CASE BASED DISCUSSION This document presents a case-based discussion focused on clinical analysis and decision-making. <img >IMG_20240418_153012.jpg</img > ## CASE 1 * 20-month-old boy * Fit and well. * Fever for 3 days. * Poor oral intake * (only icecream) * Questions for parents? * Diagnosis? Causative agent? * Infectiousness? * Peak incidence? * Management   #### Patient History - 20-month-old boy - Fit and well - Fever for 3 days - Poor oral intake (accepting only ice cream) #### Clinical Considerations - Questions for parents? - Diagnosis? - Causative agent? - Infectiousness? - Peak incidence? - Management A close-up photograph of a young child's open mouth showing the gums and teeth, associated with the clinical case description on the left. A close-up photograph of a child's lower gum and teeth area, likely presenting a clinical finding relevant to CASE 1. # PRIMARY HERPETIC GINGIVOSTOMATITIS * **Herpes simplex Virus Type I** * **Peak incidence 12-18 months** * **Symptoms – fever, headaches, malaise, irritability, cervical lymphadenopathy** * **Oral symptoms – oral pain, mild dysphagia, stomatitis, intraepithelial fluid-filled vesicles appear** * **Painful, enlarged gingiva** * **Erosions of free gingival margin** <img src="https://i.imgur.com/5g0p7VQ.jpeg" alt="">   #### Etiology and Epidemiology - **Causative Agent:** Herpes simplex Virus Type I - **Peak Incidence:** 12-18 months #### Systemic Symptoms - Fever - Headaches - Malaise - Irritability - Cervical lymphadenopathy #### Oral Manifestations - Oral pain and mild dysphagia - Stomatitis - Appearance of intraepithelial fluid-filled vesicles - Painful, enlarged gingiva - Erosions of the free gingival margin A clinical photo showing an infant's mouth, likely an example referenced by the text 'Erosions of free gingival margin'. A close-up photograph of a child's teeth and gums, illustrating the context of 'gingivostomatitis' and 'mouth pain' mentioned in the report. # **PRIMARY HERPETIC GINGIVOSTOMATITIS** * Incubation time – 3-5 days (**48hr history of irritability, pyrexia, malaise**) * Transmission – direct contact with **lesions and infected oral secretions** * Course of disease – **self limiting**, heals within **10-14 days**  #### Disease Progression - **Incubation Time:** 3-5 days - **Initial Presentation:** 48-hour history of irritability, pyrexia, and malaise - **Course of Disease:** Self-limiting; typically heals within 10-14 days #### Transmission - Direct contact with active lesions - Contact with infected oral secretions A clinical photograph on the right side of the slide shows the open mouth of a patient, illustrating a close-up view of the oral cavity. # MANAGEMENT <table><tbody><tr><td><strong>Symptomatic care</strong></td></tr><tr><td>Oral fluids</td></tr><tr><td>Bed rest</td></tr><tr><td>Soft diet (icecream ☺)</td></tr><tr><td>Analgesia ? Weight = 12kg</td></tr></tbody></table>  #### Symptomatic Care - Maintain intake of oral fluids - Bed rest - Soft diet (e.g., ice cream) #### Pharmacological Management - Analgesia calculation based on patient weight (12kg) Close-up photograph of a child's mouth, showing teeth and tongue, positioned within a black triangular overlay on the right side of the slide. # ANALGESIA? **6** ### **Analgesia ? Weight = 12kg** **Paracetamol 15mg/kg**, 4-6 hrly (maximum 1g per dose, 4g per day) 15 x 12kg = **180mg** every 4-6hrs **Panadol 1-5yrs Suspension contains** **24mg/ml** 180/24 = **7.5ml** every 4-6hrs     #### Dosage Calculation for 12kg Patient **Paracetamol Dosage:** - **Standard Dose:** 15mg/kg every 4-6 hours - **Maximum Limits:** 1g per dose, 4g per day - **Calculation:** 15mg x 12kg = **180mg** every 4-6 hours **Administration (Panadol 1-5yrs Suspension):** - **Concentration:** 24mg/ml - **Volume Calculation:** 180mg / 24mg/ml = **7.5ml** every 4-6 hours A photo of Accord Aciclovir 400 mg Tablets box, shown in background of a slide about pediatric anesthesia and weight-based dosage calculations. A small photo of the label of a topical solution bottle on the right side of the slide, near the main text block. A placeholder image of an infant or young child's mouth with open lips, positioned at the bottom right of the slide next to drug dosage text. A photo of Panadol Children 1-5 Years Paracetamol Suspension box, specifically the strawberry flavor 24mg/mL version shown as the reference product for dosage calculation. Based on the provided text and image content, here is the formatted output. # CASE 2 **7** * 5.5-year-old boy * Presented to your surgery this afternoon * Lower right-hand-side submandibular swelling started this morning * **Questions for parents?** * **Initial investigations before looking in mouth?