Nursing caries and Rampant caries

 Nursing caries and Rampant caries

Nursing caries

It is a unique pattern of dental caries in very young children due to prolonged and improper feeding habits. 

Etiologic agents in nursing cares

1) Bovine milk, milk formulas and human breast milk have all been implicated in nursing caries because of their lactose contents. 

2)  The basic mechanism of demineralization is the same and the caries tetralogy is the key in the whole process of nursing caries as all the four variables, pathogenic microorganisms, substrates, host factor( tooth) and time are essential in causing demineralization. 

Pathogenic microorganisms-

1) Streptococcus mutans is the principle organism which colonized the tooth after it erupt into oral cavity. 

2) It is transmitted to the infanta mouth primarily through mother. 

3) It is considered more virulent because of the following reasons-

a) It colonized the teeth. 

b) It produces  large amount of acid. 

c) It produces large amount of extracellular polysaccharides which favour plaque formation. 

Substrate ( Fermentable carbohydrates) -

Carbohydrate are utilized by microorganisms  to form dextrans which-

a) adhere organism to tooth surface. 

b) Cause organic acid to demineralize the tooth. 

In infant and toddlers the main sources of fermentable carbohydrates are:

Bovine milk or milk formulas. 

Human milk

Fruit juice and other sweet liquids

Sweet preparation like vitamin preparation

Pacifiers dipped in honey or sugar solution

Chocolates or other sweets. 

Host

Teeth act as the host for the microorganisms

Hypomineralisation or hypoplasia of the teeth increase the susceptibility of the child to caries. 

Thin enamel in the primary teeth is one of the reasons for early spread of lesions. 

Time

Most of the time child sleeps with the bottle in the the mouth, the higher is the risk of caries. 

Clinical features

The intraorsl decay pattern of nursing caries is characteristic. It affects the primary teeth in the following sequence-

1) Maxillary central incisiors: Facial, lingual,mesial and distal surfaces. 

2) Maxillary lateral incisors: Facial, lingual, mesial and distal surfaces. 

3) Maxillary first molars: Facial, lingual and occlusal, proximal surfaces. 

4) Maxillary canine and second molars: Facial, lingual and proximal surfaces. 

5) Mandibular molars: At later stage. 

Progression of the lesion

Initially, a dimeralized dull, white area is seen along the gum line on the labial aspects of maxillary incisors, which is undetected by the parents. 

These white lesions become cavities which involve the neck of the tooth in a ring like lesion. 

Finally, the whole crown if the incisors is destroyed leaving behind brown black root stump. 

This unique pattern and unequal severity of the lesion is due to three factors:

Chronology of primary tooth eruption. 

Duration of deleterious habits of feeding. 

Muscular pattern of the infants sucking. 

Implications

The child who has nursing caries has an increased risk of developing caries even in the permanent dentition. 

The child with caries is also susceptible to other health hazards. 

The treatment of nursing caries may prove to be financial burden for some patients. 

Management

Aims

Management of existing emergency

Arrest and control of the various process

Institutions of preventive procedures

Restoration and rehabilitation. 

Factors affecting management

Extent of lesion

Age of the patient

Behavioural problems fue to young age of the child

Treatment

It can be divided into three visits. 

First visit

This phase of the treatment constitutes treatment of the lesion, identification of the cause for counseling of the parent. 

. All lesion should be excavated and restored. 

. Indirect pulp capping or pulp therapy procedures can be evaluted by further investigation. 

. If the abscess is present it can be treated through drainge. 

. X rays are advised to assess the condition of the succedaneous teeth. 

. Collection of saliva for determining the salivary flow and viscosity. 

. Also the application of fluoride topically. 

Parent counseling-

The parent should be questioned about the child, 

feeding habits, specially regarding the use of nocturnal bottles, demand for breast feeding, pacifiers dipped in sweetening agents. 

The parents should be asked to try weaning the child from using the bottle as a pacifiers while in bed. 

The parents should be instructed to clean the child's teeth after every feed. 

Parents are advised to maintain a diet record of the child for one week which includes the time, amount of food given to the child, type of the food and number of sugar exposure. 

Second visit

It should be scheduled one week after the first visit. Analysis of diet chart and explanation of the disease process of  the child's teeth should be undertaken by a simple equation. 

Isolated the sugar factors from the diet chart and control sugar exposure. 

Reassess the restoration and redo if needed. 

Caries activity test can be started and repeated at monthly intervals to monitor the success of treatment. 

Third and subsequent visit

Restoring all grossly decayed teeth. 

Endodontic treatment

In case of unrestorable teeth, extractions can be done followed by space maintenance. 

Crowns can be given for grossly dacayed or endodontically treated teeth. 

Review and recall after every 3 months. 

Prevention

Information on nursing caries can be distributed to new parents through obstetrician. 

Sealing of all caries free pits and fissures. 

Professional fluoride programs. 

Use of antimicrobial therapy topically. 

Parents should be educated how and when to feed the child during the earliest stages of the child, when and how to introduce solid foods.