Prevention and the child patient

Question 1

Ideal time to start oral health education when woman is expecting?

Answer 1

before 6m into the pregnancy

Question 2

Why does pregnancy (gestational) gingivitis occur?

Answer 2

progesterone activates immune response to bacteria/plaque

Question 3

Percentage of women suffering from pregnancy gingivitis?

Answer 3

75%

Question 4

What is pregnancy epulis/granuloma

Answer 4

localised swelling of gum -> exaggerated reaction of host immune response to stimuli (in this case - plaque and calculus)

Question 5

Tx for pregnancy gingivitis

Answer 5

usually self limiting after removing stimulus
-> S/C, OHI, education

Question 6

Tx for epulis that doesnt stop after cleaning?

Answer 6

surgical intervention

Question 7

Instructions to pregnant women w morning sickness?

Answer 7

dont brush immediately after as may cause abrasion

wait 1/2-1h to let pH go back to normal

or rinse with water before brush if need to

dont drink acidic drinks after, will lower pH even more

(some women drink acidic drinks like ACV to prevent weight gain during pregnancy)

Question 8

Why is it important to have good OH during pregnancy?

Answer 8

studies show poor OH, periodontal disease and advanced gingival disease can make more prone to PREMATURE delivery and LOW BIRTH weight baby

Question 9

What is the reason a women might have premature birth if she has poor OH, perio of gingival diseases during pregnancy?

Answer 9

bacteria causing perio are mainly gram-negative

gram-negative bacteria produce alot of endotoxins (TNF, PGE2)

these endotoxins can enter into systemic circulation and affect foetal-placental unit

Question 10

Pattern of ECC and why?

Answer 10

Primary mx anteriors
then mx molars
then md molars
then md incisors least frequently invovled

frequent, prolonged exposure to sucrose-containing liquids (milk, formula, juice, soft drinks) in sucking bottle or sipping cup

Question 11

Why is having a bottle in while sleeping bad for the baby’s teeth?

Answer 11

decreased salivary flow during sleep causing pooling of the sugary fluid around mx anteriors

Question 12

Long term effects of ECCs?

Answer 12

1. pain
2. premature tooth loss -> malocclusions, self-esteem issues
3. growth and sleep disturbances
4. malnutrition from eating difficulties
5. possible need for tx under GA

Question 13

When should infants be weaned for bottles?

Answer 13

6-12months

Question 14

Advice to parents for preventing ECC

Answer 14

limit bottle feeding to water, milk, formula

dont use bottle as pacifier

avoid on demand feeding (handing child bottle when it cries)

establish OH routine after eruption - washcloth, gauze, soft small brush

bring child to dentist as soon as 1st tooth erupts - around 6m

give advise on toothbrushing**

Question 15

Advice to parent for toothbrushing

Answer 15

• parent responsible for childs tooth cleaning
• clean themselves after the child does it until 3-4 yrs
• supervision until 6-8 years
• no tp forup to 18 months (1.5 years)
• 18m-6y pea sized amt 500-550ppm F
• can make a song

Question 16

Toothpaste/conc for diff ages

Answer 16

under 18m - swab of damp gauze or cloth, NO to
18m-6y - pea sized smear of childrens tp, 500-550ppmF
5-11y - 1000-1500
11+ - 1500-2000