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Jun 292011
 
Dental caries is an infectious and transmissible disease intiated by a heterogeneous group of gram-positive bacteria present in the biofilm that forms on teeth soon after eruption. This complex community of bacteria, termed dental plaque, contains Streptococcus mutans, which is a necessary agent for the production of dental caries. S. mutans has been shown to be transmissible from parents or caregivers to infants at the time of tooth eruption. The dental health of direct caregivers thus becomes an important factor in the prevention of dental caries.
Dental caries disease is usually classified by four different factors:
(1) according to anatomic site of the lesion,
(2) according to the severity or rate of progession of the lesion,
(3) according to age patterns at which lesions predominate, and
(4) according to therapies that can induce decay.

Caries can occur in teeth of persons of any age, but when the disease occurs in children younger than 3 years, the condition is termed early childhood caries. Previously, most descriptions of early childhood caries focused on the period of nursing, giving rise to the term nursing bottle caries. It is now recognized that early childhood caries can be present in the absence of bottle- or breast-feeding and conversely does not always result from inappropriate bottle- or breast-feeding practices, indicating that other host susceptibility factors are involved.

Complications

Regardless of age or circumstance, all carious lesions must be eradicated by some means. Failure to do so eventually leads to invasion of the pulp chamber of the tooth with inflammation, pain, swelling, and exudation. Since the tooth pulp is encased within a rigid structure, necrosis of the tissue within the pulp chamber occurs because of the increased pressure, which prevents blood flow. An ensuing buildup of toxic products in this space will force extension of the process into the tissue surrounding the root apices, forming an abscess within the bone. Cellulitis with acute pain Continue reading »

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May 302011
 
Nutritional sufficiency of the newborn is a topic that continues to engage great debate. Delivery of the fetus is marked by the abrupt transition from the fetal nutritional state. This state is marked by a relatively constant supply of nutrients via the maternoplacental circulation, supplemented to a minor degree by enteral absorption of nutrients derived from swallowed amniotic fluid. The transition to an intermittent and wholly enteral route for neonatal nutritional needs is a critical aspect of successful adaptation at birth.
Breast Feeding and Human Milk

During the last century, the almost exclusive use of human milk was abandoned for a time by some in favor of the fashionable (and occasionally truly necessary) use of cow milk–based formula fed by bottle in developed  countries. Over the past 50 years, however, most authorities on infant nutrition the (the American Academy of Pediatrics, among others) have advocated human milk for healthy term babies. This recommendation reflects the results of the vast literature supporting breast-feeding and the use of human milk as a superior form of nutrition for infants. The psychological, nutritional, hormonal, immunologic, and economic benefits of human milk are now well established.

Optimal Newborn Nutrition

Because breast-feeding and ingestion of human milk provide optimal intakes of water and nutrients for growth of healthy term newborns over the first months of postnatal life, growth and developmental patterns of infants reared exclusively on human milk have become the benchmarks by which alternative forms of enteral and parenteral nutritional programs are Continue reading »

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May 062011
 
Erythema Multiforme Minor
  • This condition is characterized by erythematous papules that evolve into target lesions with dusky centers. Some oral lesions may be present.
  • The most common precipitant is HSV infection. It may also be drug-induced.
Treatment
  • Antihistamines provide symptomatic relief.
  • Systemic steroids may be helpful if given early.
  • Prophylactic acyclovir may be useful to prevent recurrent HSV-related disease.
Erythema Multiforme Major (Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis)
  • In Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), marked erythema or target lesions rapidly progress to blistering and epidermal sloughing.
Treatment
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