nursing bottle caries and rampant caries
TRANSCRIPT
NURSING BOTTLE
CARIES AND RAMPANT
CARIES
CONTENTSNURSING BottlE CARIESINtroductionTerminologies and DefinitionsRAMPANT CARIESClassification Etiological agentsClinical features EARLY CHILDHOOD CARIESDEFINITIONETIOLOGYCLINICAL FEATURES DIAGNOSISTreatmentprevention
IntroductionAcc. To SHAFERS, dental caries is an irreversible microbial disease of calcified tissues of the teeth,characterized by demineralization of inorganic portion and destruction of organic portion of the tooth.
NURSING BOTTLE CARIES
Terminologies and definitionsWinter et al,1960 “Nursing caries is a unique pattern of dental decay in young children due to prolonged nursing habit.”
Kroll et al,1967 “Nursing bottle mouth is a syndrome characterized by a severe caries pattern beginning with the maxillary anterior teeth in a healthy bottle fed infant or toddler”
Shelton et al,1977 “ Nursing bottle syndrome is a devastating condition that may render young children dentally crippled”. Other names are Bottle propping caries,Labial caries, Comforter caries
TERMINOLOGIES
l NURSING CARIES- WINTER ET AL, 1968l NURSING BOTTLE MOUTH- KROLL ET AL,1967l NURSING BOTTLE SYNDROME- SHELTON ET AL,1977l BABY BOTTLE CARIES-DILEY ET AL,1980l BABY BOTTLE MOUTH-CROLL,1984l NURSING BOTTLE CARIES-TSAMTSOURIS,1986l BABY BOTTLE TOOTH DECAY-MIM KELLY ET AL,1987l MILK BOTTLE SYDROME-RIPA,1988l EARLY CHILDHOOD CARIES-DAVIES,1998
RAMPANT CARIES
1)CLASSIFICATION
1)Based on anatomic site
Crown caries Root caries
PIT AND FISSURE CARIES
SMOOTH SURFACE CARIES
1)Based on progression of the lesion
ARRESTED CARIES PROGRESSIVE CARIES
RAPIDLY PROGRESSING
SLOWLY PROGRESSING
NURSING CARIES RADIATING CARIES
l Based on virginity of lesionl Primary cariesl Secondary caries
l Based on chronologyl Early childhood cariesl Adult cariesl Adolescent caries
Based on type of dentitionl Caries in primary dentitionl Caries in mixed dentitionl Caries in permanent dentition
l BASED ON SEVERITYl INCIPIENT CARIESl HIDDEN CARIESl CAVITATIONS
ETIOLOGYl 1.)Salivary deficiencyl Due to radiation therapy
l Xerostomial 2.)Feeding habits
l Feeding with sweetened milk in the night
l Pacifiersl 3)Diet
l Composed of sugary foods
CLINICAL APPEARANCEPattern: primary dentition
related to order of eruptionMandibular incisors are most resistant
INITIAL LESION:Labial surface of maxillary incisorsWhitish area of decalcification/pitting of enamel surface
EARLY CHILDHOOD CARIESAcc. To DAVIES,1998 “It is a complex disease involving maxillary primary incisors within a month after eruption and spread rapidly to involve other primary teeth.
CLASSIFICATION l Type 1- MILD TO MODERATE ECC
l Isolated lesions involving molars and incisors
l Cause is a combination of cariogenic semisolid food and poor oral hygiene
l Found commonly in 2-5 yr.
l Type 2- MODERATE TO SEVERE ECC
l Labio lingual carious lesions involving maxillary incisors, with/without molar involvement.
l Etiology is feeding bottle or at will brEast feeding and poor oral hygiene
l Occurs after eruption of 1
st tooth
l Type 3- Severe ECCl Affects all teeth including mandibular incisors
l Implicated cause is a combination of cariogenic diet and poor oral hygiene
l Rapidly prOgressing condition
l Involves the surfaces that are usually considered caries resistant.
