Dental Caries in children teeth l Pediatric dentistry MCQs

 

 Dental Caries in children teeth l Pediatric dentistry & dentistry for children MCQs for dental students

Dental caries ( tooth decay ) :

• is a infectious disease of mineralized tissue of the teeth with a multi factorial etiology related to the interaction over time b/w tooth substance and the cariogenic microorganism and the dietary carbohydrate producing plaque acids.
• dental caries and plaque on teeth ( dental plaque ) are most common disease in oral cavity.

The risk factor for dental caries include:

1.  Diet
2. oral hygiene or plaque control
3. tooth morphology
4. oral hygiene or plaque control
5. salivary characteristic.
6. social factor.
7. medical disability.

N.B :

• The cariogenic diet is the major risk factor in the etiology of dental caries.
• The 1945-53 Vipeholm study is the largest study investigating the association b/w sugar consumption and dental caries . This study concluded that consumption of sugary food and drink b/w and at meals is associated with a large caries increment.
• Several factor of diet are associated with an increased incidence of dental caries including amount , the physical form and the frequency of carbohydrate taken.
• Early childhood caries is the presence of one or more decayed , missing(due to caries),filled(due to caries)tooth surfaces in the primary dentition in children younger than 71 month of age.

Type of early childhood caries

Type I early childhood caries :

• is mild to moderate form of caries in children 2-5 year of age . It is characterized by the involvement of primary incisors and molars.

Type II early childhood caries :

• is characterized by moderate to severe form of caries lesion usually due to inappropriate feeding pattern in children 2-5 year of age and is characterized by carious involvement of maxillary incisors , maxillary and mandibular molars , Mandibular incisors are usually unaffected.

Type III early childhood caries :  

• is severe form of carious lesion seen in children 3-5 year of age and is characterized by rapid carious involvement of even those teeth which are previously immune to the process of caries decay.

Rampant dental caries:

• is a suddenly appearing , widespread , rapidly burrowing type of caries , resulting in early involvement of the pulp and affecting those teeth which are previously immune to the process of caries decay. Rampant decay of teeth show two peak , one in age group of 2-5 year and other in in teenage or young adolescent age group.

Etiological factor

1. Emotional factor : Stresses , anxiety , inferiority complex , repressed emotions , fears , identity crisis , traumatic school experience , rebellion against a family situation have been observed as contributing factor in the etiology of rampant tooth decay . The possible reason are increased frequency of snacking and reduced salivary flow in emotional state.
2. Improper/prolonged feeding : The improper method of feeding or prolonged feeding through nursing bottle can predispose to rampant decay.
3. Low socioeconomic status.
4. Immunological disorder.
5. Malnutrition.
6. Chronic systemic illness ,blood dyscrasia.
7. Radiation exposure.
8. Sjogren syndrome or other causes of xerostomia.

Clinical feature

1. Sudden onset.
2. Appearance or presence of 10 new carious lesion within a specified segment of time.
3. Carious involvement of mandibular incisors.
4. Proximal caries lesions of maxillary and mandibular anterior teeth.
5. Proximal lesions of molars.
6. Early involvement of pulp.

Management of rampant caries:

• The treatment modalities for rampant decay are based on through diagnosis of the condition in order to evaluate and assess the pulpal and periodontal health status of each individual tooth in the oral cavity. The etiological factor in causing the rampant decay should be identified and should be eliminated

1. The tooth which are minimally decayed should be restored with preventive resin restoration
2. The tooth which are exposing risk of pulpal exposure on further caries excavation should be treated with mean of indirect pulp capping/preventive resin restorations.
3. The tooth indicated with sign and symptom of pulpal pathosis should be treated with endodontic treatment , followed by full crown restoration.
4. Any un restorable tooth should be extracted and suitable space maintainer should be given.Space maintainer should be given for any tooth previously exfoliated.
5. Patient should be instructed to follow stringent oral hygiene measure and in or out office preventive fluoride application should be instituted.

Nursing dental caries :

• is the development of caries lesion in atypical and definite pattern in young children due to inappropriate feeding pattern .

• The clinical appearance of the teeth in nursing bottle caries in a child is typical and follows a definite pattern .The teeth involved in nursing bottle caries-Maxillary anterior teeth , maxillary and mandibular first primary molars , and sometimes the mandibular canines . The mandibular incisors are usually unaffected as are protected by tongue

Etiology

• Inappropriate feeding pattern-Improper and prolonged bottle feeding is an important cause of nursing bottle decay. Bottle feeding while the child is sleeping result in pooling of sugary milk or beverage around the upper anterior teeth. The carbohydrate-containing liquid provides an excellent culture medium for acidogenic microorganism . Salivary flow is decreased during sleep , and clearance of the liquid from the oral cavity is slowed at night . All these factor predispose the child to tooth decay.

• Prevention of nursing bottle caries-Correct method of feeding ,weaning of the bottle at appropriate age, early start of brushing or dental care , topical fluoride application , early counseling of the parents , are the measure which can be taken to prevent the development of nursing bottle caries.