3.2 Oral Examination
Enamel Hypoplasia and Enamel Demineralization
Children with low birthweight, developmental delays, or certain genetic syndromes may be at increased risk for enamel hypoplasia, which seems to be a predisposing factor for dental caries, especially in the maxillary incisors and primary molars. Hypoplasia usually appears on the middle or occlusal third of the teeth, whereas demineralization from poor oral hygiene and an acidic oral environment occurs most often near the gingival line. Demineralization often is characterized by white spot lesions that are best seen by “lifting the lip.”
Wipe the teeth with a 2" x 2" gauze square, and retract the lips and cheeks. Look for obvious decay and/or erosion that may result from frequent reflux, altered salivary flow, cariogenic diets, or inappropriate feeding or eating practices. Early childhood caries occurs most often on the facial and lingual surfaces of the maxillary teeth.