The following is based on a CME
at Children's Hospital and Regional Medical Center, Seattle, WA,
I. Developmental dentistry
- Usual timing of eruption:
- Central (mandibular) incisors 6mos
- Lateral incisors 8mos
- Canines 18mos
- First molars 12mos
- Second molars 24mos
- Third molars 17-25y
- Don't worry unless
no teeth by age 12mos
- Can get eruption of
mandibular incisors at or shortly after birth, can cause
tongue irritation with feeding
- "Baby teeth"--There are 20; 8 usually fall out between 6yo and
8yo; other 12 fall out usually by puberty; primary canines are the last to
fall out; Permanent dentition
usually complete by 12yo.
- THUMBSUCKING-if enough
frequency, duration, and intensity, can cause
abnormalities of jaw development-ok till permanent teeth
start to erupt, about 5-6yo.
- PER AAP first dental appt
should be at about 1y of age though one presenter said
- Tooth grinding in toddlers
is common and 'relatively benign.'
II. Dental decay (including
- Usual bacterial agent is
- Divided into enamel decay
and dentin decay
- Caries require BOTH
cariogenic bacteria and fermentable sugars-the bact are
us. not present at birth, prob. passed to kids by
- Risk indicators-pop or
juice in bottles
- Signs of caries-white or
brown spots on teeth
toothpastes, drinking water fluoride
VARNISH-for kids at risk of caries, esp. in
non-fluoridated areas. Can start with eruption of
baby teeth. Medicaid pays for it 3x per year.
Very safe. Takes 2-4min per application. Can be
done by non-MD personnel. MAY HAVE BETTER RESULTS
THAN OTHER TOPICAL FLUORIDE PREPARATIONS.
Duraflor is one brand name.
- Systemic FLUORIDE
SUPPLEMENTATION-not needed if water supply has
0.6ppm or more. Otherwise, start at 6mo and use
till age 12-13. Kids who drink bottled water may
need supplementation. Charcoal filtration
systems, like Brita filters, dont remove sig.
amounts of fluoride.
mg per day only if water has
under 0.3ppm Fl
per day if under 0.3ppm, 0.25mg
per day if 0.3-0.6ppm
per day if under 0.3ppm, 0.5mg
per day if 0.3-0.6ppm.
III. Dental radiology
- PANORAX-useful for jaw
structure, e.g. ..fracture, not for caries particularly
IV. Dental trauma
- When a permanent tooth is
knocked out, rinse in cold milk and replace in socket.
Otherwise, keep tooth in milk until it can be replaced.
TIME IS OF THE ESSENCE. DO NOT SCRUB THE TOOTH. Trauma to
primary teeth is not generally seriouc and usually txd
with extractlon. One complication of primary tooth loss
is loss of space between remaining teeth which can cause
orthodontic problems when permanent teeth come in.
- Fx of crown-if no pulp
exposure, polish or restore, if minor pulp exposure, root
canal (or extract if primary)
- Fx of root-extract (if
permanent can splint or root canal)
- Luxation or intrusion-for
primary, observe or extract, for permanent, reposition
- Evulsion (tooth knocked
out)-for primary, no tx, for permanent, reimplant and
- Tears of upper lip
frenulum-only requires suturing if gum is torn loose with
- Tongue lacs-only requires
suturing if gaping, e.g. with 3-0 or 4-0 chromic gut
IV. Dental infections
- Abx for dental
infections-PCN VK (generally first-line), erythromycin,
- Dental infections spread
from tooth to bone to soft tissue. Facial erythema and
swelling is common.
- Indications for hosp. for
orofacial infections-T over 39F, swelling to medial
canthus of eye, submandibular swelling with resp. diff.,
altered mental status, toxic appearance.
V. Dental sealants--used to
fill pits and fissures esp. on back teeth to prevent caries in
high-risk kids or where pits or fissures are deed.
VI. Aphthous ulcers--Can be
prevented with SLS-FREE toothpastes-Rembrandt, Toms of Maine
Website for pt