EARLY CHILDHOOD CARIES AND RAMPANT CARIES

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CONTENTS

• INTRODUCTION
• Key words
• DEFINITION OF ECC
• Theories
• ETIOLOGY
• CLASSIFICATION
• DIAGNOSIS
• PREVENTION
• MANAGEMENT
• CONCLUSION
• REFERENCES

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INTRODUCTION

• Dental caries affects humans of all ages throughout the world and remains the major dental health problem among school children globally.

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• It is a disease that can never be eradicated because of the complex interaction of cultural,social, behavioral, nutritional, and biological risk factors that are associated with its initiation and progression.

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Key words

‘ DENTAL CARIES ’

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Ernest Newbrun – 1989

“Dental caries is defined as a pathological process of localized destruction of tooth tissues by microorganisms.”

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• Sturdevant – 2002

“Dental caries is defined as an infectious microbial disease of the teeth that results in localized dissolution and destruction of the calcified tissues.”

WHO

Defined dental caries as localized post eruptive, pathological process of external origin involving softening of the hard tooth tissue and proceeding to the formation of a cavity

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• Massler (1945) defined rampant caries as suddenly appearing, widespread, rapidly progressing, burrowing type of dental caries resulting in early involvement of the pulp and affecting those teeth usually regarded as immune to ordinary decay.

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HISTORICAL BACKGROUND 

Caries in infant and young children have long been recognizable as a clinical syndrome, which was described as early as middle of last century.

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Beltrami characterized this pattern of early caries in young children in 1930’ & as “black teeth of the very young

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• The previous names such as baby bottle caries and baby bottle tooth decay give an impression that a bottle is a necessary cause of tooth decay . The term nursing caries is more inclusive, but it assumes that breastfeeding or other nursing practices alone could cause the condition

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Community Dent Oral Epidemiol 1999; 27: 313–5

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• ECC was first described by an American Paediatrician named Jacobi in 1862

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• Pitts (1930) characterized this pattern of early caries in young children as “black teeth of the very young”

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• James et al (1950) described it as labial caries, because according to him labial surfaces of maxillary incisors are attacked first.

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• Dr. Elias Foss (1962) called it ‘nursing bottle mouth’ and he associated the condition with the nursing bottle.

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• Ripa (1978) coined the term ‘bottle mouth caries’

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EARLY CHILDHOOD CARIES

NURSING CARIES RAMPANT CARIES

High risk caries patients

• 2 or more new carious lesions in last 3 years
• Past root caries
• Deep pits and fissures
• Poor oral hygiene
• Inadequate use of topical fluoride
• Irregular dental visits
• Inadequate salivary flow

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ETIOLOGY

• Primary factors

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• Secondary factors

KEYES TRIAD, 1960

caries

NO

caries

NO

caries

NO

caries

HOST

SUBSTRATE

MICRO FLORA

MOIDIFIED KEYES TRIAD�Newburn, 1982

Secondary factors

• Saliva
• Salivary flow rate
• Salivary viscosity
• Race and ethinicity
• Socio economic status
• Tooth brushing
• Cognitive factors
• Dental knowledge
• Stress Birth weight
• Chronic illness

Host factors

• Anatomic characteristic of the tooth
• Arch form
• Presence of dental appliance and restoration
• Composition

Anatomic characteristic of the tooth:

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• Thin enamel in primary teeth is more susceptible to caries.

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• Palatal pits- maxillary molar, buccal pits- mandibular molar & palatal pits - maxillary incissor are vulnerable to caries

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Arch form:

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• Maligned teeth, rotated teeth are at increased risk of caries
• These condition provide an area of stagnation for accumulation of plaque and also these area are difficult to clean

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Presence of dental appliance and restoration:

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• These encourages the retention of food debris and plaque

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Composition:

Composition of tooth plays an important role in dental caries for example surface zone of enamel is more resistant to caries compared to inner layers due to the presence of:

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1. Dicalcium phosphate dihydrate and fluorappatite
2. Increased mineral and less organic matter
3. Decreased water content
4. Increased fluoride, chloride, zinc, lead and iron
5. Decreased carbonate, and magnesium

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• Fluoride content of sound tooth is 410-873ppm whereas for caries tooth it is 139-223ppm

Micro flora

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• Oral cavity of a new born is sterile Carlson et al 1975

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• Within hours of birth – streptococcus salivarius, streptococcus mitis colonizes the oral cavity- Berkowitz et al 1975.

