Management Considerations for Pediatric Oral Surgery and Oral Pathology.

Purpose The purpose of this guideline is to define, describe clinical presentation, and set forth general criteria and therapeutic goals for common pediatric oral surgery procedures and oral pathological conditions. Methods This guideline is an update of the previous document adopted in 2005 and last revised in 2014. It is based on a review of the current dental and medical literature related to pediatric oral surgery, including a systematic literature search of the PubMed ® electronic database with the follow-English, clinical trials. Papers for review were chosen from the list of articles matching these criteria and from references with selected articles. When data did not appear sufficient or were inconclusive, recommendations were based upon expert and/or consensus opinion by experience researchers and clini-cians. In addition, the manual Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgery, 1 developed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), was consulted. Surgery performed on pediatric patients involves a number of special considerations unique to this population. Several critical issues deserve to be addressed. Preoperative considerations Informed consent Before any surgical procedure, informed consent must be obtained from the parent or legal guardian. For more information , refer to AAPD's Guideline on Informed Consent. 2 Medical evaluation Important considerations in treating a pediatric patient include obtaining a thorough medical history, obtaining appropriate medical and dental consultations, anticipating and preventing emergency situations, and being prepared to treat emergency situations. 3 Dental evaluation It is important to perform a thorough clinical and radiographic preoperative evaluation of the dentition as well as extraoral and intraoral soft tissues. Radiographs can include intraoral films and extraoral imaging if the area of interest extends beyond the dentoalveolar complex. Surgery involving the maxilla and mandible of young patients is complicated by the presence of developing tooth follicles. Alteration or deviation from standard treatment modalities may be necessary to avoid injuring the follicles. 6 To minimize the negative effects of surgery on the developing dentition, careful planning using radiographs, tomography, 7 cone beam computed tomography, 8 and/or 3-D imaging techniques 9 is necessary to provide valuable information to assess the presence, absence, location, and/ or quality of individual crown and root development. 6 Growth and development The potential for adverse effects on growth from injuries and/ or surgery in the oral and maxillofacial region markedly increases the potential for risks and complications in the pediatric population. Traumatic injuries …