Rampant caries is a severe form of dental caries characterized by the sudden appearance of widespread and rapidly progressing cavities affecting many or all erupted teeth. It most commonly affects children between ages 4-8 and 11-19. Successful management requires a coordinated team approach between pediatricians, pediatric dentists, parents, and the child. Initial treatment involves provisional restorations, dietary counseling to reduce sugar intake, oral hygiene instructions, and both home and professional fluoride therapy. Long term management may also include comprehensive restorative dental work and extractions, with the goal of preventing further progression of dental caries.

1. RAMPANT CARIES From sam your friend

2. Definition Dental Caries is irreversible Microbial disease of the Hard tissues of the teeth characterized by demineralization of the in organic portion followed by destruction of the organic constituents of the teeth.

3. Classification Based on anatomic site: Crown Caries Root Caries Pit & Fissures Smooth Caries

4. Based on progression Arrested Caries Progressive Caries Rapidly Progressive Slowly Progressive Nursing Caries Radiating Caries

5. Based on the virginity of the lesion Primary Caries Secondary Caries Based on the chronology Early Childhood Caries Adult Caries Adolescent Caries

6. Based on Type of Dentition Caries in Primary Dentition Caries in Mixed Dentition Caries in Permanent Dentition Based on severity Incipient Occult Caries (Hidden Caries ) Cavitations

7. RAMPANT CARIES: Rampant Caries is defined as suddenly appearing wide spread, rapidly burrowing type of caries resulting in the early involvement of the pulp. MATHEWSON:-

8. Massler defined it as suddenly appearing, vide spread, rapidly burrowing type of caries, resulting in early involvement of pulp and affecting those teeth usually regarded as immune to ordinary decay. 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. MACDONALD:- WINTER:-

9. ETIOLOGY: Acidogenic Bacteria, Dental Plaque, Tooth Structure Susceptible to Dissolution. Salivary Deficiency: A. Due to radiation therapy. B. In Stressed children who have tranquilizers C. Xerostomia Genetical

10. Habits A. Feeding of Child with sweetened Milk through the night. B. Sweetened Pacifiers C . Nursing of Child through the night.

11. Nutrition Nutritional deficiency Diet: In Between meal snacking of Cariogenic foods Sucrose Content in Diet. Psychological factors. Emotional disturbance Repressed Emotional fear. This cause decreased salivary flow.

12. CLASSIFICATION ACCORDING TO AGE Those seen in a) Infants b) Young Children c) Teenagers d) Adults of all age Most Prevalent age group: 4-8 years 11-19 years.

13. CHARACTERISTIC FEATURES: Most Common site :- Proximal surface of lower anterior teeth and development of cervical type of caries. Labial surface of all maxillary anterior teeth.

14. Soft consistency and light yellow in color. Onset and progress of lesion is very rapid. Age : Seen at all ages. Including adolescence. Sex : Female > Male Type of Lesion or Nature :-

15. Davies believed that rampant caries should be coined to condition where: Lesion are more than ten in number. High caries experience for the child age. Sudden characteristic feature:New and recurrent carious lesion (10 Months – 6 Months time) Development of caries in otherwise caries immune surface. Extensive loss of tooth structure particularly dentin even though enamel shows little defect. Soft, musty, ivory colored dentinal consistency indicating rapid progression of the lesion.

16. Pain Infection Tongue Thrusting Abnormal Swallowing habits. Speech difficulties. SEQUELE OF RAMPANT CARIES:-

17. 1 . Rampant caries in deciduous dentition TYPES: Rapid Destruction of erupted teeth related to order of tooth eruption. Most common site: Upper deciduous incisors and decimolars. Individual lesion show decalcification over wide area. Striking feature : Seen in Groups of bottle feeders and also where Resistance of child is low.

18. 2. Rampant Caries in adults: Rare in Adults Sudden onset after adolescence show that some major alternation has occurred in patient’s oral environment or diet.

19. Treatment THE TYPE OF TREATMENT DEPEND ON THE Patient’s and parent’s motivation toward dental treatment. The extent of the decay. The age Co-operation of the child.

