Child Oral Health Flashcards
Dental Caries
Dental caries is the most common chronic disease of childhood from ages 6 to 19 and are extremely preventable.
Caries destroy tooth structure leading to infection, pain, and loss of chewing function.
Early Childhood Caries is an aggressive form of caries in children under 6 years of age. ECC was once called “nursing caries” or “baby bottle tooth decay.”
Etiology
* Influenced by socioeconomic status, feeding habits, access to dental care, fluoride exposure, and family caries experience.
Progression of ECC
* Upper front teeth that are least protected by saliva are affected first.
* Disease moves posteriorly as teeth emerge
consequences of dental caries
Dental caries is the most common chronic childhood disease and has many potentially severe consequences, including:
- Pain
- Impaired chewing and nutrition
- Infection
- Increased caries in permanent dentition
- School/work absences
- Poorer school performance: Students with dental pain are 3x more likely to have a low grade point average
- Difficulty sleeping
- Poor self-esteem
- Extensive and expensive dental work which often must be completed under general anesthesia
cause of dental caries
- Caries is a multifactorial process affected by environmental, behavioral and host risk factors.
- Oral bacteria (Polymicrobial including mutans streptococci and lactobacilli) metabolize dietary carbohydrates into acids.
- Acid demineralizes the tooth enamel.
- If the cycle of acid production and demineralization continues, the enamel will become weakened and break down into a cavity
triad of dental caries
sugar, bacteria, teeth themselves
Bacterial Component of Caries
Cariogenic bacteria (including streptococci mutans and lactobacilli) are transferred two ways:
* Vertical transmission from the primary caregiver, most often the mother, via saliva contact
* Horizontal transmission from family members and care providers, such as in school and daycare settings
The higher the bacteria level in the caregiver’s mouth, the more likely the child will become colonized with mutans streptococci.
Caregivers with high bacteria levels usually have:
* High frequency of sugar intake
* Poor oral hygiene
* High levels of dental caries
Evidence supports that caregivers can decrease their risk of passing on cariogenic bacteria to their children by decreasing their own caries levels.
Caregivers can optimize their oral health and that of their children by:
* Receiving regular comprehensive dental care
* Limiting the frequency of sugar in the diet
* Maintaining excellent oral hygiene and using fluoride containing toothpaste
* Using preventive agents, in appropriate age groups, such as: Topical fluorides, Antibacterial mouth rinses, such as chlorhexidine, or Xylitol containing gums
Sugars cause of caries
- Oral bacteria produce acids that persist for 20–40 minutes after sugar ingestion.
- Oral acids lead to enamel demineralization.
- Remineralization occurs when acid is buffered by saliva.
- If sugars are consumed frequently, there is insufficient time for the remineralization process to occur. The tooth is subjected to continued demineralization and the caries process progresses.
- If sugars are consumed infrequently, teeth are able to fully remineralize and the caries process halts.
teeth impact on dental caries
Any tooth surface can develop a cavity, but some surfaces are more prone to developing a cavity. These can include newly erupted teeth due to immature enamel and teeth with enamel defects.
Nature of Enamel Defects
The cells that manufacture enamel are very sensitive to systemic insults. Disruption in the production of enamel during tooth development will result in a defect which may be microscopic or macroscopic.
* Twenty to forty percent of children have enamel defects.
* Defects may appear as changes in translucency, color, or texture.
* It may be difficult to distinguish enamel defects from early clinical signs of caries though this does not affect management.
* Enamel defects are associated with substantially increased risk of ECC.
* Increased incidence of enamel defects is associated with: Lower SES, premature birth, congenital/genetic conditions (cerebral palsy, intellectual disabilities)
healthy teeth
Healthy teeth should be creamy white with no signs of deviation in color, roughness, or other irregularities.
If the clinician cannot determine whether an abnormality in the tooth surface is a defect versus an early cavity, this will not alter management as any child with enamel abnormalities is at high risk for caries and should be referred to a dentist for further evaluation.
progression of caries
ECC affects the teeth that erupt early and are least protected by saliva. When a child sucks on a bottle, the tongue thrusts forward, so the maxillary incisors get maximal sugar exposure.
Typically ECC progresses in the following order:
* Upper incisors (maxillary anterior teeth)
* First molars (mandibular primary molars)
* Second molars (maxillary primary molars)
Mandibular incisors, although they emerge first, are generally not affected because they are protected by the tongue and pooling of saliva in that area.
Teething Concerns/Guidance
Concerns
* Teething does not cause fever, upper respiratory infection, ear infection, or diarrhea.
* Teething may cause fussiness.