** <img src="image_placeholder.jpg" alt="Photo of a 5.5-year-old boy in a grey hoodie showing a lower right hand side swelling" />  #### Patient Presentation - 5.5-year-old boy - Presented to surgery this afternoon - Lower right-hand-side submandibular swelling started this morning #### Clinical Considerations - Questions for parents? - Initial investigations before looking in mouth? A photograph of the patient mentioned in the text, a 5.5-year-old boy. The image context indicates he is present in a medical surgery with lower right-hand-side submandibular swelling. # INITIAL INVESTIGATION * **Medically fit and well, immunised** * **History of chronic nocturnal pain** * Worsened over past few days * Managing with analgesia * **No previous swellings or history of trauma** * **No prior dental treatment** * **Temperature = 38.5 degrees C** * **Firm tender swelling localised to lower RHS** * **Weight = 18kg** <img src="https://i.ibb.co/sh61g6b/78477845-89620888-7409-5947-9196-60988207059d.jpg" alt="A child in a grey hoodie with Donkey Kong logo on it and pink circles over their eyes standing next to a teal chair.">  #### Medical and Dental History - Medically fit and well, immunised - History of chronic nocturnal pain - Worsened over past few days - Managing with analgesia - No previous swellings or history of trauma - No prior dental treatment #### Clinical Findings - Temperature: 38.5 degrees C - Firm tender swelling localised to lower RHS - Weight: 18kg A photo of a young child, identified by context as weighing 18kg with a fever of 38.5 degrees C. The child has pink circles edited over their eyes and is wearing a grey 'Donkey Kong' hoodie, standing near a teal chair. # **9 INITIAL INVESTIGATION** ## **• Early mixed dentition** ## **• 46, 85, 84 visible** ## **• Large cavity with debris present 85DO** ## **• Loss of Q4 buccal sulcular depth** ## **• Possible causes of 85 cavity?** ## **• What will you see on an x-ray?** ## **• Plan for today’s management** ## **• Calculate dosages of any medications used (18kg)** <img src="" alt="Clinical photography of a child's lower left jaw in profile, displaying the lower molars with visible decay and debris. The left canine tooth is being manually depressed.">  #### Intraoral Examination - Early mixed dentition - 46, 85, 84 visible - Large cavity with debris present at 85DO - Loss of Q4 buccal sulcular depth #### Diagnostic and Management Planning - Possible causes of 85 cavity? - What will you see on an x-ray? - Plan for today’s management - Calculate dosages of any medications used (18kg) Clinical photography of a child's lower left jaw in profile, showing early mixed dentition. The image displays visible teeth 46, 85, and 84, with a large cavity and debris noted on the 85 primary molar (85DO). # Initial Investigation * 85 cavity: * **HSPM** * *Dental caries* * *Failed existing restoration* * *Trauma (fracture)* * **Or of MIH if HSPM present? 4.66** **10** <img src="" alt="Slide showing initial investigation findings: 85 cavity, HSPM, Dental caries, Failed existing restoration, Trauma (fracture), Or of MIH if HSPM present? 4.66, and page number 10."/>  #### Differential Diagnosis for 85 Cavity - HSPM (Hypomineralised Second Primary Molar) - Dental caries - Failed existing restoration - Trauma (fracture) - Consideration of MIH (Molar Incisor Hypomineralisation) if HSPM is present A detailed clinical photo showing a severe tooth cavity (labeled as '85 cavity' and 'HSPM') on the right, alongside a clinical shot of the same area on a patient. The visual evidence supports text mentions of dental caries and trauma/fracture associated with High Cervical Severity Periodontal Morphology. # INITIAL INVESTIGATION **Radiographs:** - Size 0 bitewing - OPG - Vertical bitewing - PA with parent holding film Findings: - Cavity to pulp - Furcation radiolucency - Accessory canals in furcation area <img src="image_not_loaded" alt="A dental X-ray showing teeth with cavity to pulp and furcation radiolucency" />  #### Radiographic Modalities - Size 0 bitewing - OPG - Vertical bitewing - PA with parent holding film #### Radiographic Findings - Cavity extending to pulp - Furcation radiolucency - Accessory canals in furcation area A radiograph displaying the teeth in the lower right quadrant of the mouth. It visually presents the findings listed in the text, including cavity to pulp and furcation radiolucency. # PENICILLIN V ### **12** * Dose = 12.5mg/kg up to 500mg orally every 6hrs for 5 days * Weight = 18kg * 12.5 x 18kg = 225mg * Oral suspension 150mg/5ml * 225/150 x 5 = **7.5ml every 6hrs for 5 days** #### Dosage Calculation (18kg Patient) - Recommended Dose: 12.5mg/kg (up to 500mg) orally every 6 hours for 5 days - Calculation: 12.5mg x 18kg = 225mg - Preparation: Oral suspension 150mg/5ml - Administration: 7.5ml every 6 hours for 5 days # METRONIDAZOLE **13** * Dose = 10mg/kg up to 400mg orally every 12hrs for 5 days * Weight = 18kg * 10 x 18kg = 180mg * Oral suspension 40mg/ml (*written in lecture as 200mg/5ml*) * 180/40 x 1 = **4.5ml