Caries in children

Dr. Renuga
Lecture Outline:
 Dental caries  Definition ,Theories proposed for cause
of dental caries.
 Sequelae of Dental Caries
 Rampant dental caries
 Definition, Characteristic and clinical
appearance.
 Predisposing Factors.

 Early Childhood Caries

 Definition, etiology and Diagnosis and
clinical appearance.
 Management OF ECC.

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 Definition

Dental caries is defined as an ‘’irreversible disease

of calcified tissues of teeth , characterized by
demineralization of the inorganic portion and
destruction of the organic substance of the tooth,
which often leads to cavitation’’ Shafer, Hine and Levy.

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Cont.

 Dental Caries is -a multifactorial disease –

interplay of 3 primary factors(Presence of micro-
organisms and a suitable substrate on a tooth
surface ) plus time also.
Suitable substrate

Caries Micro-
Tooth
organisms

Time 4
 Theories of the Cause of
Dental Caries
 Many theories have been proposed but only 3 have stood
the test of time:
I. The Proteolytic Theory Gottlieb (1946) later Frisbie
(1950)
II. The Proteolysis – Chelation Theory Schatz et al 1955
III. The Chemico-Parasitic Theory – Miller (1890) or
Acidogenic Theory
 This is the most popular, most supported by scientific data,
i.e. decalcification of enamel by acid followed by
disintegration of the organic component of tooth

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 Sequelae of Dental Caries

 The Bacteria ferment sugar to produce acid.

The acid dissolves tooth surface tooth decay or
dental caries which affects the enamel dentine
pulp pulpitis periapical infection dental
abscess.

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 Acute Dental Caries
Rampant Dental Caries
 Rampant caries has been defined as a suddenly
appearing, wide spread, rapidly burrowing type of
caries resulting in early involvement of the pulp and
affecting those teeth usually regarded as immune to
ordinary decay.

Winter

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 Characteristics of Rampant
Caries:
1.Most of the teeth are involved.
2.Lesion development is rapid
with frequent involvement of the
dental pulp.
3.Carious lesions occur on
surfaces generally considered to
be at low risk to decay such as
proximal surfaces of lower anterior
teeth , facial surfaces of upper
anterior teeth and lingual surfaces
of posterior teeth. 8
Clinical Appearance:
Generally the maxillary incisors develop a band of dull white
demineralization along the gum line that goes undetected by
the parents.
As the condition progresses, the white lesions develop into
cavities that girdle the neck of the teeth in a brown or black
collar.

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Cont.

 In advanced cases, the crowns of the 4 maxillary

incisors may be completely destroyed leaving
decayed brownish-black root stumps.

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Predisposing factors

 It may be:
1. Emotional disturbance.
2. Nutritional inadequacies.
3. Salivary flow and
viscosity.
4. Environmental factors.

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 Predisposing factors
1.Emotional disturbance:
 There is considerable evidence that emotional disturbance
may be the causative factor in some cases of rampant caries.
 Depressed emotions and fears.
 Dissatisfaction with achievement.
 Rebellion against home situation.
 A feeling of inferiority.
 Traumatic school experience.
 Continuous general tension and
anxiety.
Note:-
An emotional disturbance may initiate:-
a- Unusual demands for sweets or the habit of snacking also
b- Salivary deficiency is common in tense, nervous or disturbed
person.
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Cont.

2. Nutritional inadequacies:
 Some believe that rampant caries
is attributed to nutritional deficiency.
However, it is not a deficiency disease
or associated with malnutrition.
 Due to frequent and prolong use and
ingestion of sugar with or without
salivary flow.

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Cont.

3. Salivary flow and viscosity:

A direct relationship was found
between the viscosity of saliva
and the rate of dental decay. Also
inverse relationship between salivary
flow and dental decay rate.

4. Environmental factors:
Children acquire their dietary
habits ,oral hygiene habits and
oral microflora from their parents.
This makes dental caries more an
environmental than hereditary
disease. 14
Nursing Bottle caries

 It is a specific pattern of rampant caries affecting the

primary teeth of an infant during the first three years of age.
 The most commonly used name is “Nursing-Bottle Caries”.
Other names mentioned in the literatures are; Baby-bottle
caries, Nursing bottle syndrome, Baby-bottle tooth decay,
Nursing caries and recently Early Childhood Caries.

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Cont.

 because we now understand that the process of caries is

independent on the route of feeding
 but is dependent on the frequency of refined carbohydrates
in the diet.
 Milk, either natural or bottled, is fermented in the oral cavity
and the bacteria produce acids that dissolve enamel, and
the process continues as long as the child is nursed at
night.

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Nursing Bottle Caries

Etiology:
 This disorder results from:
 Inappropriate nursing habits, involving either the breast or
the bottle-feeding.
 The regular use of a sweetened comforter (a bottle
containing sweet beverages of any kind or breast-feeding at
night) at bedtime and/or during the day.

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Nursing Bottle Caries

 Breast-feeding is prolonged beyond the normal age for

weaning.
 Falling asleep with pacifier covered with honey or jam.
 The regular use of syrups for therapeutic reasons during
chronic or recurring illnesses.

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Early Childhood Caries

 It is diagnosed when there is one or more decayed (non

cavitated or cavitated lesions),missing(due to caries)or filled
tooth surface in any primary tooth in a child 71 months of
age or younger. (according American Academy of Pediatric
Dentistry (AAPD)).
 The term severe ECC(S-ECC) refers to
 Any sign of smooth surface caries in children younger than
3 years.
 One or more cavitated ,missing (due to caries) or filled
smooth surface in primary maxillary anterior teeth in
children 3-5 years.
 DMF score > or= 4 at age 3.
DMF score > or= 5 at age 4.
DMF score > or= 6 at age 5.
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The clinical Appearance

 It is similar to that of rampant caries except for:

1) Early onset of caries attack, around 11 months of
age, or may appear several years after disuse of
bottle (2-4 years).
2) Early involvement of maxillary incisors, which are
most severely affected, followed by primary first
molars and upper canines.

