Journal of Applied Dental and Medical Sciences
NLM ID: 101671413 ISSN:2454-2288
Volume 5 Issue 2 April-June 2019
Case Report
Comprehensive Management of Early Childhood Caries
Priska Angelia, Three Rejeki Nainggolan, Esti Sunyaruri, Yetty Herdiyati Sumantadireja, Eka Chemiawan
Pediatric Dentistry Department, Faculty of Dentistry – Universitas Padjadjaran, Indonesia
ARTICLE INFO ABSTRACT
Background: Early childhood caries (ECC) is a dental infection disease that common in children. ECC
appears as soon as the baby's teeth erupt, develop rapidly and cause prolonged health problems.
Objective: This case report aim to present a comprehensive management of ECC.
Overview: Dental care is very important to prevent tooth decay. Local control aims to reduce bacterial
activity to stop caries and prevent rapid propagation to the pulp with pulpectomy, stainless steel crown
restorations, fissure sealant, extraction and topical fluor.
Conclusion: ECC requires appropriate and immediate treatment to maintain the presence of teeth in the
oral cavity.
Keywords:
Early Childhood Caries, Dental
infection, pulpectomy, stainless steel
crown, fissure sealant.
INTRODUCTION children. Factors that cause the occurrence of ECC are
Early childhood caries (ECC) is a dental infection that is cariogenic microorganisms, cariogenic substrates and
common in children. American Dental Association hosts. These factors interact over a period of time and
defines ECC as characterized by one or more tooth cause an imbalance in demineralization and
decay, either cavitated or non cavitated lesions, tooth remineralization between the tooth surface and the
loss due to caries, or surface fillings of primary teeth at plaque layer. The cariogenic microorganisms are the
1
preschool age between birth ages to 71 months. main causes of ECC namely Streptococcus mutans and
2
Wyne groups ECC into three types : Streptococcus sobrinus.1
a. Type I (mild to moderate): carious lesions are molar Risk factors related to the occurrence of ECC are social
and / or incisive status, behaviour, immigrant families, lack of
2
b. Type II (moderate to severe): labial and palatal carious knowledge, low health and parental education.
lesions of the maxillary incisors and first molars
c. Type III (severe): almost all teeth are affected by CLINICAL REPORT
caries lesions, including mandibular incisive A 7 year old boy came with his parents to the
ECC appears as soon as the baby's teeth erupt and Department of Pediatric Dentistry at Padjadjaran
develop rapidly and cause prolonged health problems in University Dental and Oral Hospital with complaints of
* Corresponding author: Priska Angelia , Pediatric Dentistry Department, Faculty of Dentistry – Universitas Padjadjaran, Indonesia
48
pain in the mandibular molars. Clinical examination Clinical Procedure
showed there were deep caries in teeth 74, 75, 84 and 1. 1st visit
secondary caries in 85 teeth, deep pits and fissures in a. Determine the working length from the average root
teeth 16, 26, 36 and 46, and tooth persistence 72 (Figure length table on teeth 74, 75, 84, 85
1). Body posture shows no abnormalities (Figure 2). b. Remove all old restoration in 85 and caries by
preparing access to the cavity on teeth 74, 75, 84, 85
c. Extirpation of tooth pulp tissue 74, 75, 84, 85 with
broach barbed and 0.9% saline irrigation
d. Root canal preparation 74, 75, 84, 85 using K-File No.
10-30. Irrigation with 0.9% saline. Dry with paper points
and sterilize with Cresotin, cover with temporary fillings.
Control 3 days later.
2. 2nd visit
a. Open temporary fillings, remove cotton pellets
containing drugs, clean the root canal and irrigate with
0.9% saline on teeth 74, 75, 84, 85.
b. Dry the root canal with a paper point and sterilize
again with Cresotin, cover with temporary fillings.
Control 3 days later.
Fig 1: Intra oral pre treatment
3. 3rd visit
Root canal filling of teeth 74, 75, 84, 85 with the
material of Zinc Oxide Eugenol, then place GIC and
control 1 week later
4. 4th visit
a. There were no patient complaints, percussion tests,
pressures, and mobility are negative. There is no
inflammation in tissue around teeth 74, 75, 84, 85.
b. Dental restoration 74, 75, 84, 85 with a SSC (Figure
3).
c. Build up 74, 75, 84, 85 using cement or GIC
d. Reduce the occlusal surface to about 1.5mm
Fig 2: Body Posture
Journal Of Applied Dental and Medical Sciences 5(2);2019
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e. Using a tapered diamond bur cut the interproximal e. Application of sealants using Fuji 7
part. Reduction must allow the probe to pass through f. Check occlusion with articulating paper
contact area
f. Small buccolingual reduction may needed. However, 6. 6th visit
this reduction must be kept to a minimum because this a. Tooth extraction 72 using topical anesthesia for 3
surface is important for retention minutes followed by 1cc infliltration on muccobucal fold
g. The size of the appropriate SSC is chosen by of 72
measuring the width of the mesiodistal. It is important b. Patient were instructed to bite the tampon for 15
that the crown must be no more than 1 mm subgingival. minutes
If there is excessive pale tissue, the length of the crown
should be reduced using scissors or abrasive stones and
smoothed with white stone. c. 7th visit
i. Crown Cementing with GIC a. Control all restoration that has been done and post
extraction
b. Application of Topical Fluor by using 0.5ml varnish.
