early childhood caries

PRESENTED BY- TRISHALA BAJRACHARYA

ROLL . NO . : 07 BDS 1ST BATCH

EARLY CHILDHOOD

CARIES

CONTENTS

• DEFINITION• CLASSIFICATION• ETIOLOGY• ETIOLOGICAL FACTORS• DEVELOPMENTAL STAGES• NURSING CARIES VS RAMPANT CARIES• MANAGEMENT• PREVENTION• REFERENCE

DEFINITON

• DAVIS (1990): A complex disease involving

maxillary primary incisors within a month after eruption and spread rapidly to involve other primary teeth.

• AMERICAN ACADEMY OF PEDIATRIC DENTISTRY (1999):

Early Childhood Caries is defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child between birth and 71 months of age.

CLASSIFICATION

•Carious lesions involving the molars & incisors.

•Cause: semi-solid food, lack of oral hygiene.

•Seen in 2-5 years of age.

TYPE I ECC(Mild to

moderate)

•Carious lesion involves almost all teeth including mandibular molars.

•Usually seen in 3-5 years of age.

•Cause: inappropriate use of feeding bottle, at-will breast feeding, poor oral hygiene.

TYPE II ECC(Moderate to

severe)

•Carious lesions involve all the teeth, including mandibular incisors.

•Usually seen in 3-5 years of age.

•Cause: Factors + immune tooth surfaces.

TYPE III ECC(Severe)

ETIOLOGY

Several factors, primarily related to improper feeding practices -

-Bottle feeding before sleep-Pacifiers dipped in honey-Prolonged at-will breast feeding

NURSING CARIES

-Multifactorial with all the essential factors involved.

-Frequent snacks, excessive sticky refined carbohydrate intake-Decreased salivary flowGenetic background

RAMPANT CARIES

ETIOLOGICAL FACTORSMicro-organis

ms

Host

Time

Substrate

1. PATHOGENIC MICRO ORGANISMS

• Principle organism : Streptococcus mutans• Considered more virulent: - It colonizes the teeth. - It produces large amount of acid. - It produces large amount of

extracellular polysaccharides.

2. SUBSTRATE

• Carbohydrates Dextrans

- Adhere organisms to tooth surface. - Cause organic acids to demineralize the tooth.Infants and toddlers : main source of

carbohydrates- - Bovine milk or milk formulas - Human milk - Fruit juices and other sweet fluids - Pacifiers dipped in honey or sugar solution - Chocolates or other sweets

By micro-organisms

3. HOST

• TEETH• Hypomineralization or hypoplasia of

the teeth• Thin enamel in the primary teeth• Developmental grooves

4. TIME

• Important factor in determining caries activity.

Role of Saliva

• Caries pattern describes the role of saliva.• Caries in maxillary incisors maybe due to : - Antigravity action - Low buffer action and viscocity of saliva - Less flow during night - No lip seal – dryness - Antibodies factor IgA – less in children.

DEVELOPMENTAL STAGES

1. Stage I : Initial2. Stage II : Damaged3. Stage III : Deep lesions4. Stage IV : Traumatic

STAGE I : INITIAL (REVERSIBLE)

• Cervical & interproximal opaque white chalky demineralization seen on the smooth surfaces of maxillary anterior teeth.

• Between age of 10 and 20 months.• A distinctive whitish line

distinguished in the cervical region of the vestibular and palatal surfaces.

• The lesions are reversible.

STAGE II : DAMAGED

• Between age of 16-24 months.• Dentin is affected when the white

lesions on the incisors develop rapidly, causing the enamel to collapse.

• Dentin : exposed , appears soft & yellow.

• Maxillary primary molars – initial lesions in cervical, proximal and occlusal regions.

• Complaints of toothache on ingestion of extremely cold food.

STAGE III : DEEP LESIONS

• Between 20 – 30 months.• Large, deep lesions in maxillary

incisors and pulpal irritation.• Complaints of pain during : - Toothbrushing - Eating - Intake of hot or cold food - Spontaneous pain during the night

STAGE IV : TRAUMATIC

• Between ages of 30 – 48 months.• Coronal fractures of anterior maxillaries as a

result of amelodentinal destruction.• Fractures of one or more carious teeth;

frequent occurrence- cervically.• Maxillary incisors are necrotized and pulpal

involvement of maxillary primary molars.• Maxillary canines – carious brown lesions.• Experience sleep deprivation & refuse to

eat.

NURSING CARIES VS RAMPANT CARIES

NURSING CARIES RAMPANT CARIES

Specific form of rampant caries Acute, widespread caries with early pulpal involvement of teeth which are usually immune to decay.

Age of occurrence Seen in infants and toddlers Seen at all ages, including

adolescence

Dentition involvedPrimary dentition Primary and permanent dentition

Characteristic features-A specific pattern of involvement is seen. The maxillary incisors followed by the molars are involved.-Significantly, the mandibular incisors are not involved.

-Surfaces considered immune to decay are involved. Thus, mandibular incisors are affected.-Rapid appearance of new lesions and not just years of chronic decay due to neglect.

Treatment- If detected in early stages, can be managed by topical flourides and education.-Directed toward maintainence of teeth till the tansition occurs.

-With the presence of multiple pulp exposures would generally require pulp therapy.- Long- term treatment may be required when permanent dention is involved.

PreventionAt the young age as the child is in constant contact with the mother, education of prospective and new mothers is desired specifically.

Dental Health Education at a mass level involving people at all ages.

MANAGEMENT

• Aims : - Management of existing emergency - Arrest and control of the carious

process - Institution of preventive procedures - Restoration and rehabilitation

TREATMENT

• 3 VISITS

1. First visit : - Treatment and identification of cause, - Excavation and restore the lesion. - Radiograph – pulp therapy, succedaneous tooth - Abscess- drain - Collection of saliva for determining the

salivary flow and viscocity.

• Parent counseling: - Feeding habits - Weaning - Oral hygiene - Maintain diet record (time, amount

of food and number of sugar exposure)

Second visit (after a week) : - Analysis of diet chart - Isolation of the sugar factors from

the diet chart & control sugar exposure.

- Reassess the restoration - Redo if needed. - Caries activity tests.

• Third visit & subsequent visits:- Restore all grossly carious teeth.- Initiate endodontic treatment.- Unrestorable teeth – extraction –

space maintainer- Grossly carious teeth – crown- Review and recall every 3 months.

PREVENTION

Community : -Education - Water fluoridationProfessional : - Early detection Diet counseling Fluoride, Chlorhexidine Sealant Control of transmission of

cariogenic bacteriaHome Care : - Dietary habits, Fluoride,

dentrifrices, fluoride sealants, Oral hygiene

• Infant Oral Care : - Gum pad cleaning, oral hygiene

maintainence.• Weaning : - Introduction of the cup at 8 months

of age and complete weaning by 15 – 18 months of age.

• Anticipatory guidance : ‘Proactive counseling of parents

and patients about development changes that will occur in the interval between health supervision visits that include information about daily caretaking specific to that interval.’

REFERENCE

• TEXTBOOK OF PEDODONTICS 2ND EDITION - SHOBHA TANDON