What Is Early Childhood Caries?

Dental caries is a disease in which hard tooth tissue is gradually destroyed. The onset of the disease is in the crown. If it is not treated in time, the disease continues to develop, destroying the surface of the crown and forming a cavity, which is called dental caries. An untreated caries cavity will not heal by itself, and its development can be until the crown is completely destroyed, leaving only the root of the tooth, which eventually leads to tooth loss. Caries is a bacterial disease, so it can be secondary to pulpitis or periapical inflammation, and even cause alveolar and jaw inflammation. At the same time, secondary infections of dental caries form lesions that can cause or aggravate many other diseases such as arthritis, endocarditis, chronic nephritis, or eye disease.

Basic Information

Visiting department

Pediatrics

Multiple groups

Children

Common locations

Molar and bicuspid maxillary fossa, fissures, and contact surfaces of adjacent teeth

Common causes

Bacteria, diet, saliva, tooth structure and time, factors are interrelated

Common symptoms

Brown or dark brown spots or plaques on enamel, cold water, cold or sweet, sour food can cause tooth pain, etc.

Causes of Pediatric Caries

Dental caries is a multifactorial disease, mainly including bacteria, diet, saliva, tooth structure and time. The factors are related to each other. Without caries, caries cannot occur.

Bacteria

The main ones are certain Streptococcus mutans and Lactobacilli. These bacteria are mixed with mucin and food debris in the saliva, and firmly adhere to the tooth surface and grooves. This kind of adhesive is called dental plaque or plaque. A large number of bacteria in the plaque cause food debris or sugar to ferment and produce acid, causing the enamel surface under the plaque to demineralize and dissolve, forming a cavity. Clinical investigation has confirmed that children with more plaque also have more dental caries.

2. Diet

Food contains a large amount of carbohydrates and sugars. These substances not only provide energy for bacterial activity in plaque, but also produce organic acids through glycolysis through bacterial metabolism. Acids are retained on the tooth surface and grooves for a long time, which demineralizes and destroys enamel. Then, some bacteria dissolve the protein and form a cavity. There are many cariogenic carbohydrates, the most important being sucrose.

During the period of tooth development, nutrition determines the biochemical structure of tooth tissue, and well-mineralized teeth have high caries resistance.

Deciduous teeth have occurred, developed, and calcified during the fetal period. Unless the mother has a severe metabolic disorder or a genetic disease, deciduous teeth are generally not easily affected.

3. teeth

The shape, structure and location of teeth are obviously related to the incidence of dental caries. The fossa on the tooth surface is a defect left during the development process. It is easy to retain bacteria and food debris in the deep fossa, and it is not easy to remove, and it is easy to induce dental caries. Insufficient mineralization, especially undercalcified teeth, is prone to caries. Although the content of fluoride in the mineralized structure of teeth is very small, it is important to enhance the dental caries resistance. Tooths with an appropriate amount of fluoride are not prone to caries, and the structure and mineralization of deciduous teeth and young permanent teeth are not mature enough, so they are easily affected by caries-causing factors and have a high rate of caries.

4. Saliva

It is the external environment of the teeth, which plays a role of buffering, rinsing, antibacterial or antibacterial. A large amount of thin saliva can wash the tooth surface and reduce the accumulation of bacteria and food debris. A small amount of thick saliva is susceptible to retention, which promotes plaque formation and adhesion to the tooth surface. The nature and composition of saliva affect its buffering capacity and also the living conditions of bacteria.

Clinical manifestations of pediatric caries

Caries are most likely to occur in the maxillofacial pits and fissures of molars and bicuspids, as well as the contact surfaces of adjacent teeth. Children have fewer caries in the neck of their teeth, which can be seen when severe malnutrition or some systemic disease makes them extremely weak.

According to the degree of caries destruction, the clinical can be divided into superficial caries, medium caries and deep caries:

Superficial caries

The caries damage is only in the enamel. The initial appearance is that brown or dark brown spots or plaques appear on the enamel. The rough surface is called primary caries. Subsequent surface damage is called superficial caries. There are no conscious symptoms of primary or superficial caries. Adjacent dental caries began to occur below the tooth contact surface, and pit and fissure caries mostly started in the sulcus, which was not easy to see at an early stage. It can be seen only when it occurs in the fossa, but children's teeth are prone to pigmentation in the fossa, which may be misdiagnosed or missed if they are not carefully examined.

2. Medium caries

Caries have reached dentin, forming a superficial carious cavity of dentin. The child may have tooth pain due to cold water, air conditioning, or sweet and sour foods, because the dentin is allergic to irritation. The treatment of middle caries is timely and good.

3. Deep caries

The caries has reached the deep level of dentin, close to the pulp, or has affected the pulp, and the teeth have been damaged. Sick children are painful to cold, hot, sour, and sweet, especially sensitive to heat. After the stimulus is removed, the pain continues for a certain period of time and then gradually disappears. At this time, most of them need dental pulp treatment to save teeth.

If deep caries are not treated, they continue to develop infected or necrotic pulp. Bacteria can reach outside the apical foramen through the root of the tooth, causing inflammation around the apex, which may form a focal infection. The crown should be removed if most of the crown has been damaged or only residual roots remain.

Pediatric caries examination

1. General dental examination.

2. If necessary, X-ray examination can be performed to understand whether there is periapical inflammation.

3. During secondary infection, the peripheral blood elephant's white blood cell count and neutrophils were significantly increased.

4. In severe cases, abnormal ECG or liver and kidney function can be seen.

Pediatric caries diagnosis

The diagnosis can be confirmed based on clinical manifestations and examination results.

