This document discusses different types of early childhood caries including nursing caries, rampant caries, and arrested caries. It defines early childhood caries as occurring in children under 6 years old with one or more decayed, missing, or filled tooth surfaces. Rampant caries is an acute form that spreads widely and quickly, often involving incisors. Arrested caries occurs when the decay process stops due to improved oral hygiene or fluoride treatment, leaving white or brown lesions. Prevention, treatment, and factors promoting arrest are described for each type.

1. EARLY CHILDHOOD CARIES,
RAMPANT, CHRONIC AND
ARRESTED CARIES
Presented by :
Eman M Saeed ,Noran Waleed ,Saeed Ahmed ,
Nahla Mohie ,Hala Khalid ,Aya Awad ,Fadi Imad

2. Include two variants
1- Nursing caries
2- Rampant caries
Different between them is involvement of
incisors in rampant caries
Early childhood caries ( ECC )

3. Early childhood caries ( ECC )
Synonyms :
Nursing Bottle Caries, Baby Bottle Caries ,
Nursing Bottle Syndrome ,Baby Bottle
Tooth Decay ,Nursing Caries , Maternally
Derived Streptococcus Mutant Disease (
MDSMD ) .

4. Definition of ECC
The American academy of pediatric dentistry (AAPD)
define ECC as the presence of one or more decayed
nonactivated or cavitated, missing due to caries, or
filled tooth surfaces in any primary tooth” in children
71 month of age or younger
AAPD also specifies that in children younger than 3 years of age
any sign of smooth surface caries is indicative of sever early
childhood caries S-ECC

5.  The Child Is Younger Than Age 3 And Demonstrates Any Evidence Of
Disease Experience On Any Smooth Surface Of Any Tooth.
 The Child Is 3, 4, Or 5 Years Of Age And Demonstrates Any Evidence Of
Disease Experience On A Maxillary Incisor Smooth Surface.
 The Total Number Of Affected Surfaces Is Equal To Or Greater Than
Four Surfaces At Age 3, Five Surfaces At Age 4, Or Six Surfaces At Age 5
Sever Early Childhood Caries

6. Etiology according to APPD
1-inappropriate Nursing Habits ( Breast Or
Bottle )
2- Prolonged Breast Feeding Beyond
Normal Age Of Weaning
3-falling Asleep With Pacifier Covered With
Honey Or Jam
4- Regular Use Of Sweetened Comforter
5- Regular Use Of Therapeutic Syrup

7. Clinical picture :
Teeth Affected :
The most affected are the 4 maxillary incisors
The 4 mandibular incisors remain sound due to protection from tongue during
sucking the other primary teeth exhibit caries depending upon how long carious
process remains active but usually is not sever as maxillary incisors
Clinical Pattern :
Initially maxillary incisors develop a band of dull white of demineralization along
gum line and this is undetected by patents

8. Then the white lesions develop into cavities that circle
the neck of the teeth in brown or black collar
advance cases crown of 4 maxillary incisors maybe
destroyed completely leaving brownish black root
stumps

9. Management of ECC
Prevention
development of dietary
habits and self care habits at
home ( oral hygiene , use
of fluoride supplement if
needed , use of fluoridated
tooth paste , dietary habits )
professional examination
and preventive care
(early dental examination
before age of 1 year ,
parent counseling
,professional application
of topical fluoride varnish
and fissure sealant )
community base strategy
include
( national education
program for mothers and
care givers , personal and
community preventive
program , water
fluoridation )

10. Treatment
1- cessation of habits
2- sealing all caries free
pits and fissures
3- fluoride application
4- IRR by use IRM
5-pulp therapy and
buildups of restorable
teeth

11. Rampant caries
Rampant caries are suddenly
occurring (acute) growing
type (widespread caries) with
early pulpal involvement of
teeth which are usually
immune to decay
(Masseleu1945).

12. General Features of Rampant caries :
i. Many teeth are involved
ii. Seen in children and adolescents
iii. Carious lesion occurs on the surfaces generally
considered to be at low risk of decay
iv. Prevalence = 5-8 percent
v. Females are more prone than males
vi. Age: 4-8 year → Children
11-18 year → Adults.

