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Rampant Childhood Caries : The Need for Dental Management

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Rampant caries are the biggest hindrances to children in terms of oral and systemic health. Read the article to know all about rampant caries.

Medically reviewed by

Dr. Balreen Kaur Bali

Published At April 20, 2023
Reviewed AtAugust 3, 2023

Introduction

Tooth decay is one of the oldest and most common human diseases. Dental caries is a common chronic infection caused by cariogenic bacteria that metabolize sugars to produce acids, demineralizing the tooth structure over time. Caries is a term that refers to both the disease and the resulting lesion. The caries process occurs in biofilms, which are permanently activated with every pH fluctuation, and lesions start to appear in the tooth structure. Caries occurs when the normally homeostatic biofilm microbiota in the oral cavity transforms into an acidogenic, aciduritic, and cariogenic population due to frequent sugar consumption. The consequences of the changes are clinically invisible or result in a net loss of minerals within the hard structure of the tooth, resulting in visible carious lesions. Probable causes can be:

  1. Poor oral hygiene.

  2. High sugar intake.

  3. Malnutrition or poor macronutrient diet for the child at home.

  4. Sweetened medications or foods.

  5. Radiation to the head and neck.

What Are Rampant Caries?

It is a type of extensive caries characterized by widespread and rapidly progressing caries in which caries is present on 10 or more teeth. But, with proper education and good oral care practices at home, tooth decay is preventable. There are three types of prevalent tooth decay:

  • Baby Bottle Rampant Tooth Decay - When rampant caries occurs in infants, it is also called nursing bottle caries. This is because many infants tend to sleep with the bottle or nipple in the mouth, holding sugary or sweetened liquid or milk that commonly pools around the infant's upper maxillary anterior region. This provides a medium for acidogenic organisms to cause dental caries both in milk teeth and the primary developing teeth in children. Also because, in sleep the salivary clearance is reduced, this is the most common type of rampant caries affecting young infants.

  • Adolescent Tooth Decay - When rampant caries occurs in adolescent age, it is known as adolescent rampant caries, while it occurs in infants, it is also termed nursing bottle caries or early childhood caries. During adolescence, many children commonly as a matter of habit tend to put chocolates, toffees or sweetened biscuits into their mouth and then lie down or go to sleep. These children suffer from adolescent rampant caries at this age. The adolescent rampant caries follows the same pattern as that of nursing bottle caries.

  • Caries Prevalence Due to Xerostomia - Xerostomia-induced rampant caries on the other hand is associated with dry mouth induced caries. An important oral immune defense component that is saliva. This caries pattern is linked to salivary gland hypofunction that occurs in cases of irradiation of head and neck regions. Rampant caries is thus a sign of improper diet, excessive sweet consumption, inability to follow oral hygiene practices correctly, lack of professional dental care and even as a matter of systemic disease as well. The presence of rampant caries globally would be an indicator for the need to comprehensively evaluate children and young adoloscents .

What Are the Symptoms and Diagnostic Criteria of Rampant Caries?

Rampant dental caries are initially clinically diagnosed by the dentist as only small chalky areas that can be found on the smooth surfaces of the teeth. This is the reason why regular professional dental checkups hold importance in a clinical setting. When these lesions initially are left untreated or ignored by the parents often, then the resulting complications from uncontrolled initial caries may not only worsen but cause the cavitated lesions to aggravate and turn symptomatic as it would have involved the tooth pulp. The following symptoms then manifest dentally in the child or adolescents:

  • Tooth or jaw discomfort.

  • Tooth-bound sensitivity and pain.

  • Gum or jaw-based inflammation because of the tooth-bound pulp tissue or gums surrounding the specific tooth.

  • Acute and chronic infections leading to pus or abscess formation.

  • Tooth mobility and early loss of primary teeth.

  • Cellulitis (bacterial skin infection).

What Is the Dietary Counselling and Treatment for Rampant Caries?

Caries activity is stimulated by the frequency of the sugar consumption, rather than the quantity of sucrose the child ingests. However, the message is important to spread as a part of oral health awareness worldwide, that excessive and frequent sucrose intake is capable of causing as well as worsening dental caries. Chewing slices of sugar-free chewing gum after meals for around five to ten minutes is recommended by some dentists for high-risk adolescent population groups. The goals of dietary counseling by the dentist are to identify and eliminate or reduce the sources of sucrose in the diet and then reduce the frequency of sucrose ingestion, especially before bedtime. The attempt of the dentist to restore carious lesions, promote healthy dietary practices, fluoride application as part of school health programs or in a clinical setting along with useful oral hygiene practices are all essential components to train children, young adolescents, and even parents as part of increasing oral health awareness campaigns that are needed through the globe.

Encouraging Dental Visits:

Dental treatments are further hindered greatly because of children’s fear of the dental drill or because of the dental anesthetic injections that are used during treatment. Children may lack the cooperative ability during dental treatment, it is both dentist's and parents' responsibility to let the carious lesions be treated on time lest they aggravate to serious childhood infections of the jaw. Encouraging a healthy interaction between the child and the dentist by the parent or guardian and regular follow-ups 6 monthly to yearly at the dentist can instill feelings of positivity and also personal responsibility for maintaining oral health in the child. During the COVID-19 pandemic, the severe disruptions to school attendance as well as the suspension of regular monthly to yearly impactful school-based oral health programs have resulted in a rise in the global incidence of childhood caries.

Conclusion:

The global evidence of aggravation of rampant caries in both children and adolescents calls for the regular and increased need for professional dental care and dietary counseling for children as well. Oral hygiene maintenance and dietary modification are mainly the two primary home-care methods suggested by dentists for dental caries prevention. However, there is also a need for professional dental treatments like restorative modalities, fluoride application on smooth surfaces of the affected teeth, pit and fissure sealants, that are the most effective dental strategies with proven efficacy in the clinical setting.

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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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