Case 98

This 2-year-old child presented with almost total destruction of all primary maxillary teeth. Most were decayed to the gum line and only three teeth still have clinical crowns, but even these have caries present (Image 98). No previous dental care had been documented. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig98.jpg"/>

What does the image show?

What are the potential consequences of these findings?

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This is a classic case of dental neglect, with multiple caries likely reflecting ‘nursing bottle caries’ in response to the bottle being propped and extensive milk-tooth contact. Dental neglect has been defined as the willful failure of a parent to provide needed dental care. ¹ In this case, the deliberate bottle propping in addition to the destruction of the teeth is consistent with a willful act.

Untreated, this can lead to acute infection, pain and loss of function. This can harm lifetime function, communication, nutrition and other activities necessary for normal growth and development. If infection progresses to sepsis or deeper infection, it may result in death. An assessment for other types of child neglect should be carried out in a child presenting with such dental caries. Any siblings of this child should also be assessed.