Childhood Caries 1

Childhood Caries&Dental Trauma on Primary Teeth

Henri Hartman, drg. Sp.KGA

4 yrs old

Panoramic x-ray before treatment

Preparation

Post op with zirconia crown

6 mth later

1,5 yrs later

Caries?

progressive dissolution of the inorganic component of dental hard tissues mediated by dental plaque

A biofilm (plaque)-induced acid demineralization of enamel or dentin, mediated by saliva

Dental Plaque

contains bacteria acidogenic and aciduric

Streptococcus mutans

lactobacilli

Acidogenic : produce acid

Aciduric : live on acid environment

S. mutans

initiation of enamel demineralization

Inoculated vertically form mother/caregiver

Inoculated horizontally by peers at childcare centre

Came as teeth erupted

High S.mutans High caries risk

Diet

Host Factor

TEETH

Microbes

Tooth quality, saliva, amount of microbe, sugar contact

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Subtstrate

Bacteria can use fermentable carbohydrates as a ready source of energy and the end-products of the glycolytic pathway in bacterial metabolism are acids.

Sucrose

Saliva

Saliva Function

antibacterial and antifungal and antiviral activity.

lubrication, which also assists in bolus formation.

inhibition of demineralization and stabilization of calcium and phosphate ions, which assists remineralization.

TIME

acid challenges occur repeatedly,

collapse of enamel crystals

Ca10(PO4)6(OH)2+2H+ 10Ca2+ + 6PO43- + 2H2O

Early Childhood Caries

baby bottle tooth decay,

early childhood dental decay,

Early childhood tooth decay,

comforter caries,

Nursing bottle caries,

maxillary anterior caries,

rampant caries,

ECC

The presence of one or more decayed(non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child between birth and 71 months of age.

ECC

Terminology, aapd

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affect the primary teeth of infants and pre-school children.

the maxillary primary incisors are hit the hardest, followed by the first primary molars.

The mandibular incisors normally are spared because they are covered by the tongue during suction movements and are thus buffered against cariogenic liquids

ECC

Primary canines and second primary molars,

later eruption

ECC

Tooth usually spared or little affected by ECC.

timing of the tooth eruption,

the time span of the harmful oral habit,

the type of muscle movements the child makes when sucking

Caries develop quickly

ECC factor level

ECC stage

chalky, opaque demineralization lesions on the smooth surfaces of the maxillary primary incisors

whitish line can be distinguished in the cervical region of the vestibular and palatal surfaces of the maxillary incisors.

reversible but are frequently unrecognized

can be diagnosed when teeth thoroughly dried.

Initial stage (ages of 10 and 20 months)

The dentin is affected.

The dentin is exposed and appears soft and yellow.

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

ECC stage

Second stage (ages of 16 and 24 months)

Stage 1 and stage 2

ECC stage

large, deep lesions on the maxillary incisors

pulpal irritation.

pain when chewing or teeth brushed,

spontaneous pain during the night.

At this point, the maxillary primary molars are at stage 2, while stage 1 can be diagnosed on the mandibular primary molars and the maxillary canines.

ECC stage

Third stage (20 and 36 months)

coronal fractures of the anterior maxillaries as a result of amelodentinal destruction

maxillary incisors are usually necrotized,

maxillary primary molars are at stage 3.

The secondary molars and maxillary canines and the first mandibular molars are at stage 2.

Some young children suffer but are unable to express their toothache complaints.

They experience sleep deprivation and refuse to eat.

ECC stage

The fourth stage, (30 and 48 months)

Stage 4

ECC stage

ECC Complications

Complications

pulp necrosis,

infection spreads to the pulpalperiodontal

the acute form (cellulitis, adenopathy and mobility of the affected teeth)

the chronic form (abcesses and interdental septum syndrome).

infection can spread to the buds of the permanent teeth, causing irreversible lesions.

ECC stage

PREVENTION of ECC

Dental Health Promotion

Pregnancy treatment (routine maintanence)

After birth : cleaned erupted tooth with wet cloth / childs toothbrush / fluoride toothpaste

Age One yrs old : brushed twice daily

No candy / sugar / sweet drink

Fluoride therapy if needed

Pit & Fissure Sealant

Caries Arrested

Primary tooth anatomy

Dental Injury/Trauma

Classification of trauma to anterior teeth

Ellis and Davey (1961)

Class 1 : simple fracture of the crown, involving little or no dentin

Class 2 : extensive fracture of the crown involving considerable dentin, but not the pulp

Class 3 : extensive fracture of the crown involving dentin and pulp

Class 4 : the traumatized tooth which becomes non-vital with or without loss of crown structure

Class 5 : Loss of tooth

Class 6 : Root fracture with or without loss of crown structure

Class 7 : displacement of a tooth without fracture of crown or root

Class 8 : Fracture of crown enmass

Class 9 : Traumatic injuries of deciduous teeth

Classification

WHO clasiffication

873.60 : Enamel fracture

873.61 : Crown fracture involving enamel and dentin without pulp exposure

873.62 : Crown fracture with pulp exposyure

873.63 : Root Fracture

873.64 : Crown-root fracture

(uncomplicated/complicated crown- root fracture)

873.66 : Luxation

(Concussion / subluxation / lateral luxation)

873.67 : Intrusion or extrusion

873.68 : Avulsion

873.69 : Other injuries like soft tissue injuries

Enamel Cracking

Fracture involving only enamel

Fracture involving enamel & dentin

Fracture involving enamel & dentin & pulp

uncomplicated crown-root fracture

complicated crown-root fracture

Tooth nonvital with or without fracture

1/3 Apical root fracture

1/3 coronal root fracture

1/3 Middle root fracture

Fracture of crown enmass

I

Intrusion

Extrusion

Lingual/palatal displacement

Concussion & Subluxation

Concussion is an injury to the tooth and ligament without displacement or mobility of the tooth.

Subluxation occurs when the tooth is mobile but is not displaced.

Concussion & Subluxation

Management

Periapical radiographs as baseline.

Soft diet for 1 week.

Advice to the parents of possible sequelae, such as pulp necrosis and infection.

Individualized follow-up.

Intrusion

Management

If the crown is visible and there is only minor alveolar damage leave tooth to re-erupt.

If the whole tooth is intruded extract.

Extrusion and lateral luxation

Treatment is dependent on the mobility and extent of displacement. If there is excessive mobility the tooth should be extracted.

Avultion

No reimplantation for PRIMARY teeth

Root Fracture

No treatment needed unless : necrotic pulp, infection, sinus tract, high mobility

Leave apical fragmen

Extract coronal fragmen

Fracture without pulp involve

GIC restoration

Resin composite

Strip-crown

Zirconia crown

-Auf Wiedersein-