early childhood caries, rampant caries ,

1. Dental Caries in child and Adolescents and
development of dental caries
By:
Dr A.k.Zalan
Post graduate resident
MDS pediatric dentistry
Children hospital , PIMS. Isb

2. • Good oral health is an integral component of good
general health

3. According to WHO:
 Dental caries is a localized post eruptive pathological
process of external origin involving softening of hard
tooth tissue and proceeding to the formation of
cavity.

4.  Continuous dynamic process involving repeating
periods of demineralization by organic acids of
microbial origin and subsequent remineralization by
salivary components, but in which the overall oral
environment is imbalanced towards
demineralization.

5.  Communicable disease which requires host, dietary
substrate and aciduric bacteria.
 Saliva , substrate and bacteria form a biofilm(
plaque) that adheres to the tooth surface.
 Substrate provides nutrients to bacteria , bacteria
produces acid which deminerlize the tooth.
 The flow, dilution, buffering and remineralizing
capacity of saliva are also recognised to be critical
factors that affect, and in some ways regulate, the
progression and regression of disease.

7.  If oral environment is unfavorable , an adequate flow
of saliva can help dilute and buffer the acid, and
slow the rate of damage to the tooth or even repair it.
 Tooth starts demineralisation when the acid PH
reaches to 5.5.
 Cavitation occurs in the late stage of disease.
 Before cavitation if oral environment becomes
favorable the caries process can be arrested or even
reversed.

8.  Even after cavitation, if pulp is not involved and the
cavity is open enough to be self cleansing , the caries
process can halt and the lesion becomes arrested.

9.  We cannot paint a burning room
 Treating the oral infection by reducing the number of
cariogenic bacteria and establishing a favorable oral
environment to promote predominantly
remineralization of tooth structure over time will
arrest the caries process and limit the disease.

10.  Streptococci, lactobacilli, diphtheroids, yeasts,
staphylococci and certain stains of sarcinaes are
particularly involved in the caries process.
 Mutan strep (MS) is the major and most virulent of
the caries producing micro-organisms.
 MS can be transmitted vertically and horizontally.
 Earlier the transmission, higher the caries risk.

11.  The outer surface of enamel is more resistant to acid
demineralization then is the deeper portion, the
greatest amount of demineralization occurs 10-15um
beneath the enamel surface – incipient lesion or
white spot.
 If the demineralization continues, the thin suface
layer collapses, and a cavitated lesion forms.

14.  Time required for remineralization to replace the
hydroxyapatite lost during demineralization id
determined by the age of the plaque, nature of
carbohydrate consumed, and the presence or absence
of flouride.

15. RAMPANT DENTAL CARIES
 Suddenly appearing, widespread, rapidly burrowing
type of caries, resulting in early involvement of the
pulp and affecting those teeth usually regarded as
immune to ordinary decay.
 Rampant caries can occur suddenly in teeth that
were previously sound for many years.
 Young teenagers seem to be particularly susceptible
to rampant caries, although it has been observed in
both children and adults of all ages

17.  There is considerable evidence that emotional
disturbances may be a causative factor in some cases
of rampant caries.
 Emotional disturbances increases craving for sweets
and snacks aswell.

18.  Arrested caries :
Carious lesions which do not progress.
Results from change in oral environment
Operative treatment is not necessary

19. Carious lesion in Enamel:
 Starts from white spot
 Matt surface
 Absorbs stains… why?
 Histologically cone shaped, with apex towards E-D-J
 Further demineralization, results in the break down
of intact tooth surface.

21. Carious process in dentin:
 May be in dentin before an enamel cavity forms
 The lesion widens as it reaches the E-D-J
 Eventually cavity forms and biofilm sits directly on
dentin
 what to do with the undermined enamel?

23.  PULP DENTINE DEFENCE MECHANISM

24. EARLY CHILDHOOD CARIES
 The presence of one or more decayed (noncavitated
or cavitated), missing (as a result of caries), or filled
tooth surfaces in any primary tooth in a child 71
months of age or younger.

28. SEVERE EARLY CHILDHOOD CARIES:
 Children younger than 3 years of age, any sign of
smooth-surface caries is indicative of severe early
childhood caries.
 Frequent nighttime bottle feeding with milk is
associated with, but not consistently implicated in, S-
ECC.
 Breastfeeding more than seven times daily after 12
months of age is associated with increased risk for
ECC.

29.  The clinical appearance of the teeth in S-ECC in a
child 2, 3, or 4 years of age is typical and follows a
definite pattern.
 There is early carious involvement of the maxillary
anterior teeth, the maxillary and mandibular first
primary molars, and sometimes the mandibular
canines.

30. Approximal caries
 Early detection is important in pediatric patient
because?
proportional larger pulp size
Diagnostic tests??
Bite-wing radiograph
Diagnodont pen
Visual and tactile inspection

31. Carious lesion Assesment

32. ADDITIONAL FACTORS KNOWN TO
INFLUENCE DENTAL CARIES
SALIVA:
 The role of saliva is unique.
 Flow – deficiency of which increases caries
susceptibility.
 Viscosity
 Natural protective mechanism inherent within the
saliva.
 Salivary pH; the acid-neutralizing power.
 Mineral content of saliva.
 Parasympathetic and sympathetic stimulation

33. ANATOMIC CHARACTERISTICS OF THE TEETH
Certain teeth of many patients, particularly permanent
teeth, seem vulnerable to dental caries as they emerge
2 years is required for the calcification process to
be completed by exposure to saliva, so susceptible.
Incompletely coalesced pits and fissures with or
without hypoplasia that allows the dental plaque
material to be retained at the base of the defect,
sometimes in contact with exposed dentin.

34. ARRANGEMENT OF THE TEETH IN THE ARCH
 Crowded and irregular teeth are not readily cleansed
during the natural masticatory process.
 It is likewise difficult for the patient to clean the
mouth properly with a toothbrush and floss if the
teeth are crowded or overlapped.
 This condition therefore may contribute to the
problem of dental caries

35.  PRESENCE OF DENTAL APPLIANCES AND
RESTORATIONS.
 HEREDITARY FACTORS

36. EARLY DETECTION OF DISEASE ACTIVITY
Visual inspection of white spot lesions….
Radiographic examination
Trans-illumination
flouroscense
Need for other caries detecting instruments.

37.  The recent commercial development of detection
systems such as Diagnodent™, QLF-D™, Canary™,
Soprolife™ and CarieScan™ have the potential to
increase the accuracy of detection of enamel and
dentinal caries.

40. PREDICTION OF PATIENTS’ RISK FOR FUTURE
DISEASE (RISK ASSESSMENT)
 With the very young infant, the caries risk focuses on
the parents’ and caregiver’s oral health habits.
 Presence of white spot lesions and their activity
status.
 • Individual and familial past caries history.
 • Socioeconomic status.
 • Ethnicity.
 • Diet.
 • Total fluoride exposure.

41.  • Salivary flow and quality.
 • Oral hygiene.
 • Medical history.
 • Presence of developmental defects of enamel.
 • Ability to comply with the recommendations.

42.  Four most commonly used caries-risk assessment
tools are:
 Cariogram, CAMBRA, ADA, AAPD.

45.  The Cariogram has been evaluated and found to be
more predictive in permanent teeth than with
preschool children.
 The “Cariogram” is a computer caries-risk program
that records several data points including past caries
experience, diet, oral hygiene habits, fluoride
exposures, and analysis of saliva.
 The program then produces the results as a colored
graph.