| Tooth | Eruption times |
| Primary | |
| Central incisor | 6–8 months |
| Lateral incisor | 8–12 months |
| First molar | 12–16 months |
| Canine | 16–20 months |
| Second molar | 20–30 months |
| Permanent | |
| First molar (6-year molar) | 5–7 years |
| Central incisor | 6–8 years |
| Lateral incisor | 7–9 years |
| Canines and premolars | 9–12 years |
| Second molar (12-year molar) | 11–14 years |
| Third molar (wisdom tooth) | 16+ years |
* Relatively wide variations in these timings are possible.
CARIES AS A MULTIFACTORIAL DISEASE
Because caries is a multifactorial disease, it is up to the clinician to identify each patient’s individual risk factors and intervene preventively and therapeutically in a targeted way. Especially in children who have no influence on their own diet and oral hygiene, it is important to identify all the etiologic factors contributing to the caries so that adjustments can be made, provided the parents are compliant and reliable, to achieve a lasting reduction of the risk of caries. Figure 1-4 represents the caries etiology model5 according to Fejerskov and Kidd, illustrating the various key components and their interactions for the purpose of successful caries assessment.
Fig 1-4 Multifactorial etiology model of the development of caries.
REFERENCES
1. Müller EM, Hasslinger Y. Sprechen Sie schon Kind?: Prophylaxe auf Augenhöe. Berlin: Quintessenz, 2016.
2. Ermler R. Diagnostik von Approximalkaries bei Milchmolaren mit Hilfe des DIAGNOdent pen. Berlin: Charité, Universitätsmedizin Berlin, 2009.
3. van Waes H, Stöckli P (eds). Kinderzahnmedizin, Farbatlanten der Zahnmedizin. Stuttgart: Thieme, 2001.
4. Mittelsdorf A. Kariesprävention mit Fluoriden – Eine Fragebogenaktion zur Fluoridverordnung in Berliner Kinderarztpraxen unter besonderer Berücksichtigung der Empfehlungen der DGZMK. Berlin: Charité, Universitätsmedizin Berlin, 2010.
5. Kühnisch J, Hickel R, Heinrich-Weltzien R. Kariesrisiko und Kariesaktivität. Quintessenz 2010;61:271–280.
2SUCCESSFUL COMMUNICATION WITH KIDS AND PARENTS
“The use of humor in pediatric dentistry is highly recommended. It may be used to facilitate communications with patients and parents, alleviate patient anxiety, and assist the dentist in coping with stress associated with the practice of dentistry.”
MOSTOFSKY AND FORTUNE1
Communication with your pediatric patient begins not when the treatment starts but as soon as the child enters the dental practice. Communication is not merely about talking; it includes a plethora of nonverbal signals. American-Austrian psychologist Paul Watzlawick expressed this clearly when he said “You cannot not communicate.” Communication consists of 55% nonverbal cues (gestures and facial expressions), 38% tone of voice, and only 7% actual content of what is said.2 This chapter examines the different levels of communication and their importance in the dental practice. Suggestions are then given regarding how to use verbal and nonverbal language to gain, improve, or maintain compliance for different types of pediatric patients.
IMPORTANCE OF CHILD-APPROPRIATE ENVIRONMENT
Children need to be engaged to feel comfortable in any public space. General dentistry practices without a specialization in pediatric treatment can create a child-friendly environment with just a few resources. To do this, it is helpful and necessary to visualize the viewpoint of a child; they first see what is at their eye level or below it. Pictures, wall stickers, or even toys in the waiting room should be placed at a height where children can see and reach. A coloring table, some well-chosen books, and a set of building blocks are sufficient to create an engaging environment for children. If space is a concern, there are also some brilliant space-saving play alternatives, such as wall-mounted drawing boards, magnetic boards, jigsaw puzzles, or games. Wooden toys are often a more robust and durable choice. In the interests of other patients and the practice team, toys that emit sounds are inadvisable. When selecting toys for a common space, consider the cleansability; toys that are hard to sanitize may prove poor choices during flu season. In addition, wall decals are a useful and variable design feature for the waiting room or a treatment room because they are easy to remove without leaving a mark.
Not every dentist has the facility to mount a monitor above the treatment chair; as a more convenient alternative, a photo or painting on the ceiling will not only fascinate young children but will also help to distract older, anxious patients. Finally, the reception counter often seems enormous to children, so a small stool can make it a little more manageable for curious children to sneak a peek. Air freshener spray should be kept on hand as well to eliminate the typical smells of the dental practice, which can unsettle or frighten some children.
NONVERBAL COMMUNICATION, INDIVIDUAL PERSONAL SPACE, AND PROXIMITY
“You cannot not communicate.”
PAUL WATZLAWICK
Children are particularly sensitive to nonverbal signals communicated by body language, such as gestures and facial expressions.3 Because nonverbal communication is unconsciously controlled by our thoughts, it is important to always have a positive attitude that enables us to communicate authentically and empathetically—especially in the company of children with behavioral problems. Children have a very keen sense of how well physical and verbal signals match each other—if they do not, the intended message will be misunderstood. Thus, the treatment of a child with behavioral issues may fail from the outset if the dentist exhibits antipathy but tries to cover it up. Children are highly sensitive to discrepancies between what is said and what is felt.4
One of the greatest challenges in the practice of pediatric dentistry is controlling the often-unconscious nonverbal signals we send out so that the young patient gets a positive impression. Especially when beginning with pediatric treatment, self-reflection and analysis of these nonverbal