DENTISTRY

The following is based on a CME at Children's Hospital and Regional Medical Center, Seattle, WA, in 5/01

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 3yo.
• Tooth grinding in toddlers is common and 'relatively benign.'

II. Dental decay (including caries)

• Usual bacterial agent is Strep mutans.
• 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 parents.
• Risk indicators-pop or juice in bottles
• Signs of caries-white or brown spots on teeth
• Prevention
  • Fluoride toothpastes, drinking water fluoride supplementation--Good evidence
  • Fluoride mouthwashes--weaker evidence
  • 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.
    • FLUORIDE SUPPLEMENTATION DOSES
      • 6mo-3y-0.25 mg per day only if water has under 0.3ppm Fl
      • 3y-6y-0.5mg per day if under 0.3ppm, 0.25mg per day if 0.3-0.6ppm
      • 6y-16y-1.0mg 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 and splint
• Evulsion (tooth knocked out)-for primary, no tx, for permanent, reimplant and splint.
• Tears of upper lip frenulum-only requires suturing if gum is torn loose with the frenulum.
• 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, clindamycin
• 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 info-kidsoralhealth.org