Keels – Tooth Surface Loss due to Acid Erosion in the Pediatric Population; Periodontal Disease in Children-Keels Tooth Surface Loss due to Acid Erosion in the Pediatric Population Periodontal Disease in Children

Video Transcription

Video Summary

Dr. Martha Ann Keels, a UNC-trained pediatric dentist and epidemiologist who founded Duke Children’s Hospital’s pediatric dental program, presents on two topics: dental acid erosion and periodontal pathology in children. She argues that acid erosion is common but often missed, stresses the need to document it, and explains how to distinguish it from bruxism and bulimia. Unlike flat attrition from grinding, erosion from acid (often GERD) produces glossy, “cupped” crater-like lesions—typically first on posterior teeth—sometimes visible on radiographs as scooped cusp patterns. Because many children cannot describe reflux symptoms, clinicians must ask targeted questions (e.g., “hot burps,” sour taste, nighttime coughing). Erosion is chronic and may progress quickly in primary teeth; it can also contribute to sensitivity, restoration “standing proud,” and possibly unusual internal resorption, potentially due to digestive enzymes.<br /><br />Keels emphasizes conservative GERD management first: diet changes, avoiding late meals, stress reduction, and elevating the head of the bed. Medication (H2 blockers like ranitidine; PPIs if needed) should be used cautiously due to potential systemic risks, reserving specialist involvement for persistent cases; surgery is mainly for special-needs patients, though newer magnetic devices may help.<br /><br />In periodontal pathology, she highlights that children’s gingiva is highly vascular, so persistent gingivitis can signal systemic disease. She reviews practical cues (handedness affecting brushing patterns, orthodontic hygiene challenges), benign conditions (eruption gingivitis), and less common entities (localized spongiotic gingival hyperplasia treated with topical steroids). She urges a “gums vs. bone” diagnostic framework, noting rare but critical diagnoses like leukemia (AML/ALL) and hypophosphatasia, the latter now treatable with enzyme replacement therapy.

Keywords

dental acid erosion

pediatric dentistry

GERD-related tooth erosion

cupped crater-like lesions

radiographic scooped cusps

differential diagnosis bruxism vs erosion

bulimia vs erosion

primary teeth rapid erosion

tooth sensitivity and restorations standing proud

conservative GERD management

H2 blockers ranitidine

proton pump inhibitors risks

pediatric periodontal pathology

gingivitis as systemic disease sign