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• After tooth eruption
• Streptococcus Mutans

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• Staphylococcus, Veilonella, Neisseria

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• Less frequent – Actinomyces, Lactobacillus, Fusobacteria.

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• Mutans streptococci are the principal bacteria isolated from children with ECC - Matto et al: 1996.

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• Van Houte (1982) demonstrated that S.mutans contributed about 60% of the cultivabable flora of dental plaque obtained from carious lesions, margins of white spot lesions and clinically sound enamel surfaces of preschool children with nursing caries.

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• Berkowitz (1996) conducted a study on the etiology of nursing caries. He put forth a three step process in caries formation they are:

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• The first step: Primary infection by mutans streptococci.

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• Second step: Accumulation of these organisms to pathogenic levels as a consequence of prolonged oral exposure to cariogenic substrates.

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• Third step: Rapid demineralisation and cavitation of enamel resulting in rampant dental caries.

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Ecology of S.Mutans:�

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S.mutans colonize the mouth only after the eruption of teeth and disappears after total extractions have been performed

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The cariogenicity of S.mutans is probably related to its unique combination of properties, which includes: (Krasse-1989

It colonizes the tooth.

They synthesize extracellular polysaccharide from sucrose using enzyme glucosyl transferase that enable formation of voluminous plaque.

Produces large amounts of acids even at low Ph .

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Transmission of S.Mutans

• S.mutans are transmitted to the child by:

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VERTICAL TRANSMISSION

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HORIZONTAL TRANSMISSION

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VERTICAL TRANSMISSION

• Transmitted from primary care taker, e.g mother, father.

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• Transmission take place by
• Direct ( kissing etc.)
• Indirect ( sharing spoon, glass etc.)

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HORIZONTAL TRANSMISSION

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These are transmission occurring from close relatives, siblings, peer groups

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Van Loveren et al – demonstrated a likelihood for horizontal transmission with Mutans.S after 5 years of age.

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WINDOW OF INFECTIVITY

• Carefield (1993) – 7-24 months of age (primary period of infection).
• Krass et al(1967), Edrman et al(1975)– �6-12 years of age (secondary period of infection).
• Davey and Rogers (1984) – Additional strains of MS with newly erupting teeth.

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• Mutant streptococcus play a major role in the initiation of lesion.
• Lactobacillus acidophilus, lactobacillus casei are minimally involved in caries initiation but are believed to have a key role in caries progression

Role of substrate

• According to E.Newburn, Diet refers to the customary allowance of food and drinks taken by any person from day to day

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• Dietary component primarily responsible for dental caries are fermentable carbohydrate

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Sucrose:

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1. It is the most commonly taken form of carbohydrate

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• It is considered to be most cariogenic because of the following reasons

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1. It easily diffuses into dental plaques.

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• It is highly soluble and acts as a substrate both for the production of extracellular polysaccharides and for acid production.

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• It favours the establishment of S.mutans on teeth and a high sucrose intake gives rise to voluminous amount of plaque formation.

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4. Sucrose is the only carbohydrate that is degraded by bacteria to glucans.

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• In infants and toddlers the main source of fermentable carbohydrate are:

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• Bovine milk
• Human milk
• Fruit juices
• Carbonated Beverages
• Sweet syrups
• Pacifiers dipped in honey
• Chocolate, sweets.

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BOVINE MILK

Lactose content = 4%

Increased calcium and phosporus

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HUMAN MILK�

• Various forms of casein reduced the adherence of S. Mutans glucosyl transferase to saliva coated hydroxyapatite as well as the expression of enzyme
• Increased calcium and phosporus
• Lactose content = 7%

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Fruit juice

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Caries rate is more enhanced if extrinsic sugars is added along with the acids in the fruit juices.

