1. Epstein's pearl - A keratinized epithelial structure in the midline of the palate in 65% of newborns. Usually about 1mm in diameter.

2&3. Bohn's Nodules - keratinized epithelial structures on the maxillary buccal alveolar ridge of 40-50% of newborns.

4. Two natal teeth present in the oral cavity at birth. Extraction of normally calcified natal or neonatal teeth should be avoided if possible.

5. Two poorly developed natal teeth required extraction.

6. Irritation beginning at the base of the tongue in a three day old due to the presence of the natal tooth with sharp mammalians. (Riga-Fede) Attempt to smooth incisal edges. Avoid extraction.

7. Advanced Riga-Fede - A granulomatous lesion affecting the underside of the tip of the tongue, which has been irritated by a natal tooth. Secondary infection of the irritated area is associated with granulation tissue.

8. Eruption hematoma in the maxilla. No treatment indicated. "Lancing" will produce scaring and delay eruption.

9. Congenital Epulas -- Found only in newborns, 10 times more frequent in females, more frequent in maxilla. Easily removed at it's base, recurrence is rare.

10. Ankyloglossia - tongue-tied appearance from high attachment of lingual frenum to tip of tongue. Not necessary to treat surgically if child can touch maxillary incisors with tip of tongue.

11. Oral moniliasis - thrush - in an infant. May be related to cortisone, antibiotic, or HIV infection.

12. Ranula - mucus retention cyst - in a newborn

13. Primary herpetic gingivostomatitis of lips and tongue.

14. Impetigo Contagiosa - Crusting of the perioral lesions is a diagnostic feature.

15. Lip biting following injection of local anesthesia.

16. Tongue biting following mandibular block injection.

17. Mucocele on the lower lip of three year old caused by retention of mucin in
the tissue one week after lip injury.

18. Swollen face caused by dentoalveolar abscess. Dental infection involving the orbit is sever. Immediate extraction and antibiotics are necessary. The choice of antibiotic in children should be a cephalosporin (Keflex) or Augmentin or Clindomycin. The principle bacteria of such infections in primary teeth are primarily gram negative anerobis which in many children are Penicillin resistant.

19. Mucobuccal fold swelling caused by an infected maxillary primary tooth.

20. Abscess which formed four weeks after trauma to a permanent maxillary

21. Discoloration of a primary incisor following hemorrhage in the pulp chamber after traumatic injury.

22. Ankylosis of primary incisor following trauma at 18 months. The injury also caused hypoplasia of the developing permanent incisor as seen in next slide.

23. Turner's tooth - Local hypoplastic defect on a permanent incisor when the permanent tooth in previous slide erupted.

24. Hypoplastic defects (reduced quantity of enamel) on permanent maxillary central incisors and canines, caused by illness with high fever at about age 6 months to 1 year.

25. Hypocalcification (poor quality of enamel) on two permanent maxillary central incisor teeth. This snowcap effect is due to an intrusion injury to primary incisors at about on year of age. This appearance can also be an hereditary phenomenon.

26. Intrusion of primary incisors following traumatic injury at age three.

27. Infected and ankylosed teeth. By age six, if the primary incisors are
ankylosed, they should be extracted.

28. Radiograph arrested development of the permanent incisors. Normal
development of adjacent permanent incisors may be seen.

29. Lingual eruption of a permanent mandibular incisor behind primary incisors. Normal exfoliation of the primary teeth usually will result in the permanent incisors assuming normal position. Extraction should not be considered until the permanent incisors have erupted to the level of the occlusal plane.

30. Fused Primary Incisors - delayed exfoliation leading to ectopic permanent
incisor eruption.

31. Over-retained primary cuspid and molar teeth with dentin completely
resorbed and gingival tissue showing through the enamel (pink hue to enamel).

32. Digit sucking habits are considered normal until 4 years of age.

33. Malocclusion resulting from sucking habit in the primary dentition. Should not cause growth or occlusion problem if discontinued by the time permanent incisors erupt.

34. Over-retained Primary Maxillary central incisor (darkened from traumatic injury) Must suspect supernumerary tooth or ankylosis of primary incisor.

35. Radiograph showing supernumerary tooth (mesiodens) preventing eruption of the permanent incisor.

36. Supernumerary teeth - Maxillary incisor area is the most common site for supernumerary teeth. Some erupt while many do not and prevent permanent incisor eruption.

37. Nursing bottle pacifier used by five year old. Prolonged use of nursing bottle as a pacifier is associated with characteristic pattern of tooth decalcification.

38. Early childhood caries in a two year old.

39. Effects of using bottle as a pacifier shown by 3 ½ year old. Only the mandibular incisors are not affected; presumably they were protected by the tongue during nursing.

40. Extreme decalcification of all maxillary teeth shown by six year old. Use of the bottle continued until age six. Normal primary and permanent mandibular teeth show that cause of the decalcification is not systemic.

