Oral Health

Question 1

normal tooth eruption patterns by age (primary teeth)

Answer 1

Question 2

normal tooth eruption pattern (permanent teeth)

Answer 2

Question 3

retained baby teeth

Answer 3

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

Question 4

ectopic eruption

Answer 4

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

Question 5

eruption cyst/hematoma

Answer 5

(check eruption chart for timing)

Not painful, no Tx needed as resolves when tooth erupts.

Question 6

premature primary teeth

Answer 6

usually a lower incisor

present at birth or within 3mo

Tx: let stay if formed okay and not too loose

Question 7

etiology and transmission of dental caries

Answer 7

1. Strep mutans ferments dietary carbs–> makes acid
2. reduced pH demineralizes tooth (white spot lesion on tooth)
3. further demineralization causes tooth cavitation
4. cavitated enamel surface lets other bacteria colonize the tooth (eg. lactobacilli)
5. more acid is produced, more tooth demineralization

Question 8

I.N.F.O.

PCP strategies for preventing dental caries

Answer 8

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

Question 9

How do sealants prevent caries?

Answer 9

fill in pits and fissures to keep plaque and bacteria out BEFORE caries occur

(80% effective)

Question 10

describe oral candiasis

Answer 10

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

Question 11

describe herpangina

Answer 11

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

Question 12

describe herpetic gingivostomatitis

Answer 12

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)

Question 13

denuded/smooth/shiny patches on tongue

Answer 13

glossitis

(common in kids after: viral illness, some meds, stress, acidic foods)

Question 14

can occur at any age and common after minor mucosal trauma

Answer 14

apthous ulcer

(canker sore)

Question 15

mucocele

Answer 15

fluid-filled cysts on buccal or labial mucosa

develop following trauma

Tx: removal (oral surgeon) only if problems with chewing

Question 16

ankyloglossia

Answer 16

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)

Question 17

yellowish-white deposits of epithelial cells

occur in midline of hard palate in infants

resolve in weeks without Tx

Answer 17

Epstein pearls

Question 18

Treatment for cocksackie virus

(herpangina/ hand-foot-mouth disease)

Answer 18

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)

Question 19

Treatment for oral candidiasis

Answer 19

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

Question 20

Treatment of Herpetic gingivostomatitis

Answer 20

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

Question 21

complications of herpetic gingivostomatitis that warrent Tx

Answer 21

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)

Question 22

treatment for apthous ulcers

Answer 22

resolve spontaneously in 7-10 days

avoid citrus, tomato-based foods

OTC Orabase or Zilactin can help with pain, decrease duration

Question 23

treatment for glossitis

Answer 23

none needed, even in chronic cases

reassure parents

Question 24

Describe Dental Fracture, Class 1

Answer 24

fracture of enamel layer only

includes fine line microfractures

Question 25

Describe Dental Fracture, Class 2

Answer 25

involves enamel + DENTIN layer

(on exam will see dull yellow of dentin)

Question 26

Describe Dental Fracture, Class 3

Answer 26

enamel + dentin + TIP OF PULP

(on exam see red dot of the exposed pulp, surrounded by dull yellow dentin)

Question 27

Describe Dental Fracture, Class 4

Answer 27

fracture involves ROOT of tooth

Question 28

Treatment plan for dental fractures, by class

Answer 28

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)

Question 29

define dental “avulsion injury”

Answer 29

tooth has been traumatically removed from its socket

ALL avulsions require immediate referral to dentist

Question 30

considerations with suspected tooth avulsion

(what else could have happened, how to treat avulsion)

Answer 30

1. may actually be intrusion injury (tooth pushed INTO socket), get dental x-ray
2. 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)

Question 31

Treatment for oral lacerations

Answer 31

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.

Question 32

Treatment for oral electrical burns

Answer 32

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