Teething

Question 1

What is teething? what do teeth come in/ lost

Answer 1

• Eruption of deciduous (milk) teeth thoruhg gingival tissues
• occues at different times for every child
  average: 4-12 months

Full set of primary teeth by 3 years

start losing primary teeth by 5-6 years

Question 2

What are the features of our dentition?

Answer 2

• 20 teeth total (in adult 30 teeth)
• susceptible to dental caries (cavities)
• give shape to face
• crucial for learning to eat and speak
• role in proper alignment, spacing and occlusion of permanent teeth

*priamry teeth have thinnger enamel than permanent teeth

Question 3

describe the development of teeth

Answer 3

Children’s teeth begin developing in the womb

Pregnancy nutrition vital for development of child’s teeth

*calcium,phosphorus, vitamin C, vitamin D

Avoidance of certain medications while pregnant: ex tetracycline

*tetracycline during pregancy can cuase issues with teeth development in womb

Question 4

Normal tooth eruption timeline (children)

Answer 4

• 1st tooth erupts at 6-7 months
• erruption is symmetrical: Upper teeth usually erupt 1-2 months after the same tooth on lower teeth

~ 1 tooth/month

*central incisor on bottom usually 1st, then central incisor on top

Question 5

Normal tooth erruption timeline for adult teeth?

Answer 5

• 1st permanent dentition erupts at 6-7 years of age
• process continues for 6 years
• symmetrical eruption

Question 6

Describe delayed tooth erruption

Answer 6

• in otherwise healthy child, aa delay in up to 6 months is no clinical significance

*as long as at 12 months ahve some teeth, if not RED FLAG

• delayed tooth erruption DTE occurs:
• premature and low birth weight babies

*racial, ethnic, sexual and individual factors can have influencer

Question 7

tooth erruption timeline

Answer 7

7+4

7 months: first teeth

11 months: 4 teeth

15 months: 8 teeth

19 months: 12 teeth

23 months: 16 teeth

27 months: 20 teeth

* 4 months between each

Question 8

ex: Healthy 10 month old infant bron @ 40 weeks, no significant past medial history
- freq drooling and more iritable and has rectal temp of 37.7 for past 22 hours
- she can been drinking less formula -> wonders if teething
- has lower central incisors at 7 months: asking when will she get her two front teeth?

Answer 8

* teo teeth should come in upper jaw in next few months

Question 9

What signs and symptoms are associated with teething?

Answer 9

Gum redness, swelling +/- tenderness

Gum rubbing, biting or chewing on hard objects

Drooling -> facial irritation

Irritabilit, restlessness, crying, insomnia

Decrease inappetite, increased thirst

*symptoms peak in incidence and severity on day of or before eruption, generally resolve within 3 days

Question 10

What signs and symptoms are not associated with teething?

Answer 10

Vomiting • Diarrhea • Malaise • Fever • Rashes

Question 11

Does Teething cause fever?

Answer 11

• most studies done are poor quality, found some suggestion of association between:

inc temp and the day of tooth erruption +/- 1day

*caregivers inaccurately report slight inc in body temp as fever

*Infants with T>38.5C, or 38-38.5C on days other than the day of tooth eruption +/- 1 day should be evaluated for other sources of fever

- those presenting with low grade fever during the window may be monitored conservatively if well appearing

Question 12

What are eruption cysts

Answer 12

• localized dome shapred soft bluish swollen area filled w/ tissue fluid and blood

*forms over emerging incizers and molars

May be surrounded by inflammation
Localized to the gum overlying the crown of an erupting tooth

Not associated with infection

Usually disappear if left alone

*DO NOT BREAK -> see dentist if does not go away with tooth errupting

Question 13

what signs and symptoms require a dental consult when possible

Answer 13

Pericoronitis (gums surrouning wisome teeth become infected_

Delays of >6 mo in a primary tooth eruption (1 year of age, 6 mo before/after)

Delays of >12 mo in a permanent tooth eruption (if 7 and no permanent teeth)

Eruption cysts: If causing discomfort +/- interfering with feeding OR If they do not drain

Question 14

what signs/symptoms would require an urgent dental consult?

Answer 14

• pericoronal abscess

(caused by acute pericoronitis)

*abscess accumulation of puss that can spread to cheek)

* if there is a suspensed systemic illness in young child (diarrhea, fiver, potential 2nf underlying cause refer for medical consult)

Question 15

what are the goals of therapy for teething?

Answer 15

1. Minimize/ relieve gum pain and irritation: reduce child irritability, minimize sleep disturbances
2. Prevent complications: involve medical or dental professionals when indicated

Question 16

Prevention measures for teething

Answer 16

-Wipe gums of infants BID (like brushing teeth before you ahve them)

Brush primary teeth BID (clean and get used to sensation)

Monitor teeth

No bottles in bed with milk, formula or juice

Baby Bottle Tooth Decay

* use floride free tooth paste unil child can spit

should have assessment by a dentist within 6 months of eruption of the first tooth or by 1 year of age

*dental exams 6 months after

Question 17

Non pharmacologic therapy for teething

Answer 17

ROKD

• Rub the gums: clean finger or damp washcloth

Offer the rings: teething rings made of firm rubber (cooled rubber even better)

Keep it cool: cold washcloth or chilled teething rings, cold foods

*NEVER FOZEN

Dry the drool: clean bloth to dry chin, prevent skin irritation, absorbent bed sheet

Question 18

Pharmacologic non prescription medication for teethin

Answer 18

Oral Analgesics:

Acetaminophen:

• 10-15 mg/kg/dose by mouth Q4-6H prn
• MDD = 75 mg/kg/day *dont exceed 5 dose/day

Ibuprofen

• 5-10 mg/kg/dose by motuh Q6-8H prn
• MDD = 40 mg/kg/day, *dont exceed 4 dose/day

*DO NOT RUB ON GUMS NOT MADE FOR TOPICAL APP

Question 19

treating teething with Benzocaine

Answer 19

• no longer available for kids, short duration of action (max 30 min, and lots of haz)
• RISK OF DISABLING GAG REFLEX IS SWALLOWED
• risk of MetHh (methemoglobinemia)

* occurs when blood has to much methemoglobin bc of too much benzocaine, doesnt bind properly to oxygen-> tissues get insufficient supply can cause coma or death

Question 20

signs of methemoglobinemia

Answer 20

• weakness, confusion, headache, difficulty breathing and or pale, fray or blue coloured skin, lips and nail beds

*as % methhemolgobin increases effects more severe

Question 21

Natural Health products to treat teething

Answer 21

• Homeopathic products
  
  • Orajel Natural source homeopathic gel
    
    • Calcarea phosphorica 12X, Coffea cruda 6X, Chamomilla 6X
• Topical Anesthetics
  
  • Camilia Teething liquid: Chamomilla 9C, Belladonna 5C, Ferrum Phosphoricum 5C
  • Hyland’s baby oral pain releif: Arnica Montana 30X HPUS
  • Hylands baby nighttime roal pain releif: 8 homeopath ingred

*do not reccomend because no literaure on efficiency

Question 22

What to avoid during teething

Answer 22

Alcohol: NEVER safe for children
Teething biscuits: lots of sugar, can cause cavities
Aspirin: Reyes

* some would rub on: its an acid -> causes more irritation
Rubbing oral pain relievers directly on the gums

Topical anesthetics
Frozen items

Question 23

When to follow up for teething

Answer 23

3-5 days after treatment

*REFER if neither nonpharmacologic therapy nor nonprescription medications are relieving the symptoms

* If symptoms uncharacteristic of teething discomfort develop REFER