1. Continuity Clinic Pediatric Dental Care

2. Continuity Clinic 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. Continuity Clinic Tooth Eruption YES, THIS IS A PACIFIER!

4. Continuity Clinic 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

5. Continuity Clinic

6. Primary (Deciduous) Dentition

7. Continuity Clinic Permanent Dentition

8. Continuity Clinic 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 –Aperts Syndrome

9. Continuity Clinic Hygiene and Cleaning

10. Continuity Clinic Cleaning/Brushing AAPD recommends daily cleaning of infants 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. Continuity Clinic Fluorosis

12. Continuity Clinic Toothpaste When should parents start using toothpaste to clean childs teeth and gums? Start around age 2 years Use small pea-sized amount

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

15. Continuity Clinic 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. Continuity Clinic 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. Continuity Clinic Caries and Cavities Brown cavitations White lines Gross cavitations Douglass et al, AAFP 2004

18. Continuity Clinic Etiology of Caries

19. Continuity Clinic 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. Continuity Clinic 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. Continuity Clinic 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. Continuity Clinic Fluoride Supplement -if no fluoride in water supply- <.3 ppm.3-.6 ppm>.6 ppm Birth - 6 months none 6 mo to 3 years0.25 ppm none 3 to 6 years 0.5 ppm0.25 ppm none 6 to 16 years 1.0 ppm 0.5 ppm none

23. Continuity Clinic 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. Continuity Clinic 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. Continuity Clinic Other interesting pictures and facts…….

26. Continuity Clinic 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. Continuity Clinic 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, dont need to worry about thumb-sucking until age 6 years when permanent front teeth erupt

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

29. Continuity Clinic Inclusion Cysts Epsteins pearls Bohns nodules Dental lamina cyst Treatment

30. Continuity Clinic Conjoined Teeth Gemination Fusion Concresence