Dental karies di Anak-Anak

 

• Definition

  Caries is defined as microbial disease of the calcified tissues of teeth that leads to demineralization of the inorganic components and the subsequent breakdown of the organic moieties of enamel and dentin

• Why it Matters

  Dental caries continues to be a major problem in dentistry and should receive significant attention in everyday practice, not only from the standpoint of restorative procedures but also in terms of preventive measures designed to reduce the problem.

CARIES IN THE PRIMARY DENTITION

• Rampant caries (RC) → anterior rahang bawah

  Karies yang muncul secara tiba2, meluas, dan membentuk kavitas cepat hinggga mengenai jaringan pulpa dan melibatkan gigi yang biasanya imun karies (anterior mandible)

  P.S: no complete agreement on the definition.

  • Diagnosis

    • Meluas
    • Tiba-tiba
    • Cepat
    • Melibatkan gigi imun karies (mandible anterior)

  • Penyebab

    Poor oral hygiene

    High carbohydrate diet

    Mouth breathing → kering→ asam

    Salivary deficiency

    • Faktor Sekunder

      Teeth anatomy

      Teeth lining (crowding case)

      Habits (Life style, food intake, etc )

  • Imun Karies

    Lesi ini ditandai dengan terkenanya gigi anterior bawah yang biasanya tahan terhadap karies.

    karena ada saliva

    The mandibular incisors are probably more resistant to caries because of their close proximity to the secretions of the submandibular salivary glands as well as the cleansing action of the tongue during the process of suckling the bottle.

• Nursing caries (NC)

  Prolonged bottle feeding beyond the usual time when the child is weaned from the bottle and introduced to solid food, may result in early and rampant caries.

  This is known as Nursing Caries or Nursing Bottle Syndrome or more recently as Early Childhood Caries (ECC).

  • OTHER FACTORS OF ETIOLOGY

    Nursing bottle with milk or sugar containing beverage left in child’s mouth as he falls asleep.

    Salivary flow is decreased during sleep.

    Clearance of liquid (milk & sugar) in the oral cavity is slowed/reduced.

    Also at will

  • Karakteristik

    • Melibatkan gigi rahang atas pada bagian servikal, labial, atau lingual

    • Melibatkan gigi molar sulung rahang atas dan kaninus rahang bawah

    • nursing bottle caries: which teeth are less affected because the tongue covers them

      mandibular incisors

  • Faktor Etiology yang lain

    • Anak tidur dengan botol yang masih berisi susu menempel di mulutnya
    • Aliran saliva berkurang pada saat tidur
    • Self cleansing pada rongga mulut melambat atau berkurang pada saat tidur
    • ASI yang terlalu lama juga dapat menyebabkan NC atau ECC

• TYPICAL APPEARANCE OF THE TEETH IN A 2, 3 OR 4 YEAR OLD FOLLOWS A DEFINITE PATTERN:

  Early carious involvement of maxillary anterior teeth as cervical caries labial and/or lingual.

  The maxillary and mandibular primary molars and the mandibular canines.

  Mandibular incisors are usually unaffected.

• TREATMENT OF DENTAL CARIES IN CHILDREN

  • Preventive

    Topical application of Fluoride to early decalcified areas e.g. cervical, upper incisors.

    Pit dan fissure sealant

  • Restorations:

    Anterior teeth:

    Glass ionomer cements

    Acid etch technique, sandwich techniques composite restorations

  • Posterior teeth:

    Preventive resin restorations

    Glass ionomer

    Posterior composites

    Amalgam

    SS crowns

• Recommended

  The child who falls asleep while feeding should be burped and then placed in bed.

  Parent should start brushing child’s teeth as soon as they erupt.

  Discontinue nursing as soon as the child can drink from a cup i.e. at about age 12 months.

  Avoid prolonged breastfeeding.

  Avoid prolonged bottle feeding with milk in the bottle i.e. Beyond 12 months.

  Early counseling of parents will prevent Nursing Caries or Early Childhood Caries

  Suggest children have first dental examination between 6 and 12 months of age

  Need to educate public about NC (Ripa 1988) or ECC.

  eg. By direct contact with pregnant women.

  parents and other care givers in population subgroups that have high prevalence of NC or

• KIE

  • Anak yang tertidur ketika menyusu sebaiknya punggunnya di tepuk2 dahulu baru ditidurkan di tempat tidur
  • Orangtua sebaiknya menyikat gigi anak segera setelah giginya erupsi
  • Dikontinyu menyusu segera setelah anak dapat minum dair gelas. Kira-kira usia 1-2 tahun
  • Hidari pemberian SAI, susu botol terlalu lama
  • Orangtua melakukan konseling lebih awal
  • Pemeriksaan awal 6 bulan dan 12 bulan

• Restorasi

  • Gigi Anterior
    • Glass Ionomer Cement
    • Komposit
  • Posterior
    • Preventive resin restoration
    • Glass ionomer
    • Posterior composites
    • SS crown

sisa akar→ cabut