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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.