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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Caries Risk

The following medical conditions result in increased risk for caries:

  1. Gastroesophageal Reflux Disease (GERD)
    Enamel erosion by acid exposes the underlying dentin. This is usually most severe on palatal surfaces. Enamel appears shiny and worn, then may appear yellow as the underlying dentin becomes exposed. Dental erosion is irreversible. Reflux precautions, dietary modifications, and medications can be considered for treatment of GERD. 
    Enamel: Intensely hard calcareous substance that forms a thin layer partly covering the teeth; the hardest substance of the animal body; consists of minute prisms arranged at right angles to the surface and bound together by a cement substance.
    Dentin: A calcareous material similar to bone but harder and denser that composes the principal mass of a tooth; consists of a matrix containing minute parallel tubules which open into the pulp cavity and during life contain processes of the cells of the pulp.

    Patients should be counseled to rinse the mouth with water or a dilute baking soda solution to neutralize the oral pH. Immediate brushing may accelerate enamel loss. Regular dental examinations should be performed.

  2. Attention Deficit Hyperactivity Disorder (ADHD)
    Children with ADHD have an increased rate of caries, which is not well understood. Increased rate of caries may be the result of medication side effects, oral hygiene, and/or dietary habits.Oral hygiene and regular dental care should be discussed with families of children with ADHD and they should be referred for evaluation in the dental home.

  3. Bulimia

  4. Xerostomia

Refer to Chapter 4: Caries for a complete review of the pathogenesis of caries.
Fast Facts
Repeated acid exposure causes enamel erosion and increases caries risk.
Rinsing the mouth after episodes of reflux or emesis can help neutralize the gastric acid.
Caries rates are higher in children with ADHD.

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