Download Presentation March 2017

March 2012
Most common dental
conditions in children
Done by:
Dr Lina Sarkis Abi Doumit
Specialist in pediatric dentistry
Learning objectives:
To
identify the most common conditions
seen in pediatric dentistry.
To learn about the importance of earlier
diagnosis & earlier interventions.
 demineralization & remineralisation.
To describe the new concept of TX.
To discuss the fluoride use in caries
prevention.
To discuss the new recommendation for
prevention.
Introduction


Healthy teeth & gums are essential to any child’s overall
health and common dental problems can result in very
painful & dangerous infections, speech development
problems or delay and poor self image.
Dental problems should receive home care and clinical
care to avoid becoming a more serious issue later.
Early childhood caries
(ECC)
Definition

Severe tooth decay in young children has long been
recognized as a clinical syndrome and has been
referred to by various names, including “nursing caries,”
“nursing bottle syndrome,” “night bottle mouth,” and
“baby bottle tooth decay.”
Terminology

The Centers for Disease Control and Prevention
recently suggested that the terms for this clinical
syndrome be replaced with “Early Childhood
Caries (ECC)” because the latest research
showed that the use of bottles is not the only
cause of ECC.
What is early childhood
caries?

Early childhood caries is a “virulent” form of dental caries
that can destroy the teeth of preschool children and
toddlers. Early childhood caries can also be defined as
the occurrence of any sign of dental caries on any tooth
surface during the first 3 years of a child’s life.

ECC is an infectious disease, and the Streptococcus
mutans bacteria is the main causative agent, which does
not only produce acid, but also thrives in it.

In children with ECC, oral SM levels routinely exceed
30% of the cultivable dental plaque flora.
Transmission

The most common source, from which infants
acquire MS, is their mother (vertical transmission).


ECC begins with bacteria, especially mutans
streptococci (MS). Plaque is a film of bacteria on
teeth. Sugar (fermentable carbohydrates) is food
for the bacteria which then produce acids. These
acids attack the tooth enamel for 20 minutes or
longer! This happens every time your baby
drinks a sugary liquid and after multiple acid
attacks teeth can begin to decay.
Consumption of juice

Sucrose, Glucose & Fructose contained in fruit juices are
easily metabolized by S. mutans to form acids that
dissolve enamel.
How are dental caries produced?

Dental caries in children is typically observed clinically as
a “white spot lesion”. If the tooth surface remains intact
and non-cavitated, then remineralization of the enamel is
possible. If the subsurface of the demineralization of
enamel is extensive, it eventually causes the collapse of
the overlying tooth surface, resulting in a cavity.
Pathology process


The caries process is thought of as a dynamic alteration
between demineralization and remineralization phases.
The process of demineralization and dental caries
formation begins when cariogenic microorganisms are
present in large numbers and dietary fermentable
carbohydrates become available in the dental biofilm.

Pathologic factors
Bacteria
Carbohydrates
Protective factors
Saliva
Calcium
Phosphate
Fluoride
Photomicrographs, dental
histology pictures, SEM,
microscope
Demineralisation of enamel
Risk factors for dental caries
Frequent intake of carbohydrate-rich or sugary foods  a
low pH on the surfaces of the teeth.
 Night- time bottle feeding, or prolonged use of a Sippy
cup.
 The earlier that a child’s mouth is infected with Mutans
streptococci, the greater the risk for future caries
development.
 A low fluoride level on the surface of the teeth reduces
the remineralization process and increases the risk for
caries.
 When the saliva flow is below 0.7 ml/minute, the saliva
cannot wash carbohydrates off the dental surface.
 Finally, a low socioeconomic status can reduce interest in
oral hygiene and a healthy diet.

Risk factors

Test revealed statistically significant differences
(p<0.05) regarding to age group, duration of the
habit of drinking milk before bedtime, and age at
which oral hygiene started. Higher prevalence of
ECC was associated with the older age group,
higher duration of the bedtime feeding habit (>12
months of age), and later start of oral hygiene
(>12 months of age).

J. Appl. Oral Sci. vol.17 no.1 Bauru Jan./Feb. 2009
Associated risk factors

Multiple risk factors are involved in the
development of early childhood caries. Ones of
particular importance are demographic (e.g.,
child's age), social (e.g., annual household
income), and psychosocial factors (e.g.,
parental/caregiver depression) that are indirectly
linked to ECC.

J Contemp Dent Pract. 2010 Oct 14;11(5):001-8d
High risk patient

Children with disabilities and special needs are at
greater risk for health problems.
 Children with behavioral problems, impaired
mobility, neuromuscular problems.
 Children with Gastro esophageal reflux.
 3 year-old patients with already 4 teeth with carious
lesions.
 Low socioeconomic status…
Complications of earlier
extractions

Drifting / tipping of teeth.

Delay of eruption of permanent teeth.

Loss of arch length.

Midline shift.

Crowding of permanent teeth.

