EARLY CHILDHOOD CARIES

EARLY CHILDHOOD CARIES
CONTENTS
Introduction
Early childhood caries
Classification
Nursing caries
Etiological agents in nursing bottle caries
Clinical features
Progression of the lesion
Implications
Management
Prevention
Nursing vs rampant caries
Reference




INTRODUCTION
DEFINITION (SHAFER)
Dental caries is an irreversible microbial disease of calcified tissues of the teeth, characterized by demineralization of inorganic portion and destruction of organic substance of tooth, which often leads to cavitation.


REASONS FOR DECLINE OF CARIES
EARLY CHILDHOOD CARIES
DEFINITION: DAVIES, 1988
A complex disease involving maxillary primary incisors within a month after eruption and spread rapidly to involve other primary teeth.

CLASSIFICATION
NURSING CARIES
Winter et al, 1966
A unique pattern of dental decay in young children due to prolonged and improper nursing/feeding habit.

PATHOGENIC MICRORGANISM
Steptococcus mutans- main microbe that colonizes teeth after it erupts into oral cavity.
It is transmitted to infant’s mouth through mother.
It is more virulent because:-
It colonizes the teeth
It produces large amount of acid
It produces large amount of extracellular polysaccharides that favor plaque formation.

SUBSTRATE(fermentable carbohydrate)
Carbohydrates are converted into dextrans by microorganisms.
In infants & toddlers, the main sources of fermentable carbohydrates are:
Bovine milk or infant formulas
Human milk (breast-feeding at will)
Fruit juices & other sweet liquids
Sweet syrups like vitamin preparations
Pacifiers dipped in honey or sugar solution
Chocolates or other sweets
HOST
Teeth act as host for microorganisms
Hypomineralisation or hypoplasia of teeth increases the susceptibility of child to caries
Thin enamel in primary teeth is one of the reasons for early spread of lesions
Developmental grooves also may act as plaque retentive areas
TIME
More the time child sleeps with bottle in the mouth the higher is the risk of caries because the salivary flow and the swallowing reflex decrease, thus providing more time for accumulation of carbohydrates in the mouth which are acted upon by microbes to produce acid leading to caries.
OTHER PREDISPOSING FACTORS
Overindulgence of parents
Crowded homes
Child who has less sleep
Malnutrition
Iron deficiency & excess lead exposure- salivary gland function impaired
Low weight infants (<2500 gms)
CLINICAL FEATURES
The intraoral decay pattern is characteristic & pathognomonic of this condition.

Mandibular anterior teeth are usually spared because of:
Protection by tongue
Cleansing action of saliva due to presence of the orifice of the duct of sublingual glands very close to lower incisors.
PROGRESSION OF THE LESION
IMPLICATIONS
The child who has nursing caries has an increased risk of developing caries even in permanent dentition.
The child with caries is also susceptible to other heath hazards.
The treatment of nursing caries may prove to be financial burden for some parents.
MANAGEMENT
Aims:
Management of existing emergency
Arrest & control of the carious process
Institution of preventive procedure
Restoration & rehabilitation
Factors affecting management:
Extent of the lesion
Age of the patient
Behavioral problems due to young age of the child
TREATMENT : 1ST VISIT
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 by drainage
X-Rays are advised to assess the condition of succedaneous teeth collection of saliva for determining the salivary flow & viscosity
Also, application of fluoride topically.
PARENT COUNCELLING
Parent should be questioned about the child’s feeding habits, nocturnal bottles, demand for breast-feeding, pacifiers.
Parents should be asked to try weaning the child from using the bottle as pacifier while in bed.
In case of emotional dependence on the bottle, suggest 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 1 week that includes the time, amount of food given to the child, the type of the food & the number of sugar exposures.
2nd VISIT
Should be scheduled 1 week after 1st week.
Analysis of diet chart & explanation of disease process of child’s teeth
Isolate the sugar factors from diet chart & control sugar exposure
Reassess the restoration and redo if needed
Caries activity tests can be started & repeated at monthly interval to monitor the success of treatment
3rd & SUBSEQUENT VISITS
Restoring all grossly decayed teeth
Endodontic treatment
In case of unrestorable teeth, extraction followed by space maintainer
Crowns given for grossly decayed & endodontically treated teeth
Review & recall after every 3 months
PREVENTION
Information of nursing bottle caries can be distributed to new parents through obstetricians, pediatricians & child care centers.
Sealing of all pits & fissure caries
Professional fluoride programs
Use of antimicrobial therapy topically
Systemic fluoride in drinking water
NURSING VS RAMPANT CARIES

NURSING CARIES
RAMPANT CARIES

REFERENCE
SHOBHA TONDON (FOR PEDIATRICS DENTISTRY) 2nd EDITION.