every 12hrs for 5 days** #### Dosage Calculation (18kg Patient) - Recommended Dose: 10mg/kg (up to 400mg) orally every 12 hours for 5 days - Calculation: 10mg x 18kg = 180mg - Preparation: Oral suspension 40mg/ml (equivalent to 200mg/5ml) - Administration: 4.5ml every 12 hours for 5 days #### Dosage Calculation (18kg Patient) - Recommended Dose: 10mg/kg (up to 400mg) orally every 12 hours for 5 days - Calculation: 10mg x 18kg = 180mg - Preparation: Oral suspension 40mg/ml (equivalent to 200mg/5ml) - Administration: 4.5ml every 12 hours for 5 days [Figure 1: Two medical prescription documents are visible. The left document shows pharmacy-style prescription details, while the right document contains patient treatment instructions. The "Public Health Service" on the right document is visibly blurred out] 15 Page 1 Left Page: Dr Senior Student DMD 17 Monash Ave NEDLANDS WA 6009 6457 4400 Prescriber no. **11094567** Patient: Riley Child Address: 12 Macarena place CLAREMONT WA 6010 Date: 1/1/2025 Right Page: **DOB 2/1/2020** **Weight=18kg** Rx: Penicillin V oral suspension 150mg/5ml (200ml) Take 7.5ml orally every 6hrs for 5 days. Metronidazole oral suspension 40mg/ml (200ml) Take 4.5ml every 12hrs for 5 days. For dental treatment only. 11/05/2025   #### Prescription Details - **Patient:** Riley Child (DOB: 2/1/2020, Weight: 18kg) - **Address:** 12 Macarena Place, Claremont WA 6010 - **Date:** 1/1/2025 - **Prescriber:** Dr Senior Student DMD (Prescriber no. 11094567) #### Medications Prescribed 1. **Penicillin V oral suspension** - Concentration: 150mg/5ml (200ml bottle) - Instructions: Take 7.5ml orally every 6 hours for 5 days. 2. **Metronidazole oral suspension** - Concentration: 40mg/ml (200ml bottle) - Instructions: Take 4.5ml every 12 hours for 5 days. - Note: For dental treatment only. A medical prescription document showing details for Dr Senior Student DMD and patient Riley Child, including pharmacy- A second medical prescription document listing treatments for Riley Child (DOB 2/1/2020) with Penicillin V and Metronidazole oral suspension, dated 11/05/2025 # MANAGEMENT PLAN 16 * **Analgesia - Paracetamol and Ibuprofen** * Paracetamol 15mg/kg, 4-6 hrly (max 4000mg/day) * Ibuprofen 10mg/kg, 6-8hrly (max 2500mg/day) * **Soft diet** * **If symptoms worsen contact clinic again** * Provide referral letter to PCH Dental. Call PCH Dental **BEFORE** patient leaves your surgery to attend. * **If symptoms worsen after hours attend PCH ED** * **Book for extraction of 85 in approximately 1 week** #### Immediate Symptom Management - **Analgesia:** - Paracetamol: 15mg/kg, 4-6 hourly (max 4000mg/day) - Ibuprofen: 10mg/kg, 6-8 hourly (max 2500mg/day) - **Dietary Advice:** Soft diet #### Emergency and Follow-up Protocols - If symptoms worsen: - Contact clinic immediately. - Provide referral letter to PCH Dental. Call PCH Dental before the patient leaves the surgery. - After hours: Attend PCH Emergency Department (ED). - **Scheduled Treatment:** Book for extraction of 85 in approximately 1 week. # EXTRACTION APPOINTMENT - LA * Topical lignocaine gel 2-5% * Dry surface * Apply with cotton bud * Leave in situ for 2 minutes * Wipe away with damp gauze * Choice of injection technique? * Buccal and lingual infiltration (access lingual via interpapillary) #### Topical Anesthesia Protocol - Agent: Topical lignocaine gel 2-5% - Procedure: 1. Dry surface 2. Apply with cotton bud 3. Leave in situ for 2 minutes 4. Wipe away with damp gauze #### Injection Technique - Buccal and lingual infiltration (access lingual via interpapillary route) # IF IAN BLOCK WAS CHOSEN? - Anatomical differences between adults and children? - Ramus shorter vertically - Ramus narrower anterio-posteriorly 18 <img src="placeholder_path_to_jaw_model_image.jpg" alt="Diagram of anatomical differences between adult and child mandible showing injection site for IAN block">  #### Pediatric vs. Adult Mandibular Anatomy - Ramus is shorter vertically in children. - Ramus is narrower anterio-posteriorly in children. A close-up photograph of a dental anatomical model, specifically the mandibular ramus. The image demonstrates the location for an Inferior Alveolar Nerve (IAN) block, with a syringe and dental clamp shown in place. # EXTRACTION APPOINTMENT - LA 19 * Choice of LA agent and why? * 4% Articaine with adrenaline 1:100,000 * More effective mandibular infiltration * Short acting time * Could argue for 2% Lignocaine with adrenaline 1:80,000 * Acidic environment from infection means shorter acting time * Need to wait longer to take effect #### Local Anesthetic Agent Selection - **Primary Choice:** 4% Articaine with adrenaline 1:100,000 - Rationale: More effective mandibular infiltration and short acting time. - **Alternative Choice:** 2% Lignocaine with adrenaline 1:80,000 - Considerations: Acidic environment from infection may result in shorter