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Pediatric dental disease is the most common chronic illness of school-aged children.1 It is five times more common than asthma and has lifelong health implications. Severe tooth decay can lead to bacterial infections within the tissues of the mouth, the bones surrounding the oral cavity, and the sinuses. Pediatric dental disease can lead to malnourishment and pain, and adult dental disease is associated with bacterial pneumonia, diabetes, heart disease, stroke, and poor pregnancy outcomes, including premature labor.1 It is important to include a close examination of the oral cavity on admission, as many children have not seen a dentist in the past and have undiagnosed pathology. In a study of 120 children on a pediatric ward, more than 40% had unmet oral health needs, as determined by a dental assessment.2 Dental caries lead to more cumulative missed school hours than any other chronic disease and can lead to difficulties with eating, drinking, speaking, and paying attention.1
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Children with special healthcare needs are at particularly high risk of severe tooth decay due to their underlying medical issues and barriers to accessing dental care. Dental care remains the most frequently cited unmet health need for this population of children.3 Pediatric hospital medicine physicians can help fill this gap by addressing oral health concerns on admission and facilitating proper dental care after discharge from the hospital.
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Intraoral disease may be a primary indication for admission to the hospital (e.g. dental abscess) or may be a secondary finding on an inpatient examination (e.g. aphthous ulcers in lupus [Table 32-1] or delayed tooth eruption due to a genetic disorder [Table 32-2]). Oral lesions, commonly caused by viruses (see Table 32-3) or candida may also lead to such significant difficulty with drinking and swallowing that infants and children may require admission for pain control and treatment of dehydration. See Chapter 70 for a review of causes of stomatitis.
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