 Massler 1945, defined as suddenly appearing

widespread, rapidly spreading, burrowing

type of caries, resulting in early involvement
of pulp and affecting those teeth which are
usually regarded as immune to decay.
 •Winter 1966 –caries of acute onset involving
many or all the teeth in areas that are not
usually susceptible.
 •Related to the order of tooth eruption
 •Initial lesion –labial surface of upper incisors
close to gingival margin as a whitish area of
decalcification or pitting of enamel surface
soon after eruption
 •Become pigmented to light yellow or brown
 •Extend laterally to proximal areas, down to
incisal edge
 •At times begin on palatal / incisal area
 •Advanced stage –entire circumference of the
tooth → pathological fracture of tooth
 May also occur in permanent dentition of
teenagers –cariogenic snacks, carbonated
drinks
 •Characterized by B & L caries of PM & M,
proximal & labial caries of lower incisors
 •Radiation caries –another form of rampant
caries that occur in reduced salivary flow due
to radiotherapy
 May also occur in permanent dentition of
teenagers –cariogenic snacks, carbonated
drinks
 •Characterized by B & L caries of PM & M,
proximal & labial caries of lower incisors
 •Radiation caries –another form of rampant
caries that occur in reduced salivary flow due
to radiotherapy
 Nursing bottle caries –form of rampant caries
in primary dentition
 •More in children who frequently falls asleep
with a baby bottle filled with milk or sugar
containing liquids
 •Also in breastfed infants with prolonged
feeding habits and pacifier use (dipped in
sugary liquids)
 Decreased salivary flow + pooling of
sweetened fluids around teeth
 •Involves first upper anteriors, then
posteriors. Mandibular incisors usually spared
→secretions of submandglands + cleansing
action of tongue
 •Order of occurrence –max centrals →max
laterals → max first molars→max canine and
2nd molars → mandmolars → mandincisors
and canines
 •
 The American academy of Pediatric dentistry (AAPD)
defines it as “the presence of one or more decayed
(non cavitated or cavitated), missing (due to caries) or
filled tooth surface in any primary tooth in a child 71
months of age or younger.”

 Between the age of 3 and 5 yrs severe ECC is defined

as one or more cavitated ,missing (due to caries) or
filled smooth surface in primary maxillary anterior
teeth or a decayed, missing filled surface(dmfs) score
of > 4(age3yrs),> 5 (age 4yrs) or >6 (age 5yrs).
 Nursing bottle caries
 Nursing Caries
 Baby bottle caries
 Nursing bottle syndrome
 Milk bottle syndrome
 Bottle mouth caries
 Infant tooth decay- Dr Bonnie Breuerd
 Soother bottle caries
 1st event: Eruption of primary incisors and their not being adequately cleaned

 2nd event: Implantation of mutan streptococci from mother’s mouth which

attaches themselves to newly erupted enamel surfaces

 3rd event: Use of juices or milk which are sweet either inherently or by
addition of sugars

 4th event: Early demineralization or white spot lesions start to occur in the
stagnation areas around the maxillary incisors.

 At this stage only incisors are present hence only they are affected .Reversal of
this event is possible with active participation by parents.

 5th event: demineralization becomes more extensive and minor cavitations

occur .This is often small and easy to see. Corresponding with this event is the
eruption of 1st primary molars that now start to be affected on their occlusal
surface.

 6th event: frank cavitation

 7th event: Extract the tooth

 I –mild to moderate, isolated lesions on upper
molars and incisors
 •II –moderate to severe , any teeth other than
lower incisors
 •III –severe, all teeth
 Type I ECC (Mild to moderate) –

 Carious lesion involving the molars and incisors

 Seen between 2-5yrs of age

 Cause is usually a combination of cariogenic

semisolid or solid food and lack of oral hygiene

 Number of affected teeth usually increases as

the cariogenic challenge persists.
 Type II ECC (Moderate to severe)

 Labiolingual carious lesion affecting the maxillary

incisors with or without molar caries depending on
the age

 Seen soon after the 1st tooth erupts

 Unaffected mandibular incisors

 Cause is usually inappropriate use of feeding or

combination of both poor oral hygiene

 Unless controlled may proceed to an advanced

stage.
 Type III ECC (severe)

 Carious lesion involves almost all the teeth including

mandibular incisors

 Usually seen in 3-5 years of age (dmf >= 4 for

3yrs,>= 5 for 4ys or >=6 for 5yrs)

