Caries in Primary Dentition

Question 1

What is the definition of early childhood caries?

Answer 1

• ONe or more decayed, missing due to caries or filled tooth surface in any primary tooth under the age of 6.
• decayed may be cavitated or non-cavitated in this case

Question 2

What is the definition of severe early child hood caries.

Answer 2

As with early child hood caries in 0-3 years old
As with ECC but in primary mx anterior teeth between 3-5 years old
-DMF score equal or greater than 4 (age 3)
-DMF score equal or greater than 5 (age 4)
-DMF score equal or greater than 6 (age 5)

Question 3

What percentage of of 6 year old Australian children are affected by ECC?

Answer 3

-51% (49% caries free)

Question 4

What is SiC30, SiC20, SiC10?

Answer 4

Respectively, mean DMFT of the 30%, 20%, 10% of children with highest DMFT scores.

Question 5

T or F? Caries is transmittable?

Answer 5

T
MS transmission:
-Vertical: to a degree can inherit microbes from parents especially mother
-Horizontal: e.g. kids licking things, sucking on things in childcare centre: kids in childcare centre shown to have similar bacteria.

Question 6

T or F?

Early exposure to MS increases risk of caries in children? What implications can this carry?

Answer 6

T

Reducing MS load in mother’s mouth during pregnancy can potentially decrease caries risk

Question 7

What are some risk predictors of a child developing caries?

Answer 7

• Previous caries experience (note that the reverse does not apply; absence of dental caries is not a useful risk predictor for very young children)
• Visible plaque (again reverse does not apply)–>put on at LEAST moderate risk straight away even if no holes
• Dietary factors: bottle in over night leads to pool of fermentable liquid building up initiating decay process, sipping on bottle throughout the day other than if bottle contains water, snacks throughout day (even if not sugary)

Enamel Defects: rough/hypomin areas are at increased risk

Medical conditions: sugar based meds (rarer nowadays), dry mouth, feeding difficulties , (parents may respond by sending them to bed with bottle of milk), poor oral clearance of food due to undeveloped musculature

Socioeconomic factors

Siblings with caries

Question 8

What should you do if perm 6’s are present in a child’s mouth where decay is present?

Answer 8

Fissure seal straight away

Question 9

Which area of the mouth is more prone to acid attack and why?

Answer 9

Upper primary incisors (saliva deficiet) therefore if left bottle overnight milk can accumulate a lot more and less buffering

This is followed by distal of first deciduous molars and labial of canines

Question 10

T/F We should counsel mother on breastfeeding if child has caries and not using bottle?

Answer 10

F
We should not talk about breastfeeding unless we have received additional training to do so. Instead, look at other dietary factors

Question 11

Why do we treat primary teeth?

Answer 11

• Treat pain
• May affect adult teeth due to abscess development–>pressure cause malposition, can become hypomineralised or hypoplastic
• Load of MS can affect adult teeth when they come through
• space maintenance

Question 12

What are the two main patterns of caries spread in 6 year olds? HOw are each caused?

Answer 12

A’s B’s, distal of the D’s (due to early feeding patterns e.g. bottle overnight). This is also more prevalent in younger children

D’s E’s affected; A’s B’s fine: sugary diet but were not given bottle overnight when younger

Question 13

What area has the lowest chance of being affected by caries?

Answer 13

Lower incisors: sublingual salivary gland

Question 14

How rapidly can caries in deciduous teeth progress? What are the implications?

Answer 14

Can progress from enamel to pulp in 4 months

• Do not just put duraphat on incipient lesions and send them off as a low risk
• Education about diet, put in fluoride varnish everywhere
• Sometimes need to treat more aggressively

Question 15

What factors allow caries to progress more rapidly in deciduous teeth?

Answer 15

• Larger dentine tubules
• Thinner enamel
• Less mineralised
• Larger pulp chamber/pulp horns

Question 16

What should you consider if you detect upper anterior caries but you can not take bitewings e.g. young child?

Answer 16

-Refer for GA and review every 3 months

Question 17

Why are labial of canines thought to be susceptible to caries?

Answer 17

• Morphology has a bulge

- Thought that pressure above bulge will cause hypomin–>increase susceptibility

Question 18

What are the implications of a full mouth clearance?

Answer 18

• Complete loss of space when 5’s come through (as 6’s drift forward and anterior teeth drift backward)
• However in some cases of severe ECC there is really no other option (e.g. if every tooth is alredy a root stump)

Question 19

What are some consequences of leaving ECC untreated?

Answer 19

• Pain
• Harm to permanent dentition (when they come through + affect developing germ)
• Space loss
• Sepsis
• Disruption to quality of life/growth and development/loss of self esteem
• Higher incidence of hospitalisation and emergency visits
• Increased treatment costs and treatment time
• Greater risk of new carious lesions
• Speech disorders
• Cost taxpayer money (one of most common reasons kids have to be treated in hospital)
• Miss school/kindy
• Parents need to take time off work

Question 20

When should a child first see a dentist?

Answer 20

• 6 months after tooth first erupts

- No later than 12 months of age

Question 21

What should be included in education to parents?

Answer 21

• No bottle feeding overnight
• Inappropriate saliva sharing practices
• Diet (drink from cup as they approach first birthday, regular meals rather than whenever hungry, reasonable alternatives such as diluting cordial rather than giving up)
• Oral hygiene including fluoride use
• Timing of first dental visit (by 12 months of age)