ETIOLOGYl Pathologic microorganismsl Substrate(fermentable carbohydrates)l Hostl Timel Other predisposing factors
PATHOLOGIC MICROORGANISMl STREPTOCOCCUS
MUTANS- main microbe that colonizes teeth after it erupts in oral cavity.
l It is transmitted to infants mouth through mother.
l It is more virulent because- - it colonizes the teeth - it produces large amount of acid - it produces large amount of extracellular polysaccharides that favour plaque formation.
CARBOHYDRATESl Carbohydrates are converted
into dextrans by microorganismsl In infants & toddlers, the main
sources of fermentable carbohydrates are:
l i. Bovine milk or infant formulas
l ii. Human milk (breast-feeding at will)
l iii. Fruist juices & other sweet liquidsl iv. Sweet syrups like vitamin
preparations l v. Pacifiers dipped in honey
or sugar solution l vi. Chocolates or other sweet
HOSTl Teeth act as host for
microorganismsl Hypomineralisation or
hypoplasia of teeth increases the susceptibility of child to caries
l Thin enamel in primary teeth is one of the reasons for early spread of lesions
l Developmental grooves also may act as plaque retentive areas.
TIMEMore 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 parent
Crowded homesChild who has less sleepMalnutritionLow weight infants
(<2500 gms)
CLINICAL FEATURESl Maxillary central incisors: facial,
lingual,mesial,distall Maxillary lateral incisors: facial,lingual,
mesial, distall Maxillary 1st molars : facial, lingual, occlusal,
proximall Maxillary canines and 2nd molars:
facial,lingual,proximal surfaces.
Mandibular anterior teeth are usually spared because of:
1.Protection by tongue2.Cleansing action of saliva
due to presence of the orifice of the duct of sublingual glands very close to lower incisors.
l Harris and Garcia Godoy (1999) classified ECC according to its clinical picture of the stages of development .
l This was initially given by Veerkamp(1995) as the ‘Developmental perspective of nursing bottle caries’.
STAGE 1 - very mild or initial stagel appearance of chalky
opaque demineralization lesions on smooth surfaces
l Between 10-20 months of age
l Distinctive white lines can be distinguished
l Lesions are reversible at this stage.
l But frequently go unrecognized by the patient.
l STAGE 2- MILDl Shows demineralization in gingival third of the tooth and moderate cavitation.
l Dentin gets involved when the rapid development cause the enamel to collapse
l Exposed dentin appears soft and yellow
l Child is 16-24 months of age
l He complains of sensitivity to temerature change.
STAGE 3-MODERATEl Frank cavitation of
multiple tooth surfaces is seen.
l With large deep lesions on maxillary incisors and pulpal irritation.
l Age group affected is 20-36 months.
l History of spontaneous pain.
l Frequent cases of pulpal involvement.
l STAGE 4: SEVEREl Clinically widespread destruction of the tooth and partial to complete loss of clinical crown.
l Characterized by coronal fracture of anterior maxillaries due to amelodentinal destruction
l Maxillary incisors are usually necrotized.
l Occurs between 30-48 monthsl Child experiences severe pain and discoMfort.
DIAGNOSIS
l Like every other disease, early diagnosis increases the chances of adequate disease control and reverting back to normal condition.
l The catch lies in the fact that clinically it is difficult to detect the initial lesion as it is visible to only when the tooth is thoroughly dry.
l A positive diagnosis is based on the questions asked to parents regarding
l Maternal historyl Feeding habits l Exposure to risk factors l Clinical endo oral examination,completed by
radiographsl DiFFerential diagnosis is based on observation
of hereditary anomalies such asl Infantile melnodontial Amelogenesis imperfecta
TREATMENTl Before onset of any treatment it is mandatory to individually review every child under following parameters.
l CHILD FACTORS PARENT FACTORSl Age Cooperationl Chief complaint Socioeconomic status
l Behaviorl Physical and mental health
Based on these parameters the following modalities can be selected
Treatment under general anesthesiaToo young to comprehend the instructions.Mentally/physically challengedModerate high socioeconomic statusMultiple quadrant/teeth requiring invasive treatment
l Treatment under quadrantl Age and mental/physical health allow understand.
