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Natalteeth(1:3000births);norootsand arenotwellformed.
Statethatphysicianremovestheteeth.
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Previousterminology: replacedwiththetermECCbecausewenowunderstandthatthe
processofcariesisindependentoftherouteoffeedingbutisdependentonthefrequency
ofrefinedcarbohydratesinthediet.
ECCisaparticularlyvirulentformofcariesthatspreadsrapidlywithinthemouthand
typicallyresultsinseveredentaldisease.
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PainandinfectionresultingfromrapidprogressionofECCintothedentalpulpdistracts
fromplayandlearning;oftenresultsindisturbancesofeating, sleeping,andbehavior;and
maydisturbgrowth.
On average40%ofchildrenhavecariesbykindergarten.
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Chalky whitespots:firstappearasdullwhitebandsonthesmoothsurfaceofthetooth
atthegumline,followedbyyelloworbrowndiscoloration.Areindicativeofearlydecayor
weakenedenamel.Maybereversiblewithinexposuretotopicalfluorideandplaque
removal.IndicatereferraltoadentalhomeASAP.Ifleftuntreatedcanleadtocavitation.
Plaqueandchalkywhitespotsaresometimesmistakenforeachother.Thedifferenceis
plaquecanbewipedoffandwhitespotscannot.
Brownspots:softbrownorblackspotsappearontooth,withprogressionslowlytoward
thechewingsurfaceofthetooth.Puttheaffectedtoothatriskforfracture.Signify
advancedorseveredecay.Dentalreferraliscrucial.
Severedecay:referstothepresenceofmultiplecavitiesinseveralteeth.Mayleadtoearly
toothlossandaffectsachildsabilitytochewfoodandhisorherselfesteem.Often
requiresgeneralanesthesiaintheoperatingroomtoremediate.Placeschildrenatriskfor
infectionandcellulitis.
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Fluoride wassoimportantthatitwasaddedtowatertopreventtoothdecay.
Fluorosis:mostlikelyto beseeninareaswherethedrinkingwaterhasafluoridecontent
greaterthan1ppmandinchildrenwhohaveapoorintakeofcalcium.
Age group Adequate intake(mg/day) Tolerable
upperintake(mg/day)
Infants06mos 0.01 0.7
Infants 712mos 0.5 0.9
Children13years 0.7 1.3
Children48years 1.0 2.2
Children913 2.0 10.0
Children1418 3.0 10.0
2010 40%ofadolescentsbetween1215haddentalfluorosis;66%ofUSgetsfluoridated
water.
MostofEurope fluoride dontadditin.
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Drymouth
Toothlocation
Certainfoodsanddrinks
Frequentsnackingorsipping
Bedtimeinfantfeeding
Inadequatebrushing
Notgettingenoughfluoride
Eatingdisorders
Heartburn(GER)
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1)Frompainfulordifficulteatingorchewing
2)Atoothabscessthatcancause
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TherecommendationsaspertheAAP statesthat:
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Childrenwho areprovidedwithfluoridatedcommunitywatershouldnotbesupplemented.
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Regular andfrequentexposuretosmallamountsoffluorideisthebestwaytoprotectthe
teethagainstcaries.Thisexposurecanbereadilyaccomplishedthroughdrinkingwaterthat
hasbeenoptimallyfluoridatedandbrushingwithfluoridetoothpastetwicedaily.
Fluoridesupplementationtypicallyisnotneededinthefirst6monthsoflife.Beginningat
theageof6months,childrenshoulddrinkfluoridatedcommunitydrinkingwaterortake
prescribedsupplements(ie,dropsorchewabletablets).
Referral:Childrenshouldbereferredtoadentistsothatadentalhomecanbeestablished
by1yearofage.Forthosechildrenathighrisk,thereferralshouldbeasearlyas6months
ofageandnolaterthan6monthsafterthefirsttootheruptsor12monthsofage
(whichevercomesfirst).
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