See also
Dental trauma
HSV gingivostomatitis
Key points
- Opportunistic education for families on good oral hygiene practices and how to access dental services can prevent dental caries
- Once a dental abscess or infection has formed, extraction or root canal therapy is usually required to remove the source of the infection
Background
- Children’s lower front teeth are the first to erupt, usually between 6–10 months (range 4–15 months). Children have 20 teeth by about 3 years of age
- Dental caries (tooth decay) occurs in more than 40% of Australian children and can begin as soon as teeth erupt during infancy
- “Early childhood caries” mainly affects the upper front teeth, and is seen in both prolonged breast and bottle-fed children (>18 months) who continue to feed frequently at night or who comfort suck to sleep once teeth have erupted
- Infants can have their teeth and gums wiped with a clean cloth or baby toothbrush
- From 12 months twice daily brushing with a smear of paediatric fluoridated toothpaste supervised or performed by parents (for children under 8 years) and annual dental review helps prevent caries and complications
- Routine dental care should be provided in the community rather than by hospitals, except for children with chronic illness that may be impacted by dental caries (eg cancer, cardiac disease, immunodeficiency, bleeding disorders, special needs) or where general anaesthetic is required
Tooth Anatomy
Teeth have three layers: enamel, dentine and pulp
Primary teeth (20): small, very white, bulbous crowns, often worn with flat edges
Permanent teeth (32): larger, creamier colour, jagged edges on newly-erupted teeth.
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<6 yo, primary dentition |
6–13 yo, mixed dentition |
13 yo+, permanent dentition |
Assessment
Dental History
- Frequency, duration and who performs tooth brushing
- Exposure to sugary and high acidity foods and drinks (including processed fruit juice and cordial)
- Frequency of bottles or sleeping with bottle teat or breast in mouth
- Previous dental review and advice given
- Previous dental trauma
- Dental or facial pain
- Chronic conditions which may impact saliva production or swallowing
- Consider non-dental causes eg cervical lymphadenitis, parotitis
Examination
- “Lift the lip” to ensure thorough examination of upper front teeth and gums
- Look for early signs of decay including white or brown spots/lines along the top of the tooth adjacent to the gum line which don’t brush off
- Check for loose or tender teeth
- Abscess may be indicated by:
- tender gingival swelling or erythema
- erythema and cellulitis of facial skin overlying tooth, submandibular or periorbital
- trismus
- fever and systemic symptoms may be absent
Management
Investigations
- Blood tests are not required
- In consultation with dentist consider orthopantogram (OPG) in children over 3 years who will cooperate to assess for early decay and other abnormalities
Treatment
- Treatment of dental abscesses in children usually involves tooth extraction with incision and drainage as needed
- Refer for urgent dental review:
- fever in setting of suspected dental abscess
- facial cellulitis or swelling
- Provide adequate analgesia
- Antimicrobial recommendations may vary according to local antimicrobial susceptibility patterns; please refer to
local guidelines
- amoxicillin 25 mg/kg (max 500 mg) PO tds or benzylpenicillin 50 mg/kg (max 1.2 g) IV 6-hourly
- Definitive treatment of the carious tooth will still be required after treatment of pain and infection
Other Dental Conditions
Dental socket bleeding
- Can occur after treatment if child disturbs blood clot or due to a
bleeding disorder
- Management:
- assess and manage haemodynamic status
- clean mouth with cold water
- provide local pressure with gauze soaked in water or saline (bite down if able for 30 minutes)
- if ongoing bleeding consider gauze soaked in tranexamic acid
- may need surgical dressing and suturing
- severe bleeding: IV access, FBE, coags, cross match, IV fluids, firm pressure, discuss with maxillofacial surgery and haematology
Natal teeth
- Usually do not require intervention
- Indications for extraction: very loose, inhalation risk, difficulties breastfeeding or traumatic ulcerations of the tongue/frenulum/lip
Thumb-sucking and dummies
- Prolonged thumb-sucking and dummy use can cause problems with front teeth alignment, open bite and a “V-shaped” palate
Consider consultation with local paediatric dental team when
Children with underlying medical, developmental or behavioural issues likely to benefit from specialist dental, anaesthetic or haematology input
Consider transfer when
Children requiring care beyond the comfort level of local services
For emergency advice and paediatric or neonatal ICU transfers, see
Retrieval Services.
Consider discharge when
- Suitable for oral therapy
- Cellulitis improving and extraction planned or complete
Parent information
Dental care
Additional notes
Each state has its own eligibility criteria for access to public dental services in addition to the federal
Child Dental Benefits Schedule (which can also be accessed through private dentists)
Last updated October 2020