J CLIN DENT SCI 2017;2(2)

CASE REPORT

Treatment of Early Childhood Caries: A

Case Report
Milind Atulkar1, Milind Wasnik1, Niharika Gahlod1, Miranda George1

Department of Pedodontics and Preventive Dentistry, Swargiya Dadasaheb Kalmegh

Smruti Dental College and Hospital, Maharashtra, India.

Abstract
Early childhood caries (ECC) is a potent form of dental caries that can destroy the
primary dentition of toddlers and preschool children. It is usually prevalent in low
socioeconomic groups and the general population. ECC along with affecting the
teeth also has consequences that may lead to more wide- spread health issues.
ECC depends on multiple factors which are socioeconomic, behavioural and
psychosocial factors that contribute to caries at such early ages rather than
depending upon only contributing a factor of inappropriate feeding methods. It is of
great importance that the Pediatric Dentists should treat this pathology, returning
the oral health and smile aesthetics to these children. This case report explains full-
mouth rehabilitation treatment of patient with early childhood caries.
Keywords: Early childhood caries, Full-mouth rehabilitation, Strip crowns.

Introduction potential than a caries-free child and

Early childhood caries (ECC) is a potent
form of dental caries that can destroy
the primary dentition of toddlers and
preschool children. It is usually
prevalent in low socioeconomic groups
and the general population. ECC along
with affecting the teeth also has
consequences that may lead to more
wide- spread health issues. Premature
loss of primary maxillary anterior teeth
may result in abnormal tongue habits,
defective speech, slower the growth
decreased masticatory efficiency.
ECC can be defined as the occurrence
of any sign of dental caries lesions on
any tooth surface during the first 3 years
of life. It is defined by the American
Academy of Pediatric Dentistry as the
presence of 1 or more decayed lesions,
missing (due to caries), or filled tooth
surfaces in any primary tooth in a child
71 months of age or younger [1]. The
first sign of ECC is the appearance of
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white demineralization areas in the
cervical regions of the primary maxillary
anterior teeth [2]. The term ECC was
introduced in the 1990s.
ECC depends on multiple factors which
are socioeconomic, behavioral and
psychosocial factors that contribute to
caries at such early ages rather than
depending upon only contributing a
factor of inappropriate feeding methods
(i.e., bottle use and prolonged
breastfeeding on demand) [3]. Initial
clinical sign of caries includes the
presence of opaque and white spots.
The process evolves to the appearance
of cavities, destruction of all tooth crown
and beginning of infectious root
processes because of pulp involvement,
if not controlled.
Early childhood tooth problems are
associated with variations during
intrauterine and postnatal growth period.
Most clinicians agree that teething does
not serious cause life taking pathological
state [4]. ECC initiates on the cervical
third of the labial surfaces of the
maxillary anterior teeth followed by
affecting the occlusal surface of the
maxillary and mandibular first molars,
maxillary and mandibular canines and
second molars [4]. At more advanced
stages, it also affects the mandibular
incisors [5]. It is of great importance that
the Pediatric Dentists should treat this
pathology, returning the oral health and
smile aesthetics to these children [6].
J CLIN DENT SCI 2017;2(2)
Types of full coverage currently
available for ECC anterior primary teeth
are composite resin strip crowns,
stainless steel crowns, polycarbonate
crowns, open-faced steel crowns and
pre-veneered steel crowns [7].
Case Report
A five-year-old male patient reported to
the Department of Pedodontics and
Preventive Dentistry, Swargiya Dada
sahib Kalmegh Smruti Dental College
and Hospital, Wanadongri, Nagpur with
a chief complaint of Broken teeth in the
upper front region of jaw since 3
months. Decayed teeth in the upper
right and left region of the jaw since 15
days. Patients general health was good
and revealed no systemic medical
history, allergic, or immune-
compromising illness. The child was
born with a full term, normal delivery.
Diet history revealed that patient had a
history of the bottle. Intraoral
examination revealed Ellis Class 9
fracture with 51, 6(Figure 1) and
occlusal caries with 74, 75, 84,
85(Figure 2 and 3).
Initial treatment involved appropriate
preventive measures like oral
prophylaxis and fluoride application.
Extraction of 84. Pulpectomy for
51,61,74, 75, 85 was carried out.
Stainless steel crowns with 74,75 and
crown and loop space maintainer with
85 were given. Final restoration with
celluloid Strip crowns with 51,61 was
given. The patient was recalled after
every 3 months.
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Figure 3: Intraoral photograph

showing mandibular occlusal view.

