Early childhood caries, rampant, chronic and arrested caries

Early childhood caries, rampant, chronic and arrested caries

1. Early childhood caries, rampant, chronic and arrested caries Presented by : Eman M Saeed , Noran Waleed ,Saeed Ahmed , Nahla Mohie , Hala Khalid , Aya Awad , Fadi Imad

2. Include two variants 1- Nursing caries 2- Rampant caries Different between them is involvement of mandibular incisors in rampant caries Early childhood caries ( ECC )

3. Early childhood caries ( ECC ) Synonyms : Nursing Bottle Caries, Baby Bottle Caries , Nursing Bottle Syndrome ,Baby Bottle Tooth Decay ,Nursing Caries , Maternally Derived Streptococcus Mutant Disease ( MDSMD ) .

4. Definition of ECC The A merican academy of pediatric dentistry (AAPD) define ECC as the presence of one or more decayed nonactivated or cavitated, missing due to caries, or filled tooth surfaces in any primary tooth” in children 71 month of age or younger AAPD also specifies that in children younger than 3 years of age any sign of smooth surface caries is indicative of sever early childhood caries S-ECC

5. The Child Is Younger Than Age 3 And Demonstrates Any Evidence Of Disease Experience On Any Smooth Surface Of Any Tooth. The Child Is 3, 4, Or 5 Years Of Age And Demonstrates Any Evidence Of Disease Experience On A Maxillary Incisor Smooth Surface. The Total Number Of Affected Surfaces Is Equal To Or Greater Than Four Surfaces At Age 3, Five Surfaces At Age 4, Or Six Surfaces At Age 5 Sever Early Childhood Caries

6. Etiology according to APPD 1-inappropriate Nursing Habits ( Breast Or Bottle ) 2- Prolonged Breast Feeding Beyond Normal Age Of Weaning 3-falling Asleep With Pacifier Covered With Honey Or Jam 4- Regular Use Of Sweetened Comforter 5- Regular Use Of Therapeutic Syrup

7. Clinical picture : Teeth Affected : The most affected are the 4 maxillary incisors The 4 mandibular incisors remain sound due to protection from tongue during sucking the other primary teeth exhibit caries depending upon how long carious process remains active but usually is not sever as maxillary incisors Clinical Pattern : Initially maxillary incisors develop a band of dull white of demineralization along gum line and this is undetected by patents

8. Then the white lesions develop into cavities that circle the neck of the teeth in brown or black collar advance cases crown of 4 maxillary incisors maybe destroyed completely leaving brownish black root stumps

9. Management of ECC Prevention development of dietary habits and self care habits at home ( oral hygiene , use of fluoride supplement if needed , use of fluoridated tooth paste , dietary habits ) professional examination and preventive care (early dental examination before age of 1 year , parent counseling ,professional application of topical fluoride varnish and fissure sealant ) community base strategy include ( national education program for mothers and care givers , personal and community preventive program , water fluoridation )

10. Treatment 1- cessation of habits 2- sealing all caries free pits and fissures 3- fluoride application 4- IRR by use IRM 5-pulp therapy and buildups of restorable teeth

11. Rampant caries Rampant caries are suddenly occurring (acute) growing type (widespread caries) with early pulpal involvement of teeth which are usually immune to decay (Masseleu1945).

12. General Features of Rampant caries : i . Many teeth are involved ii. Seen in children and adolescents iii. Carious lesion occurs on the surfaces generally considered to be at low risk of decay iv. Prevalence = 5-8 percent v. Females are more prone than males vi. Age: 4-8 year → Children 11-18 year → Adults .

13. Etiology : 1-Salivary deficiency 2-Genetic 3-Habits 4-Nutration 5-Diet 6-psychological factors

14. Clinical Features : Seen in primary and permanent dentition. In primary teeth features are related to order of tooth eruption. Initial lesions appears on labial surface of maxillary incisors near the gingival margin as a white area/ pitting on enamel surface. In permanent teeth—Related to the eruption of teeth. – Here buccal and lingual surface of premolar and molar are involved. – Proximal and labial surface of maxillary incisors and proximal surface of mandibular incisors are involved

15. Complications : Affects maxillary anterior which may lead to psychological problem due to loss of esthetics Minimal trauma can lead to fracture of teeth Difficulty in speech Development of abnormal habits Orthodontic problems Multiple abscess formation General health impaired Hospitalization may be required

16. Sequalae Of Rampant Caries A- Pain B- Infection C- Tongue Thrusting D- Abnormal Swallowing Habits E-Speech Difficulties

17. Control of All Active Carious Lesion Gross excavation of caries and restoration with ZOE which will temporarily arrest the caries process and prevent pulp involvement Reduction in intake of carbohydrates Diet analysis and diet counselling Snacks should be suppressed Application of topical fluorides

18. Repeat single fluoride application therapy every 3 months. If there is no loss of enamel, topical fluorides are given. If there is extensive cavitation with no pulp involvement in anterior teeth—GIC, polycarboxylate cement and in Posterior teeth amalgam, stainless steel crown are given. Extensive cavitation with pulp involvement— pulpotomy, pulpectomy

19. Arrested Caries : No longer an active lesion This is a carious lesion that does not progress; the stage where the decay process has stopped can occur in enamel and dentine It is seen when the oral environment has changed from conditions predisposing caries to conditions that tend to slow the lesion down .

20. How Do Arrested Caries Appear Clinically ? Mostly on lingual/labial aspect, sometimes occurs inter proximally.

21. Properties of Arrested Caries : Arrested white spotted lesion : - has shiny surface; may be brown in color -is more resistant to attack by acid than sound enamel -regarded as scar tissue; thus should not be attacked with a dental drill Arrested caries in dentine : -discolored (yellow, brown or black) -hard or leather consistency, due to presence of tertiary and sclerotic dentine -rest of dentine appears polished

22. How can Arrested Lesions be Induced ? Caries can be arrested by simple clinical measures e.g : improved plaque control with a fluoride toothpaste altered diet Thus, its vital for the clinician to detect enamel caries in its earliest form by visual inspection of teeth after cleaning and drying

23. Promoting Arrest of Carious Lesions 1-Fluoride -Increase resistance of hydroxyapetite in enamel and dentine to dissolution by plaque -E.g., toothpastes, water fluoridation -Greatest benefit when there is constant availability for remineralization   -E.g., Glass ionomer cements Gluterdialdehyde Collagen fixation, reduced diffusion of ions out of lesions, and antibacterial actions

24. Promoting Arrest of Carious Lesions 2-Sugar Substitutes -E.g., xylitol or sorbitol in chewing gum Increased saliva flow 3-Atraumatic Restorative Technique 4-Make cavities accessible to cleaning 5- Sealing in Caries

25. Chronic Caries form of caries that occurs over time and  demands regular dental intervention. These lesion are usually of long standing involvement affect a fewer number of teeth and are smaller than acute caries

26. Pain is not a common feature because of protection afforded to the pulp by secondary dentin The decalcified dentin is dark brown and leathery

27. Pulp prognosis is hopeful in that the deepest of lesions usually requires only prophylactic capping and protective bases The lesions range in depth and include those that have just penetrated the enamel