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Carbonated Beverages:

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• High sugar content in carbonated beverages causes increase the pH

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• Sodas contain carbonic acid have erosive effect on the tooth enamel.

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Honey:

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• Causes caries due to
• acid producing effect.
• It has high retentive rate
• Can also cause infant nihilism as it contains spores of clostridium bacterium which are rendered harmless in the acidic pH of adult stomach, but tend to germinate in infant stomach.

Dietary Metals:

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• Fe deficiency: Reduced Salivary flow: ↑Caries

• Pb Excess: ↑Caries (Van Houte-1994)

Time Factor:

• Duration or time affects both severity off the lesions and the number of teeth involved.

Secondary Factors�

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Saliva

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• Clearance of food

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• Buffering of acids (Carbonic Acids- bicarbonate buffer system)

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• Mediates selective adhesion and colonisation of bacteria on the tooth surface.

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Salivary flow rate

• When the flow rate is very below normal then the child has more incidence of caries

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Saliva viscosity

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• Patient with thick, ropy saliva invariably had poor oral hygiene

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• Thin, watery saliva has greater oral clearance

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OTHER RISK FATORS

Race Ethnicity

• Native American children and Canadian Aboriginal children living on reservations demonstrate a extremely high rate of ECC, ranging from 70%-80%.

Socio Economic Status:

• Low status: - ↓ ability for proper care and to obtain professional health care services↓health status
• ↓resistance to oral diseases and systemic diseases.

Tooth-brushing:

• Increased frequency and better oral hygiene levels are associated with lower caries levels in preschool children

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Cognitive Factors:

• These are intellectual, perceptual and emotional variables that influence health risks either directly through psychosomatic mechanisms or indirectly through their effects on health behaviours.

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Dental Knowledge:

• Regarding the relationship between microbiology of caries, the role of cariogenic foods and the use of baby bottle is essential in preventing ECC

Stress:

• anxiety of parents about Dental Rx→ increases caries lesion in children

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Birth weight:

• low range:1.8 Kg: increases caries

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Chronic illness

• makes child’s discomfort- increases intake of sweets by child to get comfort→ increases Caries.

Lactose Intolerance:

• Is applied to the gastrointestinal symptoms caused by mal-absorption lactose containing products.

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• Children with such problem are substituted with fruit juices, carbonated beverages thus increases caries.

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Early childhood caries

• A severe, rapidly progressing �form of tooth decay in infants �and young children

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CLASSIFICATION OF ECC

According to Wyne,1999

• Type – I (Mild to moderate)

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• Type – II (moderate to severe)

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• Type – III (Severe)

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Mild-moderate-

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• Isolated carious lesions involving molars and incisors.

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• Seen in 2-5 years old.

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• Cause: combination of cariogenic semisolid or solid food and lack of oral hygiene.

Moderate –severe :

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• Labiolingual caries in maxillary incisors.

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• Cause: Inappropriate use of feeding bottle or at will breast feeding or a combination of both, with or with out poor oral hygiene.

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• Seen soon after first tooth erupts: 6 months

Severe :

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• All teeth including mandibular incisors.

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• Cariogenic food + poor oral hygiene

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• Seen in 3-5 years.

� Progression of the lesion�

• Initially , a demineralised dull, white area is seen along the gum line on labial aspect of the maxillary incisors, which is undetected by the parents

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• These white lesions becomes cavities which involve the neck of the tooth in ring like lesion.

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• Finally, the whole crown of incisors is destroyed leaving behind brown black root stumps.

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• This unique pattern of unequal severity of the lesion is due to 3 factors: chronology of primary tooth eruption, duration of deleterious habits of feeding, muscular pattern of infant sucking.

