Pediatric Dental Care

1. Pediatric Dental Care

2. Objectives • Know the general pattern of tooth eruption • Understand the pathophysiology of the formation of caries and how to prevent • Know the correct time to refer to a dental specialist

3. Tooth Eruption YES, THIS IS A PACIFIER!

4. Eruption of Teeth • By birth: • ~20 primary teeth are almost completely formed and hidden in the jawbones • Eruption of teeth highly variable but…. • Primary incisors 6-12 months • Most children have a full set of primary teeth by age 3 years • Adult teeth begin to erupt at age 6 years • Lose primary teeth beginning age 6-7 years until ~12 years

6. Primary (Deciduous) Dentition

7. Permanent Dentition

8. Tooth Eruption – When to worry? • 25% of normal babies may have delayed eruption of teeth until 4 or 6 teeth appear simultaneously after their first birthday • No teeth by 14-15 months of age – what is cause? • Normal delay in eruption (Familial delayed eruption) • Hypothyroidism and Hypopituitarism • Vitamin D Deficiency/Rickets • Trisomy 21 • Ectodermal Dysplasia • Progeria Syndrome • Albright Osteodystrophy • Incontinentia Pigmenti • Apert’s Syndrome

9. Hygiene and Cleaning

10. Cleaning/Brushing • AAPD recommends daily cleaning of infant’s gums before the eruption of first tooth • From birth to age 1 year recommend using moistened gauze or soft cloth to massage/clean gums • Use toothbrush only if parents feel comfortable – should start using by 1 year • DO NOT use toothpaste • risk of fluoride ingestion & fluorosis

11. Fluorosis

12. Toothpaste • When should parents start using toothpaste to clean child’s teeth and gums? • Start around age 2 years • Use small pea-sized amount

13. First Dental Visit • AAPD recommends first dental visit • Within 6 months of eruption of the first primary tooth • No later than 12 months of age • AAPD argues that by later age child may already having poor feeding habits and poor oral hygiene

14. Dental Caries Initial Lesions - White decalcification with beginning enamel breakdown Late stage lesions - Moderate to severe enamel and dentin destruction

15. Dental Caries • Prevalence of Dental Caries • 5 times more common than asthma • 7 times more common than hay fever • Caries Rate: • 18% aged 2 to 4 years • 52% aged 6 to 8 years • 67% aged 12 to 17 years

16. Risk Factors for Caries • Poor oral hygiene • High sugar intake • Mother with high # cavities • Enamel defects • Premature birth • Special health care needs • Low socioeconomic status

17. Caries and Cavities White lines Brown cavitations Gross cavitations Douglass et al, AAFP 2004

18. Etiology of Caries

19. Factor 1: The Tooth • Susceptibility of teeth varies: age, fluoride exposure, morphology, crowding, nutritional status, and presence of acid • Enamel is where caries begin • composed mainly of minerals in the form of hydroxyapatite • Primary tooth enamel thinner than permanent

20. Factor 2: Flora • Growth of oral acid producing (ie. Streptococcus mutans) determined by: frequency of exposure, substrate available for metabolism, oral hygiene, and fluoride • Bacteria are transmitted from caregivers/sibs to infant at or before the eruption of the first tooth • bacteria transmitted through saliva avoid pre-tasting, pre-chewing, and sharing utensils • Family members with caries increase risk for infant

21. Factor 2: Flora • Fluoride: • Promotes remineralization of enamel, and may arrest or reverse early caries • Decreases enamel solubility • Inhibits the growth of cariogenic organisms, thus decreasing acid production • Concentrated in dental plaque • Primarily topical even when given systemically • Widespread use of fluoride has been a major factor in the decline in the prevalence and severity of dental caries

22. Fluoride Supplement-if no fluoride in water supply-

23. What about water filters? • Activated carbon filters do not remove significant anounts of F-. • Reverse osmosis will remove most of the F- • Ion exchange resin filters will remove F- if the resin is in basic ( not acidic) form. • Distillation removes most of the F-. • Many home units use more than one process to filter water.

24. Factor 3: Substrate • Caries is promoted by carbohydrates, which break down to acid • Frequency of sugar ingestion is higher risk than actual quantity • Nighttime feeding  BAD • Acid causes demineralization of enamel • Saliva inhibits bacterial growth • Unremoved plaque promotes the caries process

25. Other interesting pictures and facts…….

26. Thumb-sucking • A mom brings her 3 year old for a visit because he sucks his thumb at night and she is worried that this will “ruin his teeth.” • What do you tell her?

27. Thumb-sucking • Most children stop thumb-sucking by age 4 years with no harm done to their teeth • If still sucking thumb after age 4 years, then check with dentist • In most cases, don’t need to worry about thumb-sucking until age 6 years when permanent front teeth erupt

28. Infant Anomalies • Natal/neonatal teeth - Location - Incidence - Treatment - Riga-fede

29. Inclusion Cysts • Epstein’s pearls • Bohn’s nodules • Dental lamina cyst • Treatment

30. Conjoined Teeth • Gemination • Fusion • Concresence