Normal Dental Development and Oral Pathology Rebecca L. Slayton, DDS, PhD Department of Pediatric Dentistry Amanda Keerbs, MD Department of Family Medicine

PRIMARY DENTITION

Eruption Schedule

Eruption Schedule

Distal surface – towards the back of the mouth Midline Mesial surface – towards the front of the mouth

Upper (Maxillary) Arch Incisal Surface Labial/Buccal Surface Palatal Surface Occlusal Surface

Lower (Mandibular) Arch Occlusal Surface Labial/Buccal Surface Lingual Surface Incisal Surface

Ectopic Eruption Abnormal pattern of tooth eruption Teeth are delayed in eruption or erupt in the wrong location Most common for permanent lower incisors, permanent upper canines and permanent first molars

Syndromes with Dental Manifestations Dentinogenesis Imperfecta Amelogenesis Imperfecta Cleidocranial Dysostosis Ectodermal Dysplasia

Common Causes of Malocclusion Non-nutritive sucking behaviors May cause anterior open bites or crossbites in children who use pacifiers and digits Most children will stop oral behaviors by age 2. For older children, consider using rewards, gloves, replacement items Caries or trauma with premature loss of teeth and loss of space

Common Oral Lesions in the Primary Care Office Lip lesions Angioedema Herpes Labialis Mucocele Angular cheilitis Lingual Lesions Hairy Tongue Geographic Tongue

Common Oral Lesions in the Primary Care Office Oral conditions of infants and children Natal teeth Epstein’s pearls Eruption cysts Thrush Tooth Conditions Tooth Staining Erosions

Common Oral Lesions in the Primary Care Office White lesions Candida Oral Leukoplakia Morsicatio Buccarum Vesiculobullous Lesions Primary herpes gingivostomatitis Recurrent herpes Herpangina Hand-foot-and-Mouth Disease

Common Oral Lesions in the Primary Care Office Ulcers Aphthous Ulcers Behcet’s Syndrome

Caries Caries Caries are an infectious, communicable disease resulting in the destruction of tooth structure by the acid produced by the metabolism of sugar by bacteria found in dental plaque Plaque is a dense bacterial aggregate containing about 10% bacteria per milligram that accumulates on tooth surfaces.

Dental Caries Process Host Bacteria Substrate TEETH FRUCTOSE SUCROSE MUTAN STREPTOCOCCI LACTOBACILLI TEETH Host Bacteria DENTAL CARIES Substrate FRUCTOSE SUCROSE

Dental Caries Stages The acid created by the caries bacteria’s metabolism of sugar leads to demineralization. Demineralization is the loss of calcium, phosphate and carbonate from the enamel

Dental Caries Stages Incipient Lesion (caries not more than halfway into enamel) Lesion has reached the dentinoenamel junction (DEJ) Lesion is progressing laterally and towards the pulp Lesion extended into the pulp If demineralization is allowed to continue, the tooth will eventually be eroded enough for a cavity to form.

Oral Screening Examination Tips from a practicing clinician Get in the habit of performing a brief oral examination in all patients presenting to your office for general wellness exams and use that time to discuss with patients their dental habits and risk factors for oral disease Perform more detailed evaluations in patients when indicated by history any review of systems In kids always lift the lip

Important Landmarks of the Oral Cavity Lips Labial and Buccal Mucosa Floor of mouth Hard and soft palate Parotid papilla Oropharynx and tonsilar pillars