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nInamorningsessionon10April, DrTanWeeKiatwillbepresenting a paper on paediatric dentistry as part of the Dental Hygienist and Therapist Forum at IDEM. In this interview, the head of the National Dental Centre of Singa- pore’s Paediatric Dentistry unit discusses important aspects of child treatment and how they af- fect treatment outcomes. today international: Who are the variousdentalandrelevanthealth- care professionals within a paedi- atric dentistry unit and what are theirrespectiverolesinsupporting the principle paediatric dentists? Dr Tan Wee Kiat: A paediatric dentalhealthcareteamisnodiffer- ent from a general dental practice team. Both differ only in their training and their approach to pa- tients. Furthermore, being a terti- ary institution like the National DentalCareofSingapore,ourteam works closely with a wider range of health professionals like pae- diatricians, psychologists, speech therapists, medical social work- ers, and nurses. Regardless of their respective fields of work within the dental unit,allmembersoftheteamhave a common goal which is to deliver good treatment outcomes and to provide a experience that is as pleasant as possible for the child patientandtheparent.Everyprin- cipal of a practice has an image he or she wants to convey, for ex- ample the culture and philosophy of the practice, be it fun loving, professional, kind, etc. This must then be embodied and reflected at everycustomercontactfromfront line to support staff. How can a dentist’s interaction with a child patient affect the suc- cess of their practice? Paediatric dentists know that successful patient dynamics in- volve effective communication not just with the child but also the parent. Parenting styles influence child behaviour in the operatory. Behavioural management tech- niques require parental “buy in” and in many instances their con- sent. Life style changes that ought to have an impact on the child’s oral health depend on a parent or caregiver’s co-operation. Gaining trust of both patient and parent is paramount. We are truthful in all interactions, and we do not say it does not hurt when it does, but we help the child cope. You emphasised the importance of the parent. Outside the clinical environment, which other groups of people contribute to the man- agement of a child’s oral health? Groups like school teachers are also important. For Singapore I would also add maids and care- givers such as grandparents or baby sitters. In regard to teachers, those involved in early childhood education and staff of pre-school centres are very important in helping to manage children’s oral health,inmyopinion,buthowcan they look after the children if they feed them with unhealthy snacks and make them drink milk from a bottle, when these children have beenweanedoffthebottle?Infact, I would like to see a dental compo- nent included in early childhood education programme. What are some of the more com- mon development defects of the human dentition amongst chil- dren? Enamel defects in the primary dentitionassociatedwithpre-,peri- and post-natal conditions such as low birth weight, child’s or mo- ther’sillnessarethemostcommon. The incidence is from 13 to 39 per cent in full term infants. Children oflowbirthweightaremoreprone to enamel defects1 and these leave them vulnerable to decay. Developmental dental anom- alies in the primary dentition are rare, except for fusion (two pri- mary teeth joined together) which can be found in around 1 per cent ofchildren(Fig.1).Theimplication of finding fused primary teeth is thatisthereisa50percentchance of a missing permanent successor. Supernumerarieswhich are extra teeth beyond the normal comple- ment,haveanoccurrenceof2.5per cent (Fig. 2). These teeth may im- pede or prevent the eruption of permanent teeth, or deflect them from the true eruption position. Cleft lip and palate is not gen- erally regarded as a defect of the dentition but a defect of fusion of embryonic lip and palatal struc- tures. The position of teeth is af- fected because these components carry teeth buds in them. The incidence of cleft lip and palate in Singapore in a hospital based study was found to range be- tween 1.7 and 2.07 per 1,000 births, much lower than enamel defects mentioned above.2 Devel- opmental defects of enamel and dentine of genetic origin are ex- tremely rare. How can these developmental de- fects affect the physical and psy- chological health of children? Parents do not notice enamel defects unless they are very obvi- ous. Oftentimes, these vulnerable teeth decay long before parents decide to seek help from a dentist. Preventive measures and risk as- sessmentthatcouldhavebeenim- plementedaremissedoutbecause parents do not bring their child for the first dental assessment by age 1. Genetic defects of tooth structure have a greater impact as primary and permanent teeth are affected.Affectedteethmaycause pain, be unaesthetic, and need crowns later in life. How can dental professionals identify children who deviate from normal dental development and whatareappropriateinterventions or counsel when identified? First, dentists must know what is “normal” in terms of dental de- velopment. If they have been trained in dental development, embryology and oral pathology, they would just have to refresh their training by reading and have a high index of suspicion. Many atlases show oral conditions in pictureswithgreatclarityandthis is the next best thing to seeing a case in real life, especially if the conditionisrare.Learningtothink in a systematic and logical man- ner is what a good dental school teaches you. Interventionwilldependonthe conditionandtheriskofcomplica- tions,suchasdecay.Thisstaysalso true for the anticipative guidance they can give to parents. Condi- tions of genetic causes often have an inheritance pattern. Knowl- edge of how these conditions are inherited is useful in genetic coun- selling. What are the different types of dental behavioural problems that paediatric dentists may encounter andwhatisthedifferencebetween behavioural problems and dental anxiety? We shall confine this discus- sion to behavioural problems we encounter in normal children and not special needs children. Most behavioural problems stem from anxiety, and result in avoid- ance of treatment, or uncooper- ative behaviour in the dental clinic. 5 Dr Tan Wee Kiat 5 Fig.1 5 Fig.2 “I would like to see a dental component included in early childhood education programme.” Parents can be great allies An interview with IDEM presenter DrTanWee Kiat,Singapore ©CreativaImages science & practice20 IDEM Singapore 2016 Show Preview Fig.15

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