Child Oral Health Clinical Case #2

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Question 1 of 3

1. Question
You work at a community health center in a rural area of your state. Carol, a 9 month old girl, comes in with her Mom for a routine well child visit. Mom received good prenatal care including dental restoration of several cavities, but unfortunately her pregnancy was complicated by episodes of maternal pyelonephritis and pneumonia, and Carol was delivered at 34 weeks due to premature rupture of membranes. At today’s visit, in addition to addressing common issues in the care of former premature infants, you explore Carol’s oral health risks. Your oral exam findings are displayed in the photo.

Which of the following is true about Carol’s risk for developing Early Childhood Caries (ECC)?
- Carol is low risk because she was delivered early and her teeth had more time to develop enamel. Carol is actually at high risk due to her premature delivery. The cells that manufacture enamel are very sensitive to systemic insults. Disruption in the production of enamel will result in an enamel defect which may be microscopic or visible clinically. All children have a microscopic enamel defect on the incisors termed linear hypoplasia related to the birth process. Increased incidence of enamel defects is present in children with lower socioeconomic status, premature birth, and certain congenital diseases. Areas of enamel defect are more prone to developing caries.
- Carol is high risk because she was born early and her mother had several infections during her pregnancy.
- Carol is low risk because her mother had cavities. The presence of maternal caries is a significant risk factor for the development of ECC. Mom’s dental treatment during pregnancy was important as it reduced the chance of transmission of cariogenic bacteria to Carol.
- Carol is high risk because her mother is wealthy and has health insurance. Unfortunately caries, like many diseases, is more prevalent in patients of lower socioeconomic status. Other risk factors include lack of access to dental care, cariogenic diet, lack of exposure to fluoride, special health care needs, and the presence of caries in other family members.
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Question 2 of 3

2. Question
You and Carol’s Mom agree that she is at high risk for ECC. Mom is anxious to do all that she can to help Carol avoid the extensive caries that she has experienced herself. She asks you for guidance.

Which of the following is the most appropriate anticipatory advice for Carol?
- Recommend not worrying about ECC as Carol does not yet have permanent teeth. Primary teeth are important. They play a role in proper nutrition, language development, and guiding permanent teeth into place. While it is true that they eventually are lost, they are indispensable.
- Recommend making a dental appointment when Carol reaches the age of 3 years. All children should establish a dental home by age one. This is particularly important in children at high caries risk such as Carol. There may not be easy access to a pediatric dentist in a rural area, but many general dentists are comfortable seeing small children. Carol is fortunate to be seen in a community health center, as dental services are often available in the same building.
- Recommend exclusive breastfeeding for another 3 months to reduce Carol’s risk of developing ECC. Breastfeeding does not prevent ECC. Although the disease was once called Baby Bottle Tooth Decay, babies that are breast fed also have a risk of developing ECC.
- Recommend Mom start brushing her teeth with fluoridated toothpaste twice daily.
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Question 3 of 3

3. Question
6 months pass, and Carol returns for her 15 month well child visit. On oral exam you note the following:

Joanna Douglass, BDS, DDS

Which of the following is most likely to have been a contributing factor to Carol’s rapid development of ECC?
- Mom purchased 'baby-safe' all-natural toothpaste for Carol.
- Mom offered cheese and fresh fruit for snacks. Carol’s snack foods are unlikely to be the cause of her caries. High risk snacks are those with high sugar content such as cookies, candy, and sugary drinks, and those that stick to teeth such as raisins.
- Mom limited the frequency of snacks to once between meals. While each time dietary carbohydrate is introduced into the mouth acid is generated by oral bacteria that can demineralize teeth, limiting snacks to once between meals minimizes this risk.
- Mom discontinued use of the bottle at 12 months, and offers only milk or water in her sippy cup. Mom is following recommended practice by offering only milk or water in a sippy cup rather than a bottle. This is unlikely to increase Carol’s caries risk.
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Child Oral Health

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