* Drooling is developmentally normal in infancy.
Anticipatory Guidance
* Apply cold teething ring or cloth to gums.
* Provide acetaminophen or ibuprofen if necessary.
* Avoid teething gels—they are not effective and contain topical anesthetics (benzocaine) which can be dangerous in infancy. The FDA warned in 2018 that over-the-counter drug products containing benzocaine should not be used to treat infants and children younger than 2 years. Such products carry serious risks and provide little to no benefits for treating oral pain. Benzocaine can cause a condition in which the amount of oxygen carried through the blood is greatly reduced (methemoglobinemia) which can be life-threatening or lethal.
* Remember tooth emergence may be preceded by a hematoma—no treatment is needed in primary dentition.
* Recommend never to dip pacifier in honey or other sweetened food.
Non-Nutritive Sucking Concerns/Guidance
Concerns
* Nonnutritive sucking satisfies a psychological need and diminishes with age; most children stop by two to four years of age. Persistent non-nutritive sucking increases the risk of anterior open bite, palatal narrowing, and delayed speech development.
Anticipatory Guidance
* Intervene to stop habit by 36 months, especially if changes to bite are noted.
* Offer positive reinforcement, such as a star chart or stickers.
* Restrict to limited situations (only in bed, naps, stressful times).
* Cover hands at night with mittens.
* Provide stuffed animal or other comfort object. In general, pacifier use is preferable to digit sucking as it is less likely to cause a problem and the habit is easier to break (the pacifier can be removed).
* Recommend never to dip pacifier in honey or other sweetened foods.
Oral Injury Causes, Locations, Management
- Oral injuries are common in young children (30% of preschoolers have sustained a dental injury)
Causes of injury
* Young children: Falls off of furniture, Running and tripping, or Injured with object
* Older children:Sports and outdoor activities like biking and skateboarding
Location of Injuries
* Top center teeth are the most frequently injured
* May be chipped, pushed forward/ back, into the gum, or knocked out (avulsion)
Injured primary teeth may:
* Discolor (turn brown or black)
* Cause pain
* Become infected
* Require removal
* Affect underlying permanent tooth development or eruption as the primary teeth maintain space for permanent teeth
* All of these consequences may affect self-esteem, speech, nutrition, self-confidence and overall health.
Management
* NEVER reinsert a primary tooth!
* Refer to dental home for evaluation
Injury Prevention Counsel/Management
Counsel on injury prevention. Suggestions include:
* Recommend caregivers always keep one hand on infants in high places
* Avoid walker use
* Keep car seats rear-facing until at least age 2
* Use safety gates, cover sharp edges on furniture, fit children with helmets when riding toys with wheels, keep play area free of items that may trip children and cause a fall
Mouth guards
* Mouth guards should be used in any sport where a child may suffer a head or mouth injury.
* Recommend use of a mouth guard to decrease risk of injury to the teeth, lips, tongue, face, jaw and brain (concussion).
* 3 types of mouth guards are available:
* Stock - Store bought, these provide the least protection.
* Boil and Bite- Can be purchased from the store and boiled and when slightly cool, placed in the mouth to mold to the shape of the child’s teeth
* Custom Made – Crafted by the dentist or orthodontist; offer the best protection of the 3 options (also the most expensive)
* Proper care of the mouth guard is important.
Child Abuse w/ Dental Injuries
- Craniofacial, head, face, and neck injuries are found in more than half of child abuse case. One study showed the lips are most likely to injured (54%).
- Oral cavity may be a focus of abuse due to its role in communication and nutrition.
- Injuries may include contusions, burns, lacerations of the soft tissue and loose teeth or facial bone/ jaw fractures.
- All suspicious injuries should be reported to the appropriate child welfare agency.
Oral Piercings/Grills
Piercings
* The American Academy of Pediatric Dentistry (AAPD) “strongly opposes” the practice of piercing perioral and intraoral tissues and use of jewelry on these tissues.
* Oral piercings are increasingly popular, but there are significant risks.
Procedure-related risks:
* Swelling – most common symptom post-piercing
* Prolonged bleeding
* Nerve damage
Jewelry-Related Complications:
* Injury to the gums and dental fractures, scarring
* Interference with oral hygiene, speech, chewing and swallowing
* Allergic/hypersensitivity reaction to metal
* Aspiration or ingestion if jewelry becomes loose
Grills
* Grills on the teeth can increase the risk of developing caries and trigger allergic reactions to the metal.
* Counsel grill-wearers to: Remove the grill to eat and sleep, brush and floss regularly, or limit amount of time the grill is worn