acting time and require longer onset time. # 20 ## MAXIMUM LA DOSE CALCULATION * 4% Articaïne with adrenaline 1:100000 * Weight = 18kg * 7 x 18 = 146 mg * 4% Articaine is 40 mg/ml * 126/40 = maximum 3.15 ml * 3.15/2.2 = 1.4 carpules #### Dosage Calculation for 4% Articaine (1:100,000) - Patient Weight: 18kg - Maximum safe dose calculation: 7mg/kg x 18kg = 126mg (Note: text indicates 146mg, but calculation 7x18 equals 126mg) - Concentration: 4% Articaine = 40mg/ml - Volume Limit: 126mg / 40mg/ml = 3.15ml - Cartridge Limit: 3.15ml / 2.2ml = 1.4 carpules # EXTRACTION APPOINTMENT – EXO ## INSTRUMENTATION | Page | 21 | | :-- | :-- | - Forceps: - Lower baby hawks - Luxator - 3S or 3C luxator   #### Surgical Instruments - **Forceps:** Lower baby hawks - **Luxators:** 3S or 3C luxator A photograph of dental extraction tools, specifically forceps described in the text as 'Lower baby hawks', alongside two handles and a clamp mechanism. A photograph of a dental radiograph showing a tooth and surrounding structures, contextualized by the slide's topic of extraction instrumentation. # EXTRACTION APPOINTMENT - EXO Number: **22** * **Instrumentation?** * **Forceps:** * *Lower baby hawks* * **Luxator** * *3S or 3C luxator*    #### Surgical Instruments - **Forceps:** Lower baby hawks - **Luxators:** 3S or 3C luxator A photograph showing dental extraction instruments, specifically two lower baby hawks and a pair of forceps, corresponding to the text 'Forceps: Lower baby hawks'. An image of a dental luxator, likely the '3S or 3C luxator' mentioned in the text. It shows a white handle with three grip lines and a pointed metal tip resting on a blue circular background. An X-ray image of the lower posterior teeth, illustrating the extraction appointment context related to 'EXTRACTION APPOINTMENT - EXO'. **EXTRACTION APPOINTMENT - EXO** **23** * Instrumentation? * **Forceps:** * Lower baby hawks * [Image of Lower baby hawks forceps] * **Luxator** * 3S or 3C luxator * [Image of 3S or 3C luxator] * [Image of teeth on x-ray]    #### Surgical Instruments - **Forceps:** Lower baby hawks - **Luxators:** 3S or 3C luxator Photo of lower baby hawks forceps alongside two tooth specimens, shown under the 'Forceps' section for extraction instrumentation. Photo of a 3S or 3C luxator with a close-up inset of the tip, displayed alongside the 'Luxator' text on the slide. X-ray image showing a tooth with its roots and surrounding bone structure, shown in context of luxation during dental extraction. # EXTRACTION APPOINTMENT - EXO • Luxator – wedge around the tooth to separate the PDL fibres from the tooth. Gently drive in apical direction. • ### Forceps – 1. Molar beaks engage the furcation area 2. Apical pressure (primary drive) 3. Lingual movement 4. Continuous buccal movement 5. Tooth removal towards buccal #### Extraction Technique - **Luxator Use:** Wedge around the tooth to separate PDL fibres; drive gently in an apical direction. - **Forceps Technique:** 1. Engage molar beaks at the furcation area. 2. Apply apical pressure (primary drive). 3. Move lingually. 4. Apply continuous buccal movement. 5. Remove tooth towards the buccal aspect. # AFTER EXTRACTION * Irrigate with saline to rinse out pus * Digital pressure to compress walls of socket * Bite on sterile gauze to achieve haemostasis * Suture soft tissues if required * Verbal and written postop instructions ? * <u>Documentation</u> #### Immediate Post-Operative Steps - Irrigate with saline to rinse out pus. - Apply digital pressure to compress socket walls. - Have patient bite on sterile gauze to achieve haemostasis. - Suture soft tissues if required. #### Follow-up and Records - Provide verbal and written post-operative instructions. - Complete clinical documentation. # CASE 3 - 3-year-old-boy - Initial discussion - Investigations - Diagnosis from this image - Management  - Age: 3 years - Gender: Male - Key concern: Oral bleeding  #### Patient Profile - **Age:** 3 years old - **Gender:** Male - **Chief Complaint:** Oral bleeding #### Clinical Overview - Initial discussion and history taking - Clinical and radiographic investigations - Diagnosis based on clinical presentation and imaging - Comprehensive management plan A close-up photograph of a 3-year-old boy's face showing significant oral bleeding with blood on his lips, related to CASE 3 which lists 'Diagnosis from this image' as a key agenda item. ### INITIAL DISCUSSION • **What happened?** Fell forwards onto edge of play equipment • **When?** 2 hours ago • **Where?** At the park • **Who witnessed?** Grandma and older brother • **Any loss of consciousness etc?** No • **Any previous trauma?** No • **Medical history?** Fit and healthy, immunized • **Non-dental injuries?