DENTAL CARIES
Dental caries (tooth decay), is a very common problem in Indian children, involving mainly deciduous teeth.
Etiologically, caries may be divided into three steps:
a. Collection of residual carbohydrates over dental pits and between teeth, forming a plaque.
b. Fermentation of these plaques by acid-forming oral flora, e.g. Strept. mutans, lactobacilli, etc.
c. Demineralization and destruction of enamel by these acids.
Fig. 14.4: Dental caries.
(Courtesy: Dr Adesh Kakade)
Aphthous ulcers or stomatitis present as solitary or multiple, well-circumscribed lesions of variable sizes, with gray fibrinous exudates and erythematous halo on gingival, lingual or palatal mucosa.
Etiology is probably multifactorial, thought may be associated with local trauma, vitamin B12 deficiency, emotional stress, malabsorption syndrome or allergy. Most cases improve spontaneously within 7-10 days and treatment is palliative with topical application of viscous xylocaine or steroids before feeding.
Severefrecurrentfpersistent ulcers are seen in-(a) entero- viral infections, e.g. herpangina, hand-foot-mouth disease, (b) chemical/thermal burns, (c) gingivostomatitis due to anaerobic infections, and (d) systemic diseases, e.g. Crohn disease, Beh#962;et's syndrome, SLE, etc.
Risk factors: Bottle-feeding, sticky candies, and enamel hypoplasia due to malnutrition or fluorine deficiency are three most important risk factors for caries, apart from others, e.g., poor oral hygiene, salivation disorders, GERD and family history.
Clinically, dental caries generally begins in difficult to see areas, e.g. pits,fissures or contact surfaces of two adjoining teeth, as an opaque white plaque that enlarges and deepens gradually to produce visible cavities.
Presence of pain indicates spread of caries to the pulp.Untreated caries may progress to develop more severe complications, e.g. (a) pulpitis, (b) dental abscess, and (d) neighbouring infections, e.g. gingivitis, facial cellulitis, Ludwig angina and osteomyelitis (Fig. 14.4).
Treatment: Role of pediatrician in dental caries primarily involves: (a) early detection of lesions and timely referral to dentist, (b) control of pain/inflammation with analgesics and antibiotics, and (c) management of complications, apart from preventive guidance.
Vincent angina (Trench mouth) is an acute, fulminant, necrotizing infection of oral cavity due to anerobic flora, e.g. fusobacteria and spirochetes. Mostly seen in severely malnourished children, these cases present with-(a) painful gingival ulceration and swelling, (b) adherent grayish pseudomembrane over affected gingival and (c) foul-smelling breath with/without signs of systemic infection. Treatment includes antibiotics (penicillin/erythromycin), local debridement and analgesics.
Oral thrush is very common in normal newborns or young infants lt;3 months. In older children, it may be seen in cases with—(a) prolonged antibiotic therapy, (b) chronic debility or immunodeficiency states.
Clinically, thrush appears as whitish patches over oral mucosa (Fig. 14.5), with inflamed base that leaves pin-point hemorrhages on removal (d/d milk patch).
Topical nystatin or clotrimazole application is often enough, though severe/persistent thrush requires exclusion of immunodeficiency disorders and systemic antifungal therapy. Oral rinses with 0.2% chlorhexidine may be useful to prevent recurrence, specially in immunocompromized cases.
Prevention depends on: (a) maintenance of oral hygiene, (b) improvement of nutrition and avoidance of sweetened foods, (c) adequate fluoride content of water (minimum 1 ppm) and monitoring of high-risk cases. Use of topical fluoride agents or dental sealants is beneficial in some cases.
14.5.3