Dental Disease

Dentition

primary = deciduous (6-30 months); secondary = permanent (6-25 years)

Dental Caries

Three Factors leading to Dental Caries

(1) host – not just the tooth but also the failure of the oral immune system and saliva to stop the process
(2) fermentable carbohydrate (major is sucrose) – substrate for oral bacteria to produce dextran used to form dental plaques; number of ingestions is more important than amount.
(3) bacteria – living in the plaques Strep. Mutans then produces lactic acid which decalcifies the enamel.

elimination of any of these factors will result in the prevention of dental caries

currently most caries are on the biting surface of the tooth (Pit and Fissure caries) as opposed to 25 years ago when most caries where of the "smooth surface decay" type.

Baby Bottle Caries are caries on the lingual (tongue side) surface of the upper teeth (the lower teeth are protected by the tongue) that are the result of the baby sleeping with a source of CHO in the mouth (e.g. bottle of apple juice)

Prevention

NUTRITION – frequency is worse than the amount (e.g. eat all your jelly beans at once)

BRUSHING / FLOSSING – it works

little kids should brush at least once a day, but should not use more than a "pea’s" worth of toothpaste.

SEALANT / DENTAL VISITS – a plastic coating on the biting surface reduces pit and fissure caries. Children should go to the dentist 1 or 2 times a year. (the sooner the better so they’re acclimated)

FLUORIDE – most important use fluorinated toothpaste and water

Fluoride

Fluoride works in three ways:

(1) Topically
(2) systemically (most important during tooth formation, from utero to 8 years old.)
(3) Antibiotic effect

GOOD NEWS – ½ of kids today do not have carries BAD NEWS – Fluorosis

fluorosis – happens when there is to much Fluoride systemically

first: white spots on teeth
second: brown spots
bad case: dentin is exposed

This is a cosmetic problem in the US. Prescribing Fl supplements in places that already have Fluorinated water can cause fluorosis.

current recommendations for pediatric Fluoride supplementation – first measure fluoride level in the water

if water fluoride level < 0.3 ppm:

< 6 months: none
6 months - 3 years: 0.25 mg/day
3 years - 6 years: 0.5 mg/day
6 years - 16 years: 1.0 mg/day

if water fluoride level 0.3 to 0.6 ppm:

< 6 months: none
6 months - 3 years: none
3 years - 6 years: 0.25 mg/day
6 years - 16 years: 0.5 mg/day

if water fluoride level > 0.6 ppm:

none for anyone

60% of US water has Fl. Call the Dept. of Health to find out if the water is fluorinated and if so to what extent.

Testing the water is a cheap ’n’ easy way to find out.

Home filters usually do not filter out fluoride ("reverse osmosis" filters will)