Case presentation 11

Severe Early Childhood Caries

Presented by : Dr. Shruti Deshmukh PG student Pedodontics

Patient information :
Name : Shraddha Gangurde Age : 6 years Sex : Female Address : Nashik road Accompanying person : Mother

Date : 29-5-2012

Chief complaint :
Patient reported to our department for the treatment of multiple carious teeth, poor appearace of front primary teeth.

History of present illness :

Patients mother has been noticing the decayed teeth since last 2-3months for which she did not report to any general or pediatric dentist. Patient experiences generalized mild pain in all teeth aggravated on food lodgement and sweet foods and beverages. There has been occurrence of repeated intraoral swelling in relation to upper right and left deciduous molar tooth.

Medical history :
Nil

Past dental history :

No previous dental visit or treatment

Prenatal history :
Normal delivery No illness or accidents during pregnancy

Post natal history :

Bottle feeding habit which started since early childhood is persistent till present day Feeding of milk with added sugar frequently during day times between meals and also at night before bed and is not followed by any oral hygiene measure.

 Eruption primary teeth uneventful within their normal eruption periods

Oral habits :
Nil

Other habits :
Nil

Behavior rating (Frankle 1962):

Negative

Brushing habits :
Patient does not perform any oral hygiene measure.

General physical examination :

Built : normal Height : 3.5 feet Weight : 17 kg Gait : normal Motor co-ordination : normal

Extraoral examination :
Face is symmetrical No abnormalities present in relation to lips and skin Submandibular lymph nodes are not palpable TMJ movements are normal with no pain, clicking or deviation

Intraoral examination : Soft tissue

No abnormal findings in relation to buccal and labial mucosa, palate, floor of mouth, tongue, gingiva, frenum attachments and tonsils/ oropharynx Gingival swelling in relation to 54-55 and 64-65

Intraoral examination : Hard tissue

Type of dentition : Primary Number of teeth : 20

Teeth present :
51, 52, 53, 54, 55,16 61, 62, 63, 64, 65,26 71, 72, 73, 74, 75, 36 81, 82, 83, 84, 85, 46

Dental caries status :

Advanced caries : 55,65 Moderate caries : 52, 54, 55, 62, 64, 83 Deep pits and fissures in relation to 16, 26, 36, 46 Arrested Proximal caries :51,52,53,61,62,63,72, 73, 74, 75, 82, 83, 84, 85 Root pieces :54,64 deft : 20

 55,65 - tender to percussion Grade I mobility in relation to root pieces of 54,64. No restorations present No supernumerary/missing/unerupted teeth No developmental anomaly or hypoplastic teeth present

Orthodontic evaluation :
Arch shape (maxillary and mandibular) : U shaped Molar and canine relationship : cannot be determined

Diet analysis :
Consumes only milk with added sugar 5-6 times daily and soft sweet food items and beverages due to inability to chew other food items.

Major concerns : Lack of proteins and lipids Lack of vitamins (vegetables and fruits) Intake of cariogenic food at breakfast and evening snacks times.

Provisional diagnosis :
Case of Severe Early Childhood Caries

Investigations :
Periapical radiographs with 54-55,64-65

Final diagnosis :
Case of Severe Early Childhood Caries.

Treatment plan :
Preventive treatment : Patient and parent education Diet counseling Oral hygiene measures Fluoride application Corrective treatment : Restorations Endodontic management Surgical management Orthodontic management

Preventive treatment :
Patient and parent education Importance of preservation of primary teeth Role of harmful dietary habits like bottle feeding in causation of caries Importance of balanced diet in physical growth and development Importance of appropriate oral hygiene measures

Diet guidance Breakfast : pohe, upma, idli, dosa, rajgira-milk, nachani-milk etc. Lunch : boiled vegetables (including green leafy), soup, chapati, dal, rice, curd Evening snacks : fruits- banana, chiku, mosambi etc; boiled sprouts, corn, salad sandwich, groundnuts, dates etc. Dinner : boiled vegetables, soup, sprouts, chapati, dal, rice, curd, khichadi etc.

Oral hygiene and plaque control methods Twice daily supervised brushing with a soft toothbrush and a fluoridated toothpaste with scrub technique including the lingual and occlusal surfaces Fluoride application Professional use : Topical application of APF gel repeated every 3 months Home use : Fluoride dentrifice, mouthrinse
Pit and fissure sealant for 36, 46

Corrective treatment :
Oral prophylaxis Pit and fissure sealant for 16, 26, 36, 46 Composite restorations for 52, 53, 62, 63, 72, 73, 82, 83 Stainless steel crown for 74, 75, 84, 85 Pulpectomy 55, 65 Extraction 54, 64 Follow up every 3 months

Post operative