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� Clinical features�

The intraoral decay of nursing caries is characteristic and pathognomonic of the condition. It effects the primary teeth in following sequence:

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• Maxillary central incisor first:

The facial, lingual, mesial and distal surfaces

• Maxillary first molars

The facial, lingual, occlusal and proximal surfaces

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• Maxillary canine and second molars, the facial, lingual and proximal surfaces

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• Mandibular molars at the later stage

• Mandibular anteriors are spared because of :

A] Protection by tongue

B] Cleansing action of saliva due to the presence of the orifice of the duct of the sublingual glands very close to lower incisors.

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��Initial / Reversible stage / Stage -1�

Age – 10 – 20 months

• white chalky demineralizations seen on maxillary anterior teeth.
• Pain or tooth ache does not occur
• The dentist is the only one who make diagnosis, by using air syringe and drying teeth properly.

Stage 2 / Damaged / Carious stage

• Caries extends in to the dentin and marked discolourations are seen
• Discontinuity of the enamel surface is seen, cavitation of the carious lesion occurs. Parents can now spot the decay.
• Children start complaining of tooth ache on ingesion of extremely cold food eg: ice cream.

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Stage 3 / Deep lesions

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• This stage is reached in 10 – 14 months. Complaints of pain during toothbrushing or eating especially while biting are frequent.
• Complaints of pain during intake of hot or cold drinks.
• Diagnosis is facilitated if patient complaints of pain during eating, brushing or if child uses canines to incise food.

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Stage - 4 / Traumatic stage

Age – 30 – 48 months 

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• Fractures of one or more carious teeth, cervically are frequent occurance

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• Hence when weakened by nursing caries, the tooth will tend to fracture in the weakest spot cervically. At times only root stumps remain in the oral cavity.

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Diagnosis

• Visual and tactile examination
• Radiographic method
• Tooth separation

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RECENT METHODS�

• Laser fluorescence
• Electrical conductance measurement
• Fiber optic trans illumination
• Magnetic resonance micro-imagery
• Ultrasound
• Caries detector dyes
• Xeroradiography
• Endoscopic method of caries detection

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LASER FLUORESCENCE

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• Used in early 1980

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• Scientific basis- enamel illuminated with blue light from an argon laser, emits yellow light by auto fluorescence

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• When caries is present, the intensity of fluorescence is reduced by scattering of light within the lesion

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• Dark grey areas of enamel indicates incipient caries

• Diagnodent – recently marketed compact hand held device

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• It makes use of laser auto fluorescence technology,instead of using blue light it uses red light

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Electric resistance/ECM

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popular in 1980’s

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• Principle - sound enamel has a high resistance to electric current flow. At location where the pore volume of the enamel is larger, the electrical conductance increases.

Fiber Optic Transillumination

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• Uses bright fiber optic light to transilluminate a tooth to investigate the presence of caries.

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• Trans illumination will be less for carious tooth.

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• Newer version of FOTI is digital imaging fiber optic trans illumination where the image is recorded by a CCD digital camera.

Magnetic resonance micro-imagery

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• It uses a moderate magnetic field

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• This technique is capable of producing highly accurate 3 dimensional picture of teeth

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CARIES ACTIVITY TESTS

Defined as the sum total of new caries lesions and enlargement of existing carious cavities during a given period of time.

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• To determine the need of personalized preventive measures.

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• To motivate and monitor the effectiveness of Health education programs.

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• To manage the progress of restorative procedures.

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• To identify high risk individuals

CARIES SUSCEPTIBILITY

• Refers to the new number of lesions that may develop in an individual over a period of time

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VARIOUS TEST

• Lactobacillus colony count test
• Synder test
• Strip mutans test
• Buffer capacity test
• Fordick Ca dissolution test
• Dewer test
• Swab test
• Reductase test
• Cariostat test
• Caries risk test – bacteria and buffer

LACTOBACILLUS TEST�

• Hadley(1933)

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Method:

• saliva is collected by having the subject chew paraffin before breakfast.This is stored in a bottle and shaken to mix well.
• 0.1cc of saliva is spread over Rogosa agar plate.
• The plate is incubated for 4 days.