Impactions.
3 year-old patient
4 year-old patient
4year-old patient
6year-old patient
Role of saliva






Neutralizing acid challenges.
Flushing food and bacteria from the oral cavity.
Acting as lubricant.
Delivering calcium phosphate and fluoride to the tooth
surface.
Saliva needs to be at neutral ph (around 7), for teeth to
mineralize properly.
Dry mouth increase cavity risk.
Stookey GK,J Am Dent Assoc.2008 May;139:11S-17S
Dry mouth

Side effects of many drugs as:
-anxiety.
-depression
-allergies,cold,antihistaminic asthma.
 Side effects of some disease as HIV,
hypertension.
 Damage of salivary gland.
 Mouth breather.
Concept of Treatment

In the past the treatment for dental caries was to
“drill and fill.” Restorative dentistry unfortunately
has little long-term impact on oral S.
mutans levels.
Control of disease
PREVENTION
TX back up
Before TX
4 year-old patient: TX under
GA
After TX
Fissure sealant


To apply a plastic material to one or more teeth.
To prevent rapid penetration of caries.
Evidence based

cohrane library studies (involving 3 897
children/adolescents) from 1966–2003,
with follow-up time at least two years.

T he risk reduction: decayed surfaces in sealed
teeth divided by the number of decayed surfaces
in the controls) was 33% for the fi rst permanent
molars for resin-based sealants after 2–5 years
follow-up
Evidence based

Placement of resin-based sealants on the
permanent molars of children and
adolescents is effective for caries reduction
(Ahovuo-Saloranta et al. 2004, 2008).

Reduction of caries ranged from 86% at 12
months to 57% at 48 to 54 months
(Ahovuo-Saloranta et al. 2004).
EFFICACITY
Cooperative
issue
operculum
Excellent
Marginal seal
Moisture
control issue
No leakage
2) Reduction of risk levels



Reduction of sugar intake,diet advices,
Increasing Fl use at home.
Awareness health program.
3) Remineralization of teeth

Fluoride toothpaste twice daily.
 Recommendations for fluoride supplementation can be
made based on Fluoride content of water.
 Xylitol gum is recommended.
 Other source of Ca (cheese).
Fluorosis




Defect in the enamel.
Teeth impacted by fluorosis have visible discoloration.
White spots to brown and black stains.
Increase in enamel porosity.
Severe fluorosis

Due to exposure of water naturally
fluoridated.with level above the limit.
 From shallow well & hand pumps.

The severity of fluorosis depends on the amount of
fluoride exposure.

A common source of extra fluoride is unsupervised use
of toothpaste in very young children.

Level of Fluoride in toothpaste 500 ppm.
1000 ppm.
1040 ppm.
1450 ppm.
1500 ppm.
fluoride






cereals, baby cereals.
deboned chicken.
canned fish and shellfish ,sardine
all fruit juices, including apple, grape.
others, soft drinks of all kinds, teas and tea
mixes, beers, wines, some alcoholic drinks.
Fruits and vegetables cultivated in countries with
fluoridated water.
Fluorization process
•
Enamel is composed mainly of a mineral known as
"calcium hydroxyapatite", and its crystal structure is
somewhat porous. This characteristic makes enamel
vulnerable to dissolution in acids, as well as to
deposits of stain-producing compounds.
Long term follow-up



Follow up at home.
Office recall frequency every 3 months for high risks
patients.
6 months for low risk patients.
Tips for the parents
The American Academy of Pediatric Dentistry, the American
Dental Association, and the Academy of General Dentistry
recommend:





That children visit a dentist within six months of the eruption of
the first tooth, and no later than 12 months of age.
Infants should not be put to sleep with a bottle. Breast-feeding at
night should be avoided after 12 months of age.
Infants should be weaned from the bottle at 12-14 months of age.
Juice should be offered to a child only in a cup. Infants and
toddlers should drink no more than 6 ounces of juice per day.
Cleansing of the baby teeth should be started by the time of
eruption of the first primary tooth.
For school age children

Sweets should be eaten with meals, instead of
as a stand alone snack.
 Milk and water better then soft drinks.
 Cheese is a helpful snack.
 Limit snacking.

Pathological/
Protective factors.
 Participation of the
parents.
 Preventive activities
at early ages.
References
1- World Health Organization. The World Oral Health
report 2003. Geneva: WHO; 2003. http://www.who.
int/oral_health.
2-Community Dentistry and Oral Epidemiology Volume 27, Issue
6, pages 442–448, March 2007.
3- Dominick P. Nutrition Reviews Volume 60, Issue 4, pages 97–
103, April 2002.
4- Ribelles M,Eur J Paediatr Dent.2010 Mar;11(1):9-14.
5- Angus C cameron ,Richard P Widmer .Handbook of pediatric
dentistry .third edition
6- J.Timothy, Dimensions of Dental Hygiene. February 2010; 8(2):
40, 42, 44.
7- Angus C cameron ,Richard P Widmer .Handbook of pediatric
dentistry .third edition.
8- Community Dentistry and Oral Epidemiology
Volume 27, Issue 6, pages 442–448, March 2007.
9-Daniel Ravel,Pediatric Dental Health. Nov 2004 ;1-20
10- Marinho VC, Higgins JP, Logan S, Sheiham A.
Fluoride toothpastes for preventing dental caries in
children and adolescents (Cochrane review). In: The
Cochrane Library, Issue 1, 2004. Chichester, UK: John
Wiley & Sons Ltd.
11- Guideline on Fluoride therapy (AAPD ) ,REVISED 2014