Millennium children

A federal agency's extensive report on the well-being of our children at the beginning of the new millennium provides an opportunity to review the many achievements and remaining concerns about the health and social environment of the children in our communities and in many of our dental practices.     

Protecting children

Safeguarding children from maltreatment and neglect is part of the responsibility of all health professionals, and dental practitioners may be in a unique position to recognise and respond to concerns of this kind. This article outlines some of the ways that abuse can present to the dental team and describes the action that should be taken if abuse is suspected in a young patient.     

Dentition in children with enlarged tonsils compared to control children

The aim of the present study was to evaluate whether or not there are any differences in the dentition between children with enlarged tonsils and those with normal tonsils. A sample of 73 children (33 boys and 40 girls) with enlarged tonsils and with a mean age of 10.1 years was compared with a normal control group, matched for age and sex. Eighteen dentition variables and thirty-two variables in anamnestic, clinical, pharyngeal and postural findings were recorded. Measurements were obtained from lateral skull radiographs and dental casts. Group means were compared. Relationships between variables were studied using simple correlations and multiple stepwise regression analyses. It was found that children with enlarged tonsils had more retroclined lower incisors, more anteriorly positioned upper incisors, smaller overbite, larger overjet, shorter lower dental arches, narrower upper dental arches and an increased frequency of lateral crossbite. Functional and/or morphological disorders, causing an open posture of the mouth, a lowered anterior posture of the tongue and a low position of the hyoid bone are thought to be associated with the differences in the dentition between the two groups. Obstruction of the oropharynx by enlarged tonsils, might be one factor responsible for these dysfunctions.     

Periodontitis in children

In children with a healthy periodontal condition the pocket depth may vary between 1 to 2 mm. In the mixed dentition it may increase up to 3 mm and in the permanent dentition the pocket depth usually decreases again to between 1 and 2 mm. If a pocket of 5 mm or more is diagnosed one should be aware of periodontal breakdown, i.e. periodontitis. Periodontitis is usually defined on the basis of age, localisation and the presence of systemic diseases. Frequent periodontal probing is necessary to detect periodontal breakdown in an early stage and enables subsequent periodontal treatment. Involvement of the parents in the treatment is important. Their major contribution in the treatment is daily careful cleaning of the dentition of the child.     

Polytrauma in children

Polytrauma in children is rare, however trauma is a leading cause of death in children. Clinicians with responsibility for management of the child suffering major trauma must recognize the conflict between these facts. Simulation and preparation can help to improve the quality of care at both individual and institutional levels. Children are not small adults, and their anatomical and physiological differences manifest themselves in different responses to major trauma than those seen in adults. This reality should be met with a tailored approach to assessment, investigation and management that accommodates the changes occurring from infancy, through childhood and adolescence to adulthood. This approach minimizes the risk of harm from inappropriate irradiation or intervention. Children have remarkable resilience and can make dramatic recoveries from seemingly irrecoverable situations. The comprehensive treatment of musculoskeletal injuries should therefore not be compromised in the setting of polytrauma, and attention must be given to the optimal time for treatment. Damage control resuscitation and early appropriate care facilitate an individualized response. Outcomes for paediatric polytrauma are improved by management in a specialist centre, with early aggressive management of injuries that require surgical treatment by an experienced multidisciplinary team.