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Early childhood caries.ppt
- 1. 1 NAVODAYA DENTAL COLLEGE DEPARTMENT OF PEDODONTICS STAFF NAME – Dr NAVEEN KUMAR Professor TOPIC NAME – EARLY CHILDHOOD CARIES
- 2. Dental Caries: Tooth decay, also known as Dental caries, is defined as a disease of the hard tissues of the teeth caused by the action of microorganisms, found in plaque, on fermentable carbohydrates (principally sugars). 2 According to Shafer - Dental caries is a microbial disease of the calcified tissues of the teeth, characterized by demineralization of inorganic portion and destruction of the organic substances of tooth.
- 3. EARLY CHILDHOOD CARIES it is a unique pattern of dental caries in very young children due to prolonged and improper feeding habits. Terminologies -Nursing Caries -Nursing Bottle Caries/ Mouth/ Syndrome -Night Bottle Syndrome -Baby Bottle Tooth Decay -Milk Bottle Syndrome -Tooth Cleaning Neglect -Infant & Early Childhood Decay -RIECDO [Rampant Infant and Early Childhood Dental Decay] -Maternally Derived Streptococcus Mutants Disease [MDSMD] -Early Childhood Caries [ECC] 3
- 4. DEFINITIONS ECC 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 child 71 months of age or younger . American Academy of Pediatric Dentistry (2016) ECC is defined as the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child under the age of six. 4
- 5. Classification of Early Childhood Caries Type I ECC (Mild to moderate) Type II ECC (Moderate to. severe) Type III ECC (Severe) Tooth involved Molars and incisors. Labia-lingual carious lesion affecting the maxillary incisors with or without molar caries, depending on age+ unaffected mandibular molars Carious lesions involve almost all the teeth, including mandibular molars Age 2-5 years Seen soon after first tooth erupt 3-5 years Cause Combination of cariogenic semisolid or solid food and lack of oral hygiene. In appropriate use of feeding bottle or at will breast feeding or combination of both + poor oral hygiene. Combination of factors and a poor oral hygiene. Progress Number of affected teeth usually increases as the cariogenic challenge persists. Unless controlled it may proceed to an advanced stage. Rampant in nature and involves immune tooth surfaces. 5
- 6. 6
- 7. 1. Pathogenic Microorganism Streptococcus mutans is the principle organism which colonizes the tooth after it erupts into the oral cavity. It is transmitted to the infant's mouth primarily through mother. It is considered more virulent because of the following reasons: a. It colonizes the teeth b. It produces large amount of acid c. It produces large amount of extra cellular polysaccharides which favor plaque formation. S.mutans is more commonly evident in rapid and smooth surface caries and less common in pit and fissure caries. 7
- 8. The Window of Infectivity “Window of Infectivity” is used to describe the time period when children are at greatest risk for acquiring MS MS colonization occurs between 19 – 31 months of age, but has been seen as early as 10months is some populations/studies A second “window” is speculated to occur when 1st molars are erupting 8
- 9. 2. Substrate (Fermentable carbohydrate) Carbohydrates are utilized by microorganisms to form dextrin’s which a. adhere organisms to tooth surface b. cause organic acid to demineralize the tooth In infants and toddler, the main sources of fermentable carbohydrate are: Bovine milk or milk formulas Human milk (breast feeding at will or on demand) Fruit juices and other sweet liquids Sweet syrups like vitamin preparations Pacifiers dipped in honey or sugar solution Chocolates or other sweets 9
- 10. If child sleeps with a bottle. If child has a bottle for long periods during the day. How might child get early childhood caries? 10
- 11. How might child get early childhood caries? If child sucks on a pacifier dipped in honey, syrup or anything sweet. 11
- 12. How might child get early childhood caries? Prolonged night time breast feeding after the eruption of the first milk tooth Frequent snacking, frequent exposure to sweet things like chocolates, chips etc. 12
- 13. How might child get early childhood caries? Inadequate oral hygiene Bacteria transmission from mother to child o Malnutrition o Medication 13
- 14. 3. Host Teeth act as the host for the micro-organisms Hypomineralisation or hypoplasia of the teeth increases the susceptibility of the child to caries Thin enamel in the primary teeth is one of the reasons for early spread of lesions Developmental grooves also may act as the plaque retentive areas 14
