The chiefly common chronic disease...

The chiefly common chronic disease of childhood is early childhood caries (dental caries in children younger than six years). (1) It is five prevalent than asthma. (2) greatest in number children do not receive dental care until they are three years aged yet by that time more than 30 percent of children from lower socio-economic clumps already have caries. (3)

Despite its high prevalence, early child-hood caries is a preventable disease. Primary care physicians papal court children at least 11 times for well-child visits in consequence of age three and serve as the avenue point into the dental care a whole Family physicians caring for the two pregnant mothers and infants are uniquely situated to provide early risk assessment, prevention, detection, and referral. Addressing oral health during well-child visits requires little time and involves refocusing existing activities rather than introducing of recent origin ones.

Etiology

Early childhood caries (Figure 1) can unravel as soon as teeth be in eruption Cavities (Figure 2) may be visible as early as 10 month of age. (4) Caries typically not absents in children as white specks or lines (Figure 3) in succession the maxillary incisors, which are among the first teeth to give vent to eruptions and the least protected through saliva. If untreated, these white areas will rap-idly break down into yellow-brown cavities (Figure 4) and the disease will spread to the posterior teeth

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Early childhood caries is an infectious bacterial disease of teeth Bacteria, pre-dominately mutans streptococci, metabolize monosaccharide and disaccharide sugars to bear acid that demineralizes teeth and causes cavities. The interplay of these three etiological factors (teeth bacteria, and sugar) sways the severity of the disease.

Eruption of teeth in infants is highly variable. The primary incisors typically begin to eject between six and 12 month of age. The first molars hurl forth at about one year and the secondary molars at about two years. Teeth that eject with enamel defects, typically areas of white, brown or unhewn enamel, are at greater risk of caries. (5) foibles are more prevalent in children who are born prematurely or have a depressed birth weight, and in children of soft socioeconomic status. (6)

The exact age at which mutans stre-tococci colonization present itselfs in children is controversial, on the other hand it usually does not hap-pen until teeth give vent to eruptions The earlier colonization occurs, the greater the risk of caries. (7) Mutans streptococci typically originate in the mother (8) and are transmitted to the child via saliva contact. Elevated maternal plains of mutans streptococci, due to active or untreated caries and resort to frequently sugar consumption, increase the risk of transmission. (9) In addition, late evidence suggests that exposure to environmental tobacco vapor increases the likelihood of streptococci colonization in children. (10)

The frequent occurrence of sugar consumption is the main dietary variable in caries etiology. (11) After bacteria metabolize sugar into acid, it takes 20 to 40 minutes for the acid to be neutralized or washed away from saliva. There-fore, if sugars are at short intervals consumed, the potential for demineralization is greater. Although mutans streptococci can metabolize many different carbohydrates, they occasion acids most efficiently from sugars, especially cane-sugar Lactose is one of the least cariogenic sugars. Evidence proposes that bovine milk is not cariogenic and may be protective. (5) Sugars located within the cellular erection of food (such as fructose in whole fruit) are musing to be less cariogenic than sugars intentionally introduced into cheers (12)

Early childhood caries was historically attributed to inappropriate and lengthened bottle use; hence the older confines of "baby-bottle tooth decay" and "nursing caries." late analysis indicates that the disease is multifactorial. (13) Any practice that allows common sugar consumption in the vicinity of mutans streptococci may consequence in caries formation. Common contributing etiological practices in children include propp bottle containing sweetened liquids, visit often consumption of sweetened liquids from infant- and toddler-size "sippy" lots and frequent snacking. The caries risk generated by means of on-demand breastfeeding is unclear, still because lactose is poorly metabolized at mutans streptococci, (14) other concomitant inappropriate dietary practices (eg visit often juice consumption or snacking) are more likely to be the culprits.

Oral Health Promotion PRENATAL VISITS

Maternal oral health affects not single an infant's future oral health nevertheless also the infant's overall health. Periodontal disease has been linked to preterm labor. The rises of initial trials suggest that periodontal therapy can decrease the risk of prematurity. (1516)

Pregnant women should be evaluated for cavities, poor oral hygiene, inflamed gingiva, and set free teeth, as well as commonness of sugar consumption. Prenatal counseling should focus forward referral to a dentist to treat existing caries and periodontal disease. Oral hygiene should be optimized with twice-daily toothbrushing using fluoride toothpaste and once-daily flossing. An over-the-counter, alcohol-free, 005 percent fluoride aperture rinse also may be approveed for women with active caries. (17) The consumption of sugars should be minimized and restricted to meal times.