Management & Prevention of early childhood caries

Management and prevention of ECC
Difference between ECC & Rampant caries

1. Management & Prevention Of Early Childhood Caries Sushma GR Mohan

2. Contents Management and prevention of ECC Difference between ECC & Rampant caries Rampant caries Definition Etiology Classification Clinical features Management and prevention

3. Management Aims Management of existing emergencies Arrest and control of carious process Institution of preventive procedures Restoration and Rehabilitation

4. Management The management of early childhood caries is affected by extent of carious lesions and compliance of child and parent. It includes Control of carious process Stabilization of carious lesion Restorative treatment Extraction Prognosis Recall and follow up

5. Treatment Proper First Visit Treatment of the lesion, counselling of the parent. All lesions should be excavated and restored. IPC or pulp therapy can be evaluated. Draining of the abscess. Collection of saliva to determine flow and viscosity. X-rays are advised to assess the condition of the succedaneous teeth.

6. Treatment Proper Parent Counseling The parent should be questioned about the child’s feeding habits, specially regarding the use of nocturnal bottles, demand the breastfeeding pacifiers dipped in sweetening agents. The parents should be asked to try weaning the child from using the bottle as a pacifier while in bed. In case of emotional dependence on the bottle, suggest the use of plain or fluoridated water The parents should be instructed to clean the child’s teeth after every feed. The parents are advised to maintain a diet record of the child for a week.

7. Treatment Proper Second Visit It should be scheduled one week after the first visit. Analysis of diet chart and explanation of disease process of the child’s teeth. Isolate the sugar factors from diet chart and control sugar exposure by intelligent use. Reassess the restoration and redo if needed. Caries activity test can be started and repeated at monthly intervals.

8. Treatment Proper Third and subsequent visits Restoring all grossly decayed teeth. Endodontic treatment In case of unrestorable teeth, extraction can be done followed by space maintainer. Crowns can be given for grossly decayed or endodontically treated teeth. Review and recall after every three months.

9. Prevention Prevention of early childhood caries requires addressing the social and economic factors which are endemic. The education of mothers or caregivers to promote healthy dietary habits in infants has been the main strategy used for prevention of ECC There are three general approaches 1. Community based education 2. Prevention of transmission of cariogenic bacteria 3. Home based prevention

10. Prevention 1. Community Based Education The goal of education is to increase the knowledge of mothers about ECC and to improve the dietary and nutrition habits of infants and mothers. Positive changes in infant feeding practice have been found to be modest even when, a community educational program was designed and implemented in collaboration with members of high ECC risk community.

11. Prevention 2. Prevention of transmission of cariogenic bacteria Genotypes of mutans streptococci in infants appeared identical to those of mothers in 71 % of mother-infant pairs.

12. Prevention 3. Home based preventive approach No signs of ECC / Low risk ECC Signs of ECC/ High risk ECC Fluoridated dentifrices Review of dietary and oral hygiene Fluoride varnish Sealants Chlorhexidine varnish Xylitol pacifiers Fluoridated supplements and dentifrices Dietary counseling

13. ECC Rampant Caries Specific form of rampant caries Acute, widespread caries with easily pulpal involvement of teeth which are usually immune to decay Age of Occurence Seen in infants and toddlers Seen at all ages, including adolescence Dentition involved Affects the primary dentition Affects the primary and permanent dentition Features Maxillary incisors are involved followed by molars Surfaces considered immune to decay are involved, thus Mandibular incisors are affected Difference between ECC & Rampant caries

14. ECC Rampant Caries Treatment Early - Managed by topical fluoride With multiple pulp exposure, it often requires pulp therapy Prevention At 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 involves people at all ages. Difference between ECC & Rampant caries

15. Rampant Caries

16. Rampant Caries MASSLER(1945)- Defined rampant caries as suddenly appearing widespread, rapidly spreading, burrowing type of caries, resulting in early involvement of pulp and affecting those teeth, which are usually regarded as immune to decay. WINTER ET AL.(1996)- ACute onset involving many or all erupted teeth rapidly destroying coronal tissue often on surface immune to decay and leading to early involvement of pulp.

17. Etiology Salivary Deficiency Due to radiation therapy In stressed children who have tranquilizers Xerostomia Genetical

18. Etiology Habits Feeding of the child with sweetened milk through the night Sweetened pacifiers Nursing the child through the night

19. Etiology Nutrition Nutritional deficiency Diet In between meal and snacking of cariogenic foods Sucrose content in diet Psychological factors Emotional disturbances Repressed emotional fear(this cause decrease salivary flow)

20. CLassification According to Age These are seen in Infants Young children Teenagers Adults of all age Most prevalent age groups are 4-8 & 11-19 years

21. Clinical Features Most common site Proximal surface of lower anterior teeth and development of cervical type of caries. Labial surface of all maxillary anterior teeth

22. Clinical Features Soft consistency and light yellow in colour Onset and progress of the lesion is very rapid

23. Clinical Features Advance stage, extend around the circumference of the tooth Common site- second primary molars and eventually canines

24. Management Management depends on Patients and parents motivation toward dental treatment Extent of the decay Age Co-operation of the child

25. Initial Treatment Initial treatment includes Provisional restorations Diet assessment Oral hygiene instructions Home and professional fluoride treatment

26. Provisional restorations Excavation of each carious lesion and provisional restorations should be placed in symptom free teeth to minimize the pulpal exposure. Patients with acute and severe signs and symptoms requires immediate treatment. If the pulp is vital → Formocresol pulpotomy Pulp is non-vital → pulpectomy followed by obturation with ZOE

27. Diet Assessment Parents should be educated to reduce the frequency of sucrose consumption by their child, especially between meals In infants- bottle feeding habit should be stopped by gradually decreasing bottle content with water as well as decreasing amount of added sugar over 2-3 weeks period. Dietary vitamin supplements as well as oral medications must also be included.

28. Oral Hygiene Instructions It is important to teach children the proper techniques of brushing at different age groups. i .e, under the age of 8 years - Fones technique After 11-12 years - Bass Technique. Explain the proper brushing technique to the patient by demonstrating with articulated models of dental arches and brush.

29. Fluoride Treatment Both systemic and topical fluoride treatments are useful for preventing dental caries. The choice depends on the level of fluoride in the drinking water and the stage of development of the detention. Level of fluoride in the drinking water of various ages is: Age(Year) < 0.3 ppm 0.3 - 0.7 ppm > 0.7 ppm 0 - 2 0.25 0.00 0.00 2- 3 0.50 0.25 0.00 3 - 16 1.00 0.5 0.00

30. Age specific prevention of rampant caries Dentition: 0-5 years Diet advice : diet counselling with parent on good nursing technique. Fluoride Therapy Toothpaste Fluoride Tablets in area without water fluoridation. Professional topical fluoride application every six months. Plaque Control Oral Hygiene instructions to parents. Tooth brushing with parental supervision.

31. Age specific prevention of rampant caries B. Mixed dentition: 5-12 years onwards Diet advice: diet counselling with parents and patients Fluoride Therapy Toothpaste Tablets upto 8 years if in area without water fluoridation Mouth Rinse Plaque control Oral Hygiene instructions to patient. Tooth brushing without parental supervision Disclosing tablets Fissure sealants (3-6 months recall)

32. Age specific prevention of rampant caries C. Permanent dentition: 12 years onwards Fluoride Therapy Toothpaste Professional fluoride application every 6 months Mouth Rinse Plaque control Oral prophylaxis Oral Hygiene instructions to patient. Tooth brushing Disclosing tablets Interdental cleaning with floss or tooth picks

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