RAMPANT

CARIES

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Definition
Dental Caries is irreversible
Microbial disease of the
Hard tissues of the teeth
characterized by
demineralization of the in
organic portion followed by
destruction of the organic
constituents of the teeth.
Classification
Based on anatomic site:

Crown Caries Root Caries

Pit & Fissures Smooth Caries

 Based on progression

Arrested Caries Progressive Caries

Rapidly Progressive Slowly Progressive

Nursing Caries
Radiating Caries
 Based on the virginity of the lesion

Primary Caries Secondary Caries

Based on the chronology

Early Childhood Adolescent Caries Adult Caries

Caries
 Based on Type of Dentition

Caries in Permanent
Caries in Primary Caries in Mixed
Dentition
Dentition Dentition

Based on severity

Incipient Occult Caries Cavitations

(Hidden Caries)
 RAMPANT CARIES:

MATHEWSON:-

Rampant Caries is defined as

suddenly appearing wide spread,
rapidly burrowing type of caries
resulting in the early involvement of
the pulp.
MACDONALD:-
Massler defined it as suddenly appearing, vide
spread, rapidly burrowing type of caries,
resulting in early involvement of pulp and
affecting those teeth usually regarded as
immune to ordinary decay.
WINTER:-

Acute onset involving many or all erupted

teeth rapidly destroying coronal tissue often
on surface immune to decay and leading to
early involvement of pulp.
ETIOLOGY:

Salivary Deficiency:
A. Due to radiation therapy.
B. In Stressed children who have
tranquilizers
C. Xerostomia
Acidogenic Bacteria, Dental Plaque, Tooth
Structure Susceptible to Dissolution.

Genetical
Habits

A. Feeding of Child with sweetened Milk through the night.

B. Sweetened Pacifiers

C. Nursing of Child through the night.

Nutrition
Nutritional deficiency

Diet:

 In Between meal snacking of Cariogenic foods

 Sucrose Content in Diet.

Psychological factors.

 Emotional disturbance
 Repressed Emotional fear.
This cause decreased salivary flow.
CLASSIFICATION ACCORDING TO AGE

Those seen in a) Infants

b) Young Children
c) Teenagers
d) Adults of all age
Most Prevalent age group: 4-8 years
11-19 years.
CHARACTERISTIC FEATURES:

Most Common site:-

 Proximal surface of lower anterior teeth and
development of cervical type of caries.
 Labial surface of all maxillary anterior teeth.
 Type of Lesion or Nature:-

 Soft consistency and light yellow in color.

Onset and progress of lesion is very rapid.

 Age: Seen at all ages. Including adolescence.

Sex: Female > Male
Davies believed that rampant caries should be
coined to condition where:

1. Lesion are more than ten in number.

2. High caries experience for the child age.
3. Sudden characteristic feature:New and recurrent
carious lesion (10 Months – 6 Months time)
4. Development of caries in otherwise caries immune
surface.
5. Extensive loss of tooth structure particularly dentin
even though enamel shows little defect.
6. Soft, musty, ivory colored dentinal consistency
indicating rapid progression of the lesion.
SEQUELE OF RAMPANT CARIES:-

A. Pain
B. Infection
C. Tongue Thrusting
D. Abnormal Swallowing
habits.
E. Speech difficulties.
TYPES:

1. Rampant caries in deciduous dentition

 Rapid Destruction of erupted teeth related to order of tooth
eruption.
 Most common site: Upper deciduous incisors and decimolars.
Individual lesion show decalcification over wide area.
Striking feature : Seen in Groups of bottle feeders and also
where Resistance of child is low.
2. Rampant Caries in adults:
Rare in Adults

 Sudden onset after adolescence show that some major

alternation has occurred in patient’s oral environment or diet.
 Treatment

THE TYPE OF TREATMENT DEPEND

ON THE

• Patient’s and parent’s motivation toward dental

treatment.
• The extent of the decay.
• The age
• Co-operation of the child.
INITIAL TREATMENT INCLUDES

•Provisional restorations
•Diet assessment
•Oral hygiene instructions
•Home and professional fluoride
treatment
 1. Provisional restorations:

 Caries stabilization with gross excavation of each carious lesion and provisional
restorations should be placed in symptom free teeth established dentinal caries to
minimize the risk of pulpal exposure in future and to improve function.
 However,
Patients with acute and severe signs and symptoms of
caries

