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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
C. Sleep Issues
D. Dental Issues |
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Teeth: Eruption Pattern, Trauma, Caries; Prevention of Problems
Tooth Eruption
Rule of 4's: 4 by a year of age, 8 by 16 months; 12 by 20 months, 16
by 24 months and 20 by 28 months. Having delayed eruption of either
deciduous or permanent teeth is not that unusual and usually needs no
evaluation.
Trauma to Teeth:
- Avulsed deciduous teeth: never try and replace a deciduous tooth.
- Avulsed permanent teeth: the quicker the tooth is replaced, the more
likely it will stay in. The tooth can be rinsed, but should not be
scrubbed; have to exert a lot of pressure to get tooth back in proper
place. Transport medium: milk, saline; water if nothing else available.
- Chipped permanent tooth: can be repaired, but also has a tendency to
chip off.
- Bruised tooth: no treatment necessary unless suspect infection.
Gumboil will occur over the root of the tooth; its presence means that an
abscess is present, and the tooth either needs to be removed or a root
canal be performed.
Steps to take to promote prevention of dental problems in children:
- Regular check-ups: recommended 6 months after initial tooth erupted:
i.e., about 1 year of age. Most pediatric dentists actually start to do
routine evaluations at about 2-3 years of age, but prefer to see the
children younger because they want to have a more positive relationship
with them at the start.
- Fluoride in water: should know that in the Augusta area there are
pockets of people living in the city limits who have well water, and,
therefore, need to be supplemented with fluoride. (Age at starting
fluoride supplementation has recently risen to 6 months: Dose: 0.25 mg 6
mos. - 3 years; 0.5 mg 3-6 years; 1.0 mg > 6 years.)
- Seat belts: one of the most common ways teeth are injured is in car
accidents.
- Helmets for bicycles: again, a common way for children to hurt
themselves.
- Mouthguards for sports: particularly if there are traumatic sports
anticipated.
- Daily hygiene and care: we were shown many awful slides of just poor
hygiene.
- Minimize carbohydrate intake: if give juice in bottle give as few
times/day as possible.
Abnormal Tooth Eruption: Can be normal to have no teeth up
to 15 months of age.
- missed teeth: seen in deciduous as well as permanent teeth as well.
- crowded teeth (we want the deciduous teeth to be widely spaced in the
mouth--children need that space for permanent teeth). Many different
braces and splints available.
Miscellaneous Things to Note:
- Gum Boil: always means there is an abscessed tooth that needs
extraction or root canal.
- Caries: nursing are often in front teeth (Caries caused by oral strep:
Streptococcus mutants).
- Eruption blisters - when teeth are actually erupting, can have an
ecchymotic blister.
- Geographic Tongue: not painful, but looks like it should be.
- When to suture a tongue: only if through and through in the middle of
the tongue.
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