Dens Invaginatus in Patients With Cleft Lip and Palate: A Case Series.

Dens invaginatus is a rare developmental anomaly characterized by an infolding of the enamel organ within the crown or root of a tooth, and it is an example of a dental anomaly that has a higher incidence in patients with CL/P. If undiagnosed, dens invaginatus can lead to severe, acute pain and pulpal necrosis since it can permit direct entry of bacteria into the dental pulp. Treatment of dens invaginatus includes prophylactic sealant or composite restoration, endodontic therapy if pulpal involvement has already occurred, or extraction if aberrant tooth morphology precludes endodontic therapy. Few studies report on the incidence of dens invaginatus in patients with CL/P. The purpose of this article is to describe 4 cases of dens invaginatus in patients with CL/P which were encountered in a cleft-craniofacial orthodontic clinic. Each case describes dens invaginatus in a maxillary lateral incisor, and treatments ranged from sealant application to endodontic therapy to extraction. These cases highlight the importance of awareness of this dental anomaly among cleft team providers to facilitate early diagnosis in patients with CL/P.

Improving caries diagnosis and early intervention in the primary and young permanent dentition.

Contemporary dental care incorporates individually tailored preventive protocols based on caries risk assessment and minimally invasive tooth preparation for restoration. Methods that allow for the earliest possible detection of caries provide clinicians with the options of preventive intervention or caries excavation during initial enamel or dentinal penetration. Adding laser fluorescence to the traditional caries diagnostic armamentarium enhances diagnostic accuracy and the clinician's ability to confidently select the appropriate modality for intervention in the primary and young permanent dentition.

Non-nutritive sucking with a pacifier: pros and cons.

The detrimental effects of prolonged pacifier use on the developing oral structures are often the primary focus of dental professionals; however, non-nutritive sucking with a pacifier has other consequences that include not only harmful effect but positive influences as well. This article will address some of the issues for consideration regarding the use of pacifiers and provide information for appropriate recommendations to parents of infants and toddlers regarding the use and cessation of non-nutritive sucking with a pacifier.

Parenting the parents of pediatric patients.

Managing the behavior of pediatric patients has been the focus of many studies; however, paying attention to the parents and their individual circumstances may be just as important to achieve our treatment goals. Parents today expect to be involved in treatment decisions and often have distinct expectations regarding their children's experiences. Parental attitudes and emotions can adversely affect the tone of the appointment and negatively influence the child's perception of the event. Managing the behavior of a challenging child is difficult, but combining that with the challenging behavior of a parent can be exhausting. This article will provide anticipatory guidance on how to enhance communication skills to avoid confusion and offer direction to parents before, during, and after the treatment of their children.

Preventive guidelines for the preschool patient.

This article focuses on risk-based caries prevention and specific protective measures for preschool pediatric patients, to provide an age-appropriate approach designed for individual caries risk and optimize preventive care for preschoolers both in-office and at home.

Upper airway obstruction in the pediatric dental patient.

This article presents clinical observations as well as a review of the literature regarding upper airway obstruction in the pediatric dental patient. Dentists will derive enhanced skills to identify the various types of upper airway obstruction and provide appropriate recommendations for intervention or referral to a physician to minimize detrimental effects on dental development.

Considerations for treating adolescent patients.

Adolescence is a time of accelerated growth with increasing caloric needs. A strong attraction for the taste of sugar and its availability have had detrimental consequences for the adolescent's dentition and general health. Numerous factors combine to contribute to the demineralization and erosion that predispose the enamel to smooth surface caries. Obesity and its associated maladies, eating disorders, and pregnancy are additional issues for consideration. Determining the need for and appropriate timing of extraction of third molars should be included in the treatment plan.

The first dental visit.

The recommended age for the first dental visit seems to vary among and within the professions. Unfortunately, the first visit often is prompted by clinical caries or dental trauma. The purpose of this paper is to provide guidelines for examining the toddler and information to be offered to parents during the consultation. Early identification and intervention for children with high caries risk, education of other health professionals and parents with preventive strategies, and the establishment of a relationship with a dentist prior to a traumatic injury should be mutual goals.