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Lactobacillus Colonies �Developed Are Counted

SNYDER TEST

• This snyders test measures the ability of salivary micro organisms to form organic acids from a carbohydrate medium.
• snyders medium consists of:
• Casein
• Yeast extract
• Dextrose
• Agar
• Bromocresol green

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METHOD

• Saliva is collected by having the subject chew paraffin.
• It is inoculated into glucose agar- ph – 4.7 – 5.
• Bromocresol green.

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• 0.2ml of saliva is added to the agar tube. The Snyder agar tube with saliva is incubated at 37 °C.

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• The color change of indicator is observed after 24,48 and 72 hours.

Color Observations in Snyder test

24 hours 48hours 72hours

ALBANS TEST (modified Snyder test)

• Alban modified the Snyder test to make it easier and for use in regular dental office.

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• In this method lesser amount of agar is used.

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• The agar is taken from the refrigerator but is not heated. To this saliva is added and incubated for 4days.

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• Color observations are same as that of Snyder test.

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SALIVARY REDUCTASE TEST

• The test measures the rate at which an indicator dye, Diazoresorcinol changes from blue to red to colorless.

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• Method:5ml of saliva is collected by the same method and stirred. It is then mixed with a fixed amount of Diazoresorcinol.

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• Color change obtained after 15mins is taken as a measure for caries activity.

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COLOR OBSERVATIONS

Strip test:

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• Saliva or plaque samples are obtained by using tongue blade or tooth picks

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• This is transferred to S. mutans strip which is incubated in MSB agar (MITIS SALAVARIUS BACITRACIN AGAR)

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• Number of S.mutans is then estimated.

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Caries risk test

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• This is a new quick and effective caries activity test

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• It has two components

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1. CRT bacteria-It is used to determine cariogenic bacteria

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• CRT buffer- to determine buffering capacity

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Method

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• Stimulated saliva is collected and applied to both the sides of slide and then incubated for 48 hrs at 37^oc

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• CRT buffer strips are placed in mouth and the change in colour is used as an indicator for buffering capacity

CARIES RISK ASSESSMENT

AAPD – CAT

Low risk

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Oral conditions - No enamel caries teeth in past 24 months

- Caries “white spot lesions”

- No visible plaque; no gingivitis

Environmental - Optimal systemic and topical, fluoride factors exposure

- Consumption of simple sugars or foods strongly associated with caries initiation primarily at mealtimes

- High socioeconomic status.

- Regular dental care.

AAPD – CAT

Moderate risk

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Oral conditions - Carious teeth in the past 24 months

- Presence of white spot lesions

- Gingivitis

Environmental - Suboptimal systemic fluoride

factors with optimal topical exposure

- Consumption of between – meal simple sugars

- Midlevel socioeconomic status.

- Irregular dental care.

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AAPD – CAT

High risk

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Oral conditions - Carious teeth in the past 12 months

- Presence of white spot lesions

- Radiographic enamel caries

- Visible plaque on anteriors

- High titers of MS

- Enamel hypoplasia

- Ortho treatment

Environmental - Frequent intake of sugars factors - Low socio economic status

- No dental care.

- Systemic illness

PREVENTION

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Professional care

Home care

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PROFESSIONAL CARE

• Parents education regarding importance of deciduous teeth, gum pads cleaning, tooth brushing, frequent mouth rinsing.
• Diet counseling

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• topical fluoride if needed.

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• Application of fissure sealants

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• Regular recalls, motivation.

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Home Care

• Elimination of cariogenic food items from the diet

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• Substitution with tooth friendly food

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• Discouraging bottle feeding at night

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• Falling asleep with pacifiers should be stopped

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• Digital or baby tooth brushing as the teeth erupts

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• Regular visit to dental clinic once in six months.

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American Academy of Pediatric Dentistry (AAPD) Recommendations for prevention of Early Childhood Caries

• Infants should not be put to sleep with a bottle. nocturnal breast feeding should be avoided after the first primary tooth begins to erupt.