Figure1: Intraoral photograph

showing case of early childhood
caries.
Figure 4: Intraoral photograph
showing pulpectomy followed by
strip crown with 51, 61.

Figure 2: Intraoral photograph

showing maxillary occlusal view.

Figure 5: Pulpectomy followed by

stainless steel crowns with 74, 75.
Pulpectomy followed by Crown and
loop fixed space maintainer
cementation with 85.

Discussion
Early childhood caries is similar to other
types of caries. However, it may differ
regarding feeding pattern. Early
childhood caries has an unfavourable

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effect on the health and quality of life of
the child [8]. ECC can be avoided by
maintaining proper oral hygiene and
dietary practices, using agents such as
fluoride [9]. Composite resins with
various acid etch techniques, stainless
steel crowns, open face stainless steel
crowns, and polycarbonate crowns are
frequently used today for anterior teeth.
Amalgams and stainless steel crowns
are contraindicated when esthetics is a
major consideration [10,11].
Polycarbonate Crowns provide excellent
esthetics but require exact cementation
procedures for retention. Failure in the
cementation of the polycarbonate crown
is a major problem, resulting in early
fracture and loss of the crown prior to
the exfoliation of the restored tooth [12].
In this case, celluloid preformed crown
with composite resin material was used
because of its advantage of producing
an aesthetic, functional and economic
restoration easily and with minimal chair
time.
In 1994, Waggoner suggested that
indication of the full coronal restoration
of carious primaryincisors: 1. caries is
present on multiple surfaces, 2. The
incisal edge is involved, 3. there is
extensive cervical decalcification, 4.
pulpal therapy is indicated, 5. Caries
may be minor, but oral hygiene is very
poor (high-risk patients), or 6. the child's
behaviour makes moisture control very
difficult, creating difficulties in placing
Class III restorations [13]. Croll reported
that SSCs were easy to place, fracture
proof, wear resistant, and attached
J CLIN DENT SCI 2017;2(2)
firmly to the tooth until exfoliation [14].
The main disadvantage is its unsightly,
silver metallic appearance. As the
population has become more
aesthetically conscious, SSCs have
become less desirable.
Riekman and Badrawy reported that the
loss of primary anterior teeth before the
age of 3 years resulted in speech
problems. Restoration of aesthetic
appearance is one of the most
significant reasons for replacing missing
anteriors which promotes a normal
psychological development in the child.
This space maintainer offers several
advantages regarding the restoration of
speech and masticatory efficiency,
aesthetics, and prevention of abnormal
oral habit development. The main
disadvantage is the accumulation of
food debris and plaque [15].
Conclusion
Full-mouth rehabilitation of a child with
early childhood caries is challenging for
a pediatric dentist. Along with dental
benefits, oral rehabilitation also
contributes towards the improvement of
general and psychological well-being.
Rehabilitation of carious primary anterior
teeth include wide range of options and
the choice of material depends upon
clinicians expert and skill.
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Address for Correspondence
Dr. Milind Atulkar
Department of Pedodontics and
Preventive Dentistry
Swargiya Dadasaheb Kalmegh Smruti
Dental College and Hospital,
Maharashtra, India
Tel: +91-9028411461
E-mail: milinddr0412@gmail.com
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How to Cite this Article Conflict of Interest

Atulkar Milind, Wasnik Milind, Gahlod None Declared
Niharika, George Miranda. Treatment of
Early Childhood Caries: A Case Report.
J Clin Dent Sci 2017;2(2):34-39.

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