 Cause is a combination of factors and poor oral

hygiene

 Rampant in nature and involves immune tooth

surface
 Stages

 There are four stages in the development of

ECC

 The initial stage (stage I) is characterized by the

appearance of chalky, opaque demineralization
lesions on the smooth surfaces of the maxillary
primary incisors when the child is between the ages
of 10 and 20 months, or sometimes even younger

 At this stage, the lesions are reversible

 lesions can be diagnosed only after the affected teeth

have been thoroughly dried
 The second stage/Damaged (carious): occurs when
the child is between the ages of 16 and 24 months

 The dentin is exposed and appears soft and yellow.

The maxillary primary molars present initial lesions
in the cervical, proximal and occlusal regions

 At this stage, the child begins to complain of great

sensitivity to cold. The parents sometimes notice the
change of colour on their own and become
concerned.
 Deep Lesion/stage 3

Lesions in maxillary anterior teeth are large.

 The primary molars are all affected.
 Complaints of pain during tooth brushing or
eating, especially while biting are frequent.
 Incidentally, pulp problems in the maxillary
incisors can occur (spontaneous pain during the
night; and pain after hot or cold drinks, lasting for
several minutes).
 In this stage the diagnosis could be made easily,
even without actually seeing the child’s teeth
Traumatic stage/4th stage :Neglecting all the previous
symptoms, the teeth (starting with maxillary incisors) can
become so weakened by caries that relatively small forces suffice
to fracture them.

The maxillary incisors already have become non vital in most of

the cases.
 •Risk for permanent dentition getting
involved
 •Other health problems
 •Financial burden
 •Psychological problems
 •Speech defect
 •Habit development
 Pathogenic microorganism
 •Most common –S.mutans.
 •Not detectable till first tooth erupts.
Presence indicates primary infection. Main
source –mother.
 •S.mutans–60% of all cultivable flora. Less
than 1% in caries free. Colonizes tooth fast,
more acid production, more extracellular
polysaccharides
 •Other org –Veillonella, Lactobacillus
 •In 1993, Caufield et al described a discrete “window of
infectivity” during which infants acquired mutans streptococci
(MS) from their maternal host.
 •It is defined as the period of initial acquisition of mutans
streptococci (MS) by infants.
 •This “window” opened at 19 months and extended to 31
months, with a mean of 26 months.
 •During this period, the prevalence of MS was seen to rise
from 0% to 82%.
 •Caufield hypothesized that the discrete nature of initial MS
acquisition was directly related to the presence of non-
desquamated hard surfaces, namely newly erupted teeth.
 Forms Dextrans→ adherence of plaque and
also acids →demineralization
 •Texture and frequency more important than
amount consumed
 •Lower molecular weight → diffuses into
plaque faster → more cariogenic
 •Breast milk more cariogenic than bovine
milk
 •Bovine → more Ca and P → remineralization
 •Breast milk →high lactose → cariogenic
 •Among all simple sugars –lactose is less
cariogenic
 –More time child sleeps with bottle in the
mouth, more risk of decay
 -Salivary flow and swallowing reflex reduced
for longer time, carbohydrates accumulate for
longer time →more acid production and
contact → more caries
 -Overindulgent parents
 -Crowded homes
 -Malnutrition
 -Impaired salivary gland function
 -Low birth weight babies
 -Mouth breathing
CARIES RISK ASSESSMENT FORM
FACTORS HIGH RISK MODERAT LOW RISK
E RISK

Biological
 Mother / primary care giver has active caries (for 0-3 Yes
years of age)
 Child is put to bed with a bottle containing natural or Yes
added sugar ( for 0-3 years of age)
 Primary caregiver has low socio-economic status Yes
 Child has >3 between meal sugar-containing snacks or
beverages per day Yes
 Child has special health care needs Yes
 Child is a recent immigrant Yes
Protective
 Child receives optimally-fluoridated drinking water Yes
 Child has teeth brushed daily with fluoridated toothpaste Yes
 Child receives topical fluoride from health professional
 Child has regular dental care Yes
Yes
Clinical Findings
 Child has >1 decayed/missing/filled surfaces (for 0-6 Yes
years) / >1 interproximal lesions
 Child has active white spot lesions or enamel defects Yes
 Child has plaque on teeth Yes
 Child has low salivary flow Yes
 Child is wearing intraoral appliance Yes

