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Teething
1.
2. D E E P T H I P . R .
P U S H P A G I R I C O L L E G E O F D E N T A L S C I E N C E S
TEETHING
3. CONTENTS
INTRODUCTION
DEFINITION
CLINICAL FEATURES
MANAGEMENT
STUDY REPORTS
ASSOCIATION WITH HERPES SIMPLEX
INFECTION
CONCLUSION
BIBLIOGRAPHY
4. INTRODUCTION
Teething - ‘eruption of primary teeth’.
Abnormal or difficult eruption
Eruption of primary teeth - fifth or sixth month.
Eagerly awaited and important MILESTONE
No distress
Sometimes local irritation- minor or severe enough
to interfere with the child’s sleep
Relatively large molars
Diseases – 6 to 26 months –19th century teething
5. Teething is the physiologic process of the eruption of
primary teeth through the gums.
6. CLINICAL FEATURES
LOCAL SIGNS
Hyperemia or swelling of the mucosa overlying the
erupting teeth
Patches of erythema on the cheeks
Flushing of the skin of the adjacent cheek
Hand and fingers always put in the mouth
7. CLINICAL FEATURES
SYSTEMIC SIGNS
General irritability and crying
Increased salivation and drooling
Loss of appetite
Insanity
Sleeplessness and restlessness
Meningitis
Increased thirst
Circumoral rash
Cough
10. POSSIBLE EXPLANATION FOR THE
SYMPTOMS
Eruption- local inflammatory process
Irritability- child puts whatever object found into
mouth- relief
Unclean objects- infection and inflammation in the
already inflamed gums
If not relieved- restless,
wakeful, fretful, fearful and
refuses nourishment
11. 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
12. MANAGEMENT
PREVENTIVE MEASURES
Mention teething in prenatal counselling- the first
postnatal oral issue confronted
Educate members of the family
Good oral and body hygiene;
gums healthy and fresh
Gums wiped after each meal with cotton soaked in
weak antiseptic- 1:100 KMnO4
Adequate vitamins, minerals, proteins
13. LOCAL MANAGEMENT
Gentle massage- clean finger or saline soaked gauze
piece & increased fluid consumption
TEETHING OBJECTS
Satisfy the natural desire of the infant to chew on
hard objects
Stimulates the gumpads for the smooth and painless
eruption
15. LOCAL MANAGEMENT
Teething toys
Specifically manufactured teething rings, keys,
blowers, rattles
Relief from soreness by the pressure
Liquid containing ones – avoided
Caution against cheap toys with lead
19. SYSTEMIC TREATMENT
Only if local treatment has been ineffective
ANALGESICS
Sugar 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
20. SYSTEMIC TREATMENT
HYPNOTICS & SEDATIVES
To restore normal sleep rhythm after a succession of
sleepless nights
Combined with analgesics
22. CAUTION
If symptoms persist for more than 24 hours,
physician should be consulted to rule out
URTI and other diseases of infancy
23. 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
24. SURGICAL
TREATMENT
Pain relief from an eruption cyst or hematoma
TECHNIQUE:
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
25. 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
26. 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 children
Slight change in another 1/3rd
Pronounced change with small haemorrhages in 1/3rd
27. STUDY REPORTS
Study on 46 healthy infants - Jaber, Cohn & Mor
a small increase in body temperature
- 43%
-the day of emergence of their first tooth
Macknin et al confirmed these results
Leung 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
28. 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 gingiva
Several ulcerated areas in
the mucosa
Coated white tongue
Several partially erupted teeth
29. ASSOCIATION WITH HERPES SIMPLEX
INFECTION
Diagnosis
Subjective symptoms
Prodrome of itchiness or mild tingling sensation
before the development of the lesions
Mild flulike symptoms
Objective symptoms
2-4 mm diameter size vesicles
Rupture & crust over in
36-48 hours
Heals in 7 days
30. ASSOCIATION WITH HERPES SIMPLEX
INFECTION
Investigations
Viral titre peak in 48 hours - then falls
Tzanck preparation of the vesicles-
multinucleated giant cells(Tzanck cells) &
inclusion bodies(Lipschutz bodies)
31. ASSOCIATION WITH HERPES SIMPLEX
INFECTION
Therapy
Keep the lesions well lubricated with an emollient to
promote healing
Isolate the patient from persons at risk for primary
herpes infection
Prophylactic oral acyclovir reduce the frequency
32. 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.
33. 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 Dentistry
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