DEFINITION = American Academy of Paediatric Dentistry (AAPD) defines early childhood caries as ‘the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child 71 months of age or younger.
A window of infectivity 2M**:
Caufield (1996) stated that there is a window of infectivity between 19 and 33 months during which teeth get infected with S. mutans
The most beneficial time for vaccination against dental caries would be in infancy before the eruption of teeth.
This would promote the induction of adherence inhibiting salivary IgA thus delaying colonization of S. mutans.
With the establishment of early colonizers, there would be a synergistic effect of suppressing the colonization of S.mutans during the period of the window of infectivity.
A booster dose of vaccination may be required at the time of eruption of first permanent molars
ETIOLOGY AND PATHOGENESIS 3M
Early colonization of MS is the most imp risk factor for developing ECC – MS transmission can be through the mother or from peers [ other kids]
MS Colonization of pre dentate children is mostly associated with maternal factors [ high level of MS in the mother, poor OH, and active caries ]
How is nocturnal bottle feeding/breastfeeding related to ECC?
When a child is laid to rest, the bottle or breast nipple rests against the palate and the tongue covers the lower incisors [ that’s why they are not affected] –
As the child becomes sleepy, saliva flow and swallow reflex are reduced
Sugar remains stagnant around the neck of the teeth
what practices increase the chance of developing ECC?
Prolonged nighttime bottle feeding
On-demand breastfeeding after the age of 1
Frequent snacking with sugary foods
Frequent sipping of sugary drinks throughout the day
CLINICAL FEATURES 2M
ECC = also known as nursing bottle caries, baby bottle tooth decay
Seen in infants and preschool children [ below the age of 6
Demineralization at the necks of the upper incisors – mandibular incisors are not affected
Decay pattern:
Maxilla: incisors, canines, first molars
Mandible: canines, first molars
Lesion progresses to the necks of the teeth and in advanced cases, only a root stump is left
Why does ECC follow this specific pattern?
Chronology of primary tooth eruption
Duration of the deleterious habit [ bottle feeding]
A muscular pattern of infant sucking
STAGES
Very mild: slight demineralization usually at the gingival crest and no cavitation.
Mild: demineralization in a gingival third of tooth and moderate cavitation.
Moderate: frank cavitation on multiple tooth surfaces.
Severe: Widespread destruction of tooth and loss of the clinical crown
MANAGEMENT 6M
Identify the cause and stop the habit
Give parental instruction on proper oral hygiene measures + diet counseling
Decide if the case can be managed in the clinic [ with regular LA or nitrous sedation ] or the child needs GA
If the case is treated in the clinic: full assessment of all affected teeth to know
which teeth can be restored
which need pulp therapy
which need extractions
First visit
Second visit
Third visit
Immediate excavation of caries followed by temporization Dietary chart Caries activity doneTopical fluoride application doneParent counselling
Examine diet chart Caries activity done again Replace any temporary restoration with permanent restoration
Pulpul procedures Extractions Space maintersRecall the pt every 3 months
What instructions would you give the parents to a child with ECC?
STOP NIGHT TIME BOTTLE FEEDING / stop breastfeeding at will after the first tooth erupts
Feed the child while being held + burp the infant after feeding
Clean the teeth after each feeding [ wipe the teeth with a wet gauze]
regularly lift the upper lip to check for signs of demineralization of the upper Interiors
OH should start with the eruption of the first tooth – wipe the teeth with gauze and for ages 2- 6 brush with low fluoride tooth past [ 400-500 ppm] – parental supervision until the child can properly spit
Children are encouraged to drink from a cup as they become 1 year old
Avoid frequent snacking and have regular meals instead
First dental visit should be combined with immunization dates [ at or before 6 months]
Prevention of ECC ideally begins prenatally:
give the mother information about diet and OH
treat the mother’s own oral diseases and lower MS count by mouth rinses and restorative care
educate the mother on modes of transmission of MS [ don’t lick spoons or pacifiers etc..]
Minor connector: connecting link between the major connector and other components of the RPD
MAXILLA = Must extend up to tuberosity
MANDIBLE = must extent up to 2/3rd of the edentulous area or cover retromolar pad
Must be rigid to distribute the stress between the linked components, must not impinge on the mucosa, the mucosal surface must be highly polished
Functions of the minor connector :
Join the denture parts together
Transfer functional stresses to abutment teeth through the occlusal rest
Transfer the effect of the retainer, rests, stabilizing components to the rest of the denture
FOUR TYPES OF MINOR CONNECTORS
Joins the clasp assembly to major connector
Broad B-L and Thin M-D = allow easy placement of prosthetic teeth.