All the teeth being prophylactically using pumis
followed by applying fluor varnish using a brush on the
entire surface of the tooth and left to dry for 5 minutes
c. Patients were instructed not to eat and drink for 30
minutes
d. Patients were instructed to control periodically every 6
months
DISCUSSION
Childhood and early adolescence are crucial periods in
the development of healthy dentition. Early childhood
Fig 3: Intra oral post treatment caries (ECC) is a major public health problem, being the
most common chronic infectious childhood disease,
5. 5th visit which is difficult to control. While not life-threatening,
a. Control all SSC restorations. On subjective its impact on individuals and communities is
examination there were no patient complaints, clinical considerable, resulting in pain, impairment of function,
percussion tests, compressive tests, mobility was deleterious influence on the child’s growth rate, body
negative and good gingival adaptation weight, and ability to thrive, thus reducing quality of
b. Fissure sealants in teeth 16, 26, 36, 46 life.9
c. Teeth are cleaned using a dental prophylaxis ECC treatment must be adjusted to conditions and
d. Teeth are isolated on the quadrant which will be complaints of patients. The main treatment is relieving
carried out with fissure sealants
Journal Of Applied Dental and Medical Sciences 5(2);2019
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pain. It can be treated locally on the teeth or oral. over retained tooth are ankylosis, slow root resorption of
Clinical caries control can be done by monitoring eating primary teeth, hypothyroidism and malposition of
1
habits by diet analysis. ECC is a preventable disease. permanent tooth seeds. Etiology in this case is the
The physical, psychological, and economic malposition of primary teeth.6 Over retained teeth and
consequences of ECC can be avoided through the teeth that cannot be treated anymore must be removed
education of prospective and new parents on good oral immediately so as not to disturb the teeth while growing
hygiene and dietary practices.10 and not becoming bacterial retention or as focal
Pulpectomy is indicated in primary teeth with a infections.
diagnosis of irreversible pulpitis or pulp necrosis, with Main purpose of giving sealants is to penetrate the
the crown of the tooth still can be restored. Resorption of material into the pit and fissure to close the area from
roots is less than the apical third of radiographic images bacteria and debris. Pits and fissures vary in shape and
of primary teeth with widespread pulp inflammation but depth. U-shape fissures tend to be shallow, wide so they
roots and alveolar bone are free of pathological are easy to clean and more caries resistant. While the
3
resorption so that periodontal tissue is still healthy. In shape of the pit and fissure in the form of V or I tends to
this case pulpectomy treatment in teeth 74, 75, 84, 85 be deep, narrow and winding so that it is more
was chosen according to the indications. Pulpectomy susceptible to caries. This formation results plaques,
expected to prevent further infections and teeth can be microorganisms and debris.4 A study from AAPD, the
maintained until the time of change with permanent 2002 Consensus Conference on Child Restorative
teeth. The advantage of pulpectomy is to maintain the Dentistry recommended the use of sealants in permanent
function of mastication, maintain space for permanent molars in children and adolescents.5
teeth, prevent problems in speech, prevent bad habits of Topical fluor was given regularly to prevent further tooth
the tongue, prevent the psychological effects of tooth decay. Fluor works by inhibiting the metabolism of
3
loss. plaque bacteria which can ferment carbohydrates through
Prefabricated SSC can be adapted to each primary tooth changes in the hydroxyl apatite on enamel to become
and cemented to provide definitive restoration. SSC is more stable and more resistant to acid dissolution. The
very durable, relatively inexpensive, and offers full reaction of Ca10 (PO4)6 (OH) 2 + F → Ca10 (PO4)6 (OHF)
coronal closing benefits. SSC is often used to restore produces enamel which is more acid resistant so that it
primary teeth in children while other restorations often can inhibit the process of demineralization and increase
fail. remineralization.7
Over retained tooth is a case where the deciduous teeth The use of fluor as a topical application has been shown
persist in the dental arch beyond the normal time causing to inhibit acid formation and the growth of
eruption disorders of the replacement permanent teeth. microorganisms resulting in a significant increase in
Normally, the roots of the decidui teeth will be maintaining the tooth surface from the caries process.8
completely absorbed by osteoclasts so there will be
mobility and eventually loss just before the replacement
permanent teeth erupt. Some of the causative factors for
Journal Of Applied Dental and Medical Sciences 5(2);2019
51
SUMMARY 8. Angela A. Pencegahan Primer pada Anak yang
Early childhood caries forms of caries in the primary Beresiko Karies Tinggi. Maj. Ked. Gigi (Dent J),
teeth. Caries treatment is important for maintaining the 2005, 38(3).
condition of the teeth in the period of the primary teeth 9. Ramos-Gomez FJ, Tomar SL, Ellison J, Artiga N,
so that they can be dated on time and replaced with Sintes J, Vicuna G. Assessment of early childhood
permanent teeth. Total care in ECC cases requires good caries and dietary habits in a population of migrant
collaboration between patients - dentists - parents of Hispanic children in Stockton, California. J Dent
children, so that the expected results can be achieved. Child, 1999, 395-403.
10. Kowash MB, Pinfield A, Smith J, Curzon ME.
ACKNOWLEDGMENTS Effectiveness on oral health of a long-term health
The authors declare no conflict of interest education programme for mothers with young
children. Br Dent J. 2000; 188:201-205.
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