Oral Health Flashcards
normal tooth eruption patterns by age (primary teeth)
normal tooth eruption pattern (permanent teeth)
retained baby teeth
baby teeth usually fall out bc permanent tooth erodes baby tooth’s root, if poor alignement btwn primary and permanent tooth, this doesn’t happen
ectopic eruption
adult tooth erupts hrough sidewall of gum, MC with canines (curved portion of jaw). dentist can see on x-ray and pull before this happens
eruption cyst/hematoma
(check eruption chart for timing)
Not painful, no Tx needed as resolves when tooth erupts.
premature primary teeth
usually a lower incisor
present at birth or within 3mo
Tx: let stay if formed okay and not too loose
etiology and transmission of dental caries
- Strep mutans ferments dietary carbs–> makes acid
- reduced pH demineralizes tooth (white spot lesion on tooth)
- further demineralization causes tooth cavitation
- cavitated enamel surface lets other bacteria colonize the tooth (eg. lactobacilli)
- more acid is produced, more tooth demineralization
I.N.F.O.
PCP strategies for preventing dental caries
I= Initial Hx: child AND caregiver to dentist if poor oral habits.
N= Nutrition: stop bottle use at age 1, water only in bottle for nap/bedtime, milk only at mealtime, NO juice before 6mo (after give less than 6oz, at most 1x/day), Limit=2-3 snacks/day, rinse with water after low weight supplements (are high in sugar)
F= Fluoride: supplement after 6mo if home water source not adequate (test it), professional Fl application q 3-6mo
O= Oral Hygiene: brush with first tooth eruption, floss any touching teeth, brush for child until 8yo. NO sharing eating utensils. NO cleaning pacifier in parent’s mouth
How do sealants prevent caries?
fill in pits and fissures to keep plaque and bacteria out BEFORE caries occur
(80% effective)
describe oral candiasis
white, curd-like plaques
begin on oral mucosa, then to tongue, lips
can be scraped off but not easily (make sure not just milk on tongue)
check for diaper dermatitis
describe herpangina
low fever, rhinorrhea, vesicular/ulcerative oral muccosal lesions
MC in summer/fall, MC under 3yo
Cocksackie Virus
(if vesicular lesions are also on hands/feet/buttocks= Hand, Foot and Mouth disease
describe herpetic gingivostomatitis
HSV-1
MC under 8yo
high fever (7-10days), differentiate from herpangina by GINGIVAL involvement and significant cervical LAD
can spread to skin around mouth & nose
if suck thumb= herpetic whitlow (not painful/problematic)
denuded/smooth/shiny patches on tongue
glossitis
(common in kids after: viral illness, some meds, stress, acidic foods)
can occur at any age and common after minor mucosal trauma
apthous ulcer
(canker sore)
mucocele
fluid-filled cysts on buccal or labial mucosa
develop following trauma
Tx: removal (oral surgeon) only if problems with chewing
ankyloglossia
congenital defect
lingual frenum is attached close to tip of tongue
common-screen ALL infants (esp if difficultly with latch)
Tx: to oral surgeon or ENT for frenectomy (prevents feeding and later speech problems)
yellowish-white deposits of epithelial cells
occur in midline of hard palate in infants
resolve in weeks without Tx
Epstein pearls
Treatment for cocksackie virus
(herpangina/ hand-foot-mouth disease)
oral discomfort: oral ibuprofen 10mg/kg/dose q 6hrs (until Sx resolve, usually 3-5 days)
3:1 mouth soln (KBX or magic mouthwash)–> 20cc of each: Kaopectate/Maloox, Benedryl, +/- viscous Xylocaine
apply KBX using a Q-tip and only on lesions easily reached (NOT on pharynx, NOT in very young kids)
Treatment for oral candidiasis
oral Nystatin suspension up to 4weeks for infant
breastfeeding moms also apply to nipples
bottles, nipples, pacifiers through dishwasher after each use
Tx failure: oral Diflucan for 7 days
Treatment of Herpetic gingivostomatitis
self-limited: Sx control with ibuprofen and KBX
if Sx <72hrs: oral acyclovir
Oral pain is severe and fevers high so risk for DEHYDRATION. Give ibuprofen around the clock (wake child if sleeping) and copious cold drinks. Milkshakes soothing and good bc high in calories.
reocurrences with illness/ sun exposure, but less severe
complications of herpetic gingivostomatitis that warrent Tx
ezcema herpeticum: HSV-1 on top of ezcema can result in disseminated HSV infection (admit for IV-antivirals)
seizure: consider herpetic encephalitis or meningitis and the child will need appropriate work-up (lumbar puncture in ED)
treatment for apthous ulcers
resolve spontaneously in 7-10 days
avoid citrus, tomato-based foods
OTC Orabase or Zilactin can help with pain, decrease duration
treatment for glossitis
none needed, even in chronic cases
reassure parents
Describe Dental Fracture, Class 1
fracture of enamel layer only
includes fine line microfractures
Describe Dental Fracture, Class 2
involves enamel + DENTIN layer
(on exam will see dull yellow of dentin)
Describe Dental Fracture, Class 3
enamel + dentin + TIP OF PULP
(on exam see red dot of the exposed pulp, surrounded by dull yellow dentin)
Describe Dental Fracture, Class 4
fracture involves ROOT of tooth
Treatment plan for dental fractures, by class
Classes 1-2: 2-3 day dental referral
Class 1: asthetic repair (smooth edge in 1º tooth, crown on permanent tooth)
Class 2: tooth restoration (resin in 1º tooth, crown on permanent tooth)
Classes 3-4: immediate referral to dentist: 1º tooth might be extracted to save permanent tooth, while permanent tooth will need root canal and all effort will be made to save permanent tooth)
define dental “avulsion injury”
tooth has been traumatically removed from its socket
ALL avulsions require immediate referral to dentist
considerations with suspected tooth avulsion
(what else could have happened, how to treat avulsion)
- may actually be intrusion injury (tooth pushed INTO socket), get dental x-ray
- child may have aspirated avulsed tooth (consider chest x-ray if avulsed tooth isn’t provided)
If PERMANENT tooth→ can reinsert after gentle rinsing (don’t touch the root), if less than 60min has passed AND child can safely hold in place on drive to dentist
Do NOT re-insert 1º tooth (may damage developing permanent tooth)
Treatment for oral lacerations
tongue lacerations usually do NOT require suturing (unless significant portion lost or can’t control bleeding-use silk suture NOT dissolving)
If not sutured: rinse with salt water after each meal
**Expect closure in ~1week
Through and through lip laceration requires suture of face/vermillion border (pink portion of lip) but NOT labial mucosa. Requires rinsing and oral Abx.
Treatment for oral electrical burns
MC under 3yo (explore with mouth)
PCP→ debride burned tissue, give Abx prophalaxis, verify tetanus immunization, dental referral
to dentist IMMEDIATELY→ fit for commissure splint to prevent corners of mouth from fusing as heals