Pain, abscess, Sinus or facial swelling

Require immediate treatment

 If the pulp is still vital Form cresol pulpotomy

Pulp is nonvital Pulpactomy followed by obturation

with zinc – oxide eugenol cement.
 2. Diet assessment:

 Parents should be educated to reduce the frequency of

sucrose consumption by their child, especially, between
meals.
 Consumption of sugar containing foods and beverages
should be restricted to meal times.
 In infants : Bottle feeding habit should be stopped by
Gradually decreasing bottle contents with
water as well as decreasing amount of
added sugar over a 2-3 weeks period.
 Dietary vitamin supplements as well as oral
medications must also be included.
3. Oral hygiene instructions

 Many 3 to 5 years old children can’t brush their teeth

adequately when untutored and unsupervised so, it is
important to teach children the proper techniques of tooth
brushing at different age groups.
i.e. under the age of 8 years: circular scrub technique
eg. foons technique
after 11-12 years : A sulcular brushing technique
eg. bass technique
 Explained the proper brushing technique to the patients by
demonstrating the procedure with articulated models of
dental arches and brush
4. FLUORIDE TREATMENT
 Both systemic and topical fluoride treatments are useful for
preventing dental caries.
 The choice depends on the level of fluoride in the drinking
water and the stage of development of the dentition
 Level of fluoride in the drinking water of various ages is:

Water Fluoridation concentration (PPM)

Age (Year) < 0.3 0.3 – 0.7 > 0.7

0-2 0.25 0.00 0.00
2-3 0.50 0.25 0.00
3-16 1.00 0.50 0.00
Mg F/ day
 Methods of fluoride treatment and other methods for
prevention of rampant caries in different age group.
(a) Primary dentition : 0-5 Years

Dietary Advice : Dietary Counseling with parents on good nursing

techniques

1. Fluoride Therapy  Tooth Paste

 Tablets if in area without water fluoridation
 Professional topical fluoride application every 6
months

2. Plaque Control  Oral hygiene instructions to parents

 Tooth brushing with parental supervision.
 (a) Mixed dentition : 5-12 Years

Dietary Dietary Counseling with parents and patients

Advice :

1. Fluoride  Tooth Paste

Therapy
 Tablets up to 8 years if in area without water
fluoridation.
 Mouth rinse.

2. Plaque Control  Oral hygiene instructions to parents

 Tooth brushing with parental supervision.
 Disclosing Tablets
 Fissures Sealants (3-6 Months recall)
 Permanent Dentition : 12 Years Onward

Fluoride Tooth Paste

Therapy :
Mouth rinse
Professional fluoride application every 6 months.

1. Plaque Control:  Oral Prophylaxis

Oral Hygiene instructions to Patients.
Tooth brushing.
Disclosing tablets.
Interdental Cleaning with floss or tooth picks.
Comprehensive Restorative Treatment

Once rampant caries is under control, comprehensive

restorative treatment can be carried out .

 Restorative strategies for rampant caries are:

1. Early caries with minimal loss of enamel
Weekly professionally applied topical fluoride.
2. Extensive cavitations with no pulpal involvement.
* Anterior Teeth:-
* Acid – etched – composite resin
restoration
* Pedo strip crowns.
* Glass–ionomer cement restorations.
* Posterior Teeth:-
* Posterior composite resin restorations.
* Glass- Ionomer cement restorations.
* Stainless Steel crowns.

3. Extensive cavitations with pulpal involvement.

 Pulpotomy or pulpactomy where appropriate,
followed by permanent restoration.
 Extraction followed by space maintainer or partial
or complete dentures.
SUMMARY

 Rampant caries is a distressing clinical

condition confronting the child, parents and
dentist.
 With the advances in knowledge about the
etiology and pathogenesis of dental caries,
rampant caries can now be prevented.
 Successful management depends on a co-
ordinated team approach among the
pediatrician, pediatric dentist, parents and
child.
• The pediatrician should educate the parents

 about good nursing and dietary habits and the

importance of good oral hygiene to their Child’s
teeth.

 and to bring their child to the dental office before

he or she is 12 months of age for a screening
examination and counseling.

• However, interest and co-operation from the parents and children

are equally important.

Consequently educational efforts should be emphasized and

reinforced, especially in areas where the prevalence of rampant
caries is high.