Ent, eye and dental disorders

Cause of conjunctivitis Symptoms Signs

Viral Moderate discomfort Moderate epiphora

Mild discharge

Mild to moderate erythema

Bacterial Moderate to severe discomfort Moderate epiphora

Copious discharge

Moderate to severe erythema

Allergic Itch often prominent Mild to moderate epiphora

Stringy discharge

Mild erythema

Chemical Pain intense Severe epiphora

Mild discharge

Moderate to severe erythema

The descriptions in this table are intended to be a guide; there may be considerable variation and overlap in the signs and symptoms of conjunctivitis due to different causes.
Table 22.3.1 A summary of the eruption times for primary and permanent teeth

Primary dentition (months after birth)

Central incisors Lateral incisors Canines First molars Second molars

6–12 9–16 16–23 13–19 23–33

Permanent dentition (years of age)

Central Lateral First Second First Second Third

incisors incisors Canines premolars premolars molars molars molars

6–8 6.5–8.5 9–13 9.5–11.5 10–13 5.5–7.0 11–13 17

Risk factor Influence

Fluoride exposure Exposure to fluoridated water source and the regular use of fluoridated toothpaste are two key factors that reduce caries risk

Sugar exposure Infant feeding habits are very important with frequency of exposure being most relevant. High risk associated with prolonged on-demand night-time feeds

Family oral health history Poor parental oral health places child at risk of decay as cariogenic bacteria can be transmitted to infants from their primary care giver (usually the mother)

Social and family practices Poor, indigenous, ethnic and migrant groups have higher levels of dental disease

Medical history Medically compromised children are more at risk of dental decay the impact of which, on their general health, can be considerable. They are also less likely to receive appropriate treatment

Saliva flow Children with reduced salivary flow are at significant risk of developing caries as the acids in the oral cavity cannot be diluted, buffered and cleared effectively. Examples of such children are those on certain medications (e.g. anti-depressants, anticholinergics), exposed to radiotherapy or with certain conditions, e.g. Prader Willi and Velocardiofacial Syndrome.

 eruption

For most individuals a junior toothpaste (400  ppm fluoride) will be adequate until about the age

 of 5–6. However, for children with additional risk factors, an adult toothpaste may be more

 appropriate

Teeth should be brushed twice a day with nothing to eat or drink after the night-time brushing

Parents should supervise toothbrushing until around 8 years of age

The use of additional topical fluoride supplements (tablets or drops) can be of benefit to a few

 individuals but should be prescribed by an appropriate dental professional

Diet Reduce the total amount and frequency of intake of sugary foods and drinks

Avoid on-demand feeding through the night

Limit sugary snacks to meal times, when salivary flow is optimal

Avoid sugary snacks close to bedtime

Increase water intake

Dental attendance Parents should be encouraged to take their infant to a dental professional within 6 months of

 the eruption of their first teeth

Regular monitoring by a dental professional should continue in to adulthood

Remineralizing products Products containing calcium phosphopeptides, e.g. Tooth Mousse (GC Corporation, Itabashi-ku,

 Tokyo, Japan), are available through dental practitioners. These promote remineralization of

 early carious lesions
Table 22.3.4 The potential sources of acid responsible for dental erosion

Extrinsic Intrinsic

Citrus fruits and juice Cerebral palsy

Carbonated drinks (including Dysphagia

 ‘diet’ products) Gastro-oesophageal

Sports drinks  reflux

Wine

Swimming (poorly regulated Bulimia nervosa

 pool water)

Nutrition regimes for elite athletes

Recreational drugs

Topical effect – aspirin, vitamin C, phenylketonuria supplements, nebulized asthma medications (although this is controversial, and probably a minor problem more likely to affect adults)

Systemic effect on saliva – anti-depressants, anticholinergics

Some mouthwashes

Reducing acid exposure Inform patients of types of foods and drinks that have greatest erosive potential

Consumption of still/non-carbonated drinks as an alternative

Limiting the intake of acidic foods/drinks to meal times

Advocate consumption of a neutral food, e.g. cheese, immediately after a meal

Rinsing mouth out after acid exposure, i.e. after an episode of vomiting, but delaying

 brushing teeth immediately after the exposure as this increases wear of tooth tissue.

Optimizing salivary function Increased water intake

Use of water bottles in school bags

Advise use of sugar-free chewing gum to enhance salivary flow.

Enhancing resistance to erosion Suitable products include: neutral fluoride mouthwashes, Recaldent chewing gum and

 Tooth Mousse (Cadbury Japan Limited)