1. SPECIAL CONSIDERATIONS FOR
ORAL SURGEY IN PEDIATRIC
PATIENTS

2. OBJECTIVES
• Background
• Conditions that occur in pediatrics
• Treatment

3. BACKGROUND
• Preoperative evaluation:
– History of presenting complaint
– Medical history
– Dental history
– Examination
• Behavioral management

4. Growth and Development
• Injuries may have adverse effect to growth
• E.g. Injuries to the mandible:
– Ankylosis
• Limited mandibular functions
• Restricted growth
• Surgery for acquired/congenital anomalies
may tamper with growth.
– Cleft Palate repairs cause palatal scarring resulting
in maxillary constriction

5. Maxillofacial Infections
• Vary according to age:
– < 5 yrs Upper face infections: non-odontogenic
– >5 yrs lower face infections : odontogenic
Treatment
• Non-odontogenic infections: Broad spectrum
antibiotics and hydration
• Odontogenic infections: Antibiotics, hydration,
drainage, treat underlying dental pblm

6. Impacted Teeth
Impacted Canines
• 2nd most impacted tooth
• Treatment is by extraction of the primary
canine (normal space and no incisor
resorption)
• No improvement in canine position in a year,
surgical and orthodontic treatment

7. Supernumerary Teeth
• Mesiodens
• Most common supernumerary
• Treatment
– No surgery for non-erupting primary mesiodens
(damage to succedeneous tooth)
– Mixed dentition extract the mesiodens ensure
2/3rd of root formation of incisor
– Allow erupted primary mesiodens to shed

8. Mesiodens

9. Pediatric Oral Pathology
• Epstein’s pearls
– Found in the median palatal raphe area
– Due to trapped epithelial remnants along the line of fusion
of the palatal halves.
• Dental lamina cysts,
– Found on the crests of the dental ridges, most commonly
seen bilaterally in the region of the first primary molars.
– From remnants of the dental lamina.
• They are both asymptomatic 1 mm to 3 mm nodules.
Smooth, whitish in appearance, and filled with keratin.

10. Epstein Pearl and Dental Lamina Cyst
Treatment:
• Reassure parents
•Disappear during the first 3
months of life.

11. • Congenital epulis of the newborn/ granular
cell tumor / Neumann’s tumor,
– Rare benign tumor seen only in newborns.
– Protuberant mass arising from the gingival
mucosa.
– Found on the anterior maxillary ridge.
– Patients typically present with feeding and/or
respiratory problems.
– Treatment: surgical excision.

12. Neumann’s tumor

13. • Eruption cyst (eruption hematoma)
– Soft tissue cyst that results from a separation of
the dental follicle from the crown of an erupting
tooth.
– Fluid accumulation occurs within this created fol-
licular
– Most commonly found in the mandibular molar
region.
– Color range from normal to blue-black or brown

14. Eruption Cyst
Difference from hemangiomas
• Hemangiomas may undergo a rapid growth phase in the first
year of life but then regress spontaneously.
• Eruption cysts resolve with eruption of the tooth.

15. Natal and Neonatal Teeth
• Natal teeth: teeth present at birth
• Neonatal teeth: erupt during the first 30 days
of life
• Teeth most affected:mandibular primary
incisors.
• In most cases they are part of the normal
complement of the dentition

16. • Treatment
– Reassure parents
– Preserve and maintain in a healthy condition unless
excessively mobile or causes feeding problems
– Monitor Closely
Riga-Fede disease
• Caused by the natal or neonatal tooth rubbing the
ventral surface of the tongue during feeding leading to
ulceration.
• Treatment :
– conservative :Create round, smooth incisal edges
– If it does not correct: extraction is the treatment of choice to
avoid ‘failure to thrive’

18. Riga-Fede disease

19. REFERRENCES
• AAPD. Guideline on Pediatric Oral Surgery.
Reference Manual. 2010. 34:6;264-271.
• AAOMS. Parameters of Care: Clinical Practice
Guidelines for Oral and Maxillofacial Surgery.
Journal of Oral and Maxillofacial Surgery.
2012.
• Cawson R.A. and Odell E.A. Essentials of
OralPathology and Oral Medicine. 7th Edition.
Churchill Livingston Publishers. 2002.

20. THANK YOU