** Nil  <img src="placeholder.png" alt="Image of a child playing on equipment at a park">  #### Injury History - **Mechanism of Injury:** Fell forwards onto the edge of play equipment - **Timing:** 2 hours ago - **Location:** At the park - **Witnesses:** Grandma and older brother #### Medical and Trauma Screening - **Loss of Consciousness:** No - **Previous Dental Trauma:** No - **Medical History:** Fit and healthy; fully immunized - **Non-dental Injuries:** None reported A close-up photo of a young child's face showing an injured mouth with visible bleeding and teeth exposure, placed next to the text section titled 'INITIAL DISCUSSION'. # INVESTIGATIONS? - Check for tooth displacement - 61 palatally luxated - Mobility - 51 grade I mobile, 61 and 62 nil - Tenderness - 51 and 61 tender - Bleeding at gingival crevice - 51 and 61 - Soft tissue injuries – mild gingival bruising only <div style="text-align: center;"> <img src="https://i.imgur.com/1234567.jpg" alt="Child's mouth with visible dental injury" /> </div>  #### Clinical Examination Findings - **Tooth Displacement:** - Tooth 61 is palatally luxated - **Mobility:** - Tooth 51: Grade I mobility - Teeth 61 and 62: No mobility - **Tenderness to Percussion/Palpation:** - Teeth 51 and 61 are tender - **Gingival Assessment:** - Bleeding at the gingival crevice of 51 and 61 - Soft tissue injuries: Mild gingival bruising only Clinical photograph of a child's mouth showing dental injury context, specifically highlighting investigation areas related to tooth displacement as listed in the slide text. # **INVESTIGATIONS? RADIOGRAPHS** Maxillary occlusal + 3xPAs - 51 - normal PDL - 61 - root appears shortened - Displaced - Widened PDL  #### Radiographic Imaging - **Views Obtained:** Maxillary occlusal and 3 Periapical (PA) radiographs #### Radiographic Findings - **Tooth 51:** - Normal Periodontal Ligament (PDL) space - **Tooth 61:** - Root appears foreshortened - Tooth is displaced - Widened PDL space Dental radiograph showing maxillary teeth, with mention of normal PDL for tooth 51 and shortened root, displaced position, and widened PDL for tooth 61. # DIAGNOSIS? **Tooth 61:** lateral luxation in palatal direction **Tooth 51:** subluxation <img src="missing_image_url" alt="child smile masking the eyes" width="400"/>  #### Clinical Diagnosis - **Tooth 61:** Lateral luxation in a palatal direction - **Tooth 51:** Subluxation A close-up photo of a smiling child with pink circles masking the eyes, showing teeth and blood near the mouth, consistent with dental trauma diagnosis text on the left. ### MANAGEMENT #### Tooth 61 – - **If occlusal interference** = **exo** - **If no occlusal interference** = **conservative management** #### Tooth 51 – - **Conservative management** - **Soft diet** - **Analgesia** - **Ongoing review and monitoring**   #### Treatment Plan by Tooth **Tooth 61** - If there is occlusal interference: Extraction (Exo) - If there is no occlusal interference: Conservative management **Tooth 51** - Conservative management #### General Post-Trauma Instructions - Soft diet - Analgesia as required - Ongoing review and clinical monitoring Close-up photo of closed mouth teeth shown next to the section discussing Conservative management for Tooth 51. **32** # **PATTERN OF CARIES SPREAD**  **32**  #### Pattern of Caries Spread Research and statistical analysis regarding the distribution and progression of dental caries. A饼图 (pie chart) illustrating the 'PATTERN OF CARIES SPREAD'. It features a large dark blue section taking up roughly 75% of the chart, alongside a light blue section representing approximately 25%. # Q39 – Which of these statements is false? <figure> <img src="placeholder_chart_image_url" alt="Horizontal bar chart displaying four statements about dental caries risk associated with MIH and prior caries history, along with corresponding percentages"> <figcaption> **Horizontal bar chart displaying four statements. The x-axis represents percentages ranging from 0 to 45.** </figcaption> </figure> Q39 - Which of these statements is false?  #### Caries Risk Assessment Q39 - Which of these statements is false? - Statement 1: Children with MIH are 5.89 times more likely to have a DMFT greater than zero than children without MIH. - Statement 2: 69% of primary teeth with proximal caries developed caries on the adjacent proximal surface. - Statement 3: 89% of patients with a proximal carious lesion on a primary tooth in one quadrant developed another primary molar proximal lesion in another quadrant. - Statement 4: Children with MIH are 8X more likely to develop caries than children without MIH. Horizontal bar chart showing percentages for four caries risk statements. The x-axis ranges 0–45. The bars represent: 8X MIH caries risk; 70% adjacent lesion chance; 3X permanent tooth risk; and 90% cross-quadrant primary molar lesion chance. # **Caries Spreading To Adjacent Proximal Surfaces** > **69%** of primary teeth with proximal caries developed caries on the adjacent proximal surface. **Source:** Dean et al., 1997   #### Adjacent Surface Involvement According to research by Dean et al. (1997), 69% of primary teeth with proximal caries developed caries on the adjacent proximal surface. A medical image showing dental X-rays illustrating the progression of caries. Document header from the source study 'Progression of interproximal caries in the primary dentition' by Dean et al., 1997. <!