RAMPANT RAMPANT CARIESCARIES

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DefinitionDefinition

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.

ClassificatioClassificationn

Based on anatomic site:

Crown Caries Root Caries

Pit & Fissures

Smooth Caries

Based on progression

Arrested Caries Progressive Caries

Rapidly Progressive

Slowly Progressive

Nursing CariesRadiating Caries

Based on the virginity of the lesion

Primary Caries Secondary Caries

Based on the chronology

Early Childhood

Caries

Adult Caries Adolescent Caries

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

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:-MATHEWSON:-

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:-MACDONALD:-

WINTER:-WINTER:-

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

Habits

A. Feeding of Child with sweetened Milk through the night.

B. Sweetened Pacifiers

C. Nursing of Child through the night.

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.

CLASSIFICATION ACCORDING TO AGECLASSIFICATION 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.

CHARACTERISTIC FEATURES: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.

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:-

Davies believed that rampant caries should Davies believed that rampant caries should be coined to condition where:be coined to condition where:

1. Lesion are more than ten in number.

2. High caries experience for the child age.

3. Sudden characteristic feature:New and recurrent carious lesion (10 Months – 6 Months time)

4. Development of caries in otherwise caries immune surface.

5. Extensive loss of tooth structure particularly dentin even though enamel shows little defect.

6. Soft, musty, ivory colored dentinal consistency indicating rapid progression of the lesion.

A. Pain B. Infection C. Tongue Thrusting D. Abnormal Swallowing

habits.E. Speech difficulties.

SEQUELE OF RAMPANT CARIES:-SEQUELE OF RAMPANT CARIES:-

11. . Rampant caries in deciduous Rampant caries in deciduous dentitiondentition

TYPES: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.

2. Rampant Caries in adults: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.

TreatmentTreatment

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.

INITIAL TREATMENT INCLUDES

•Provisional restorations •Diet assessment•Oral hygiene instructions •Home and professional fluoride treatment

1. Provisional restorations: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.

2. Diet 2. Diet assessment: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.

3. Oral hygiene instructions3. 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

4. FLUORIDE TREATMENT4. 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:

Age (Year) < 0.3 0.3 – 0.7 > 0.7

0-2 0.25 0.00 0.00

2-3 0.50 0.25 0.00

3-16 1.00 0.50 0.00

Water Fluoridation concentration (PPM)

Mg F/ day

Methods of fluoride treatment and other methods for prevention of rampant caries in different age group.

(a) Primary dentition : 0-5 Years(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.

(a) Mixed dentition : 5-12 Yearsa) 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)

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 Permanent Dentition : 12 Years OnwardOnward

Comprehensive Restorative TreatmentComprehensive Restorative Treatment

Once rampant caries is under control, comprehensive restorative treatment can be carried out .

Restorative strategies for rampant caries are:1. Early caries with minimal loss of enamel Weekly professionally applied topical fluoride. 2. Extensive cavitations with no pulpal

involvement. * Anterior Teeth:-

* Acid – etched – composite resin

restoration * Pedo strip crowns. * Glass–ionomer cement

restorations.

* 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.

SUMMARYSUMMARY

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.

• 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.