A child brought in with fever, poor feeding, night waking or simply for a growth check is usually examined from the chest down. The mouth gets a torch only if the presenting complaint points there.
Lift the upper lip. Early childhood caries begins on the upper incisors, where it is invisible during a normal conversation and painless until it is not, and it appears in children who have never seen a dentist and whose parents have no reason to think anything is wrong. A white or brown band along the gum margin of the upper front teeth is the finding, and it means the process is active now.
The follow-up questions take thirty seconds: does the child take a bottle to bed, is the bottle sweetened, how often through the night, and is anyone brushing those teeth with fluoride toothpaste. A child with visible caries at two has a trajectory that is far easier to alter at that visit than at the one where they arrive in pain.
- Lift the upper lip and look at the gum margin of the incisors
- Ask directly about bottles in bed and their contents
- Ask who brushes, how often, and with what
- Refer at the first white or brown band, not at the first cavity
- Record the finding — it is a marker of future dental and general health, not just of teeth
Why it matters
It is a condition found by looking, missed by not looking, and is one of the commonest reasons small children need a general anaesthetic.
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