Addressing Tooth Erosion in a 10-Year-Old

Topic: ‘Prevention of Erosion’ Patient Group; Primary school children

Patient age: 10 years old Gender: Male Visit: “first”

A 10 years old boy with his mother has been referred to me for providing them with necessary oral health advise in terms of preventing tooth erosion (Gomes et al. 2017). Tooth erosion is the dental issues in which there is diffusion of the dentine and enamel of the teeth. Dentine and enamel are associated with forming the outer coating of the teeth, tooth erosion is the serious dental issue that leads to the high risk of tooth decay and chronic dental erosion. In case of this patient the dental assessment shows that there is severe damage in the dentine and enamel which need immediate clinical intervention to improve the dental condition.

Dental assessment and evaluation of the personal history of the patient show the following details:

The patient never visits dental clinic which is the potential reason behind his poor dental health.

He has also the sign of gingival recession that needs immediate treatment otherwise the patient will face premature tooth decay.

The soft tissue checks and dental screening show that there is severe infection in the gumline which affects the structure of dentine and enamel. The boy lives with his mother and grandmother. Hash mother is a widow and works in a private bank. She has to manage all the household staffs as her mother is aged and ill. Therefore, it is not possible for her to check her son’s oral health regularly. The mother is unable to provide the homemade food in tiffin to her son. Therefore, the son eats the junk foods at his school canteen. As the mother is busy at her household works and office, there is no one in the home to look after the food habits and the oral health of the child.

Advice:

The first visit has been held in my cabin. here I start the visit with providing a leaflet to the mother and child and tell them to go through the leaflet. The leaflet is about the oral hygiene and the prevention of dental erosion (Maharani, 2017). I use one demonstration teeth, pointer, scalpel and a demonstration gum structure. Through using these structures, I explain to them what is gum line, what are the functions of each tooth and how oral hygiene can be maintained. I also explained that how precautions can be taken to maintain good oral health. I use some videos to show the patient and his mother that what the tooth erosion is, how it develops and how it impacts on the physical, social, psychological and emotional health of patients (AlShahrani et al. 2017). I also explain the condition of the gum and the enamel of patient’s teeth. I advise the mother that she needs to visit dental clinic with her son at every month because her son needs consistent dental advise to prevent further deterioration of the tooth erosion.

I advise the child to avoid brushing teeth for two weeks. In case of tooth erosion, regular bruising of teeth can cause further damages of dentine and enamel (Roque‐Torres et al. 2020). I recommend the patient to use the fluoride mouthwash which will protect his teeth from any bacterial infections.

I advise the mother to take care of the food habits of her son. I recommend the mother to provide only homemade foods to the child and also ensure that the foods are alkaline in nature (low pH value) (Lussi et al. 2019). I recommend the mother to take good care that her son must not consume the junk foods and packaged foods because most of them are acidic which can cause severe damage of dentine and enamel thereby causing further damage of the teeth.

I provide the mother with some videos and softcopy of poster which will assets her to follow the instructions regarding maintaining good oral health her child (Carvalho and Lussi, 2020). I advise the mother to check that her son use the mouthwash after each meal, especially in the morning and at the night after dinner. I advise the patients that he must use his finger to brush his teeth by fluoride toothpaste that will protect his teeth from any kind of further erosion. I recommend the mother to go through different online blogs and poster about prevention of dental erosion and follow the instructions thereby ensuring that her child follow that instruction and guidelines for maintaining good oral hygrine (Lussi et al. 2019). I also recommend the mothers to train her child about how to wash the mouth properly to eliminate chances of any bacterial infection due to the left food inside the mouth.

I also advise the patient to avoid eating the acidic food that can cause that further erosion thereby enhancing chance of premature tooth decay. Finally, I advise the mother to brings her son after two weeks for the second visit which will be the follow up of the first visit.

Reference list:

Gomes, R.N.S., Bhattacharjee, T.T., Carvalho, L.F.C. and Soares, L.E.S., 2017. Fast monitoring of tooth erosion caused by medicaments used in the treatment of respiratory diseases by ATR-FTIR and μ-EDXRF analysis. Lasers in medical science, 32(9), pp.2063-2072.

Maharani, D.A., 2017. Prevalence and risk factors of tooth erosion in children. J. Med. Sci, 17(2), pp.53-60.

AlShahrani, M.T., Haralur, S.B. and Alqarni, M., 2017. Restorative rehabilitation of a patient with dental erosion. Case reports in dentistry, 2017.

Roque‐Torres, G.D., Kwon, S.R., Oyoyo, U. and Li, Y., 2020. Measurement of erosion depth using microcomputed tomography and light microscopy. Microscopy Research and Technique, 83(12), pp.1450-1455.

Lussi, A., Buzalaf, M.A.R., Duangthip, D., Anttonen, V., Ganss, C., João-Souza, S.H., Baumann, T. and Carvalho, T.S., 2019. The use of fluoride for the prevention of dental erosion and erosive tooth wear in children and adolescents. European archives of paediatric dentistry, 20(6), pp.517-527.

Carvalho, T.S. and Lussi, A., 2020. Acidic beverages and foods associated with dental erosion and erosive tooth wear. The Impact of Nutrition and Diet on Oral Health, 28, pp.91-98.

Schlueter, N. and Luka, B., 2018. Erosive tooth wear–a review on global prevalence and on its prevalence in risk groups. British dental journal, 224(5), pp.364-370.

Yılmaz, N., Baygin, O., Cakıroglu, T.N., Tüzüner, T. and Deger, O., 2019. In vitro evaluation of the effects of frequently prescribed pediatric drugs on the microhardness of permanent tooth enamel. Dental and medical problems, 56(2), pp.131-136.