Pediatric Caries Treatment

The main method of treating dental caries is filling. That is, the carious tissue is completely removed and made into a certain hole shape. After cleaning and disinfection, it is filled with filling materials and the shape of the tooth defect is restored. The caries can not continue to develop. Superficial caries filling works best. For the treatment of middle and deep caries, after removing the carious tissue, sometimes the bottom of the cavity is close to the pulp, and a layer of pulp protection agent needs to be added to the bottom of the cavity before filling. Sometimes deep caries are exposed after the carious tissue has been cleaned out. It is necessary to take endodontic treatment before filling. The filling material is mainly amalgam or composite resin (suitable for filling the anterior teeth and the posterior cavity without bearing the chewing force). Deciduous teeth are sometimes replaced with glass ionomer cements (temporary filling materials).

The initial caries that have not formed a cavities can also be treated with drugs to achieve a certain effect. Frequent fluorinated solutions are used to rub caries; after application, treatment may still recur. Therefore, the sooner the better, the better. Generally check and treat once a year, those who are susceptible to caries can check and treat once every six months.

Prognosis of Pediatric Caries

Prompt treatment has a good prognosis, but if the treatment is delayed, secondary infections or lesions can often occur, causing complications such as nephritis and carditis.

Pediatric caries prevention

The basic principle of preventing dental caries is to take corresponding measures according to the disease factors. include:

1. Enhance the anti-caries properties of teeth

It is mainly through the fluoride method to increase fluoride in the teeth, change the structure of the enamel surface or surface layer, and enhance its caries resistance. The fluorination method has an effect on both teeth that have not yet emerged during development and teeth that have emerged. Any fluorinated anti-caries method can only be used in water-free or low-fluorine areas. The fluorination methods considered to be effective are:

(1) Tap water fluoridation and caries prevention The water supply center automatically adds sodium fluoride to adjust the fluorine content of the water to a suitable concentration for caries prevention. Once considered the best method. However, because the fluorine content of water sources in different regions of China is different, it is not appropriate to promote it in China.

(2) Fluoride toothpaste brushing method Generally, the concentration is not more than 0.4% sodium fluoride. Children brush their teeth once a day in the morning and at night, which can reduce the effect of dental caries. But in theory, fluorination of toothpaste should be selective and varies from person to person.

(3) The specific method of rinsing with a fluoride solution is to gargle once a week with a 0.1% sodium fluoride solution, or once every other week with a 0.2% sodium fluoride solution, or a 0.05% sodium fluoride solution daily after brushing your teeth Rinse once, 10 ml each time. Rinse vigorously for 1 minute. Do not rinse or eat for 30 minutes. Rinse mouth once every six months.

2. Reduce or eliminate pathogenic irritants

Reducing or eliminating plaque, changing the oral environment, and creating clean conditions are important aspects of preventing dental caries. The most practical and effective methods are brushing and mouthwashing. Publicity and education should be strengthened to enable children to develop oral hygiene habits and learn to brush their teeth reasonably. Children can scrub their teeth with a soft towel or velvet. Toddlers can learn to brush their teeth after 3 years of age. Brush as much as possible in the morning and evening, and rinse your mouth after meals. Brushing your teeth before going to bed is more important, because bacteria are prone to multiply at long intervals at night. You must brush in a smooth way, that is, "the upper teeth are brushed from top to bottom, the lower teeth are brushed from bottom to top", "both inside and outside are brushed", and the surface of the back teeth must be brushed. In this way, the food residues on the teeth and between the teeth can be washed as much as possible, and the mouth should be rinsed after brushing. Do not brush horizontally, it is easy to damage the gums, and it will not clean the residue in the teeth. In 1975, the Ministry of Health, the Ministry of Light Industry and the Ministry of Commerce jointly held a national toothbrush conference and formulated the "Provisional Specifications for Health Toothbrushes". Toothbrush bristles used by young children should not exceed two rows, 5-6 per row, and the hair quality should be soft. Primary school students should not exceed three rows of toothbrush bristles, 6-7 per row.

Should pay attention to children's eating habits, eat more rough, hard and fiber-containing foods, friction and cleansing the teeth, reducing food debris accumulation. Hard foods need to be fully chewed, which not only strengthens the periodontal tissue, but also rubs the tooth surface, which may make the pits shallow, which is beneficial to reduce the pit and pits.

3. Reduce or control sugar in your diet

In China, where cereals are the main food, it is difficult to control carbohydrates in the diet to prevent caries. However, sugar consumption has increased in recent years, and sugar-based foods and various beverages have increased significantly. Attention should be paid to making parents educate children to develop the habit of eating less snacks and sweets, not eating sugar before going to bed, and paying attention to the quality and quantity of children's three meals. From young children to develop more vegetables, fruits and foods containing calcium, phosphorus, vitamins and more. Eat as much coarse grains as possible. Pay attention to breastfeeding infants. Recently, the international control of carbohydrates in diets and the use of sugar substitutes to reduce dental caries are currently impractical and uneconomical in China. Recently, it is reported that a certain sugar substitute commonly used in the United States contains toxicity, which has attracted international attention.

In short, the causes of dental caries are complex, and there is currently no single effective way to prevent the occurrence of new caries. Therefore, the prevention and treatment of dental caries must be combined with prevention and treatment. It is necessary to control the occurrence of new caries, and to detect and treat them early. Conduct oral health care in a led and organized manner, with active prevention and early treatment regularly in nurseries, kindergartens, elementary and junior high schools. At the same time, strengthening maternal and child health care and nutrition and health work to ensure the health of the body and teeth can reduce the incidence of dental caries.