Dental age, radiographs guide dental diagnosis

Dr. Gregory Psaltis addresses diagnosis and treatment planning for infants and children. Photo: Robb Cohen Photography & Video.

If the room packed with attendees for Friday’s “Mini-Residency: Pediatric Oral Healthcare” is an indication, then Hinman 2016’s Mini-Residency program is off to a great start. Hinman introduced three multi-day courses this year to provide in-depth, expert discussions on pediatrics, geriatrics and cone beam anatomy.

Moderated by Dr. J.C. Shirley, Atlanta, the Friday pediatric program kicked off with Dr. Gregory Psaltis from Olympia, Washington, and Dr. David Rothman from San Francisco, covering an introduction to pediatrics; exam, diagnosis and treatment planning; prevention; behavior guidance; dental caries options and treatment planning; guidance of the developing dentition; and medical emergency diagnosis and assessment.

In his talk, “Exam, Diagnosis and Treatment Planning for Infants and Children,” Dr. Psaltis called on attendees to pique their curiosity by treating each pediatric exam as a new exam. Noting that both adult and pediatric dentists look at dental caries, periodontal disease and oral cancer in a total exam, he said children are different every time they come into a dental practice.

“I want you to become more attentive to the things that don’t seem quite right. Radiographs on children for examinations are incredibly important because almost every single development that occurs in children is an anomaly and asymptomatic,” said Dr. Psaltis, adding that it also is vital to be aware of the patient’s “dental age.”

“We have 4-year-old children in our practice who are getting their permanent teeth, and we have 9-year-old children who still have all primary teeth,” he said. “Do not treat all 9-year-olds in terms of where they are on the dental scale. You have to be aware of where they are in terms of their dental development.”

For example, “if on a radiograph a primary tooth has complete root formation”, Dr. Psaltis said, “that tooth, regardless of the patient’s chronologic age, will be present for a minimum of two more years.”

“To help you understand why I’m enthused about radiographs, 70 percent of primary tooth decays are interproximal,” he said. “If a parent says, ‘I don’t want to do radiographs,’ there is only one thing to say to that parent: ‘Go somewhere else.’”

To help the audience appreciate how radiographs reveal various dental issues in asymptomatic patients, Dr. Psaltis shared several slides of ankylosis, talon cusp, enamel hypoplasia, dens in dente, supernumerary bicuspid, mesioden, odontoma and ecoptic molars.

Beyond what the radiographs provide for dentists, he appreciates that parents also can see the X-rays. He shared that when he once showed a radiograph of a supernumerary bicuspid to a parent, the parent said, “Oh my gosh. I’ve never seen one of those.” Dr. Psaltis’ reply: “Really? I’ve seen it a ton.”

In showing the last slide, which revealed no issues, he said, “Are you seeing what I’m seeing? This is normal,” he joked. “We also see kids who have 20 teeth that are all in the right place at the right time.”

The “Mini-Residency: Pediatric Oral Healthcare,” which is in partnership with Children’s Healthcare of Atlanta, will continue Saturday morning for paid registrants. Dr. Melinda Clark, a pediatrician from Albany, New York, will share her insights on early intervention, risk assessment and role of the pediatrician in improving oral health care for children. Using physician/dentist team cases, Dr. J.C. Shirley of Atlanta, will lead the panel in a discussion about how best to provide oral health care for children with special health care needs. The mini-residency will conclude with a 60-minute panel discussion.