Transcript GINGIVAL & PERIODONTAL DISEASES IN CHILDREN.

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Presented by:
Dr. Rajeev Kumar Singh
☺ Archaeological
evidence shows that tooth decay
is an ancient disease dating far into prehistory
☺ Tooth worms were considered to be the cause.
☺ Many believed that the tooth worm bore a hole
through the tooth, hiding beneath the surface.
☺ Historical evidence suggest that Chinese used
acupuncture around 2700 BC to treat pain
associated with tooth decay.
☺ Pierre
Fauchard, known as the father of
modern dentistry, was one of the first to reject
the idea that worms caused tooth decay and
noted that sugar was detrimental to the teeth
and gingiva
☺ In
the 1890s, W.D. Miller conducted a series of
studies that led him to propose an explanation
for dental caries that was influential for current
theories.
The dental drill dates back 9,000 years ago
The tooth worm as Hell’s demon:
a battle with the “tooth worm”
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Dental caries is a microbial disease which causes
dissolution of inorganic and destruction of
organic component of the tooth leading to
cavitation.
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It is a dynamic process with episodes of
demineralization and remineralization.
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Dental caries is a preventable disease.
☺ Dental
caries an infectious disease, the initiation &
progression of which is influenced by multiple
factors.
☺ W. D. Miller
proposed the chemopasitic theory
(acidogenic theory) in 1890. The main features of this
theory are:☺ The carious process require a host (tooth in the
oral environment), a dietary substrate and
acidogenic bacteria.
☺ The presence of fermentable carbohydrate serves
as nutrient for bacteria. These bacteria produce
organic acids that can demineralize the tooth.
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Two groups of bacteria are primarily responsible
for initiating of dental caries: Streptococcus
mutans and Lactobacilli.
☺ These bacteria in the presence of fermentable
carbohydrate (such as sucrose, fructose &
glucose) produce organic acids(lactic acid) which
leads to dissolution of enamel.
☺ These bacteria also produce proteolytic enzymes
which are responsible for breakdown of organic
macromolecules after demineralization leading to
cavitation.
☺ Apart
from the three primary factors, time also
plays an important role in initiation of caries.
☺ Robert Stephan plot a curve of plaque pH against
time known as Stephan curve.
☺ Plaque pH falls from an average of 6.8 to 5
within 2-3 minutes of eating sugar or rinsing
with a sugar solution & takes about 40 minutes
to return to its original value.
☺ The demineralization of enamel occurs below pH
5.5(Critical pH)
☺ The
development of caries may be considered as a
continuous dynamic process involving repeating
episodes of demineralization by organic acids and
subsequent
demineralization
by
salivary
components or therapeutic agents but in which the
overall oral environment is imbalanced towards
demineralization.
☺ Saliva plays an important role in remineralization of
incipient caries. Protective factors which include
salivary calcium, phosphate and proteins, salivary
flow, and fluoride in saliva can balance, prevent or
reverse dental caries.
Enamel caries
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Enamel is destructed by a chemical process brought
on by the acidic environment produced by bacteria
who consume the sugar for their own energy &
produce lactic acid.
☺ This process demineralizes the enamel crystals over
time until the bacteria physically penetrate the dentin.
☺ Enamel rods run perpendicular from the surface of the
tooth to the dentin. Different triangular patterns
between pit and fissure and smooth-surface caries
develop in the enamel because the caries follows the
direction of enamel rods & orientation of enamel rods
are different in the two areas of the tooth.
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As the enamel loses minerals , and dental caries
progress, they develop several distinct zones,
visible under a light microscope.
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From the deepest layer of the enamel to the
enamel surface, the following identified areas are
present:1. Translucent zone
2. Dark zones
3. Body of the lesion
4. Surface zone.
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The translucent zone is the first visible sign of
caries and coincides with a 1-2% loss of
minerals.
☺ A slight remineralization of enamel occurs in the
dark zone, which serves as an example of how
the development of dental caries is an active
process with alternating changes.
☺ The area of greatest demineralization and
destruction is in the body of the lesion itself.
☺ The surface zone remains relatively mineralized
and is present until the loss of tooth structure
results in a cavitation.
