MOUTH AND ESOPHAGUS
Cleft palate and Dental caries
Feeding difficulties in infants and your children may result from abnormalities in the structure of the mouth. When the parts of the upper jaw and of the palate separating the mouth and the nasal cavity do not fuse properly during fetal development, the anatomic abnormality creates difficult feeding problems. If this fusion of the parts of the upper jaw and mouth fails to occur, cleft lip (harelip) or cleft palate or both result. Since the infant is unable to suck adequately with this abnormality, early feedings are tiring and lengthy. A softened nipple with enlarged openings through which the infant can obtain milk by chewing motion is helpful. In some instances a medicine dropper or gavage feedings may be used initially. The infant should be held in an upright position and fed slowly in small amounts to avoid aspiration. There should be brief rest periods and frequent burping to expel the large amount of air swallowed. If acid foods such as orange juice are irritating, ascorbic acid supplement is usually prescribed. As solid foods are added, they may be mixed with milk in the bottle and given in gruel or thickened form through a large nipple opening.
Surgical repair of a cleft palate is usually carried out over the growth years, depending on the extent of the deformity and the growth of the child. During this period the child may be cared for by a group of specialists to handle his overall development. This group may be found in larger medical centers and is called the Cleft palate Team. Preparation for surgery demands good nutritional status. After survey good nursing and nutritional care are essential. The infant or child is usually Fed a fluid or semi-fluid diet using a medicine dropper or spoon. Great care must be exercised to protect the suture line and avoid any strain.
Incidence. Of all the problems affecting the teeth, dental decay is the most prevalent among young children. Almost no one escapes it. According to surveys, over 99% of the children in the North America are affected by it at one time or another, and its incidence seems to have little pattern. It is found both in well-fed and in undernourished children. It may have small effect and cause little difficulty, or it may be rampant and cause considerable destruction of teeth and thus influence eating ability. Perhaps because it is so common and does not usually cause grave problems, it is often dismissed with indifference or ignored. Yet it remains and continues to disfigure, cause pain, create nutrition problems, and cost money.
Causes. Three factors contribute to tooth and work together to sustain the problem susceptible host, various oral bacteria, and child’s diet.
Susceptible host. Differences in susceptibility to dental caries vary widely among individual children. Some of these differences are hereditary, in that the anatomic characteristics and shape of the tooth are at fault. However, the ultimate cause is basic interrelationships between the shape of the tooth and the environment of the mouth that sustains tooth development during formative periods of growth. Since teeth once formed are stable structures, a positive nutritional influence can have effect only during growth and development of the enamel-forming organ in the gums and tooth bud. Certain vitamins and minerals, especially vitamins A and D, calcium, and phosphorus, play a part during this period of tooth formation. Studies also indicate that fluoride ingestion during this period may have a direct influence on tooth formation.
Oral Bacterial. Dental plaque is the gelatinous coating of a tooth. These plaques contain a number of bacteria. In humans streptococci are the bacteria in greatest number in these dental plaques. These bacteria seem to have a particular affinity for carbohydrates and act on them rapidly. Controlled tests show that only 13 minutes after carbohydrate is present in the mouth, streptococci alone can increase the acidity of the dental plaque a great deal. However, the oral flora is complex, and bacterial effects vary among several microorganisms. Whatever the microorganism involved, the necessary material for them to feed on is the caries producing base. This material is carbohydrate.
The Child’s Diet. As carbohydrate food accumulates in the mouth, therefore, it provides the necessary media for the normal growth of these acid producing microorganisms, which cause tooth decay. In sites on the tooth where the shape contributes to retention of food particles, especially of sticky, gummy foods, which adhere and remain more readily on these tooth surfaces, this bacterial activity is greatest. Persistent and continuous snacking of such sticky carbohydrate snacks such as candy have been consumed at numerous times throughout the day, the incidence of caries is greatly increased, especially when candy is of a sticky nature such as camels. During periods when the candy has been withdrawn, the caries rate has decreased.
The other dietary element that has a large influence on dental caries is fluoride. Repeated studies consistently confirm about 60% reduction in the incidence of dental caries in children with both prenatal and postnatal exposure to fluoridated water.