Dental caries, commonly referred to as “cavities,” occurs as a result of interactions between the tooth enamel, dietary carbohydrates, and oral flora. There is increased susceptibility if the enamel is abnormal or hypoplastic. Bacteria (Streptococcus mutans) that can adhere to and colonize the teeth, survive at low pH, and produce acids during fermentation of carbohydrates cause dental caries. The diet has a significant role. A classic example is “bottle mouth,” or baby bottle caries. This condition results when infants are allowed to have a bottle in the mouth for prolonged periods, especially during sleep, and with sweet beverages or milk in the bottle. Bacteria then have continuous substrate for acid production and can destroy multiple teeth, especially the upper incisors. Sticky sweet foods, such as candy, have the same effect.
Risk of caries is associated with lack of dental care and poorsocioeconomic status and, predictably, is greatest in developingcountries. Baby bottle caries is seen in 50% to 70% of low-incomeinfants. Treatment of caries is with dental restorative surgery. Thecarious portion is removed and filled with silver amalgam or plastic. If the damage is severe, a protective crown may be required;extraction of the tooth may be necessary when not salvageable.If not properly treated, dental decay results in inflammation andinfection of the dental pulp and surrounding alveolar bone, whichcan lead to abscess and facial space infections.
Avoiding inappropriate use of bottles and excessive sweets isa commonsense remedy for baby bottle caries. Oral hygiene offers some protection, but young children (<8 years old)do not have the ability to brush their own teeth adequately;brushing should be done by the parents. Fluoride supplementation of community water supplies to a concentration of 1 ppm is highly effective in reducing dental caries.Home water supplies, such as from a well, should have thefluoride content tested before supplements are prescribed.If the child spends part of the day at another location, thetotal fluoride concentration from all sources must be considered before prescribing any oral supplements. Excessivefluoride supplementation causes fluorosis, a largely cosmetic defect of chalky white marks and brown staining ofthe teeth.
Cleft lip and palate occur separately or together and affect approximately 1 in 700 infants. It is more common in Asians (1:500) and least common in Africans (1:2500). Clefting occurs with two possible patterns: isolated soft tissue cleft palate or cleft lip with or without associated clefts of the hard palate. Isolated cleft palate is associated with a higher risk of other congenital malformations. The combined cleft lip/palate type has a male predominance.
Cleft lip is due to hypoplasia of the mesenchymal tissues withsubsequent failure of fusion. There is a strong genetic component; the risk is highest in children with affected first-degreerelatives. Monozygotic twins are affected with only 60%concordance, suggesting other nongenomic factors. Environmental factors during gestation also increase risk, including drugs (phenytoin, valproic acid, thalidomide), maternalalcohol and tobacco use, dioxins and other herbicides, and possibly high altitude. Chromosomal and nonchromosomal syndromes are associated with clefting, as are specific genesin some families.