teething

DEEPTHI P. R .PUSHPAGIRI COLLEGE OF DENTAL SCIENCES

TEETHING

CONTENTS

INTRODUCTIONDEFINITIONCLINICAL FEATURESMANAGEMENTSTUDY REPORTSASSOCIATION WITH HERPES SIMPLEX

INFECTIONCONCLUSIONBIBLIOGRAPHY

INTRODUCTION

Teething - ‘eruption of primary teeth’.Abnormal or difficult eruption Eruption of primary teeth - fifth or sixth month.Eagerly awaited and important MILESTONENo distressSometimes local irritation- minor or severe

enough to interfere with the child’s sleepRelatively large molars Diseases – 6 to 26 months –19th century

teething

Teething is the physiologic process of the eruption of primary teeth through the gums.

CLINICAL FEATURES

LOCAL SIGNSHyperemia or swelling of the mucosa

overlying the erupting teethPatches of erythema on the cheeksFlushing of the skin of the adjacent cheekHand and fingers always put in the mouth

CLINICAL FEATURES

SYSTEMIC SIGNSGeneral irritability and cryingIncreased salivation and droolingLoss of appetiteInsanitySleeplessness and restlessnessMeningitisIncreased thirstCircumoral rashCough

ASSOCIATED PROBLEMS

SYSTEMICFeverConvulsionsDiarrheaVomitingBronchitisCholeraTetanusInfantile paralysis

ASSOCIATED PROBLEMS

LOCALEruption hematomaEruption sequestrumEctopic eruptionTransmigrationTransposition

POSSIBLE EXPLANATION FOR THE SYMPTOMS

Eruption- local inflammatory processIrritability- child puts whatever object found

into mouth- reliefUnclean objects- infection and inflammation

in the already inflamed gumsIf not relieved- restless, wakeful, fretful, fearful and refuses nourishment

POSSIBLE EXPLANATION FOR THE SYMPTOMS

Alimentary canal active-diarrhea, nausea, vomiting, convulsions

Association with diarrhea, fever, convulsions- coincidental

Mouthing of contaminated toys or teethers used to rub the gums

MANAGEMENT

PREVENTIVE MEASURESMention teething in prenatal counselling- the

first postnatal oral issue confrontedEducate members of the family Good oral and body hygiene; gums healthy and freshGums wiped after each meal with cotton

soaked in weak antiseptic- 1:100 KMnO4Adequate vitamins, minerals, proteins

LOCAL MANAGEMENT

Gentle massage- clean finger or saline soaked gauze piece & increased fluid consumption

TEETHING OBJECTSSatisfy the natural desire of the infant to

chew on hard objectsStimulates the gumpads for the smooth and

painless eruption

LOCAL MANAGEMENT

Teething foods -Hard non sweetened firm rusks

-Toasted bread -Biscuit preparations - Hard fruits and

vegetables

apple,guava,carrot

LOCAL MANAGEMENT

Teething toysSpecifically manufactured teething rings,

keys, blowers, rattlesRelief from soreness by the pressureLiquid containing ones – avoidedCaution against cheap toys with lead

LOCAL MANAGEMENT

Pacifiers releasing preventive agents- sodium fluoride, xylitol

Teething necklaces

Clove oil, licorice sticks, vanilla extract

Frozen items

LOCAL MANAGEMENT

Topical Medicaments - glycerin -lignocaine hydrchloride(tds/qid)Caution : Rapid systemic absorption- toxic doses if

misused -benzyl alcohol -mild purgatives (phenolphthalein, castor

oil, calomel, milk of magnesia)

INGREDIENTS IN PREPARATIONS

NAME LOCAL ANALGESIC

ANTISEPTIC ANALGESIC/ANTI-INFLAMMATORY

AGENT

Bonjela none 0.01% cetalkonium chloride4.6% glycerin

8.7% choline salicylate0.05% menthol

Dentinox 0.3% lignocaine hydrochloride

0.1% cetylpyridinium chloride0.3% polyethoxdodecane3% alcohol

0.06% menthol0.08% myrrh tincture

Pyralvex none 5% anthraquinone glycosides

1% salicylic acidTeejel none 0.01%

cetalkonium chloride

8.7% choline salicylate

SYSTEMIC TREATMENT

Only if local treatment has been ineffectiveANALGESICSSugar free Paracetamol

preparations(5ml=120mg) Dosage: upto 1year- 5ml at bedtime 1-5 years - 10ml at bedtime