-- Image (435, 107, 925, 910) --> #### Comparative Study > *J Clin Pediatr Dent. 1997 Fall;22(1):59-62.* # Progression of interproximal caries in the primary dentition J A Dean${}^{1}$, D H Barton, I Vahedi, E A Hatcher # CARIES IN A DIFFERENT QUADRANT 89% of patients with a proximal carious lesion on a primary tooth in one quadrant developed another primary molar proximal lesion in another quadrant Dean et al 1997  #### Cross-Quadrant Progression Research published in *J Clin Pediatr Dent* (1997) titled "Progression of interproximal caries in the primary dentition" by Dean et al. indicates: - **Contiguous Spread:** 69% of primary teeth with proximal caries spread to the adjacent surface. - **Quadrant Correlation:** 89% of patients with a proximal carious lesion on a primary tooth in one quadrant developed another primary molar proximal lesion in a different quadrant. A black and white dental radiograph (X-ray) illustrating several primary molars. The image accompanies the text statistic that '89% of patients with a proximal carious lesion on a primary tooth in one quadrant developed another primary molar proximal lesion in another quadrant', referencing the study 'Dean et al 1997'. # 3. CARIES IN PRIMARY TO PERMANENT TEETH ## **RESEARCH REPORTS** ### Clinical **Y. Li$^{1*}$ and W. Wang$^{2}$** $^{1}$Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, 345 E. 24th Street, New York, NY 10010-4086, USA; and $^{2}$Department of Community and Preventive Dentistry, Peking University School of Stomatology, Beijing, China; *corresponding author, yihong.li@nyu.edu *J Dent Res 81(8):561-566, 2002* --- ## Predicting Caries in Permanent Teeth from Caries in Primary Teeth: An Eight-year Cohort Study ## ABSTRACT Several cross-sectional studies report that caries in primary teeth is correlated with caries in permanent teeth. This eight-year cohort study sought to determine if caries in the primary dentition can predict caries in the permanent dentition of the same individuals and, if so, with what degree of prediction accuracy. A total of 362 Chinese children, from 3 to 5 years old at the time of the 1992 baseline study, were re-examined in 2000. The study found statistically significant associations between caries prevalence in primary and permanent dentitions (p < 0.01). Children having caries in their primary teeth were three times more likely to develop caries in their permanent teeth (relative ratio = 2.6, 95% CI = 1.4-4.7; p < 0.001). Caries on primary molars had the highest predictive value (85.4%). This study demonstrates that caries status in the primary teeth can be used as a risk indicator for predicting caries in the permanent teeth. ## KEY WORDS: dental caries, primary and permanent teeth, Chinese children. --- ## INTRODUCTION Dental caries is the most prevalent of all chronic diseases among US children (USDHHS, 2000). It affects 18% of all children ages 2-4, 52% of children ages 6-8, and 80% of adolescents age 17 (Kaste *et al*., 1996). In China, caries prevalence ranges from 67% to 86% among pre-school children (3 to 6 yrs old) and 32% to 48% among adolescents (12 yrs old) (PRCMPH, 1987, 1999; Petersen and Guang, 1994; Wang *et al*., 1994; Douglass *et al*., 1995; Peng *et al*., 1997; Wong *et al*., 1997, 2001; Petersen and Esheng, 1998). High caries prevalence still endures as one of the major oral health issues in children. Because dental caries is a disease that is both preventable and costly to treat, previous studies have focused on identifying caries risk predictors, including developmental tooth defects, mutans streptococci infection (time, source, and level), lactobacilli counts, salivary buffer capacity and flow rate, sucrose intake frequency, and past caries experience (Seppä *et al*., 1989; Alaluusua *et al*., 1990; Helfenstein *et al*., 1991; Disney *et al*., 1992; Steiner *et al*., 1992; Vehkalahti *et al*., 1996; van Palenstein Helderman *et al*., 2001). Most of these studies, however, consisted of a single or several cross-sectional surveys. Information validating the correlation between caries in primary and permanent dentitions of the same individuals is needed. The present eight-year cohort study addresses the following questions: Does the caries status of the primary teeth correlate with that of the permanent teeth in the same individual? If so, which teeth contribute most strength to the correlation? Finally, can caries in the permanent teeth be predicted from caries status