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• Infants should be weaned from bottle at the age of 12-14 months .

• Oral hygiene measures should be implemented by the time of eruption of the first primary tooth.

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• An oral health consultation visit within six months from the eruption of the first primary tooth .

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PARENT COUNSELING

• Parent counseling can be defined as educating the parents regarding the child’s oral health status, optimal health care and informing them about the prevention of potential dental diseases.

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• Dental development of their child

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• Appropriate feeding practices emphasizing the hazards of improper bottle and breast-feeding.

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• Oral hygiene measures appropriate for infants and toddlers.

Pre-natal counseling

• Primary teeth start forming at 3 months after conception, so it is important that the mother gets proper nutrition, stays in good health.

Avoids medications which are either harmful to her baby’s teeth.

Imbalance in the mother’s calcium and phosphorus levels due to fever or infection during pregnancy can also lead to disruptions in the baby’s tooth structure

ANTICIPATORY GUIDANCE

• Nowak (1995) describes anticipatory guidance as a proactive, developmentally based counseling technique that focuses on the needs of a child at each stage of life.

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• First dental visit: AAPD- within six months of the eruption of the first primary tooth but not later than 12 months of age.

ORAL HYGIENE PRACTICES

Gum Pads

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• The cleaning of gum pads is started as early as first week of birth.

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• Lay the baby down with his/her head in your lap and feet pointing away.

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• Take a small gauze (2” x 2”) between thumb and forefinger and wipe vigorously over the ridge of the baby’s top and bottom jaws.

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• Infants tooth brushes, finger coats and wipes can also be used.

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• Clean at least twice a day, morning and after last feed in the night.

IDEAL PEDODONTIC BRUSH

• Diameter of each nylon filament – 0.007” – 0.008”

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• Tufts – 24-33.

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• Long handle

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• Small head size

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RECOMMENDED BRUSHING TECHNIQUES FOR CHILDREN

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• Scrub or circular scrub are best for young children

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• Soft to medium brushes are more efficient. Time taken is at least 2 ½ to 3 minutes to cover the entire surface

BDA – June - 1997

For children who are considered to be at high risk and are living in areas with water supplies with less than 0.3ppm fluoride ion, supplements may be used.

It is advisable though that fluoride supplements only be given following guidance from a dentist.

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Guidelines for F supplements in areas with less than 0.3ppm fluoride

Age mg F per day

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• Birth – 6 months - 0
• 6 months to 3 years - 0.25mg
• 3 years to 6 years - 0.50mg
• 6 years and over - 1.00mg

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Fluoride supplements should not normally be given to children living in areas with water containing fluoride at a level of 0.7ppm or more.

Guidelines for F supplements in areas at or between 0.3 and 0.7ppm fluoride

Age mg F per day

• 6 months to 3 years - 0
• 3 years to 6 years - 0.25mg
• 6 years and over - o.50mg

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Recommended use of flouride tooth paste

• Below 4 years – not recommended

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• 4 – 6yrs – brush once with fl tooth paste and once with non-fl tooth paste

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• 6 – 12yrs – Brush twice with fl – tooth paste and once with non-fl tooth paste

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• Above 12yrs – Brush 3 times with fl tooth paste.

Topical flouride used in clinics

• NaF – 2%

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• SnFl – 8%

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• APF - solution – 1.23%

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• APF – gel – 1.23%

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Flouride varnishes

• Bifuride

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• Duraphat

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• Florprotector

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• Flouritop

�� � � Caries Prevention

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• Combating the Caries inducing microbes

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• Increasing the resistance of tooth structure to caries attack

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• Modifying the diet and augmenting salivary factors

Walsh - 2004

Caries Balance

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Protective Factors

• Salivary Flow and Components
• Proteins, Antibacterial

Components and

Agents

• Dietary Components

Pathologic Factors

• Reduced Salivary Function
• Bacteria: mutans streptococci,

lactobacilli

• Dietary Components:

frequency of

carbohydrates

Advances in Antiplaque agents

• Anti-bacterial and anti-adherence agents are being tested as plaque building blockers.