Dentinal caries
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Unlike enamel, the dentin reacts to the progression
of dental caries.
☺ After
tooth formation the ameloblasts are
destroyed, once enamel formation is complete and
cannot later regenerate enamel after its destruction.
☺ On
the other hand, dentin is produced
continuously throughout life by odontoblasts,
which reside at the border between the pulp and
dentin.
☺ A carious stimulus can trigger a biologic response
by odontoblasts. These defense mechanisms
include the formation of sclerotic and tertiary
dentin.
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In dentin from the deepest layer to the enamel,
the distinct areas affected by caries are the:1. Translucent zone
2. Zone of bacterial penetration
3. Zone of destruction
☺ The translucent zone represents the advancing
front of the carious process and is where the
initial demineralization begins.
☺ The
zones of bacterial penetration and
destruction are the locations of invading bacteria
and ultimately the decomposition of dentin.
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Suddenly appearing, widespread, rapidly
burrowing type of caries, resulting in early
involvement of the pulp and affecting those teeth
usually regarded immune to dental decay.
Specific Features :☺ Sudden,
rapid and almost uncontrollable
destruction of teeth.
☺ Surface considered immune to decay are
involved. Thus, mandibular incisors are affected.
☺ A caries increment of 10 or more new carious
lesions over a period of about a year.
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Most observed in primary dentition of young
children & permanent dentition of teenagers, 1119 years
Types :1. Nursing Bottle caries
2. Adolescent caries
Causes :1. Xerostomia
2. Drug induced dry mouth
3. Large sugar intake
4. Emotional disturbances
5. Radiation therapy
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According to AAPD, early childhood caries is
characterized by the presence of one or more
decayed, missing(due to caries) or filled tooth
surfaces in any primary tooth in a child 71
months of age or younger.
Also known as:
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Baby Bottle Tooth Decay (BBTD)
Infant caries
Bottle mouth syndrome
Early Childhood Caries (ECC)
Etiology :☺ Nursing bottle feeding holding milk or sugar
containing beverages before & during sleep
☺ Prolonged bottle or breast feeding
☺ Pacifiers dipped in honey / other sweeteners.
Mild
Moderate
Severe
Caries follow the particular teeth eruption order
pattern
☺ Upper primary incisors affected first followed by
upper first primary molars
Lower first primary molars
☺ Mandibular canines sometimes
☺ Mandibular incisors are usually
unaffected.
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Pain
☺ Tooth abscess
☺ Tooth loss
☺ Broken teeth
☺ Chewing problems
☺ Serious infections
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Management of pain at first visit
☺ Pain is a common complication of ECC
☺ Excavation & appropriate dressing of
teeth with ZOE or dilute formocresol will
usually help to temporarily manage pain
and localized infection.
☺ Antibiotics should be prescribed in acute
soft tissue swelling or signs of systemic
involvement
☺ Child should be referred to specialist for
urgent management in case of increasing
facial swelling or serious systemic
involvement
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All lesions should be excavated and restored.
☺ X-rays are advised to assess the condition of the
succedaneous teeth.
☺ Treatment depends on how far the disease has
progressed
☺ Very early detection-topical fluoride application
and diet modification.
☺ Obvious decay – stainless steel crowns or
veneered crowns.
☺ Severe decay – Pulp therapy followed by crown
placement.
☺ In case of unrestorable teeth, extractions can be
done followed by space maintenance.
Role of Parents
☺ Clean your child's teeth daily.
☺ Never allow your child to fall asleep with a
bottle filled with juice, milk or formula.
☺ Start bottle weaving by at least a year.
☺ Give your child plain water for thirst.
☺ Make sure your child gets the fluoride needed to
prevent decay.
☺ Have regular dental visits for your
child beginning when their first
tooth erupts.
Role of Dentist
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To create awareness and alert prospective
parents and new parents about the conditions and
its cause.
☺ Sealing of all caries free pits and fissures.
☺ Professional fluoride programme.
☺ Supervised home care should be taught.
☺ Systemic fluoride programme if there is
suboptimal fluoride concentration in drinking
water.