Pediatric Case Presentation STUDENT NAME

Pauline Tran
PD 347 (Pediatric Rotation seminar)
SUPERVISING FACULTY NAME
Dr. Gerges

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Patient Name: Zayn Mirza Axium Record # 1169383 Age: 1 y 3 m Gender: M

Reason for Visit / Chief Complaint: Clinical Significance:

Patient would like a checkup. He was scheduled for a The patient is at an age where he may be vulnerable to
recall, prophy, and fluoride treatment. baby bottle caries, nursing caries, or rampant caries.

Past/Present Medical History: Clinical Significance:

Patient was hospitalized for RSV infection at 1 month. Although the patient's parent did not report any other
Patient is otherwise healthy with no allergies and significant medical history, we must still be alert and look
medications, and the only recent illness experienced was out for symptoms that may suggest otherwise.
the common cold.

Social History: Clinical Significance:

Patient is the youngest of four children. He lives in His age and previous behavior can give us an idea of
Stockton with his family. He was overall well-behaved what to anticipate during his next visit.
during his last dental visit. Horizontal transmission of cariogenic bacteria from
siblings can occur from playing or eating.

Past Dental History (brief): Clinical Significance:

His previous (and first) dental visit was at UOP when he Since the patient is nursing throughout the day, we want
was 9 months old. His mom was using a washcloth to to make sure his parents know how and when to clean
clean his teeth after nursing before being recommended his teeth as they begin to erupt.
to brush his teeth upon their eruption.

Oral (visual) Findings: Clinical Significance:

Healthy, pink gums An involved labial frenum can cause a diastema in the
Normal mucosa maxillary midline or can lead to periodontal problems
Involved maxillary frenum further down the line.
No signs of carious lesions

Clinical/Radiographic Findings: Clinical Significance:

Generalized spacing between all teeth except #O and P. With the patient's advanced dental development, we can
Patient's dental development was advanced, as he soon anticipate the eruption of the primary second
presented with both his maxillary and mandibular molars. We also need to advise the parents to floss for
canines already. the patients if they notice any teeth in direct contact.
Treatment Rendered:
At this appointment, I completed an exam, toothbrush prophy, and application of fluoride varnish for the patient. Feeding
habits and oral hygiene instructions were discussed with the mother. Mother stated that the patient was nursing around
six times each day. We advised her to start transitioning the patient to drinking milk in a cup with a straw and to continue
her good habit of brushing for him after feeding.

Unique or Interesting Features of the Case:

I chose to present this case because not everyone got the opportunity to perform a knee to knee exam on such a young
patient. It was definitely different from any other exam I have done since the patient was directly in my lap. During the
exam, he turned side to side and kicked around a lot, trying to prevent anything from entering his mouth whether it was
my finger or a toothbrush. Being able to stabilize and control the patient's head was crucial in obtaining the information
that I needed and to perform the treatment. In the case of a crying child who is moving around a lot, I realized you had to
work quickly and take advantage of every second where their mouth is open.

Going into this appointment, I expected Zayn to only have his upper and lower incisors and primary first molars erupted
since he is 15 months old. When I actually saw him, I realized that both his upper and lower canines had already erupted
as well. These teeth usually come in at 16-18 months, so Zayn's dental development was advanced, especially for a
male.

His mother did state that Zayn was nursing six times a day in addition to having other meals, so this raised some concern
over how susceptible his teeth may be toward caries. However, no white spot or carious lesions were detected. Zayn
does not live in a community with fluoridated water, but his mother was using a smear of toothpaste to brush his teeth
about three times each day after meals, and this appeared to be sufficient to maintain the health of his teeth.

Anything You Would Have Done Differently:

Reflecting back on this case, I would be more conscious about maintaining a firm grasp on Zayn's head to better stabilize
him during the exam. His movements made it difficult to see into his mouth, so I had to stop frequently to reposition him.
I also would have liked to reach further back into his retromolar pad area to keep his mouth open as this would have also
prevented me from having to worry about him biting my fingers. Next time, I would work quicker and take advantage of
his small size to hold him in a way where I can perform my work most efficiently while still being gentle.

Take Away Points from this Experience:

1. 2. 3.
Maintain a firm grasp on your
patient's head during a knee to
To help wean a child from
nursing, you can slowly transition
Work quickly and efficiently
because a child will only keep
knee exam to avoid excess to giving the child milk in a cup their mouth open for so long. Fill
movements, preventing you from with a straw. Warming the milk is out anything that you can on the
performing your work. Also give a good idea because it will head and neck form (like
the parent clear instructions on appear similar to breast milk, extra-oral features) prior to
how you would like them to hold which is typically around room reclining the patient into your lap
their child as you do the exam. temperature. to decrease the amount of time
you have to keep them on their
back.