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• Inhibition of Glucan Mediated Adhesion. (Competitive inhibitors, Anti GTF Antibodies)

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• An ecological shift from a cariogenic to a non cariogenic biofilm.

Fluorides

• Key agents In battling dental caries.
• Efficacy of topical fluorides depend on:

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Frequency and duration of application

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Concentration

of fluoride

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Specific

Compound

used

Featherstone 2000

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• Fluoride varnish applied 2x/year was found to be more efficacious, in caries reduction, than a weekly rinse of NaF.

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• Fluoride releasing pit and fissure sealants

(FISSURIT-F)

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• Dual- phase systems containing NaF and Dicalcium phosphate Dihydrate

Remineralization Therapy

• A new RM technology has been developed based on Phosphopeptides from Milk Casein.

• The CPP-ACP nanocomplexes have been shown to localize at the tooth surface and prevent enamel demineralization.

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• Trademarked as “Recaldent”

Nova Min Technology

• Novamin is a formulation of calcium, phosphate, sodium and silica which is Odorless, colorless and biocompatible.
• Only man made mineral which directly leads to formation of hydroxyapatite crystals.
• Extraordinary desensitization and whitening effects.

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• The biomimetic process uses the body’s existing mechanism for the defense and rebuilding of teeth .

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• When Nova Min is exposed to saliva, it releases Ca and Po4 ions that become available to the body’s natural RM process.

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• In toothpaste, Nova Min improve RM in early lesions by 68% as against fluorides �

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Caries Management Tools For The Future

Lasers

• Co2 laser irradiation increased acid resistance of enamel at a rate of 20 pulses in100 microseconds.
• It caused an irregular ,rough and melted enamel surface and increased the bonding strength between the resin and enamel surface �

Altering biofilm communication pathways�

• Blocking the cell to cell signalling (“quorum sensing”) within the biofilm.
• Reduces the ability of the biofilm to tolerate stresses .
• Slowing the biofilm accumulation rate may be possible using agents such as furanone which affect quorum sensing.

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Targeted therapies�

• “Magic bullet” and “smart bomb” therapies

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• Antibodies to particular bacterial species in the biofilm could be conjugated to a toxin or biocide.
• Photosensitization of biofilm bacteria.

FEEDING PRACTICES�Breast feeding

• From nutritional point of view, breast milk has several systemic and immunological advantages

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• However, breast feeding, beyond the stipulated weaning time of the child, specially throughout the night and sometimes throughout the day, has been associated with nursing caries.

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• AAPD- soon after the first primary tooth erupt

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• WHO- 2yrs

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BOTTLE FEEDING

• AAPD- if used it should be stopped by 12-14 months

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SOME IMPORTANT TIPS FOR BOTTLE FEEDING

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• Remove the bottle immediately after feeding

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• Encourage your baby to stay in upright position while feeding

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• Use a nipple that has a small hole so that it enables the infant to work with perioral muscles.

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• It should not be used as a pacifier

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• Give water after feeding with the bottle and clean the mouth soon after feeding.

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• TREATMENT

TREATMENT PROPER

FIRST VISIT

• Parent education
• Collection of saliva to estimate flow rate and viscosity
• Caries activity test
• Plaque index,gingival bleeding index
• Seal the open lesions
• Fluoride tooth paste,topical fluoride application
• Diet chart

SECOND VISIT (after 10 days)

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• Diet chart analysis
• Isolation of sugar factors
• Diet modification
• Explain the pt about the role of sugar and plaque in the progression of caries
• Caries activity test
• Plaque index, gingival bleeding index
• Recall after 15 days

THIRD VISIT

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• Pulpotomy
• Endodontic treatment
• Extractions
• Crowns
• Review and recall

OTHER JOURNALS:

