Notes

Outline

Infant and Toddler Oral Health Greater New York Dental Meeting December 1, 2002 Steven Chussid D.D.S.

Timing of First Visit Guidelines of the American Academy of Pediatric Dentistry recommend: An initial oral evaluation should occur within six months of the eruption of the first primary tooth and no later than twelve months of age Revised in 1994

Timing of First Visit Dental caries is the single most common chronic childhood disease-5 times more common than asthma and 7 times more common than hay fever Over 50 percent of 5- to 9-year old children have at least one cavity or filling, and the proportion increases to 78 percent among 17-year olds

Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents Based on extensive review of scientific literature and best practices Represent consensus of more than 100 multidisciplinary experts: reviewed by over 1000 health professionals Developed with support of HRSA’s Maternal and Child Health Bureau

Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents Make an appointment for the toddler’s first dental examination and risk assessment at 12 months

Rationale for First Oral Exam Early intervention and risk assessment are essential components in assuring that oral health is an outcome for all children

Risk Assessment Provides the dentist the opportunity to tailor periodicity and oral health supervision to the individual’s level of risk for specific diseases, conditions, and injuries

Anticipatory Guidance Refers to the information provided to the child and family about the child’s current oral health and what to expect as the child enters the next developmental phase

Risk Factors for Early Childhood Caries Fluoride History Dietary Habits Sleep time Habits Oral Hygiene Habits SES Special health needs History of BBTD High Mutans Streptococci count Poor family oral health

Risk Factors- Fluoride History Fluoridated community? Taking supplements? Well water?  Fluoride level? Fluoride dentifrice? Bottled water?

Risk Factors- Dietary Habits Does/did child sleep with a bottle? Is/was child breastfed? Does child drink from a cup? Types, consistency, and frequency of food and liquid intake

Risk Factors- Sleep time Habits

Risk Factors- Oral Hygiene Nature of care given Consistency Products used

Risk Factors- Poor Family Oral Health Caries rate of primary caregiver Transmission of S. mutans from caregiver to child Parental Attitude

Risk Factors- SES Striking disparities in dental disease by income Poor children suffer twice as much dental caries and their disease is much more likely to be untreated

Risk Factors- Special Health Needs Special diets Medications containing sucrose Physical limitations

Anticipatory Guidance- Topics to Incorporate Oral Development Oral Hygiene/Health Fluoride Diet and Nutrition Habits Injury Prevention

Anticipatory Guidance- Oral Development Teething Drooling, desire to bite or chew, mild pain No evidence of high fever, diarrhea or sleep problems Patterns of Eruption Occlusion Exfoliation

Eruption Patterns of Primary Teeth Tooth formation begins at about 7 weeks in utero Mineralization at about the 4th month Sequence more important than timing Symmetrical pattern Mandibular teeth erupt first

Anticipatory Guidance- Oral Hygiene/Health Oral hygiene techniques Transmission of microflora to infant Use of dentifrice Child’s role in oral hygiene Radiographs and sealants

Toothbrushing Should begin with eruption of first tooth Position child to assure ease of access and stabilization of head Proper size toothbrush Technique Pea sized amount of toothpaste Supervised until about 6 years of age

Anticipatory Guidance- Fluoride Assess fluoride status and determine if and what supplementation is needed Discuss toxicity and safety

Anticipatory Guidance- Fluoride

Anticipatory Guidance- Diet and Nutrition Nursing bottle decay Encourage weaning Role of sugar in the caries process Frequency of carbohydrate intake

Anticipatory Guidance- Injury Prevention Give parents emergency numbers Simple instructions in the event of injury Electrical cord safety Mouthguards

Nonnutritive Sucking Habits Normal part of neonatal development Arise from rooting and sucking reflexes Habit normally ceases between two and four years of age Effects on dentition depends on intensity, frequency, and duration of habit Success of intervention depends on child’s readiness

Pacifier Use and Safety AAPD recommends pacifiers only in children that exhibit NNS behavior Pacifier should be sturdy, one-piece, flexible NEVER attach around child’s neck Replace when worn Don’t use sweeteners Don’t allow child to run or play with pacifier in mouth

Effects of NNS

Lap Examination Procedure Dentist and caregiver make a ‘cradle’ by sitting face to face on chairs and joining knees Head in lap of dentist Parent supports child

Lap Examination

Common Oral Conditions Inclusion cysts Natal/Neonatal Teeth Iron Stain Primary Herpetic Gingivostomatitis

Inclusion Cysts Epstein’s pearls Midpalatal raphe Epithelial remnant Bohn’s nodules Side of alveolar ridge Mucous gland remnant  Dental lamina cyst Crest of alveolar ridge Odontogenic epithelial remnant

Natal/Neonatal Teeth Natal teeth- present at birth Neonatal teeth- erupt shortly after birth Most lower incisors Most are of normal primary complement Due to superficially positioned tooth bud Treatment

Natal/Neonatal Tooth

Iron Stain Extrinsic Easily removed

Primary Herpetic Gingivostomatitis Usually occurs between 6 months and     6 years of age Fever Malaise Cervical lymphadenopathy Gingival erythema Fragile vesicles quickly progress to painful ulcers Acute phase lasts 7 to 10 days

Primary Herpetic Gingivostomatitis

Primary Herpetic Gingivostomatitis Treatment is palliative and supportive Rest, antipyretics, and analgesics Patient is contagious Be aware of dehydration! Palliative mouthrinses Diphenhydramine HCL (12.5/5ml) mixed with Kaopectate (or Maalox)- 50% mixture by volume Local anesthetics (such as viscous lidocaine or dyclonine) are also used-either individually or in previous mixture

Management of Traumatized Primary Teeth Keep it simple Always consider developing succedaneous tooth and behavior Be alert to potential child abuse Advise parents of permanent tooth injury possibility

Crown Fractures of Primary Teeth  Ellis Class I and II No treatment, selective grinding, or composite bandage restoration Ellis Class III Pulpotomy, pulpectomy or extraction

Luxation of Primary Teeth Extract tooth if buccal plate is fractured Radiographs reveal that primary tooth is impinging on follicle of permanent tooth Otherwise, allow to re-erupt or re-align

Avulsion of Primary Teeth Don’t replace

Root Fracture of Primary Teeth If coronal fragment is not excessively mobile-observe If coronal fragment is very mobile-     extract fragment If extraction is treatment of choice-   do not attempt to remove apical fragment

Thank You!