in the primary teeth of the same individual? Here, we examined the specificity, sensitivity, predictive value, and efficiency of various risk predictors that might be used to predict future caries in this prospective study. #### Longitudinal Cohort Study Results An eight-year cohort study (Li and Wang, 2002) conducted on 362 children investigated the correlation between primary and permanent dentition caries. - **Key Findings:** - Statistically significant associations exist between caries prevalence in primary and permanent dentitions (p < 0.01). - Children with caries in primary teeth were approximately three times more likely to develop caries in their permanent teeth (Relative Ratio = 2.6, 95% CI = 1.4-4.7). - Caries on primary molars demonstrated the highest predictive value at 85.4%. - **Context and Prevalence:** - Dental caries remains a prevalent chronic disease, affecting 18% of children ages 2-4 and up to 80% of adolescents by age 17 in the US. - In China, prevalence ranges from 67-86% in pre-school children. - Primary tooth status serves as a reliable risk indicator for future permanent tooth health. 37 # CHILDREN WITH MIH AND CARIES Children with MIH are **5.89 times** more likely to have a DMFT greater than zero than children without MIH. **CASE-CONTROL STUDY** **Relating Molar Incisor Hypomineralization and Caries Experience Using the Decayed, Missing, or Filled Index** Gabriela C.A. Americano, DDS, MS • Roberta C. Jorge, DDS • Luiz Flávio M. Moliterno, DDS, MS, PhD • Vera M. Soviero, DDS, MS, PhD **Abstract: Purpose:** This case-control study aimed to investigate the association between molar incisor hypomineralization (MIH) and caries experience in seven- to 11-year-old children. **Methods:** Children seen in a pediatric dental clinic in 2011 to 2012 and born in 2002, 2003, or 2004 were considered eligible. Children with decayed, missing, or filled teeth in the permanent dentition (DMF-T) were allocated to the case group, and those with no DMF-T were allocated to the control group. An examiner assessed MIH according to European Academy of Pediatric Dentistry criteria and caries according to World Health Organization criteria. The odds ratio was calculated to evaluate the association between MIH and caries; the chi-square test was used to analyze the association between categorical variables, and the Mann-Whitney test was used to compare means. **Results:** The final sample comprised 57 children in the case group and 58 in the control group. The groups were similar in relation to age, gender, and caries experience in the primary dentition. MIH children were 5.89 (95 percent confidence interval equals 2.69 to 12.88; P<0.05) times more likely to have a DMF-T greater than zero. **Conclusions:** Children with decayed, missing, or filled permanent teeth are more likely to have MIH. *(Pediatr Dent 2016;38(5):419-24) Received January 12, 2016 I Last Revision July 25, 2016 | Accepted July 26, 2016* **Americano et al 2016** | | | | :--- | :--- | | Children with MIH are 8X more likely to develop caries than children without MIH | **False statement** | #### Association Between MIH and Caries Experience A case-control study by Americano et al. (2016) investigated the relationship between Molar Incisor Hypomineralization (MIH) and the Decayed, Missing, or Filled Index (DMF-T) in children aged 7 to 11. - **Statistical Risk:** Children with MIH are **5.89 times** more likely to have a DMFT score greater than zero than children without MIH (95% CI = 2.69 to 12.88; P < 0.05). - **Study Parameters:** The groups were balanced for age, gender, and primary dentition caries experience. - **Conclusion:** There is a significant association between the presence of MIH and increased caries experience in permanent teeth. **Fact Check:** - True: Children with MIH are 5.89x more likely to have DMFT > 0. - False: Children with MIH are 8x more likely to develop caries. # CHILDREN WITH MIH AND CARIES Children with MIH are <b>5.89 times</b> more likely to have a DMFT greater than zero than children without MIH. <img src="image_path" alt="Clinical photograph showing a child's upper dentition from the occlusal view, which reveals hypoplastic patches of dental material and color anomalies."> Americano et al 2016  #### Clinical Presentation of MIH Data from Americano et al. (2016) confirms that children with Molar Incisor Hypomineralization (MIH) face a significantly higher risk of caries. - **Risk Ratio:** 5.89 times increased likelihood of having a DMFT > 0. - **Clinical Observations:** MIH often presents as hypoplastic patches and color anomalies on the occlusal surfaces of permanent molars and incisors, increasing susceptibility to decay. An occlusal view clinical photograph showing a child's upper dentition. The image reveals hypoplastic patches and color anomalies on the teeth, consistent with the slide's topic of 'CHILDREN WITH MIH AND CARIES'. # CARIES ON DISTAL OF SECOND PRIMARY MOLARS Caries on the distal of a primary second molar increases the risk 15x for caries on the mesial surface of the first permanente tooth.  **BONUS!**  #### Impact on First Permanent Molars The presence of caries on the distal surface of a second primary molar is a significant predictor for the health of the erupting permanent dentition. - **Risk Factor:** Caries on the distal surface of a second primary molar increases the risk for caries on the mesial surface of the first permanent tooth by **15 times**. Dental X-ray showing the posterior region of a child's mouth, illustrating caries on the distal of a primary second molar, which is linked to a 15x increased risk for caries on the mesial of the permanent first molar. **QUESTIONS** [^1]: Original PDF page 1: [[W2 Case Based Discussion 2.pdf#page=1|W2 Case Based Discussion 2, p.1]] [^2]: Original PDF page 2: [[W2 Case Based Discussion 2.pdf#page=2|W2 Case Based Discussion 2, p.2]] [^3]: Original PDF page 3: [[W2 Case Based Discussion 2.pdf#page=3|W2 Case Based Discussion 2, p.3]] [^4]: Original PDF page 4: [[W2 Case Based Discussion 2.pdf#page=4|W2 Case Based Discussion 2, p.4]] [^5]: Original PDF page 5: [[W2 Case Based Discussion 2.pdf#page=5|W2 Case Based Discussion 2, p.5]] [^6]: Original PDF page 6: [[W2 Case Based Discussion 2.pdf#page=6|W2 Case Based Discussion 2, p.6]] [^7]: Original PDF page 7: [[W2 Case Based Discussion 2.pdf#page=7|W2 Case Based Discussion 2, p.7]] [^8]: Original PDF page 8: [[W2 Case Based Discussion 2.pdf#page=8|W2 Case Based Discussion 2, p.8]] [^9]: Original PDF page 9: [[W2 Case Based Discussion 2.pdf#page=9|W2 Case Based Discussion 2, p.9]] [^10]: Original PDF page 10: [[W2 Case Based Discussion 2.pdf#page=10|W2 Case Based Discussion 2, p.10]] [^11]: Original PDF page 11: [[W2 Case Based Discussion 2.pdf#page=11|W2 Case Based Discussion 2, p.11]] [^12]: Original PDF page 12: [[W2 Case Based Discussion 2.pdf#page=12|W2 Case Based Discussion 2, p.12]] [^13]: Original PDF page 13: [[W2 Case Based Discussion 2.pdf#page=13|W2 Case Based Discussion 2, p.13]] [^14]: Original PDF page 14: [[W2 Case Based Discussion 2.pdf#page=14|W2 Case Based Discussion 2, p.14]] [^15]: Original PDF page 15: [[W2 Case Based Discussion 2.pdf#page=15|W2 Case Based Discussion 2, p.15]] [^16]: Original PDF page 16: [[W2 Case Based Discussion 2.pdf#page=16|W2 Case Based Discussion 2, p.16]] [^17]: Original PDF page 17: [[W2 Case Based Discussion 2.pdf#page=17|W2 Case Based Discussion 2, p.17]] [^18]: Original PDF page 18: [[W2 Case Based Discussion 2.pdf#page=18|W2 Case Based Discussion 2, p.18]] [^19]: Original PDF page 19: [[W2 Case Based Discussion 2.pdf#page=19|W2 Case Based Discussion 2, p.19]] [^20]: Original PDF page 20: [[W2 Case Based Discussion 2.pdf#page=20|W2 Case Based Discussion 2, p.20]] [^21]: Original PDF page 21: [[W2 Case Based Discussion 2.pdf#page=21|W2 Case Based Discussion 2, p.21]] [^22]: Original PDF page 22: [[W2 Case Based Discussion 2.pdf#page=22|W2 Case Based Discussion 2, p.22]] [^23]: Original PDF page 23: [[W2 Case Based Discussion 2.pdf#page=23|W2 Case Based Discussion 2, p.23]] [^24]: Original PDF page 24: [[W2 Case Based Discussion 2.pdf#page=24|W2 Case Based Discussion 2, p.24]] [^25]: Original PDF page 25: [[W2 Case Based Discussion 2.pdf#page=25|W2 Case Based Discussion 2, p.25]] [^26]: Original PDF page 26: [[W2 Case Based Discussion 2.pdf#page=26|W2 Case Based Discussion 2, p.26]] [^27]: Original PDF page 27: [[W2 Case Based Discussion 2.pdf#page=27|W2 Case Based Discussion 2, p.27]] [^28]: Original PDF page 28: [[W2 Case Based Discussion 2.pdf#page=28|W2 Case Based Discussion 2, p.28]] [^29]: Original PDF page 29: [[W2 Case Based Discussion 2.pdf#page=29|W2 Case Based Discussion 2, p.29]] [^30]: Original PDF page 30: [[W2 Case Based Discussion 2.pdf#page=30|W2 Case Based Discussion 2, p.30]] [^31]: Original PDF page 31: [[W2 Case Based Discussion 2.pdf#page=31|W2 Case Based Discussion 2, p.31]] [^32]: Original PDF page 32: [[W2 Case Based Discussion 2.pdf#page=32|W2 Case Based Discussion 2, p.32]] [^33]: Original PDF page 33: [[W2 Case Based Discussion 2.pdf#page=33|W2 Case Based Discussion 2, p.33]] [^34]: Original PDF page 34: [[W2 Case Based Discussion 2.pdf#page=34|W2 Case Based Discussion 2, p.34]] [^35]: Original PDF page 35: [[W2 Case Based Discussion 2.pdf#page=35|W2 Case Based Discussion 2, p.35]] [^36]: Original PDF page 36: [[W2 Case Based Discussion 2.pdf#page=36|W2 Case Based Discussion 2, p.36]] [^37]: Original PDF page 37: [[W2 Case Based Discussion 2.pdf#page=37|W2 Case Based Discussion 2, p.37]] [^38]: Original PDF page 38: [[W2 Case Based Discussion 2.pdf#page=38|W2 Case Based Discussion 2, p.38]] [^39]: Original PDF page 39: [[W2 Case Based Discussion 2.pdf#page=39|W2 Case Based Discussion 2, p.39]]