Dental caries and oral-health prevention — structured clinical encounter

A three-year-old girl is brought for a check. Her mother mentions her upper front teeth have gone brown over the last year; she has fallen asleep each night with a bottle of sweetened milk since infancy, and brushing is inconsistent. On examination the maxillary anterior primary teeth show chalky white spots and brown cavitated lesions while the lower anterior primary teeth are spared; she is otherwise well, with no swelling or fever. You are the paediatric registrar working through the case definition and pattern of early childhood caries, the caries-risk assessment, the prevention ladder and the developmental enamel defect differential, with a later scenario of a four-year-old with a swollen face, fever and trismus from a necrotic molar representing a spreading odontogenic infection.