Normal+dental+development+and+oral+pathology

Normal Dental Normal Dental Development and Oral Development and Oral

PathologyPathology

Rebecca L. Slayton, DDS, PhDDepartment of Pediatric Dentistry

Amanda Keerbs, MDDepartment of Family Medicine

PRIMARY DENTITION

Eruption ScheduleEruption Schedule

Eruption ScheduleEruption Schedule

Mesial surface – towards the front of the mouth

Distal surface – towards the back of the mouth

Midline

Upper (Maxillary) Arch

Labial/BuccalSurface

PalatalSurface

Occlusal Surface

Incisal Surface

Lower (Mandibular) Arch

Labial/BuccalSurface

LingualSurface

OcclusalSurface

IncisalSurface

Ectopic Eruption

Abnormal pattern of tooth Abnormal pattern of tooth eruptioneruption

Teeth are delayed in eruption or Teeth are delayed in eruption or erupt in the wrong locationerupt in the wrong location

Most common for permanent Most common for permanent lower incisors, permanent upper lower incisors, permanent upper canines and permanent first canines and permanent first molarsmolars

Syndromes with Dental Manifestations Dentinogenesis ImperfectaDentinogenesis Imperfecta Amelogenesis ImperfectaAmelogenesis Imperfecta Cleidocranial DysostosisCleidocranial Dysostosis Ectodermal DysplasiaEctodermal Dysplasia

Common Causes of Common Causes of MalocclusionMalocclusion

Non-nutritive sucking behaviorsNon-nutritive sucking behaviors– May cause anterior open bites or crossbites May cause anterior open bites or crossbites

in children who use pacifiers and digitsin children who use pacifiers and digits– Most children will stop oral behaviors by Most children will stop oral behaviors by

age 2. For older children, consider using age 2. For older children, consider using rewards, gloves, replacement itemsrewards, gloves, replacement items

Caries or trauma with premature loss of Caries or trauma with premature loss of teeth and loss of spaceteeth and loss of space

Common Oral Lesions Common Oral Lesions in the Primary Care in the Primary Care OfficeOffice Lip lesionsLip lesions

– AngioedemaAngioedema– Herpes LabialisHerpes Labialis– MucoceleMucocele– Angular cheilitisAngular cheilitis

Lingual LesionsLingual Lesions– Hairy TongueHairy Tongue– Geographic TongueGeographic Tongue

Common Oral Lesions Common Oral Lesions in the Primary Care in the Primary Care OfficeOffice Oral conditions of infants and Oral conditions of infants and

childrenchildren– Natal teethNatal teeth– Epstein’s pearlsEpstein’s pearls– Eruption cystsEruption cysts– ThrushThrush

Tooth ConditionsTooth Conditions– Tooth StainingTooth Staining– ErosionsErosions

Common Oral Lesions Common Oral Lesions in the Primary Care in the Primary Care OfficeOffice White lesionsWhite lesions

– CandidaCandida– Oral LeukoplakiaOral Leukoplakia– Morsicatio BuccarumMorsicatio Buccarum

Vesiculobullous LesionsVesiculobullous Lesions– Primary herpes gingivostomatitisPrimary herpes gingivostomatitis– Recurrent herpesRecurrent herpes– HerpanginaHerpangina– Hand-foot-and-Mouth DiseaseHand-foot-and-Mouth Disease

Common Oral Lesions Common Oral Lesions in the Primary Care in the Primary Care OfficeOffice UlcersUlcers

– Aphthous UlcersAphthous Ulcers– Behcet’s SyndromeBehcet’s Syndrome

CariesCaries

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.

CariesCaries

DENTAL CARIES

Host Bacteria

Substrate

TEETH

MUTANSTREPTOCOCCILACTOBACILLI

FRUCTOSE

SUCROSE

Dental Caries ProcessDental Caries Process

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 StagesDental Caries Stages

Dental Caries StagesDental Caries Stages

If demineralization is allowed to continue, the tooth will eventually be eroded enough for a cavity to form.

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

Oral Screening Oral Screening ExaminationExamination Tips from a practicing clinicianTips from a practicing clinician

– Get in the habit of performing a brief oral Get in the habit of performing a brief oral examination in all patients presenting to examination in all patients presenting to your office for general wellness exams and your office for general wellness exams and use that time to discuss with patients their use that time to discuss with patients their dental habits and risk factors for oral dental habits and risk factors for oral diseasedisease

– Perform more detailed evaluations in Perform more detailed evaluations in patients when indicated by history any patients when indicated by history any review of systemsreview of systems

– In kids always lift the lipIn kids always lift the lip

Important Landmarks Important Landmarks of the Oral Cavityof the Oral Cavity LipsLips Labial and Buccal MucosaLabial and Buccal Mucosa Floor of mouthFloor of mouth Hard and soft palateHard and soft palate Parotid papillaParotid papilla Oropharynx and tonsilar pillarsOropharynx and tonsilar pillars