Sales Training 2014 - Dentistry

Chapter 24 Early Childhood Caries 179

Table 24.3  Stages of Progression of Early Childhood Caries (ECC)

Stage

Illustration

Description of Lesion

Age of Occurrence

Symptoms

Initial

Cervical and interproximal opaque, white, chalky demineralisation seen on maxillary anterior teeth Molars also display chalky white discolouration on occlusal surfaces around pits and fissures Discontinuity of enamel surface Marked discolouration is seen and caries extends into dentin Dentinal caries demonstrated on molars Caries progresses further to involve deeper layers of dentin approximating the pulp Molars also incur deep dentinal involvement approximating the pulp Caries encircles the cervix of the anterior tooth Multiple surfaces are involved in molars, namely occlusal,

Usually 10–18 months

No pain Dentist discovers

(reversible) stage

lesion by drying the tooth with an air syringe

Damaged

18–24 months

Parents spot decay

(carious) stage

due to penetration into lesion

Child expresses difficulty and

toothache while eating cold food

Stage of deep lesion

24–36 months or sooner

Child complains of pain during

brushing and taking hot or cold drinks

Child refrains from

using anterior teeth for incising food Frequent fracture of carious tooth at the cervix

Traumatic stage

36–48 months or sooner

mesial and distal, and sometimes cervical too (multi-surface carious lesion)

Of these, the caries arising due to the first reason, or pattern A, can be described as nursing bottle caries . Caries caused due to pattern B can be called tooth cleaning neglect. Dental carious involvement with respect to pattern C refers to rampant caries . NURSING BOTTLE CARIES Nursing bottle caries is a unique pattern of dental caries in very young children due to prolonged or improper feeding habits. The infant may be fed with a nursing bottle containing a high amount of fermentable carbohydrates during sleep. The sugary liquid substrate from the bottle pools around the maxillary incisors (Figs 24.2 and 24.3). This retentive, sugary environment

Early childhood caries comprises

A. Inappropriate nursing pattern

B. Inadequate oral hygiene

C. Enhanced caries susceptibility

‘Nursing bottle caries’

‘Tooth cleaning neglect’

‘Rampant caries’

Figure 24.1  Early childhood caries is a universal set and nursing bottle caries, tooth cleaning neglect and rampant caries are subsets.

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