l Parent cooperation for multiple appointment
l Multiple teeth involvedl In this situation 2 options can be followed:
l First,where the chief complaint is dealt with first
l severely debilitating condition of child due to that tooth
l cooperative age groupl previous experience of dental treatment
l Secondly,where minor treatment is started first
l First dental visitl Cooperative but apprehensive childl Allows development of trust between child and dentist.
l The treatment of ECC is usually restricted to surgical removal or restoration of carious teeth coupled with recommendations regarding feeding habits.
l treatment protocol for ECCl Incipient or white spot lesionsl Topical fluoride and observationl Fissure sealant applicationl Carious lesion in enamel and dentinl Preventive resin restorationl Glass ionomer fillingl Composite restorationl Stainless steel crown
l Carious lesion with pulp involvementl Pulp therapyl exodontia
PREVENTIONl INFANT ORAL HEALTHl It is the professional intervention within 6 months after the eruption of first primary tooth with history taking directed to pre and post natal factors affecting the oral cavity and counseling about oral diseases risk and providing anTicipatory guidance
l ORAL HYGIENE MEASURESl Prior to tooth eruption the gum pads shoulD be meticulously cleaned with a gauze piece wrapped around the index finger.
l Care should be taken to ckean the dorsal surface of the tongue
l This should be doe 3 times a day.
l After the eruption of tooth, the parent shouLd be instructed to clean the tooth with tooth brush.
l Fluoridated dentrifice should be incorporated.
FLUORIDE THERAPYTopical- tooth paste:up to 2 yrs- rice grain size up to 5 yrs.- pea grain size (under parent supervision)-professional applicationSystemic-water fluoridation-Salt fluoridation
l FEEDING HABITSl Breast fed the child even on demand during first six months of life.
l If the child is bottle fed,it should be I the caregivers arms and ten put to bed once he falls asleep without a bottle or sweetener.
l At all other times the child should be given water to drink without added sugars.
l The use of fruit juice should be limited.l When the child reaches 6 months of age he should be encouraged to drink using training cup.
l At the age of one the child should stop using the bottle and start using only the training cup.
l Faster swallowing reduces the cond perio with the liquid.
l DO NOT GIVE teething biscuits.They provide no real benefit and are a food of choice for bacteria.
WEANINGIt is essentially expansion of diet.It is integral part of nutritional development in infancyDefined as “ the process of exanding the diet to include food and drinks other than breast mild or infant food”Timing-no earlier than 4 months and no later than 6 months of age.The eruption of primary dentition usually starts during or after establishment of weaning.Thus weaning may directly or indirectly affect onset of caries.
l FOODS THAT DO NOT HARMl It is important to know that food is composed of proteins and fats cannot be used by bacteria to produce acids.
l They tend to increase the pH levels and neutralize the acid that may have been produced.eg. Nuts and seeds
l They stimulate saliva and it easily neutralizes the acids produced. eg. Raw or uncooked vegetables.
l Milk prevents dissolution of enamel by providing calcium and phosphate ions
TIPS FOR PARENTSl The American Academy of Pediatric Dentistry, the
American Dental Association, and the Academy of General Dentistry recommend that children visit a dentist within six months of the eruption of the first tooth, and no later than 12 months of age.
l Infants should not be put to sleep with a bottle. Breast-feeding at night should be avoided after 12 months of age.
l Infants should be weaned from the bottle at 12-14 months of age.
l Consumption of juice from a bottle or sippy cup should be avoided. Juice should be offered to a child only in a cup. Infants and toddlers should drink no more than 6 ounces of juice per day.
l Cleansing of the baby teeth should be started by the time of eruption of the first primary tooth. A small piece of clean gauze or a small toothbrush can be used.
DIFFERENCE BEWEEN NURSING BOTTLE AND RAMPANT CARIES
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