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Cont.

3) Generally, mandibular incisors are not affected,

because they are protected by the tongue in the
suckling position.

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Cont.

4)Teeth are subjected to caries attack in sequence

with their eruption order, and may be unilateral.

5)The second primary molars may escape the

caries attack if the habit is discontinued before
their eruption.

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 Early Childhood Caries Rampant Caries
(ECC)
Age of Seen in infants & toddlers Seen in all ages,
occurrence: including adolescence

Dentition Affects the primary Both primary and

involved: dentition permanent dentition
Characterist  Specific pattern is seen
ic Feature:
 Mandibular incisors are  Mandibular incisors
not involved are also affected

Etiology:  Improper bottle feeding  Multifactorial

 Frequent snacks
 Sticky refined CHO
 Decreased salivary
flow.
 Genetic background.
 Pacifier dipped in
honey/other sweeteners
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The effects of ECC

 Pain

 Infection

 Self-esteem

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Primary teeth are important!

 Eating and nutrition

 Holding Space

 Talking

 Smiling

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Management of Early Childhood
Caries:-
Management of Early Childhood Caries can be
divided into two main categories:-
A. Prevention.
B. Treatment.

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Prevention of Nursing Caries

 Avoid nocturnal feeding after the first primary

tooth begins to erupt.
 Avoid the use of nursing bottle for juices
 Juices should be offered in a cup as soon as
the child can drink from it.

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Cont.

 Oral hygiene measures should be implemented

by the time of eruption of the first primary tooth.
 Clean the infant’s teeth after each feeding.

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Cont.

 Discontinue nursing at 12-15 months

when child can use a cup.
 If night feeding is necessary only
water in the bottle should be allowed.
 Decrease the intake of sugar
and snacking habits.

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Cont.

 The first dental visit should be before 12 months of age to

allow early diagnosis and to educate parents.

 The use of sweetened pacifiers should be strongly

discouraged.

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Treatment

1. Control of all active carious lesions.

2. Dietary modification.
3. Encouragement of good oral hygiene.
4. Restoration.
5. Use of fluorides.
6. Pits and fissure sealants.

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 Treatment

1. Control of all active carious

lesions:
 Massive gross excavation of caries using
excavators or a large round bur.
 Sealing teeth with zinc oxide eugenol
or glass ionomer cement to arrest the
lesions &control caries activity(indirect
pulp capping).

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Cont.

2. Dietary modification:
The aim is the reduction in the intake of freely
fermentable carbohydrate.
a- Diet history assessment.
b- Dietary recommendation.

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Dietary recommendations:

1- Healthy , adequate and balanced diet.

2- Encourage sound breakfast.
3- Reduce the frequency of intake of
refined carbohydrate.
4- Select soluble forms and avoid sticky candies.
5- Restrict sugar containing foods to meal times.
6- Avoid between meals sugary snacks
& substitutated by fresh fruits,
vegetables or slices
of cheese.

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Cont.

3. Encouragement of good oral

hygiene.

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Cont.

Tooth brushing should begin

 With the eruption

of the first tooth.

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 Cont.

 As soon as the first teeth come

in, begin brushing them with
a small, soft-bristled toothbrush
and a pea-sized dab of fluoride
toothpaste.

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Cont.

We have to
 Brush for 2 minutes
every morning and
2 minutes every
night before bed.
 Be sure to spit out
all the tooth paste.
“ don’t swallow ”

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Cont.

 Help a young child

brush at night, which is
the most important time
to brush (due to lower
salivary flow during
sleep and higher
susceptibility to
cavities and plaque).

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Cont.

Toothbrushing Technique

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How to Brush & Floss Teeth Dr Michelle To' Pediatric DDS Sherman Oaks,Ca - 10Youtube.com.mp4

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Toothbrushes Designed for children

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 Disclosed Plaque and flossing

 Dental plaque is difficult to

see,it is easier to locate and
remove if stained with a
disclosing agent (solution
or tablets).

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Cont.

Advice for flossing

a- flossing should only introduce to
children who use a tooth brush
easily, efficiently.
b- Advice to floss on anterior teeth
first, later extending to posterior
teeth.
c- It is important for the dentist to
supervise the procedure
periodically.
d- Use unwaxed floss or tape.
e- After flossing all the teeth,
rinse the mouth.
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Cont.

4.Restorative strategies:
 Once rampant caries is under control ,comprehensive
treatment can be carried out.

 Early stages of cavities………..treated with restorations.

 Advanced cases…………………need full coronal
coverage.
 Pulpotomy or pulpectomy……..in extensive caries with
pulp involvement.
 A prosthetic appliance e.g.space maintainer……..if tooth
extraction is indicated.

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Cont.

5.Use of fluoride:

Systemic Topical

 Water fluoridation  Professionally applied:

 Salt fluoridation -Fluoride gel
 Milk fluoridation -Fluoride solution
 Fluoride supplements:  Self applied: -Dentifrices
Tablets , drops. -Mouth rinse
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Cont.

6. Pit and Fissure Sealants:

 Are plastic coating materials used
to seal deep pits and fissure of
posterior teeth and change
them in to non retentive surfaces.

 Prevent decay.

 Quick and easy to apply.

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