• This study demonstrates that the habit of allowing infants to sleep with breast nipple in their mouth and the late start of tooth brushing are associated with prevalence of ECC. Educational programs for pregnant women and mothers of young children should be emphasized to enhance their knowledge and awareness of mothers in preventing ECC.
• Maj. Ked. Gigi. (Dent. J.), Vol. 39. No. 2 April–June 2006: 54–58

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• There are no specific antibiotics or vaccines yet available against cariogenic bacteria. The present study showed, povidone iodine was used resulted in significant reductions in Mutans streptococci and lactobacilli were achieved that lasted for 3 weeks or more, and that the use of this agent is promising as a caries antibacterial. However, future clinical studies will be needed to determine the effect of frequent povidone iodine applications on cariogenic bacterial reduction.
• Ling Zhan et al, Journal of Public Health Dentistry , Vol. 66, No. 3, Summer2006

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• Mutans streptococci are important organisms in the initiation and progression of dental caries.

• Recent evidence demonstrates that these bacteria are found in the mouths of pre-dentate infants and are acquired via vertical and/or horizontal transmission from human reservoirs.

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• [Indian J Pediatr 2009; 76(2) : 191-194]

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• prolonged exposure of teeth to breastfeeding (2–5), bottlefeeding (2, 6, 7), and feeding at night (2, 4, 5, 8) have been identified as risk factors of early childhood caries (ECC).
• Consequently, weaning from breast and ⁄ or bottle is recommended by dental professionals soon after the child’s first birthday

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• Community Dent Oral Epidemiol 2008; 36: 363–369

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• ECC was associated with milk bottle feeding at night, this practice should be curtailed for children, whereas prolonged breastfeeding appears to have no such negative dental consequences.

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• International Journal of Paediatric Dentistry 2007; 17:289–296

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• Children who used systemic antibiotic during the first year of age had significantly greater risk for ECC during the follow up.
• After first year of life, only children who used systemic antibiotic at 13 – 18 months old showed increased risk of ECC.

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• Sumer.M.Alaki, Paediatric Dentistry, 2009: vol-19: No-1

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Conclusion

Early childhood Caries is a distressing clinical condition, confronting the child, parents and the dentist. Successful management of the caries depends upon coordinated approach by, paediatric dentist, parent and the child.

Proper education of the parent should encourage the parent to bring the child before the age of 12 months for the 1st dental check up. Followed by recall and maintenance phase

References

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• Finn: Textbook of Pedodontics.
• Paediatric Dentistry: Pinkham
• Dentistry for children and adolescent: Mcdonald
• Principles and Practice of Pedodontics, Arathi Rao, 2^nd Edition.
• Textbook of Pedodontics, Shobha Tandon
• Damle S.G: Paediatric Dentistry
• Matee: Caries re 26: 813-87, 1992
• Berkowitz: Paed. Dent 21(3): 160~3, 1996.
• Vaon Houte : J. Dent Res 73:672-81,1994.
• Pediatric dentistry, vol – 29, no:7, 2007
• Nadia.Mohammad: J.Cl.Paed.Dent – vol – 32, no:3, 2008
• Faiez.N.Hattab, J.Dent.for.Children, vol- 66, jan – 1999

Marinela Păsăreanu JOURNAL OF PREVENTIVE, MEDICINE 2007, 15, 130 – 133

Community Dent Oral Epidemiol 1999; 27: 313–5

The Saudi Dental Journal, Volume 8, Number 3, September 1996

(Al–Rafidain Dent J, Vol. 7, Sp Iss, 2007

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• Maj. Ked. Gigi. (Dent. J.), Vol. 39. No. 2 April–June 2006: 54–58
• BDA – June – 1997

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[Indian J Pediatr 2009; 76(2) : 191-194]

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Community Dent Oral Epidemiol 2008; 36: 363–369

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International Journal of Paediatric Dentistry 2007; 17:

• 289–296

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• Ayhan H - J Clin Pediatr Dent - 01-APR-1996; 20(3): 209-12

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• Text book of pediatric dentistry, Nikhil Marwah

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• Soben peter

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