Soluble acetyl salicylic acid tablets

Chamomilla- homeopathic medicine

SYSTEMIC TREATMENT

HYPNOTICS & SEDATIVESTo restore normal sleep rhythm after a

succession of sleepless nightsCombined with analgesics

SYSTEMIC TREATMENT

Chloral Elixir Paediatric BPC (5ml=200mg of chloral

hydrate) Dosage: Upto 1year- 2.5ml bd 1-5 years- 2.5-5ml tdsDichloralphenazone Elixir BPC (Welldorm Elixir) (5ml= 225mg

dichloralphenazone) Dosage: Upto 1 year- 2.5-5ml hs 1-5 years- 5-10ml hs

CAUTION

If symptoms persist for more than 24 hours, physician should be consulted to rule out URTI and other diseases of infancy

SELECTION OF TREATMENT

COMPLAINT TREATMENT

Irritation at the site of tooth eruption

Topical application

Daytime irritability and fretfulness Topical application & systemic analgesics

Disturbed sleep Topical application, systemic analgesics &hypnotic

SURGICAL TREATMENT

Pain relief from an eruption cyst or hematomaTECHNIQUE:Two semilunar incisions are made over the

crown of the tooth which meet at their extremities

The intervening portion of the tissue which lies over the occlusal portion of the unerupted tooth , is then removed with a pair of tissue forceps

STUDY REPORTS

King & Dally reported 5016 deaths in England & Wales – teething (1839)

Illingworth – failed to produce evidence of teething causing fever, convulsions, bronchitis or diarrhea

Supported by Tasanen’s study observing 192 eruptions in 126 infants & 107 controls, which concluded that

teething does not increase the incidence of infection

does not cause any rise in temperature, ESR, WBC count

does not cause diarrhea, cough, sleep disturbance or rubbing of the ear or cheek

STUDY REPORTS

It does cause: Day time restlessness Increase in finger sucking Increase in drooling Loss of appetite Change in the colour of the mucosa in the area of

the erupting tooth:No change in 1/3rd of the childrenSlight change in another 1/3rd

Pronounced change with small haemorrhages in 1/3rd

STUDY REPORTS

Study on 46 healthy infants - Jaber, Cohn & Mor a small increase in body temperature

- 43% -the day of emergence of their first toothMacknin et al confirmed these resultsLeung reported- serious systemic disturbances

were overlooked by ascribing symptoms to teething

Swann identified an organic cause of illness in 48 patients out of 50 hospitalised due to symptoms- teething

ASSOCIATION WITH HERPES SIMPLEX INFECTION

Few scientific data to implicate teething as the etiology of fever, diarrhea

Children with teething symptoms- culture positive for HSV Type1

On examination:Generalized erythematous gingivaSeveral ulcerated areas in the mucosaCoated white tongueSeveral partially erupted teeth

ASSOCIATION WITH HERPES SIMPLEX INFECTION

DiagnosisSubjective symptomsProdrome of itchiness or mild tingling sensation

before the development of the lesionsMild flulike symptomsObjective symptoms2-4 mm diameter size vesicles Rupture & crust over in 36-48 hoursHeals in 7 days

ASSOCIATION WITH HERPES SIMPLEX INFECTION

InvestigationsViral titre peak in 48 hours - then falls Tzanck preparation of the vesicles-

multinucleated giant cells(Tzanck cells) & inclusion bodies(Lipschutz bodies)

ASSOCIATION WITH HERPES SIMPLEX INFECTION

TherapyKeep the lesions well lubricated with an

emollient to promote healing Isolate the patient from persons at risk for

primary herpes infectionProphylactic oral acyclovir reduce the

frequency

CONCLUSION

Since the time of Hippocrates (460-377BC) it has been observed that teething infants often suffer from several systemic conditions including fever, diarrhea, convulsions.

This discussion concludes with the note that, from the review of the available literature on teething there is no conclusive evidence to attribute teething as the sole factor leading to the conditions associated with it.

This is an area that requires still lot of investigation for explanation.

BIBLIOGRAPHY

Dentistry for the Child and Adolescent- McDonald, Avery, Dean(8th edition)

Pediatric Dentistry- Infancy through Adolescence- Pinkham(3rd edition)

A manual of paediatric dentistry- R.J.Andlaw & W.P.Rock(4th edition)

Textbook of Pedodontics- Shobha Tandon (2nd edition) Textbook of Pediatric Dentistry- S.G.Damle (3rd edition)Principles & Practice of Pedodontics- Arathi Rao (2nd edition)Jablonki’s Dictionary of Dentistrywww.infantteethingtoys.com

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