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NURSING

BOTTLE
CARIES AND
RAMPANT
CARIES

CONTENTS
NURSING BottlE CARIES

INtroduction
Terminologies and Definitions
RAMPANT CARIES
Classification
Etiological agents
Clinical features
EARLY CHILDHOOD CARIES
DEFINITION
ETIOLOGY
CLINICAL FEATURES
DIAGNOSIS
Treatment
prevention

Introduction
Acc. 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 definitions
Winter 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

KROLL ET AL.TERMINOLOGIES l l l l l l l l l NURSING CARIES.1988 EARLY CHILDHOOD CARIES-DAVIES.1998 .1986 BABY BOTTLE TOOTH DECAY-MIM KELLY ET AL.WINTER ET AL.1980 BABY BOTTLE MOUTH-CROLL.SHELTON ET AL.1977 BABY BOTTLE CARIES-DILEY ET AL.1987 MILK BOTTLE SYDROME-RIPA.1967 NURSING BOTTLE SYNDROME.1984 NURSING BOTTLE CARIES-TSAMTSOURIS. 1968 NURSING BOTTLE MOUTH.

RAMPANT CARIES .

1)CLASSIFICATION 1)Based on anatomic site Crown caries PIT AND FISSURE CARIES SMOOTH SURFACE CARIES Root caries .

1)Based on progression of the lesion PROGRESSIVE CARIES ARRESTED CARIES RAPIDLY PROGRESSING NURSING CARIES RADIATING CARIES SLOWLY PROGRESSING .

Based on virginity of lesion l l l Primary caries Secondary caries l l l l Based on chronology Early childhood caries Adult caries Adolescent caries Based on type of dentition l l l Caries in primary dentition Caries in mixed dentition Caries in permanent dentition .

l l l l BASED ON SEVERITY INCIPIENT CARIES HIDDEN CARIES CAVITATIONS .

)Salivary deficiency Due to radiation therapy l Xerostomia 2.ETIOLOGY l l l l 1.)Feeding habits l Feeding with sweetened milk in the night l Pacifiers 3)Diet l Composed of sugary foods .

CLINICAL APPEARANCE Pattern: primary dentition related to order of eruption Mandibular incisors are most resistant .

INITIAL LESION: Labial surface of maxillary incisors Whitish area of decalcification/pitting of enamel surface .

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.EARLY CHILDHOOD CARIES Acc.

CLASSIFICATION l l l l Type 1.MILD TO MODERATE ECC Isolated lesions involving molars and incisors Cause is a combination of cariogenic semisolid food and poor oral hygiene Found commonly in 2-5 yr. .

MODERATE TO SEVERE ECC Labio lingual carious lesions involving maxillary incisors. with/without molar involvement.l l l l Type 2. Etiology is feeding bottle or at will brEast feeding and poor oral hygiene Occurs after st .

l l l l l Type 3. .Severe ECC Affects all teeth including mandibular incisors Implicated cause is a combination of cariogenic diet and poor oral hygiene Rapidly prOgressing condition Involves the surfaces that are usually considered caries resistant.

ETIOLOGY l l l l l Pathologic microorganisms Substrate(fermentable carbohydrates) Host Time Other predisposing factors .

PATHOLOGIC MICROORGANISM l STREPTOCOCCUS MUTANS.it colonizes the teeth .main microbe that colonizes teeth after it erupts in oral cavity.it produces large amount of acid . l It is transmitted to infants mouth through mother. l It is more virulent because.it produces large amount of extracellular polysaccharides that favour plaque formation. .

Pacifiers dipped in honey or sugar solution l vi. Chocolates or other sweet . Human milk (breastfeeding at will) iii.CARBOHYDRATES l l l l l Carbohydrates are converted into dextrans by microorganisms In infants & toddlers. Fruist juices & other sweet liquids l iv. Bovine milk or infant formulas ii. Sweet syrups like vitamin preparations l v. the main sources of fermentable carbohydrates are: i.

HOST l l l l Teeth act as host for microorganisms Hypomineralisation or hypoplasia of teeth increases the susceptibility of child to caries Thin enamel in primary teeth is one of the reasons for early spread of lesions Developmental grooves also may act as plaque retentive areas. .

TIME More 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 homes Child who has less sleep Malnutrition Low weight infants (<2500 gms) .

.proximal surfaces. mesial. distal Maxillary 1st molars : facial.distal Maxillary lateral incisors: facial. lingual.CLINICAL FEATURES l l l l Maxillary central incisors: facial. lingual.mesial.lingual. occlusal.lingual. proximal Maxillary canines and 2nd molars: facial.

Cleansing action of saliva due to presence of the orifice of the duct of sublingual glands very close to lower incisors.Protection by tongue 2.Mandibular anterior teeth are usually spared because of: 1. .

. l This was initially given by Veerkamp(1995) as the ‘Developmental perspective of nursing bottle caries’.l Harris and Garcia Godoy (1999) classified ECC according to its clinical picture of the stages of development .

STAGE 1 . . But frequently go unrecognized by the patient.very mild or initial stage l l l l l appearance of chalky opaque demineralization lesions on smooth surfaces Between 10-20 months of age Distinctive white lines can be distinguished Lesions are reversible at this stage.

