teething
TRANSCRIPT
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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