- 15. 4. Time It is an important factor that determines caries activity. More the time child sleeps with the bottle in the mouth, the higher is the risk of caries. This is because the salivary flow and the swallowing reflex decrease, thus providing more time for the accumulation of carbohydrates in the mouth which are acted upon by microorganisms to produce acid leading to caries. 15
- 16. 5. Other predisposing factors Over indulgence of parents Crowded homes Child who has less sleep Malnutrition Recently, it has been seen that salivary gland function is impaired by iron deficiency and excess of lead exposure, which makes the oral environment more caries susceptible. Low birth-weight infants (less than 2500 g) 16
- 17. CLINICAL FEATURES It affects the primary teeth in the following sequence of involvement. a. Maxillary central incisors b. Maxillary lateral incisors c. Maxillary first molars d. Maxillary canine and second molars e. Mandibular molars: At later stage Mandibular anterior teeth (nursing caries) are usually spared because of: a. Protection by the tongue b. Cleansing action by saliva due to presence of the orifice of the duct of the sublingual glands very close to lower 17
- 18. Progression of Early Childhood Caries 18 Initially, a demineralized dull, white area is seen along the gum line on the labial aspect of maxillary incisors, which is undetected by the parents. These white lesions become cavities which involves the neck of the tooth in a ring like lesion. Finally, the whole crown of the incisors is destroyed leaving behind brown black root stumps.
- 19. 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 involved Affects the primary dentition. Affects the primary and permanent dentition Characteristic features -A specific pattern of involvement is seen. The maxillary incisors followed by the molars 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 just years of chronic decay due to neglect. 19
- 20. Nursing Caries Vs Rampant Caries Nursing Caries Rampant Caries Etiology Several factors, primarily related to improper feeding practices such as: - Bottle feeding before sleep. - Pacifiers dipped in honey/other sweeteners - Prolonged at will, breast feeding. More multifactorial with all the essential factors involved and not just feeding practices. . Frequent snacks, excessive sticky refined carbohydrate intake. . Decreased salivary flow. . Genetic back ground. Treatment If detected in early stages, can be managed by topical fluoride applications and education. . Directed toward maintenance of teeth till the transition occurs. . With presence of multiple pulp exposures would generally require pulp therapy. . Long term, treatment may be required when permanent dentition is involved. 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. 20
- 21. Management Aims Management of existing emergency Arrest and control of the carious process Institution of preventive procedures Restoration and rehabilitation Factors affecting management Extent of the lesion Age of the patient Behavioral problems of the child due to young age of the child 21
- 22. Treatment It can be divided into three visits First visit This phase of treatment constitutes treatment of the lesion, identification of the cause for counseling of the parent. All lesions should be excavated and restored Indirect pulp capping or pulp therapy procedures can be evaluated by further investigation If the abscess is present it can be treated through drainage X-rays are advised to assess the condition of the succedaneous teeth. Collection of saliva for determining the salivary flow and viscosity, Also, the application of fluoride topically 22
- 23. Treatment Parent counseling The parent should be questioned about the child's feeding habits, especially regarding the use of nocturnal bottles, demand the breast feeding, 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 considerable 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. Parents are advised to maintain a diet record of the child for one week which includes the time, amount of food given to the child, the type of food and the number of sugar exposures. 23
- 24. Treatment Second visit It should be scheduled one week after the first visit. Analysis of diet chart and explanation of the disease process of the child's teeth should be undertaken. Isolate the sugar factors from the diet chart and control sugar exposure. Reassess the restoration and redo if needed. Caries activity tests can be started and repeated at monthly intervals to monitor the success of treatment. 24