recognition:
    • The infant starts to differentiate between themselves and others, laying the groundwork for developing a sense of identity.

2. Practicing Period (10 – 16 Months)

  • Upright Locomotion:
    • The beginning of this phase is marked by the child achieving upright locomotion, such as standing and walking.
  • Separation from Mother:
    • The child learns to separate from the mother by crawling and exploring their environment.
  • Separation Anxiety:
    • Separation anxiety is present, as the child still relies on the mother for safety and comfort while exploring.

3. Rapprochement (16 – 24 Months)

  • Awareness of Physical Separateness:
    • The toddler becomes more aware of their physical separateness from the mother and seeks to demonstrate their newly acquired skills.
  • Temper Tantrums:
    • The child may experience temper tantrums when the mother’s attempts to help are perceived as intrusive or unhelpful, leading to frustration.
  • Rapprochement Crisis:
    • A crisis develops as the child desires to be soothed by the mother but struggles to accept her help, reflecting the tension between independence and the need for support.
  • Resolution of Crisis:
    • This crisis is typically resolved as the child’s skills improve, allowing them to navigate their independence more effectively.

4. Consolidation and Object Constancy (24 – 36 Months)

  • Sense of Individuality:
    • The child achieves a definite sense of individuality and can cope with the mother’s absence without significant distress.
  • Comfort with Separation:
    • The child does not feel uncomfortable when separated from the mother, as they understand that she will return.
  • Improved Sense of Time:
    • The child develops an improved sense of time and can tolerate delays, indicating a more mature understanding of relationships and separations.
Diagnostic Tools in Dentistry
Pedodontics

Diagnostic Tools in Dentistry

  1. Fiber Optic Transillumination (FOTI):

    • Principle: FOTI utilizes the difference in light transmission between sound and decayed tooth structure. Healthy tooth structure allows light to pass through, while decayed areas absorb light, resulting in a darkened shadow along the path of dentinal tubules.
    • Application: This technique is particularly useful for detecting interproximal caries and assessing the extent of decay without the need for radiation.

  2. Laser Detection:

    • Argon Laser:
      • Principle: Argon laser light is used to illuminate the tooth, and it can reveal carious lesions by producing a dark, fiery orange-red color in areas of decay.
      • Application: This method enhances the visualization of carious lesions and can help in the early detection of dental caries.

  3. DIAGNOdent:

    • Principle: DIAGNOdent is a laser fluorescence device that detects caries based on the fluorescence emitted by decayed tooth structure. It is sensitive to changes in the mineral content of the tooth.
    • Application: This tool is effective in identifying the precavitation stage of caries and quantifying the amount of demineralization present in the tooth. It allows for early intervention and monitoring of carious lesions.
Distal Shoe Space Maintainer
Pedodontics

Distal Shoe Space Maintainer

The distal shoe space maintainer is a fixed appliance used in pediatric dentistry to maintain space in the dental arch following the early loss or removal of a primary molar, particularly the second primary molar, before the eruption of the first permanent molar. This appliance helps to guide the eruption of the permanent molar into the correct position.

Indications

  • Early Loss of Second Primary Molar:
    • The primary indication for a distal shoe space maintainer is the early loss or removal of the second primary molar prior to the eruption of the first permanent molar.
    • It is particularly useful in the maxillary arch, where bilateral space loss may necessitate the use of two appliances to maintain proper arch form and space.

Contraindications

  1. Inadequate Abutments:

    • The presence of multiple tooth losses may result in inadequate abutments for the appliance, compromising its effectiveness.

  2. Poor Patient/Parent Cooperation:

    • Lack of cooperation from the patient or parent can hinder the successful use and maintenance of the appliance.

  3. Congenitally Missing First Molar:

    • If the first permanent molar is congenitally missing, the distal shoe may not be effective in maintaining space.

  4. Medical Conditions:

    • Certain medical conditions, such as blood dyscrasias, congenital heart disease (CHD), rheumatic fever, diabetes, or generalized debilitation, may contraindicate the use of a distal shoe due to increased risk of complications.

Limitations/Disadvantages

  1. Overextension Risks:

    • If the distal shoe is overextended, it can cause injury to the permanent tooth bud of the second premolar, potentially leading to developmental issues.

  2. Underextension Risks:

    • If the appliance is underextended, it may allow the molar to tip into the space or over the band, compromising the intended space maintenance.

  3. Epithelialization Prevention:

    • The presence of the distal shoe may prevent complete epithelialization of the extraction socket, which can affect healing.

  4. Eruption Path Considerations:

    • Ronnermann and Thilander (1979) discussed the path of eruption, noting that drifting of teeth occurs only after eruption through the bone covering. The lower first molar typically erupts occlusally to contact the distal crown surface of the primary molar, using that contact for uprighting. Isolated cases of ectopic eruption should be considered when evaluating the eruption path.