24.3
Tooth Eruption Sequences
A child has a total of 20 primary teeth; 10 in the maxillary arch and 10 mandibular in the mandibular arch. As permanent teeth erupt, a mixed dentition results. Below is tooth eruption sequences:
| Age at eruption of central incisors | Maxillary: 7-8; Mandibular: 6-7 |
| Age at eruption of lateral incisors | Maxillary: 8-9; Mandibular: 7-8 |
| Age at eruption of canines | Maxillary: 11-12; Mandibular: 9-10 |
| Age at eruption of 1st premolar | Maxillary: 10-11; Mandibular: 10-12 |
| Age of eruption of 2nd premolar | Maxillary: 10-12; Mandibular: 11-12 |
| Age of eruption of 1st molar | Maxillary: 6-7; Mandibular: 6-7 |
| Age of eruption of 2nd molar | Maxillary: 12-13; Mandibular: 11-13 |
| Age of eruption of 3rd molar | Maxillary: 17-21; Mandibular: 17-21 |
Prescribing of Dental Images
Prescribing dental images depends not only on the individual needs of the child but also on the age of the child and his or her ability to cooperate with the procedures. An imaging examination including all of the tooth-bearing areas is recommended at the early mixed dentition stage after the first permanent tooth has erupted.
In the absence of caries, bite-wing images are usually prescribed every 12-18 months with primary tooth contact or every 24 months with permanent tooth contact.
Recommended Techniques
Imaging techniques are similar to those used in adults. Typical examinations of primary and transitional dentition’s use various techniques.
In the Iannucci & Howerton, Dental Radiography Principles & Techniques, 6th Edition textbook, on page 265, refer to Table 24-2 and on pages 265-266 Fig 24-4 through 24-8.
Types of Examinations
When a pediatric patient is first treated and does not have a previous dental image, it is necessary to obtain a baseline series of images that show all tooth-bearing areas.
Examination images may include:
| Four-image series | 2 posterior BW, 1 maxillary occlusal and 1 mandibular occlusal |
| Eight-image series | 1 Max. incisor PA., 1 Mand. incisor PA, 2 canine max PA (right & left), and 2 mand. PA (right & left) and 2 BW’s (right and left) |
| Twelve-image series | 1 incisor Max PA, 1 incisor Mand PA, 2 canine Max PA (R&), 2 canine Mand. (R & L), 2 posterior max PA (R & L), 2 posterior mand PA (R & L), 2 BW (R & L) |
| Sixteen-image series | 1 incisor max PA, 1 incisor mand PA, 2 canine Max PA (R&), 2 canine mand. (R & L), 2 premolar max PA (R&L),2 premolar mand PA (R&L), 2 molar max PA (R & L), 2 molar mand PA (R & L), 2 BW (R &L) |
Digital Sensor Issues
Pediatric patients may or may not be able to tolerate the use of a wired digital sensor. Using the correct size of digital sensor is critical. Wireless sensors are preferred over wired sensors in pediatric dentistry. As an alternative to digital sensors, less bulk PSP sensors may be used in young children.
Patient and Equipment Preparations
For a pediatric patient, special attention must be devoted to:
- Explanation of the procedure
- Lead apron must always be placed before exposure
- Exposure factors
- Receptor size will need to be altered according to each individual pediatric patient based on size of mouth
Imaging procedures that are to be performed should be explained to the patient in a language he or she can understand, and the lead apron and thyroid collar must be placed before radiation exposure.
Patient Management Helpful Hints
Management of children requires that the dental radiographer be confident, patient, and understanding.
The following are helpful hints with managing a child patient:
- Be confident
- Show, tell, do
- Reassure the patient
- Demonstrate behavior
- Request assistance
- Postpone the examination
