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  1. 1. 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. 3. 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
  4. 4.  Teething is the physiologic process of the eruption of primary teeth through the gums.
  5. 5. 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
  6. 6. 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
  7. 7. ASSOCIATED PROBLEMS SYSTEMIC  Fever  Convulsions  Diarrhea  Vomiting  Bronchitis  Cholera  Tetanus  Infantile paralysis
  8. 8. ASSOCIATED PROBLEMS LOCAL  Eruption hematoma  Eruption sequestrum  Ectopic eruption  Transmigration  Transposition
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. LOCAL MANAGEMENT Teething foods -Hard non sweetened firm rusks -Toasted bread -Biscuit preparations - Hard fruits and vegetables apple,guava,carrot
  14. 14. 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
  15. 15. LOCAL MANAGEMENT  Pacifiers releasing preventive agents- sodium fluoride, xylitol  Teething necklaces  Clove oil, licorice sticks, vanilla extract  Frozen items
  16. 16. 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)
  17. 17. INGREDIENTS IN PREPARATIONS NAME LOCAL ANALGESIC ANTISEPTIC ANALGESIC/ ANTI-INFLAMMATORY AGENT Bonjela none 0.01% cetalkonium chloride 4.6% glycerin 8.7% choline salicylate 0.05% menthol Dentinox 0.3% lignocaine hydrochloride 0.1% cetylpyridinium chloride 0.3% polyethoxdodecane 3% alcohol 0.06% menthol 0.08% myrrh tincture Pyralvex none 5% anthraquinone glycosides 1% salicylic acid Teejel none 0.01% cetalkonium chloride 8.7% choline salicylate
  18. 18. 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
  19. 19. SYSTEMIC TREATMENT HYPNOTICS & SEDATIVES  To restore normal sleep rhythm after a succession of sleepless nights  Combined with analgesics
  20. 20. SYSTEMIC TREATMENT  Chloral Elixir Paediatric BPC (5ml=200mg of chloral hydrate) Dosage: Upto 1year- 2.5ml bd 1-5 years- 2.5-5ml tds  Dichloralphenazone Elixir BPC (Welldorm Elixir) (5ml= 225mg dichloralphenazone) Dosage: Upto 1 year- 2.5-5ml hs 1-5 years- 5-10ml hs
  21. 21. CAUTION If symptoms persist for more than 24 hours, physician should be consulted to rule out URTI and other diseases of infancy
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. 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
  29. 29. 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)
  30. 30. 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
  31. 31. 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.
  32. 32. 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  www.infantteethingtoys.com
  33. 33. THANK YOU