Infant and Toddler Oral
Health
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Greater New York Dental Meeting |
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December 1, 2002 |
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Steven Chussid D.D.S. |
Timing of First Visit
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Guidelines of the American Academy of
Pediatric Dentistry recommend: |
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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 |
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Revised in 1994 |
Timing of First Visit
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Dental caries is the single most common
chronic childhood disease-5 times more common than asthma and 7 times more
common than hay fever |
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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
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Based on extensive review of scientific
literature and best practices |
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Represent consensus of more than 100
multidisciplinary experts: reviewed by over 1000 health professionals |
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Developed with support of HRSA’s
Maternal and Child Health Bureau |
Bright Futures:
Guidelines for Health Supervision of Infants, Children, and Adolescents
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Make an appointment for the toddler’s
first dental examination and risk assessment at 12 months |
Rationale for First Oral
Exam
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Early intervention and risk assessment
are essential components in assuring that oral health is an outcome for all
children |
Risk Assessment
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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
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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
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Fluoride History |
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Dietary Habits |
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Sleep time Habits |
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Oral Hygiene Habits |
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SES |
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Special health needs |
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History of BBTD |
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High Mutans Streptococci count |
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Poor family oral health |
Risk
Factors-
Fluoride History
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Fluoridated community? |
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Taking supplements? |
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Well water? Fluoride level? |
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Fluoride dentifrice? |
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Bottled water? |
Risk
Factors-
Dietary Habits
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Does/did child sleep with a bottle? |
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Is/was child breastfed? |
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Does child drink from a cup? |
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Types, consistency, and frequency of
food and liquid intake |
Risk Factors-
Sleep time Habits
Risk Factors-
Oral Hygiene
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Nature of care given |
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Consistency |
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Products used |
Risk Factors-
Poor Family Oral Health
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Caries rate of primary caregiver |
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Transmission of S. mutans from
caregiver to child |
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Parental Attitude |
Risk Factors-
SES
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Striking disparities in dental disease
by income |
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Poor children suffer twice as much
dental caries and their disease is much more likely to be untreated |
Risk
Factors-
Special Health Needs
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Special diets |
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Medications containing sucrose |
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Physical limitations |
Anticipatory
Guidance-
Topics to Incorporate
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Oral Development |
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Oral Hygiene/Health |
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Fluoride |
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Diet and Nutrition |
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Habits |
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Injury Prevention |
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Anticipatory
Guidance-
Oral Development
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Teething |
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Drooling, desire to bite or chew, mild
pain |
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No evidence of high fever, diarrhea or
sleep problems |
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Patterns of Eruption |
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Occlusion |
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Exfoliation |
Eruption Patterns of
Primary Teeth
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Tooth formation begins at about 7 weeks
in utero |
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Mineralization at about the 4th month |
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Sequence more important than timing |
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Symmetrical pattern |
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Mandibular teeth erupt first |
Anticipatory Guidance-
Oral Hygiene/Health
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Oral hygiene techniques |
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Transmission of microflora to infant |
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Use of dentifrice |
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Child’s role in oral hygiene |
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Radiographs and sealants |
Toothbrushing
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Should begin with eruption of first
tooth |
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Position child to assure ease of access
and stabilization of head |
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Proper size toothbrush |
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Technique |
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Pea sized amount of toothpaste |
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Supervised until about 6 years of age |
Anticipatory Guidance-
Fluoride
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Assess fluoride status and determine if
and what supplementation is needed |
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Discuss toxicity and safety |
Anticipatory Guidance-
Fluoride
Anticipatory Guidance-
Diet and Nutrition
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Nursing bottle decay |
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Encourage weaning |
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Role of sugar in the caries process |
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Frequency of carbohydrate intake |
Anticipatory Guidance-
Injury Prevention
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Give parents emergency numbers |
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Simple instructions in the event of
injury |
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Electrical cord safety |
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Mouthguards |
Nonnutritive Sucking
Habits
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Normal part of neonatal development |
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Arise from rooting and sucking reflexes |
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Habit normally ceases between two and
four years of age |
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Effects on dentition depends on
intensity, frequency, and duration of habit |
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Success of intervention depends on
child’s readiness |
Pacifier Use and Safety
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AAPD recommends pacifiers only in
children that exhibit NNS behavior |
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Pacifier should be sturdy, one-piece,
flexible |
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NEVER attach around child’s neck |
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Replace when worn |
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Don’t use sweeteners |
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Don’t allow child to run or play with
pacifier in mouth |
Effects of NNS
Lap Examination Procedure
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Dentist and caregiver make a ‘cradle’
by sitting face to face on chairs and joining knees |
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Head in lap of dentist |
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Parent supports child |
Lap Examination
Common Oral Conditions
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Inclusion cysts |
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Natal/Neonatal Teeth |
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Iron Stain |
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Primary Herpetic Gingivostomatitis |
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Inclusion Cysts
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Epstein’s pearls |
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Midpalatal raphe |
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Epithelial remnant |
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Bohn’s nodules |
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Side of alveolar ridge |
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Mucous gland remnant |
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Dental lamina cyst |
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Crest of alveolar ridge |
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Odontogenic epithelial remnant |
Natal/Neonatal Teeth
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Natal teeth- present at birth |
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Neonatal teeth- erupt shortly after
birth |
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Most lower incisors |
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Most are of normal primary complement |
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Due to superficially positioned tooth
bud |
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Treatment |
Natal/Neonatal Tooth
Iron Stain
Primary Herpetic
Gingivostomatitis
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Usually occurs between 6 months and |
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6 years of age |
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Fever |
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Malaise |
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Cervical lymphadenopathy |
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Gingival erythema |
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Fragile vesicles quickly progress to
painful ulcers |
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Acute phase lasts 7 to 10 days |
Primary Herpetic
Gingivostomatitis
Primary Herpetic
Gingivostomatitis
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Treatment is palliative and supportive |
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Rest, antipyretics, and analgesics |
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Patient is contagious |
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Be aware of dehydration! |
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Palliative mouthrinses |
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Diphenhydramine HCL (12.5/5ml) mixed
with Kaopectate (or Maalox)- 50% mixture by volume |
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Local anesthetics (such as viscous
lidocaine or dyclonine) are also used-either individually or in previous
mixture |
Management of Traumatized
Primary Teeth
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Keep it simple |
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Always consider developing succedaneous
tooth and behavior |
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Be alert to potential child abuse |
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Advise parents of permanent tooth
injury possibility |
Crown Fractures
of
Primary Teeth
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Ellis Class I and II |
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No treatment, selective grinding, or
composite bandage restoration |
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Ellis Class III |
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Pulpotomy, pulpectomy or extraction |
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Luxation of Primary Teeth
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Extract tooth if |
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buccal plate is fractured |
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Radiographs reveal that primary tooth
is impinging on follicle of permanent tooth |
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Otherwise, allow to re-erupt or
re-align |
Avulsion of Primary Teeth
Root Fracture of Primary
Teeth
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If coronal fragment is not excessively
mobile-observe |
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If coronal fragment is very
mobile- extract fragment |
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If extraction is treatment of
choice- do not attempt to remove
apical fragment |
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Thank You!