Dental/Periodontal Emergencies

Chapter 43 Dental/Periodontal Emergencies



Susanne Kost, MD



1 What is the typical age at which an infant acquires the full complement of primary teeth?


The second primary molars typically erupt at about 22 months of age; most children have the full complement of 20 primary teeth around their second birthday.



2 Which are the first permanent teeth to erupt? Which teeth come next?


The first permanent teeth to erupt are usually the first permanent molars (“6-year” molars), followed by the mandibular central incisors, maxillary central incisors, lateral incisors, cuspids, and bicuspids. The mixed dentition phase concludes at about age 12 years with the eruption of the second permanent (“12-year”) molars, but the adult complement of 32 teeth is not achieved until the eruption of the third molars (“wisdom” teeth) in late adolescence (Fig. 43-1).


image

Figure 43-1 Primary and secondary tooth eruptions.


From Nazif MM, et al: Oral disorders. In Zitelli BJ, Davis HW [eds]: Atlas of Pediatric Physical Diagnosis, 2nd ed. New York, Harcourt, 1992, Fig. 20.9.



3 What are Epstein’s pearls? How do they differ from Bohn’s nodules and dental laminal cysts?


Cystic lesions in the oral cavity of newborns are quite common, occurring in 80% of normal newborns. They are generally small, and superficial, and are caused by entrapment of bits of embryologic tissue within dental epithelium.



image Epstein’s pearls are tiny, 1- to 2-mm keratin-filled cystic lesions located along the midpalantine raphe.


image Bohn’s nodules are small mucous gland cysts found on the alveolar ridges or posterior palate.


image Dental laminal cysts are larger, more lucent, fluctuant cysts consisting of remnants of dental laminal epithelium. They are usually single lesions, and they are found only on the crest of the alveolar mucosa.


Nelson LP, Shusterman S: Dental emergencies. In Fleisher GR, Ludwig S (eds): Pediatric Emergency Medicine, 4th ed. Philadelphia, Lippincott Williams & Wilkins, 2006.



4 Does teething cause fever?


Teething has been blamed for a number of symptoms in infants throughout time, ranging from fever, congestion, diarrhea, and rashes to seizures and death. A recent prospective descriptive study of 425 tooth eruptions in 125 children looked at parental reports of 18 “teething symptoms” daily for 8 months. Symptoms that were statistically linked to the eruption of a tooth included mild temperature elevation (temperature < 38.8° C), biting, drooling, facial rash, and decreased appetite for solids. Congestion, cough, vomiting, diarrhea, and temperature > 38.8° C were not associated with teething.


Macknin ML, Piedmonte M, Jacobs J, Skibinski C: Symptoms associated with infant teething: A prospective study. Pediatrics 105:747–752, 2000.




KEY POINTS: CONDITIONS FOR WHICH TEETHING SHOULD NOT BE BLAMED




1 Common viral symptoms of young children


2 Upper respiratory tract infections


3 Diarrhea


4 Significant fever



5 An 8-year-old presents with a blue-black cystic lesion over an erupting tooth What is the cause?


An eruption cyst is a nontender, fluid-filled cyst that sometimes forms over the crown of an erupting tooth. Occasionally, these cysts will fill with blood, creating the eruption hematoma described above. These cysts or hematomas are benign and self-limiting conditions that resolve when the tooth erupts.



6 What are the three main “ingredients” in the development of dental caries?


Dental caries is one of the most common disease processes in children, affecting about 5% of all children in the first few years of life, with much higher percentages in indigent children. The disease of dental caries is multifactorial in origin, requiring a susceptible host (genetic predisposition), a cariogenic diet (sticky sweets), and bacteria (most commonly Streptococcus mutans).


Tinanoff N, Kanellis MJ, Vargas CM: Current understanding of the epidemiology, mechanisms, and prevention of dental caries in preschool children. Pediatr Dent 24:543–551, 2002.

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Sep 1, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Dental/Periodontal Emergencies

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