41. Rampant Caries -- NOT typical of early childhood nursing caries.

42. Enamel Fluorosis - generalized white fluorosis

43. Enamel Fluorosis- affected permanent first molars, normal second molars. The result of systemic overdose from birth to 3 years.

44. Current recommended supplemental fluoride dose schedule

45. Materia alba collections around gingival margins of the teeth due chiefly to poor oral hygiene.

46. Extreme cervical decalcification is evident immediately after removal of the materia alba seen in previous slide.

47. Green stain of the teeth, thought to be associated with chromogenic bacteria, and is found mainly on the anterior teeth. An indication of a caries - prone child.

48. Partial removal of the green stain with professional prophylaxis.

49. Black stain or pellicle formation found throughout the mouth is difficult to remove and is associated with a high resistance to caries.

50. Periodontal diseases in childhood. Children are different!

51. Gingivitis periodontal diseases in childhood is usually due to poor oral hygiene and is easily reversible with oral hygiene improvement.

52. Calculus in a primary dentition. In the young child the calculus is soft and chalky, usually in the mandibular incisor area. Generalized calculus deposits are frequently seen in children fed by a gastric (G) tube.

53. Calculus in a two year old seen on maxillary molar. Most common sites if calculus formation are buccal surfaces of the maxillary molars and lingual surfaces of the mandibular incisors.

54. Periodontal disease in 12 year old caused by calculus deposits.

55. Healing three weeks after calculus has been removed. The gingival surrounding the mandibular incisor now appears healthy.

56. Calculus formation around the mandibular incisors of a 12-year-old girl with spastic cerebral palsy, mouth breathing and a tongue thrust habit. Deposits are so heavy that the teeth will be lost in a few years if treatment is not begun and continued and oral hygiene dramatically improved.

57. Primary herpetic gingivostomatitis -- The most common form of severe Periodontal disease in children 2-5 years.

58. Dilantin hyperplasia - Dilantin sodium sensitizes gingival tissue to irritation. Resulting in hyperplasia.

59. Above patient following gingivectomy to remove hyperplastic tissues. Good oral hygiene is necessary to maintain these patients.

60. Tetracycline Stains - Chronology for risk of staining in primary and permanent teeth.

61. Tetracycline stains - Orange staining in a primary dentition with hypoplastic enamel in primary molars and canines. The result of mother taking drug during pregnancy.

62. Tetracycline stains - Gray-green staining in primary dentition. Tetracycline administered shortly after premature birth -- permanent teeth most likely NOT effected.

63. Neonatal Enamel hypoplasia related to premature birth or early febrile diseases. Those portions of the primary teeth that calcified before birth are unaffected.

64. Enamel hypoplasia in permanent incisors and first molars caused by systemic disease and high fever during the first 6 months to 1 year.

65. Dentinogenesis imperfecta has also been referred to as hereditary opalescent dentin, when it is transmitted as a autosomal dominant Mendelian trait.
Radiographic series - Dentinogenesis imperfecta shows characteristics imperfect root formation and calcified root canals.

66. Dentinogenesis imperfecta - Early loss of enamel due to faulty (smooth) Dentino-enamel junction.

67. Hereditary Amelogenesis Imperfecta enamel hypoplasia has a wide range of clinical appearances. The defective tooth structure is limited to the enamel.

68. Radiographic survey of amelogenesis imperfecta illustrates normal root formation.

69. Amelogenesis Imperfecta - Pitting hypoplastic and hypocalcified
type. Autosomal dominant.

70. Congenitally missing teeth - Radiograph showing missing primary incisors and Permanent (succedaneous) incisors.

71. Oligodontia related to ectodermal dysplasia

72. Oligodontia involving permanent lateral incisors. Maxillary lateral incisors are the most commonly missing permanent teeth.

73. Supernumerary incisors - Six mandibular incisors are present. Always begin the oral exam in children by counting teeth to evaluate the developing dentition and occlusion.

74. Fusion, Gemination and Concrescence Diagram.

75. Gemination of a maxillary permanent incisor. Radiographically this tooth exhibits one root canal with an extra clinical crown. All other permanent teeth are developing normally.

76. Fusion of primary mandibular central and lateral incisors. The total number of crowns is normal.

77. Fusion of maxillary right and left primary central and lateral incisors. This tooth has two roots and two pulp chambers. The total number of crowns present is normal.

78. Fusion of mandibular right permanent cuspid and lateral incisor.

79. Gemination of maxillary permanent incisors. Permanent lateral incisors are present and developing normally.

80. Hutchinson's incisors -- screwdriver shape and notching of permanent maxillary incisors due to congenital syphilis.

81. Rubella Syndrome -- child shows screwdriver shaped primary incisors and prenatal enamel hypoplasia. The result of maternal rubella during second trimester.