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Maternal and Child Health Bureau logoA Health Professionals Guide to Pediatric Oral Health Management
HomeModuleModule 1: An Introduction to Infants' and Young Children's Oral HealthModule 2: Managing Infants' and Young Children's Oral HealthModule 3: Oral Conditions and AbnormalitiesModule 4: Prevention of Oral DiseaseModule 5: Non-Nutritive Sucking HabitsModule 6: Oral InjuryModule 7: Infants and Young Children with Special Health Care NeedsContentsGlossaryEvaluationHelp
Module 3: Oral Conditions and Abnormalities
Module Contents
3.1 Recognizing Healthy Teeth, Soft Tissues, and Facial Bones
3.2 Healthy Teeth
3.3 Healthy Soft Tissues
Lips, Tongue, and
Oral Mucosa
Frena & Gingiva
Major Salivary Glands
3.4 Healthy Facial Bones
3.5 Tooth Conditions and Abnormalities
Dental Caries (current page)
Untreated Tooth Decay
Hypodontia & Anodontia
Amelogenesis Imperfecta
Dentinogenesis Imperfecta
Extrinsic and Intrinsic Enamel Coloration
3.6 Soft Tissue Conditions and Abnormalities
Epithelial Cysts
Congenital Epulis
Natal or Neonatal Teeth
Eruption Cysts
Fibroma & Papilloma
Key Points
Additional Resources

3.5 Tooth Conditions and Abnormalities

All of the following tooth conditions and abnormalities require referral to a dentist for further assessment and possible intervention.

Dental Caries

photo of dental caries (tooth decay)
  Fig 8. Tooth decay

Dental caries (the disease process leading to tooth decay, Figure 8) is a transmissible oral infection. When food is consumed, cariogenic bacteria (especially Streptococcus mutans) is able to break down carbohydrates (e.g., glucose, fructose, sucrose) in the mouth, producing acids that cause mineral loss from teeth (demineralization). (See Module 4, section 4.3, The Role of Food in Oral Health.) This mineral loss results in cavities when the attack is prolonged and exceeds an individual’s resistance and the ability of the teeth to heal (remineralization). Resistance and healing ability are determined partly by an individual’s physiology and partly by health behaviors.

Early childhood caries (ECC), previously termed nursing caries or baby bottle tooth decay, can occur any time after teeth erupt. ECC may occur in infants or children with frequent and prolonged exposure to beverages containing sugar (e.g., fruit drinks, soda, fruit juice), milk, or formula in a bottle or covered cup (a “sippy cup”) during the day or at night. In addition, ECC has been associated with (1) frequent and prolonged breastfeeding, (2) frequent snacking on foods containing sugar (e.g., candy, cookies, cake), and (3) coating pacifiers with sweeteners (e.g., sugar, honey, syrup).[1]

Other risk factors for ECC include altered salivary composition and volume (resulting from the use of certain medications or malnourishment) and blockage of saliva flow in a bottle-fed infant.[2]

The first clinically detectable stage of a cavity is the incipient lesion, which is characterized by an opaque, white appearance. Although a certain amount of mineral loss has occurred, the loss is predominately in the subsurface of the enamel, with the surface of the enamel essentially intact and amenable to demineralization. If the lesion progresses, demineralization continues to exceed remineralization. Further mineral loss eventually causes structural weakening of the enamel.

The younger the age at which dental caries begins, the greater the risk of future decay. Both the level of caries attack and the infant’s or child’s resistance can be managed through oral health supervision that promotes positive health behaviors including good oral hygiene, use of fluorides and dental sealants, good dietary habits, and chemical or physical reduction of dental plaque.[3]

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logo: U.S. Dept. of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau