Childhood

Caries
&
Dental Trauma
on Primary
Teeth
Henri Hartman, drg.
Sp.KGA

4 yrs old

Panoramic x-ray before

treatment

Preparation

Post op with zirconia crown

6 mth later

1,5 yrs later

Caries?
progressive

dissolution of the
inorganic component of dental
hard tissues mediated by dental
plaque

A biofilm (plaque)-induced acid

demineralization of enamel or
dentin, mediated by saliva

Dental Plaque
contains

bacteria acidogenic and

aciduric
Streptococcus mutans
lactobacilli

Acidogenic : produce acid

Aciduric : live on acid
environment

S. mutans
initiation

of enamel
demineralization
Inoculated vertically form
mother/caregiver
Inoculated horizontally by
peers at childcare centre
Came as teeth erupted
High S.mutans High caries
risk

Host Factor

TEET
H

Microbes

Diet

Subtstrate
Bacteria

can use fermentable

carbohydrates as a ready source
of energy and the end-products
of the glycolytic pathway in
bacterial metabolism are acids.

Sucrose

Saliva

Saliva Function
antibacterial

and antifungal and

antiviral activity.
lubrication, which also assists in
bolus formation.
inhibition of demineralization and
stabilization of calcium and
phosphate ions, which assists
remineralization.

TIME
acid

challenges occur repeatedly,

collapse of enamel crystals

Ca10(PO4)6(OH)2+2H+ 10Ca2+ + 6PO43- + 2H2O

ECC

Early Childhood Caries

baby

bottle tooth decay,

early childhood dental decay,
Early childhood tooth decay,
comforter caries,
Nursing bottle caries,
maxillary anterior caries,
rampant caries,

ECC

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 preschool-age child
between birth and 71 months
of age.

ECC

affect

the primary teeth of infants and preschool children.

the maxillary primary incisors are hit the
hardest, followed by the first primary
molars.
The mandibular incisors normally are
spared because they are covered by the
tongue during suction movements and are
thus buffered against cariogenic liquids

ECC

Tooth usually spared or little

affected by ECC.
Primary

canines and second primary

molars,
later eruption

ECC factor level

timing

of the tooth eruption,

the time span of the harmful oral habit,
the type of muscle movements the child makes
when sucking

Caries develop
quickly

ECC stage
Initial stage (ages of 10 and 20 months)
chalky,

opaque demineralization lesions

on the smooth surfaces of the maxillary
primary incisors
whitish line can be distinguished in the
cervical region of the vestibular and
palatal surfaces of the maxillary incisors.
reversible but are frequently unrecognized
can be diagnosed when teeth thoroughly
dried.

ECC stage
Second stage (ages of 16 and 24 months)
The

dentin is affected.
The dentin is exposed and appears soft
and yellow.
The maxillary primary molars present
initial lesions in the cervical, proximal
and occlusal regions

ECC stage
Stage 1 and stage 2

ECC stage
Third stage (20 and 36 months)
large,

deep lesions on the maxillary

incisors
pulpal irritation.
pain when chewing or teeth brushed,
spontaneous pain during the night.
At this point, the maxillary primary molars
are at stage 2, while stage 1 can be
diagnosed on the mandibular primary
molars and the maxillary canines.

ECC stage
The fourth stage, (30 and 48 months)
coronal

fractures of the anterior maxillaries as a

result of amelodentinal destruction
maxillary incisors are usually necrotized,
maxillary primary molars are at stage 3.
The secondary molars and maxillary canines
and the first mandibular molars are at stage 2.
Some young children suffer but are unable to
express their toothache complaints.
They experience sleep deprivation and refuse
to eat.

ECC stage
Stage 4

ECC Complications

ECC stage
Complications
pulp

necrosis,
infection spreads to the pulpalperiodontal
the acute form (cellulitis, adenopathy and
mobility of the affected teeth)
the chronic form (abcesses and
interdental septum syndrome).
infection can spread to the buds of the
permanent teeth, causing irreversible
lesions.

PREVENTION of ECC
Dental

Health Promotion
Pregnancy treatment (routine
maintanence)
After birth : cleaned erupted tooth with
wet cloth / childs toothbrush / fluoride
toothpaste
Age One yrs old : brushed twice daily
No candy / sugar / sweet drink
Fluoride therapy if needed

Pit & Fissure

Sealant

Caries Arrested

Primary tooth anatomy

Dental
Injury/Trauma

Classification
Classification of trauma to anterior teeth
Ellis and Davey (1961)
Class 1 : simple fracture of the crown, involving
little
or no dentin
Class 2 : extensive fracture of the crown involving
considerable dentin, but not the pulp
Class 3 : extensive fracture of the crown involving
dentin and pulp
Class 4 : the traumatized tooth which becomes
nonvital with or without loss of crown structure
Class 5 : Loss of tooth
Class 6 : Root fracture with or without loss of crown
structure
Class 7 : displacement of a tooth without fracture of
crown or root
Class 8 : Fracture of crown enmass
Class 9 : Traumatic injuries of deciduous teeth

WHO clasiffication
873.60 : Enamel fracture
873.61 : Crown fracture involving enamel and
dentin without pulp exposure
873.62 : Crown fracture with pulp exposyure
873.63 : Root Fracture
873.64 : Crown-root fracture
(uncomplicated/complicated crown- root
fracture)
873.66 : Luxation

(Concussion / subluxation / lateral luxation)

873.67 : Intrusion or extrusion

873.68 : Avulsion
873.69 : Other injuries like soft tissue injuries

Enamel
Cracking

Fracture
involving only
enamel

Fracture
involving
enamel &
dentin

Fracture
involving
enamel &
dentin & pulp

uncomplica
ted crownroot
fracture

complicate
d crownroot
fracture

Tooth
nonvital
with or
without
fracture

1/3 Apical
root
fracture

1/3 coronal
root
fracture
1/3 Middle
root
fracture
Fracture of
crown
enmass

Intrusion

Extrusion
Lingual/palata
l
displacement

Concussion & Subluxation

Concussion

is an injury to the
tooth and ligament without
displacement or mobility of the
tooth.
Subluxation occurs when the tooth
is mobile but is not displaced.

Concussion & Subluxation

Management
Periapical radiographs as baseline.
Soft diet for 1 week.
Advice to the parents of possible
sequelae, such as pulp necrosis and
infection.
Individualized follow-up.

Intrusion
Management
If the crown is visible and there is only
minor alveolar damage leave tooth to
re-erupt.
If the whole tooth is intruded extract.

Extrusion and lateral

luxation

Treatment

is dependent on the mobility

and extent of displacement. If there is
excessive mobility the tooth should be
extracted.

Avultion
No

reimplantation for PRIMARY teeth

Root Fracture
No

treatment needed unless : necrotic

pulp, infection, sinus tract, high mobility
Leave apical fragmen
Extract coronal fragmen

Fracture without pulp involve

GIC

restoration
Resin
composite
Strip-crown
Zirconia
crown

-Auf
Wiedersein-