MILD Shows demineralization in gingival third of the tooth and moderate cavitation. Dentin gets involved when the rapid development cause the enamel to collapse Exposed dentin appears soft and yellow Child is 16-24 months of age He complains of sensitivity to temerature change. .l l l l l l STAGE 2.

Age group affected is 2036 months. With large deep lesions on maxillary incisors and pulpal irritation. Frequent cases of pulpal involvement. .STAGE 3-MODERATE l l l l l Frank cavitation of multiple tooth surfaces is seen. History of spontaneous pain.

Characterized by coronal fracture of anterior maxillaries due to amelodentinal destruction Maxillary incisors are usually necrotized. Occurs between 30-48 months Child experiences severe pain and discoMfort. .l l l l l l STAGE 4: SEVERE Clinically widespread destruction of the tooth and partial to complete loss of clinical crown.

early diagnosis increases the chances of adequate disease control and reverting back to normal condition. A positive diagnosis is based on the questions asked to parents regarding . 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.DIAGNOSIS l l l Like every other disease.

l l l l l l l Maternal history Feeding habits Exposure to risk factors Clinical endo oral examination.completed by radiographs DiFFerential diagnosis is based on observation of hereditary anomalies such as Infantile melnodontia Amelogenesis imperfecta .

TREATMENT l l l l l l Before onset of any treatment it is mandatory to individually review every child under following parameters. CHILD FACTORS PARENT FACTORS Age Cooperation Chief complaint Socioeconomic status Behavior Physical and mental health .

Based on these parameters the following modalities can be selected Treatment under general anesthesia Too young to comprehend the instructions. Mentally/physically challenged Moderate high socioeconomic status Multiple quadrant/teeth requiring invasive treatment .

where the chief complaint is dealt with first severely debilitating condition of child due to that tooth . Parent cooperation for multiple appointment Multiple teeth involved In this situation 2 options can be followed: First.l l l l l l l l Treatment under quadrant Age and mental/physical health allow understand.

where minor treatment is started first First dental visit Cooperative but apprehensive child Allows development of trust between child and dentist.l l l l l Secondly. . The treatment of ECC is usually restricted to surgical removal or restoration of carious teeth coupled with recommendations regarding feeding habits.

l l l l l l l l l treatment protocol for ECC Incipient or white spot lesions Topical fluoride and observation Fissure sealant application Carious lesion in enamel and dentin Preventive resin restoration Glass ionomer filling Composite restoration Stainless steel crown .

l l l Carious lesion with pulp involvement Pulp therapy exodontia .

PREVENTION l l INFANT ORAL HEALTH 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 l l l l ORAL HYGIENE MEASURES Prior to tooth eruption the gum pads shoulD be meticulously cleaned with a gauze piece wrapped around the index finger. After the eruption of tooth. Care should be taken to ckean the dorsal surface of the tongue This should be doe 3 times a day. the parent shouLd be instructed to .

tooth paste:up to 2 yrs.FLUORIDE THERAPY Topical .pea grain size (under parent supervision) -professional application Systemic -water fluoridation -Salt fluoridation ..rice grain size up to 5 yrs.

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The use of fruit juice should be limited. When the child reaches 6 months of age he should be encouraged to drink using .it should be I the caregivers arms and ten put to bed once he falls asleep without a bottle or sweetener.l l l l l l FEEDING HABITS Breast fed the child even on demand during first six months of life. If the child is bottle fed. At all other times the child should be given water to drink without added sugars.

DO NOT GIVE teething biscuits. Faster swallowing reduces the cond perio with the liquid.They provide no real benefit and are a food of choice for bacteria. .l l l At the age of one the child should stop using the bottle and start using only the training cup.

WEANING It is essentially expansion of diet. The eruption of primary dentition usually starts during or after establishment of weaning. Thus weaning may directly or indirectly . It is integral part of nutritional development in infancy Defined 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.

l l l l l FOODS THAT DO NOT HARM It is important to know that food is composed of proteins and fats cannot be used by bacteria to produce acids. They tend to increase the pH levels and neutralize the acid that may have been produced. Milk prevents dissolution of enamel by providing calcium and phosphate ions . Raw or uncooked vegetables. eg.eg. Nuts and seeds They stimulate saliva and it easily neutralizes the acids produced.

Infants should not be put to sleep with a bottle.TIPS FOR PARENTS l l l l l The American Academy of Pediatric Dentistry. Infants should be weaned from the bottle at 12-14 months of age. Consumption of juice from a bottle or sippy cup should be avoided. and the Academy of General Dentistry recommend that children visit a dentist within six months of the eruption of the first tooth. Juice should be offered to a child only in a cup. Breastfeeding at night should be avoided after 12 months of age. Cleansing of the baby teeth should be started by the time of eruption of the first primary tooth. and no later than 12 months of age. Infants and toddlers should drink no more than 6 ounces of juice per day. the American Dental Association. A small piece of .

DIFFERENCE BEWEEN NURSING BOTTLE AND RAMPANT CARIES .

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