This is an area that many general dentists can find challenging. It can be commonplace for kids to grow up being scared of dentists. Unpleasant experiences can often linger for a long while. I can recall parents recounting stories of their childhood unpleasant dental experiences. In this dentist podcast, Dr Andrew Chang and Dr Diane Tay talk about:

1. Why Connecting with your Pediatric Patient is important and why first impressions count.
2. What are clinical tips and tools to make the initial exam easier for them.
3. What are principles of communicating to a child that can be applied to clinical dental practice.

This is a clinically relevant topic and we go through many clinical situations. For more information, visit our blog.

Lots of advances in the restoration of primary teeth and important to consider as parents are keen for alternative, aesthetic options. We also know the importance of maintaining primary teeth for function, aesthetics and space maintenance. Crowns provide a full coronal coverage restoration to help preserve form and function.

Reasons and indications for placement of crowns

• following a pulpotomy/pulpectomy
• for teeth with developmental defects (enamel hypomineralisation) or large carious lesions involving multiple surfaces where a normal restoration is likely to fail
• high caries risks patients
• where longevity of restoration is required

Types of crowns available and What are zirconia crowns made of

• Stainless steel crowns, composite crowns, Porcelain fused to metal crowns and Zirconia crowns (Pre-fabricated)
• Zirconia crowns are made from zirconium dioxide, a very durable type of metal that's related to titanium. They are still classified under ceramic crowns

Pros and cons of zirconia crowns

• Pros- strength and aesthetics. Research shows similar durability and strength as SSC. Can be used in patients with nickel allergy or who require MRIs (where SSC may cast artefacts in the scan). Ferrule Effect.What colour choices do prefabricated have?
• Cons- extensive prep, technique sensitive, more time consuming, cost. Good colour match but are opaque. Areas of severe crowding? Cannot adjust shape easily. Bond strength where isolation poor?
• contraindications- severe bruxism,

Cementation:

• RMGIC or GIC?

Some tips for dentists interested in trying:

• take a course
• practice, practice, practice
• choose your first case carefully
• Be careful of back-to-back crowns
• Ensure excellent haemostasis

In this part 2, Orthodontist Dr Andrew Chang discusses:

Treatment Options:

1. No treatment
2. Interceptive Treatment now: Functional Appliances with U maxilla expansion + referral to speech therapist.
3. Wait till permanent dentition, then camouflage with upper arch extractions, U expansion is less effective.

Treatment Timing:

1. Is it too early? Primary dentition?
2. 1. If have habits eg: thumb sucking or dummy, best to cease habit first
3. Mixed dentition: best time for maximum orthopedic effect (CVMS 2: Baccetti 2002): Shape of vertebral bodies of C2-4 and inferior borders of C3-4
4. Adult. Is it too late? What happens with functional appliances? Compliance and success rate (due to temporary speech disruptions), greater lower incisor proclination. Jaw surgery and risks of morbidity.
5. Adv & Disadv of Early Treatment- Gingival trauma, Upper incisor trauma, psychosocial.
6. Adv & disadv of Late mixed dentition or Permanent dentition Tx: Orthopedic effects best retained.

What should dentists be looking out for?

1. Age and Dental Status. Mobile D's and E's at 10-11 yrs may be difficult to retain functional appliances.
2. Habits - ask about thumbsucking, dummy, mouth breathing etc.
3. Signs of Risk Factors manifesting as gingival trauma, narrow jaw, Upper Incisor trauma.
4. Assessing risk factors through their lifestyles and habits ie: sports, mouthbreathing
5. >7mm Overjets and referral to orthodontist
6. My experience has been parents would prefer to do a combined functional appliance + teeth alignment that address root causes, rather than orthodontic camouflage and adults are not keen on jaw surgery procedures due to significant risks.

In this Part 1 for dentists on skeletal Class 2 malocclusions, Dr Andrew Chang Orthodontist shares with Dr Diane Tay identifying features, risk factors and the differential diagnosis of Class 2 malocclusions. We cover the areas below:

1. Diagnosis
   • Facial: Small lower jaw
   • Dental ie: Class 2 div 1 or div 2's
   • Radiographic
   • Assessing skeletal maturation and its importance in success. The Lateral Ceph x-ray
2. Risks factors:
   • Hx of anterior overjet getting larger- why this is the case
   • Difficulty chewing and slow eater.
   • Traumatic deep bites and teeth wear, gingival recession
   • Trauma upper incisors
   • Bullying: psychosocial
   • Open mouth posture and gingival inflammation due to drying of the gingivae
3. Differential Diagnosis: Proclined U incisors, Normal Maxillomand relationships

In this Part 2 of the Q&A with Dr Diane Tay, Sydney Orthodontist Dr Andrew Chang discusses and outlines treatment options for Class 3 based upon the dental developmental stages:

1. Primary
2. Mixed
3. Permanent/adult

And the 12-21 yrs age group whom are generally too late for early orthodontic treatment and their jaw growth is not complete.

Takeaway messages are:

• the 6-8 years age group is better to start early orthodontic treatment
• Early Orthodontic Treatment does reduce the severity of skeletal Class 3's and the incidence of jaw surgery later

For the 12-21 years age group, watch for the long face Class 3's. These are difficult to treat. General strategies are to start later, when their jaw growth is complete. 2 situations of when to treat early in this age group are indicated:

• Accompanying signs of a narrow jaw.
• Signs of traumatic incisor occlusion ie: wear or teeth mobility.

We are humbled to have both Felicia and her mother share their experiences with us and with their braces. In this episode, we have an open and authentic conversation. They also share their advice and tips for children and parents considering orthodontic treatment. Sorry for the audio quality at times.

While we miss seeing them for their regular adjustments, it gives us great satisfaction knowing she does not hold back smiling anymore.

We are humbled to be able to serve our patient's and help them along their smile transformations. Personally, it has been rewarding for me and all the members of our team to play a role in their orthodontic care.
We are grateful to have Zahra how sharing her experiences, having just completed her braces orthodontic treatment.

In this Q&A with Dr Diane Tay, Sydney orthodontist Dr Andrew Chang shares the best time to start treating skeletal Class 3 malocclusions. In this Part 1, he covers:

1. Class 3 Growth and Growth Indicators
   • Simple
   • Radiographic
2. Types of Class 3's
3. Which Class 3's are easy to treat