20. INITIAL TREATMENT INCLUDES Provisional restorations Diet assessment Oral hygiene instructions Home and professional fluoride treatment

21. 1. Provisional restorations: Caries stabilization with gross excavation of each carious lesion and provisional restorations should be placed in symptom free teeth established dentinal caries to minimize the risk of pulpal exposure in future and to improve function. However, Patients with acute and severe signs and symptoms of caries Pain, abscess, Sinus or facial swelling Require immediate treatment If the pulp is still vital Form cresol pulpotomy Pulp is nonvital Pulpactomy followed by obturation with zinc – oxide eugenol cement.

22. 2. Diet assessment: Parents should be educated to reduce the frequency of sucrose consumption by their child, especially, between meals. Consumption of sugar containing foods and beverages should be restricted to meal times. In infants : Bottle feeding habit should be stopped by Gradually decreasing bottle contents with water as well as decreasing amount of added sugar over a 2-3 weeks period. Dietary vitamin supplements as well as oral medications must also be included.

23. 3. Oral hygiene instructions Many 3 to 5 years old children can’t brush their teeth adequately when untutored and unsupervised so, it is important to teach children the proper techniques of tooth brushing at different age groups. i.e. under the age of 8 years: circular scrub technique eg. foons technique after 11-12 years : A sulcular brushing technique eg. bass technique Explained the proper brushing technique to the patients by demonstrating the procedure with articulated models of dental arches and brush

24. 4. 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 dentition Level of fluoride in the drinking water of various ages is: Water Fluoridation concentration (PPM) Mg F/ day 0.00 0.50 1.00 3-16 0.00 0.25 0.50 2-3 0.00 0.00 0.25 0-2 > 0.7 0.3 – 0.7 < 0.3 Age (Year)

25. Methods of fluoride treatment and other methods for prevention of rampant caries in different age group. (a) Primary dentition : 0-5 Years Dietary Advice : Dietary Counseling with parents on good nursing techniques 1. Fluoride Therapy Tooth Paste Tablets if in area without water fluoridation Professional topical fluoride application every 6 months 2. Plaque Control Oral hygiene instructions to parents Tooth brushing with parental supervision.

26. ( a) Mixed dentition : 5-12 Years Dietary Advice : Dietary Counseling with parents and patients 1. Fluoride Therapy Tooth Paste Tablets up to 8 years if in area without water fluoridation. Mouth rinse. 2. Plaque Control Oral hygiene instructions to parents Tooth brushing with parental supervision. Disclosing Tablets Fissures Sealants (3-6 Months recall)

27. Fluoride Therapy : Tooth Paste Mouth rinse Professional fluoride application every 6 months. 1. Plaque Control: Oral Prophylaxis Oral Hygiene instructions to Patients. Tooth brushing. Disclosing tablets. Interdental Cleaning with floss or tooth picks. Permanent Dentition : 12 Years Onward

28. Comprehensive Restorative Treatment Once rampant caries is under control, comprehensive restorative treatment can be carried out . Restorative strategies for rampant caries are: Early caries with minimal loss of enamel Weekly professionally applied topical fluoride. Extensive cavitations with no pulpal involvement. * Anterior Teeth:- * Acid – etched – composite resin restoration * Pedo strip crowns. * Glass–ionomer cement restorations.

29. * Posterior Teeth:- * Posterior composite resin restorations. * Glass- Ionomer cement restorations. * Stainless Steel crowns. 3. Extensive cavitations with pulpal involvement. Pulpotomy or pulpactomy where appropriate, followed by permanent restoration. Extraction followed by space maintainer or partial or complete dentures.

30. SUMMARY Rampant caries is a distressing clinical condition confronting the child, parents and dentist. With the advances in knowledge about the etiology and pathogenesis of dental caries, rampant caries can now be prevented. Successful management depends on a co-ordinated team approach among the pediatrician, pediatric dentist, parents and child.

31. The pediatrician should educate the parents  about good nursing and dietary habits and the importance of good oral hygiene to their Child’s teeth.  and to bring their child to the dental office before he or she is 12 months of age for a screening examination and counseling. However, interest and co-operation from the parents and children are equally important. Consequently educational efforts should be emphasized and reinforced, especially in areas where the prevalence of rampant caries is high.