Oral health/smiles for life Flashcards
_____ is the most common chronic disease of
childhood from ages 6 to 19
Dental caries
Early Childhood Caries (ECC)
Aggressive form of caries in
children < 6 years of age
Etiology of ECC
o Feeding habits
o SES influence
o Access to dental care
o Fluoride exposure
o Family caries experience
Severe Consequences of Caries
- Pain
- Infection
- Impaired chewing and
nutrition - Increased caries in
permanent dentition - Sleep difficulty
- Poor self-esteem
- School/Work absences
- Poor school performance
- Extensive and expensive
dental work under
anesthesia
What causes dental caries?
Oral bacteria (Polymicrobial including Mutans
Streptococci and Lactobacilli) metabolize
dietary sugars into acid
* Acids demineralize the tooth enamel
Cariogenic bacteria are transferred by:
- Vertical transmission from the primary caregiver, often the
mother, via saliva contact - Horizontal transmission from family members and care providers-
in school and daycare settings
Caregivers with high bacteria levels usually have:
- High frequency of sugar intake
- Poor oral hygiene
- High levels of dental caries
Etiology: Sugars and teeth
- Acids produced by oral bacteria persist 20–40 minutes after sugar ingestion and cause enamel demineralization
- Remineralization occurs when acid is buffered by saliva
- Frequent sugar consumption = insufficient time for remineralization to occur; teeth are subjected to continued demineralization and the caries process progresses
T/F Any tooth surface can develop a cavity
T
Surfaces with high cavity risk:
- Newly erupted teeth
- Enamel defects
Early ECC : White Spots
- White spots and lines are the
first clinical signs of demineralized enamel - Usually affects upper front teeth first and typically appear at the gingival margin
Severe ECC signs
- Enamel destruction has exposed underlying dentin which may appear dark
- Multiple dark cavities appear in anterior and posterior teeth
- Possible abscesses and draining fistulae
- Patients may experience pain, but young children often unable to verbalize it
Pediatric Oral Exam
- Examine the soft tissues – tongue, lips, gums, cheeks
- Examine the hard tissues – front, back, sides of all teeth for plaque, white spots, cavities, & abscesses
- Palpate for submucosal clefts
Small Children: Knee-to-Knee Exam
- Child is held facing the caregiver in a
straddle position - Child leans back onto examiner
while caregiver holds child’s hands - Provider performs exam while caregiver
holds child’s hands and legs
Prevention of caries
- Toothbrushing/flossing
- Fluoride
- Diet
- Dental home establishment
Oral Hygiene: Brushing and Flossing guidelines
- Brush twice daily starting with first tooth
emergence - Caregiver should brush child’s teeth
until age 8 or 9 - Floss once daily between teeth that
touch
How Much Toothpaste for children < 3 vs > 3?
Small smear or “grain of rice”: Less than 3 years of age
Pea sized: All children age 3 and older
Effects of Fluoride: Topical vs. Systemic mechanism
Topical Mechanisms (main effect)
* Inhibiting tooth demineralization
* Enhancing remineralization
* Inhibiting bacterial metabolism
Systemic Mechanism (lesser effect)
* Reducing enamel solubility by incorporating into the
structure during tooth development
Fluoride Sources
Topical:
* Fluoride toothpastes
* Gels, foams, mouthwashes
* Fluoride varnish
Dietary:
* Water fluoridation
* Systemic fluoride supplements
All fluoride prescriptions should specify a ____
sugar-free prescription
Diet & Feeding Advice - Infancy
Encourage the following:
* Breastfeeding
* Introduce sippy cup by 6 months; stop
bottle use by 12 months of age
* No bottles or sippy cups in bed
* No juice in the first year of life
* Healthy snack choices to promote a
lifetime of healthy snack habits
All children should establish a
dental home by age ____
1
Dental home provides:
– Evaluation and diagnosis of oral disease
– Dental trauma management
– Evaluation of growth and development
– Enhanced preventive services including:
Caries Management
Caries Management
* Comprehensive dietary and oral hygiene
counseling
* Urgent dental referral for comprehensive
treatment
Fluoride varnish may arrest small cavitated lesions and prevent development of new lesions