Overall assessment of the dental caries risk: HIGH MODERATE LOW

 Aims
 -Treat existing emergency
 -Arrest and control carious process
 -Institution of preventive procedures
 -Restoration and rehabilitation
 •Factors affecting
 -Extent of lesion
 -Age
 -Behavioral problems and cooperation
 -Motivation of parents and patients
 Treatment protocol

 Preventive care
- Professional care

 Restorative care - Home care

 Professional care

 Educating parents regarding importance of deciduous teeth

 Diet counseling
 Dental health education to parents regarding gum pads
cleaning, tooth brushing, frequent mouth rinsing.
 Advocating fluoride supplementation if needed
 Advocating fluoride containing dentrifrices .
 Applying fluoride varnish topically
 Application of fissure sealants in 1st & 2nd primary molars
 Regular recall for routine monitoring for dental health
 Reinforcing & motivating parents to continue supervised home
care
 Home care
 Elimination of cariogenic food items from the diet
 Substitution with tooth friendly food
 Discouraging bottle feeding at night
 Falling asleep with pacifiers should be stopped
 Cleaning of gum pads during infancy period is
encouraged
 Digital or baby tooth brushing as the teeth erupts
 Initiating mouthrinsing habit after consuming any
solid or liquid drinks
 Regular visit to dentist once in 6 months
 Incipient/white spot carious lesions
 Professional topical fluoride application &
observation of lesion for reversal
 Fissure sealant application

 Carious lesion in enamel & dentine

 Preventive resin restoration
 Glass ionomer filling
 Composite restoration in anterior teeth
 Posterior composite restoration
 Amalgam restoration in posterior teeth
 Nickel chrome stainless steel crown
 Strip crowns for anteriors
 Carious lesion with pulp
involvement
 Pulp therapy with full
coverage restoration
 Extraction followed by
space management
 •All lesions excavated and restored
 •If deep lesions, do IOPA
 •Assess condition of underlying permanent
tooth as well
 •Any abscess →drained
 •Estimate salivary flow and viscosity
 •Fluoride application topical for early
superficial lesions
 •Introduce diet record –time, type of food,
amount and number of exposure
 •Question about feeding habits –nocturnal
bottles, breast feeding, pacifier use
 •OHE
 After one week
 •Analyze diet record & explain caries process
 •Advise control of sugar exposure –reduce frequency and
restrict consumption to meal times
 •Series of small changes over a period of time –more
acceptable and longer lasting than drastic changes
 •If on bottle, ask to wean slowly –gradually dilute the
contents with water and reduce the amount of sugar added
 •Substitute with plain water or F water
 •Slowly substitute the bottle with feeding cup
 •Caries activity tests –for the child and the mother
 Reduction of high S.mutans by diet counseling,
professional tooth cleaning, OHE, F treatment and
caries excavation of cavities in mothers
 •Age wise toothbrushing to be taught to children
 •Use of F –topical and systemic
 •F tablets –topical effect to erupted teeth and
systemic effect to unerupted teeth
 •Systemic therapy ineffective as age increases
 •Topical F –APF gel or F varnish, toothpastes n
mouth rinses
 •Reassess restoration, redo if needed
 Incipient caries –improve OH, Diet
modifications, weekly home or professional F
application
 •Cavitated anterior teeth –Composite, GIC,
Strip crowns
 •Cavitated posterior teeth –Composite, GIC,
SSC
 •Restore all pulpally involved teeth –
Pulpotomy, Pulpectomy
 •Grossly decayed / Unrestorable→extract
→prosthesis / space maintainer
 •Review after every 3 months
 •ShobhaTandon. Textbook of Pedodontics. 2nd ed.
India : Paras Medical Publisher; 2009.
 •Nikhil Marwah. Textbook of PediatricDentistry.
2nd ed. India : JaypeeBrothers Medical Publishers
(P) Ltd; 2009.
 •Ralph E. Mc Donald, David R. Avery, Jeffrey A.
Dean. Dentistry for children and adolescent. 8th
ed. India: Mosby; 2010.
 •Jimmy Pinkham, Paul Casamassimo, Henry W.
Fields, Arthur Nowak. PediatricDentistry: Infancy
Through Adolescence. 4th ed. India: Elsevier