Kim, E.J. and Jin, B.H., 2019. Effects of titratable acidity and organic acids on enamel erosion in vitro. Journal of Dental Hygiene Science, 19(1), pp.1-8.

Topic: ‘Prevention of Erosion’ Patient Group; Primary school children

Patient age: 10 years old Gender: Male Visit: “second”

The second visit is about the follow up of the oral health treatment in which I evaluate the usefulness of the advice and treatment that are provided to the patient in his first visit. First, I perform some dental tests such as soft tissues check, predental assessment, checking of gumline, periodontal assessment and dental screening (Salas et al. 2017). By evaluating the results of all these tests, I come to know that there is not the expected improvement in patient’s teeth. Although there is sign of improvement of gingival recession, there is hardly any sign of improvement in the structure of the dentine and the enamel. From the dental screening it is clear that although there is no further deterioration of the enamel and dentine structure, there is no improvement in the outer coating of the teeth.

By evaluating these test reports, I tell the patient and the mother that they are failed to follow the advice that are given to them in their first visit. I explain to the patient and mother that if they follow the instruction properly the structure of the enamel and dentine must be improved, but there is no sign of improvement (De Souza et al. 2018). I advise the patient as well as the mother that they must be careful and more concern on following all the advice and oral health guidelines given to them in the first visit for prevention of the deterioration of teeth condition. I explain to the mother that her son has high risk of further teeth erosion with premature teeth fall which can cause chronic tooth decay. Therefore, they must follow the advice such as using fluoride mouthwash, avoid toothbrush and rub teeth gently by finger.

I also tell the mother that the periodontal screening and dental assessment shows that despite giving advice on avoiding the food with high ph value, her son continue to consume acidic foods that pose barriers on the prevention of tooth erosion (Pereira et al. 2018). In this context, I advise the mother to be more careful about her son’s feeding habits and daily food intake that are important for maintaining good oral health. I recommend her to provide an alkaline meal at least one time day which can balance the acidic foods inside the body thereby reducing the risk of the tooth erosion. I advise the patients to follow the instruction of regular washing of mouth by mouthwash after taking each meal.

The mother explains that as she is the only earning member in her family and there is no one at her home to manage the household work, she is busy in her cooking, office and other household work. Therefore, she fails to check what her son eats in the day. She also explains after the first visit she use to prepare the recommended foods and serve low ph fruits to her son, but after she goes to office, she cannot check that if her son eats high ph foods such as banana, cranberries and nuts (Salas et al. 2018). Moreover, the patient also consumes acidic foods at the school canteen which enhance his chances of developing chronic tooth decay.

In this context I recommend the mother to interact with the school teachers and staffs to request them to take care of what foods the patient eats in the school. I also advise the mother to ensure that she must provide the homemade alkaline foods to the patient and also contact the school staffs to check what food the patient eats during the tiffin time (Macdonald, 2019). I recommend the mother to provide training to her son in every weekend about how to maintain the good oral health and prevent dental illness such as toot erosion, dental caries and tooth decay;

I advise the patient that after two weeks he can use the tooth brush but while brushing teeth he must hold the brush at 450 angles to the gumline. I also advise the patient to move the brush gently over the teeth as it will prevent the further tooth erosion. I also advise the mother that although she can not manage time all the day to check her son’s food intake, she needs to check the morning and night oral health routine of her son, for example she must check at the morning that whether her son uses the fluoride toothpaste and whether he uses the toothbrush gently (Gomes et al. 2017). I recommend the mother to train the patient to use mouth wash at every night after diner which will protect the teeth from any infection.

Finally, I advise the mother to bring the patient to my clinic in every month as he needs regular dental check up which will assist me as well as other dental experts to follow up the usefulness of the entire treatment process. Finally, I advise the patient to follow the instruction that are given to him in this second visit and listen to his mother carefully regarding maintaining healthy feeding habits to avoid further tooth erosion.

Reference list:

Salas, M.M.S., Vargas-Ferreira, F., Ardenghi, T.M., Peres, K.G., Huysmans, M.C.D. and Demarco, F.F., 2017. Prevalence and associated factors of tooth erosion in 8-12-year-old Brazilian schoolchildren. Journal of Clinical Pediatric Dentistry, 41(5), pp.343-350.

De Souza, B.M., Santi, L.R.P., de Souza Silva, M., Buzalaf, M.A.R. and Magalhães, A.C., 2018. Effect of an experimental mouth rinse containing NaF and TiF4 on tooth erosion and abrasion in situ. Journal of dentistry, 73, pp.45-49.

Pereira, D.L., Freitas, A.Z., Bachmann, L., Benetti, C., Zezell, D.M. and Ana, P.A., 2018. Variation on molecular structure, crystallinity, and optical properties of dentin due to Nd: YAG laser and fluoride aimed at tooth erosion prevention. International journal of molecular sciences, 19(2), p.433.

Salas, M.M.S., Vargas-Ferreira, F., Nascimento, G.G., Huysmanns, M.C. and Demarco, F.F., 2018. Tooth erosion association with obesity: findings from a Brazilian survey in schoolchildren. Pesquisa Brasileira em Odontopediatria e Clinica Integrada, 18(1), p.3764.

Macdonald, A.A., 2019. Cheek tooth erosion in male babirusa (genus Babyrousa). Comptes rendus biologies, 342(5-6), pp.199-208.

Gomes, R.N.S., Bhattacharjee, T.T., Carvalho, L.F.C. and Soares, L.E.S., 2017. Fast monitoring of tooth erosion caused by medicaments used in the treatment of respiratory diseases by ATR-FTIR and μ-EDXRF analysis. Lasers in medical science, 32(9), pp.2063-2072.

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