13. Etiology :
1-Salivary deficiency
2-Genetic
3-Habits
4-Nutration
5-Diet
6-psychological factors

14. Clinical Features :
Seen in primary and permanent dentition.
 In primary teeth features are related to order of tooth eruption.
 Initial lesions appears on labial surface of maxillary incisors near the
gingival margin as a white area/
pitting on enamel surface.
 In permanent teeth—Related to the eruption of teeth.
– Here buccal and lingual surface of premolar and molar are involved.
– Proximal and labial surface of maxillary incisors and proximal
surface of mandibular incisors are involved

15. Complications :
 Affects maxillary anterior which may lead to
psychological problem due to loss of esthetics
 Minimal trauma can lead to fracture of teeth
 Difficulty in speech
 Development of abnormal habits
 Orthodontic problems
 Multiple abscess formation
 General health impaired
 Hospitalization may be required

16. Sequalae Of Rampant Caries
A- Pain
B- Infection
C- Tongue Thrusting
D- Abnormal Swallowing Habits
E-Speech Difficulties

17. Control of All Active Carious Lesion
Gross excavation of caries and restoration with ZOE which
will temporarily arrest the caries process and prevent pulp
involvement
Reduction in intake of carbohydrates
Diet analysis and diet counselling
Snacks should be suppressed
Application of topical fluorides

18. Repeat single fluoride application therapy every 3
months.
If there is no loss of enamel, topical fluorides are given.
If there is extensive cavitation with no pulp involvement in
anterior teeth—GIC, polycarboxylate cement and in
Posterior teeth amalgam, stainless steel crown are given.
Extensive cavitation with pulp involvement— pulpotomy,
pulpectomy

19. Arrested Caries :
No longer an active lesion
This is a carious lesion that does
not progress; the stage where the decay
process has stopped
can occur in enamel and dentine
It is seen when the oral environment has
changed from conditions predisposing caries
to conditions that tend to slow the lesion
down .

20. How Do Arrested Caries Appear Clinically ?
Mostly on lingual/labial aspect, sometimes occurs
inter proximally.

21. Properties of Arrested Caries :
Arrested white spotted lesion :
- has shiny surface; may be brown in color
-is more resistant to attack by acid than sound enamel
-regarded as scar tissue; thus should not be attacked with a dental drill
Arrested caries in dentine :
-discolored (yellow, brown or black)
-hard or leather consistency, due to presence of tertiary and sclerotic
dentine
-rest of dentine appears polished

22. How can Arrested Lesions be Induced ?
Caries can be arrested by simple clinical measures e.g:
 improved plaque control with a fluoride toothpaste
 altered diet
Thus, its vital for the clinician to detect enamel caries in its
earliest form by visual inspection of teeth after cleaning and
drying

23. Promoting Arrest of Carious Lesions
1-Fluoride
◦ -Increase resistance of hydroxyapetite in
enamel and dentine to dissolution by
plaque
-E.g., toothpastes, water fluoridation
◦ -Greatest benefit when there is
constant availability for remineralization
-E.g., Glass ionomer cements
◦ Gluterdialdehyde
◦ Collagen fixation, reduced diffusion of ions
out of lesions, and antibacterial actions

24. Promoting Arrest of Carious Lesions
2-Sugar Substitutes
-E.g., xylitol or sorbitol in chewing gum
Increased saliva flow
3-Atraumatic Restorative Technique
4-Make cavities accessible to cleaning
5- Sealing in Caries

25. Chronic Caries
form of caries that occurs over time and
demands regular dental intervention.
 These lesion are usually of long standing
involvement affect a fewer number of teeth and
are smaller than acute caries

26.  Pain is not a common feature because of protection
afforded to the pulp by secondary dentin
 The decalcified dentin is dark brown and leathery

27.  Pulp prognosis is hopeful in that the deepest of
lesions usually requires only prophylactic capping and
protective bases
 The lesions range in depth and include those that
have just penetrated the enamel