Triangular cross-section
Lingual embrasure = bulk is not evident
Joins indirect retainer to major connector
90 degrees to the major connector but slightly curved as it will decrease the concentration of stress
Should always fit into embrasure areas
Joins denture base to major connector (draw)
Open lattice
Mesh or ladder pattern = Require acrylic attachments
Bead, wires, and nail heads = capture acrylic material
Class III is completely tooth supported = do not reline procedure
Class I and II = are distal extension cases = Relining or rebasing procedure, therefore metal parts should not be in direct contact with tissue = Hence, METAL nail heads and beads come in direct contact with underline tissue.
External and internal finish lines are necessary for class I and Class II situations
Serves as an approach arm for the vertical projection or bar clasp.
Rest = part of RPD = rigid extension of the RPD – provides support.
Rest Seat = Prepared on abutment teeth
Functions:
Directs and distributes occlusal force apically to abutment teeth
Acts as vertical stop = doesn’t allow RPD to move in the tissue-ward direction
Maintains retentive clasp in position = SUPPORT in RPD
Rest do allow slight movement = dissipates horizontal forces
TYPES
PRIMARY = part of the clasp assembly
SECONDARY/AUXILLARY = indirect retention
OCCLUSAL
Shape = ROUNDED TRIANGULAR
Base = Margin of tooth
Apex = center of tooth
Floor = spoon-shaped
Dimensions = 1/3rd to half of M-D diameter of tooth and ½ of B-L diameter of the entire tooth
Measured from cusp tip of buccal side to cusp tip of lingual side. (draw)
ACUTE angle = floor is inclined to towards center of tooth and angle is less than 90* = hence, Increases the support (draw)
If an obtuse angle is present, it causes Slippage of the prosthesis = therefore, avoiding the inclined plane effect
Occlusal rest = 0.5mm thick at the thinnest point
1-1.5 mm = when it crosses the marginal ridge
We use diamond or carbide round burs with water and light pressure
Preparation is done entirely on enamel only
If the rest seat needs to be placed away from the edentulous area→it is not flared to the facial line angle and should be more flared lingually ( to provide space for minor connector)
Interproximally extended occlusal rest seat:
Flared more buccally and lingually without affecting the contact area
U shaped trough that is 1mm wide and 1 mm deep
Without breaking the contact = Use a shoulder bur to create a 1 mm Buccolingual clearance from the proximal side then use a round bur to create the seat
In RPA with intracoronal occlusal rest seat
A partial denture that is totally tooth supported by means of cast retainers on all abutment teeth may use intracoronal rests for both occlusal support and horizontal stabilization
Open the margins more and do slight lingual flaring for the minor connector
Extended occlusal seat rest
In Kennedy Class II, modification 1, and Class III situations in which the most posterior abutment is a mesially tipped molar
an extended occlusal rest should be designed and prepared to minimize further tipping of the abutment and to ensure that the forces are directed down the long axis of the abutment.
This rest should extend more than ½ the MD width of the tooth and 1/3 rd the B L width of the tooth
1mm thickness of metal = the preparation should be rounded with no undercuts or sharp angles
LINGUAL REST/CINGULUM REST
Only for maxillary canine
The mandibular canine is avoided as it lacks the bulk of enamel.
V-shaped = boomerang shape – Cross section view
Cresant/Half moon shape – Lingual view
Dimensions = 2.5mm M-D to 2mm B-L
Depth = 1.5mm = as average thickness of enamel is 2 mm
INCISAL REST
Mandibular canines and rarely incisors
V-shaped notch = 1.5 – 2mm away from the proximal incisal angle
Purpose = functioning as secondary rest for indirect retention
Dimensions = 1.5mm wide, 1.5 mm deep, and 1.5mm away from the proximal incisal angle
If multiple incisal rests are needed = rests are connected with linguloplate i.e Choice of major connector
Lingual rest are more commonly preferred than incisal= as lingual rest will be very close to the rotational center of tooth = Bear loads in a much better manner than incisal rest
Major problem = Anterior zone are aesthetic zones. Hence, lingual is chosen over incisal.
EMBRASSURE REST
B-L = 3-3.5mm wide
Depth = 1.5mm – 2mm deep
If not met = definite chances of fracture of RPD components. It is very difficult to fix it with the same strength of RPD design
