A Physician's Guide to Identifying Pediatric Dental Decay and Common Oral Pathology

Publication ID Published Version
9223 August 20, 2012 1


For most children the entry point into the healthcare system is through primary care physicians and pediatricians. These individuals are experts at screening and diagnosing disease, and are thoroughly trained to ascertain when physical findings deviate from normal. Although they are responsible for surveillance of the full spectrum of human disease, a provider can only be expected to perceive abnormalities they have been trained to recognize. Oral health is just one of the many areas that medical providers are responsible to evaluate, but because clinicians often receive so little training in this area it is likely that they will only be able to diagnose very obvious deviations from the healthy dental state.

Like many other areas of a physical examination, the oral health exam is visual. The clinician must use a trained sense of sight to evaluate a young child’s mouth. If the clinician is not calibrated to recognize the various states of disease and health, it is quite likely that they will not diagnose mild forms of dental caries. This is critical, because when caries is mild, preventive interventions are most capable of stopping its progression. When decay progresses past the point of mild disease it often must be surgically corrected with a dental restoration. To address the specific need for a sophisticated tutorial on the visual presentation of Early Childhood Caries (ECC) and common pediatric oral pathology this visual guide was developed.

Areas of Emphasis:

-Positioning for the oral examination
One of the most important aspects of the oral exam is preparation and positioning of the patient. The tutorial demonstrates the knee-to-knee examination position. This technique places the child at ease, and is recommended as an excellent method for visualizing the mouths of very young children.

-White spot lesion identification
The tutorial focuses on the recognition of the mild or incipient stage of dental decay: the white spot lesion. The white spot lesion forms when acid from dental plaque has caused enamel to demineralize. Removal of minerals from the enamel causes the tooth surface to appear chalky and white. This change is subtle, and often is not recognized when the tooth is wet with saliva. For this reason, it becomes important to dry the teeth with gauze prior to visual inspection. Only then can this subtle lesion be best appreciated. Photographs of wet and dry teeth are be presented to highlight this subtle but important concept. Recognition of this lesion is critical because therapeutic modalities like fluoride varnish and antimicrobials are optimally effective at this stage of the caries process. White spot lesions that are treated at this stage can be arrested before they become frank decay. If the lesion is not recognized and treated it will cavitate-a state which most often must be treated using restorative dentistry.

-Typical patterns of decay
As with other types of pathology, ECC has a variable presentation. For this reason the tutorial will focus on typical patterns of decay and give numerous case examples of each type. Photographic examples will include: the nursing habit-associated pattern (maxillary anterior pattern), Molar pit pattern, and the Molar proximal pattern. It is important that physicians understand variations in presentation and examine patients in a fashion that will enable them to recognize it. For example: the maxillary anterior pattern of decay can easily be missed when it is in the early stages because decay initially forms on the posterior surface of the maxillary incisor. Unless the clinician turns their neck to visualize this area or uses a mirror they will miss diagnosing large lesions. The tutorial emphasizes the importance of understanding each pattern and examining in a fashion that will enable diagnosis of difficult-to-see lesions.

-Common pediatric oral pathology 
Several common forms of pediatric oral pathology are presented. These range from developmental anomalies of the dentition to soft tissue lesions of the newborn. Recognition of these is important, and understanding of the common presentation will better equip the clinician to recognize deviations from normal.

-Therapeutic interventions
Fluoride varnish application and occlusal sealants have been shown to dramatically reduce caries incidence. Photographs demonstrating these interventions are shown to familiarize the practitioner with the modalities and encourage partnership with dentists to optimally care for children’s oral health.


Nelson T. A Physician's Guide to Identifying Pediatric Dental Decay and Common Oral Pathology. MedEdPORTAL Publications; 2012. Available from: https://www.mededportal.org/adea/publication/9223   http://dx.doi.org/10.15766/mep_2374-8265.9223

Educational Objectives

  1. To learn proper placement of the child patient for an oral exam.
  2. To become familiar with the appearance of white spot lesions- the earliest sign of dental caries.
  3. To learn to diagnose frank dental caries in children <6 years of age.
  4. To be able to differentiate normal tooth variants from the disease state.
  5. To recognize common pediatric oral pathology.
  6. To understand therapeutic modalities physicians and dentists can use to treat dental decay.


  • Oral Health, Pediatric Dentistry, Dental Caries, Fluoride Varnishes, Dental Sealants, Pits and Fissure Sealants, Oral Pathology, Building Oral Health Capacity (BOHC) Collection


  • Medical
    • Pediatrics
    • Preventive Medicine
  • Dental
    • Oral and Maxillofacial Pathology
    • Pediatric Dentistry


  • Knowledge for Practice
  • Patient Care

Professional Interest

  • Assessment
  • Interprofessional
  • Oral Health

Instructional Methods

  • Assessment
  • Independent Learning
  • Lecture
  • Tutorial

Organ Systems

  • Gastrointestinal system

Academic Focus

  • Basic Sciences
    • Pathology
  • Clinical Sciences
    • Clinical Exam

Intended Audience

  • Professional School
    • Dental Student
    • Medical Student
  • Professional School Post-Graduate Training
    • Fellow
    • Predoctoral
    • Resident


  • Presentation

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ISSN 2374-8265