A 15-month-old girl is brought to the office by her parents for a routine well-child visit. The girl has been teething lately, and the mother says, "Using a pacifier and giving her a bottle of milk before she sleeps have really helped soothe the teething pain. I also nurse her several times overnight since she wakes up a lot." The patient eats 3 meals daily with 2 snacks and drinks water throughout the day. Her parents brush her teeth twice daily with fluoridated toothpaste, and she had her first dental visit at age 12 months with no follow-up scheduled. The family gets drinking water from a nearby well that was recently tested and has no fluoride. The girl has no chronic health conditions and takes no medications except for a daily multivitamin with fluoride. Her growth is tracking at the 75th percentile for height, weight, and head circumference. Oral examination reveals 4 maxillary incisors and 4 mandibular incisors. There is a small area of brown discoloration on the right central incisor consistent with caries. Several other teeth have white, opaque spots along the gum line that are concerning for early tooth decay as well. Which of the following most likely contributes to this patient's dental findings?

Question

A 15-month-old girl is brought to the office by her parents for a routine well-child visit.  The girl has been teething lately, and the mother says, "Using a pacifier and giving her a bottle of milk before she sleeps have really helped soothe the teething pain.  I also nurse her several times overnight since she wakes up a lot."  The patient eats 3 meals daily with 2 snacks and drinks water throughout the day.  Her parents brush her teeth twice daily with fluoridated toothpaste, and she had her first dental visit at age 12 months with no follow-up scheduled.  The family gets drinking water from a nearby well that was recently tested and has no fluoride.  The girl has no chronic health conditions and takes no medications except for a daily multivitamin with fluoride.  Her growth is tracking at the 75th percentile for height, weight, and head circumference.  Oral examination reveals 4 maxillary incisors and 4 mandibular incisors.  There is a small area of brown discoloration on the right central incisor consistent with caries.  Several other teeth have white, opaque spots along the gum line that are concerning for early tooth decay as well.  Which of the following most likely contributes to this patient's dental findings?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c162_2e2f_8f63_0f36b7aec3c6_MD0005_00 Dental caries, or tooth decay from bacteria, is a preventable chronic disease associated with pain and infection and may affect appearance and speech. Risk factors for dental caries include frequent exposure to sugar-containing snacks or beverages, nighttime feeding (eg, bottle with juice or milk, frequent nursing), low socioeconomic status, and family members with cavities. Oral hygiene education should be provided at every well-child visit during infancy. Dental screening examinations by primary care providers should begin as soon as the first teeth erupt (usually around age 5-8 months). Signs of tooth decay (eg, white spots, discoloration) should prompt immediate referral to a dentist for evaluation. Establishment of a dental home is recommended for all children by age 1 with routine follow-up every 6 months (Choice E). (Choices A and D) Brushing with fluoride toothpaste twice daily is recommended for all children to help prevent caries. For children age <3, a very thin layer (smear) covering less than half of a toothbrush should be used. Oral fluoride supplementation is recommended for children whose primary source of water has minimal fluoride content, such as this patient's well water. Well water is not a risk factor for the development of dental caries. smear (Choice B) Nonnutritive sucking (eg, digits, pacifier) is developmentally normal for infants and toddlers. Pacifier use when primary teeth are present increases the risk of malocclusion but not dental caries. Educational objective: Bedtime bottle use and frequent exposure to sugar-containing snacks are cariogenic risk factors. Dental caries prevention includes adequate fluoride exposure (eg, water, toothpaste, supplementation) and establishment of a dental home. References: Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. (http://www.ncbi.nlm.nih.gov/pubmed/24799546) Influence of feeding practices on dental caries. A case-control study. (http://www.ncbi.nlm.nih.gov/pubmed/23597222) Effects of nursing bottle misuse on oral health. Prevalence of caries, tooth malalignments and malocclusions in North-German preschool children. (http://www.ncbi.nlm.nih.gov/pubmed/18213457)

A 15-Month-Old Girl Is Brought to the Office by Her