Aka Would You Please Say Ahhh

■ "Now let's see what's in your mouth."

■ "Can you stick out your whole tongue?"

■ "I bet you can't open your mouth really wide!"

■ "Let me see the inside of your teeth."

■ Don't show a tongue blade unless really necessary.

■ Demonstrate first on an older sibling (or even the parent).

■ Offer enthusiastic praise for opening their mouths a little and encourage them to open even wider!

If you need to use the tongue blade, the best technique is to push down and pull slightly forward toward yourself while the child says "ahhh," being careful not to place the blade too far posteriorly, eliciting a gag reflex. Sometimes young and anxious children will need to be restrained and will clamp their teeth and purse their lips. In these cases, you will need to carefully slip the tongue depressor between the teeth and onto the tongue. This will either allow you to push down on the tongue or elicit a gag reflex, which should permit a brief look at the posterior pharynx and tonsils. Remember, an unplanned, direct frontal assault on the front teeth will only meet with failure and a splintered tongue blade; careful planning and parental help are needed.

Examine the teeth for the timing and sequence of eruption, number, character, condition, and position. Abnormalities of the enamel may reflect local or general disease.

Carefully inspect the inside of the upper teeth, as shown in the figure below. This is a common location for nursing bottle caries.

Dental caries are caused by bacterial activity. Caries are more likely among young children who have prolonged bottle-feeding ("nursing-bottle caries"). See Table 17-15, Abnormalities of the Mouth and Teeth, p. 772, for different stages of caries.

As in most developmental changes of childhood, there is a predictable progression of tooth eruption and also a wide variation in the age of eruption. A rule of thumb is that the infant will have one tooth for each month of age between 6 and 26 months, up to the full complement of 20 primary teeth. The table below displays a common pattern of teeth eruption. In general, lower teeth erupt a bit earlier than upper teeth.

Tooth Types and Age of Eruption

Tooth Type

Approximate Age of Eruption

Primary (mos)

Permanent (yrs)

Central incisor

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