Treatment Options of Nursing Bottle Caries

The type of treatment instituted depends on patients and parents motivation towards dental treatment, the extent of the decay and the age and cooperation of the child.

The initial treatment, including:

(1)     Provisional restorations.
(2)     Diet assessment
(3)     Oral hygiene instructions and
(4)     Home and professional fluoride treatments.
 These should be performed before any comprehensive restorative treatment commences.

1.    Provisional Restorations

Caries stabilization with gross excavation of each carious lesion and provisional restorations should be placed in symptom free teeth to minimize the risk of Pulpal exposure and to improve function. It results in the reduction in the number of oral microorganism, which in itself plays an important role in the caries control program.
This procedure also gives the dentist time to take a history and complete tests to determine the cause of rapid destructive process. It will also provide an opportunity to outline a preventive and restorative approach, which will increase the chances of success.

2.    Diet Assessment

Parents should be educated to reduce the frequency of sucrose consumption by their child, especially between meals. Parents can be instructed to record the amount and quantities of food and beverages consumed during and between meals.
A series of small changes over a period of time is usually more acceptable to the child and parents and longer lasting.
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.

3.    Oral Hygiene Instructions for prevention of Nursing Bottle Caries

Tooth brushing is the most widely accepted and used form of oral hygiene. Parents must have a good view of the child’s oral cavity and be able to observe any changes so as to consult the dentist early.
Many 3 to 5 years old children can’t brush their teeth adequately when unsupervised so, it is important to teach children the proper techniques of tooth brushing at different age groups.
Under the age of 8 years: circular scrub (fones technique) After 11-12 years: A sulcular brushing (Bass technique)
Proper brushing technique should be explained 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.

 Primary dentition: 0-5 Years

  • Tooth Paste
  • Tablets if in area without water fluoridation
  • Professional topical fluoride application every 6 months  

Mixed dentition: 5-12 Years

  • Tooth Paste
  • Tablets up to 8 years if in area without water fluoridation.  
  • Mouth rinse

Permanent Dentition: 12 Years Onward

  • Tooth Paste
  • Mouth rinse
  • Professional fluoride application every 6 months.

5.    Comprehensive Restorative Treatment:
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

6.    Polycarbonate Crowns 

Poly carbonate crowns are temporary crowns which can be given as fixed prosthesis to deciduous anterior teeth which will get exfoliated in future.

 Contraindication:-These crowns cannot be given in certain situations. They are comparatively soft and are not given in the conditions lke-

  • Severe bruxism (grinding of teeth)
  • deep bite
  • Excessive abrasion

Advantages of Polycarbonate Crowns 

  • They save time
  • Are easy to trim.

Disadvantages of Polycarbonate Crowns 

  • Difficult to place
  • Poor retention
  • Prone to excessive wear
  • Brittle and have high incidence of fracture.

Anterior Strip Crown

Indications

  • Primary incisors with loss of mesial and distal incisors   corners,
  • 2. Malformed primary incisors.
  • 3. Dental hypoplasia.       
  • 4. Fractured primary incisors due to trauma.

Procedure for Polycarbonate Crowns in Nursing Bottle Caries

  • The teeth should be anaesthetized, and then isolated cotton wool roll isolation is usually sufficient, rubber dam is preferred.

  • All caries is removed using a small round bur in a slow speed hand piece.
  • Caries from the mesial and distal walls of the incisors prepared for strip crowns is removed.

 

  • The shade of composite resin is chosen when the tooth is discolored; an adjacent tooth or the lower incisors can be used for shade matching.

 

  • The celluloid crown are trimmed using fine curved scissors, care should be taken at this stage to avoid splitting or distorting the crown form.

 

  • The trimmed celluloid crowns are fitted on to the prepared incisors. The length and cervical fit should be checked at this stage.

 

 

  • Vent holes are made in the mesial and distal corners of the incisal edge of each crown from to allow air and excess composite resin to escape

 

  • A proprietary calcium hydroxide paste or GIC is applied to the Pulpal wall of any exposed dentin.
  • The teeth are etched for 1 minute with a 37% phosphoric acid washed and dried. It gives opaque frosty appearance of the enamel.


 

 

  • The bonding agent is applied, and then cured for 15 second.

 

 

  • The crown forms, containing composite resin, are placed firmly on the prepared tooth; but care should be taken at this stage, since excess pressure can result in splitting.
  • Excess composite resin is removed with a probe. It will make final finishing easier and quicker.

     
  • The composite resin is cured for one minute, labially and palatally.

  • An Excavator or probes inserted beneath the edge of the celluloid, in the crown form is stripped off after the composite resin has been cured.
  • The last step is to smooth and polish the crowns, although finishing is usually minimal. Flexible carborandum disc are used for this.
  • A labial view of the finished strip crown restoration
     

  • A palatal view of the finished strip crown restoration clearly demonstrating the full coverage provided by this restoration technique.

Advantages

  • More esthetic crown.
  • Improved retention.
  • Better wear resistance.

Disadvantages

  • More technique sensitive.
  • Fractured or debond when traumatized.

7.    Stainless Steel Crowns For Children   
 

 Indications:

  • Primary or young permanent tooth with extensive carious lesion.
  • Hyperplasic primary or permanent tooth that can’t be adequately restored with silver amalgam or a composite resin restoration.
  • Fractured tooth.

Conclusion

Nursing bottle caries is a significant public health problem, the manifestations of which are of symptomatic importance and has underlying maternal and pediatric problems. It has a debilitating effect on the development, speech, general health and self-esteem of infants.

In addition to behavior related to baby bottle usage, several other risk factors for nursing bottle caries include, race and ethnicity, socioeconomic status, diet and oral hygiene behavior,.

Nursing Bottle Caries occurs most frequently in families living in poverty or in conditions of economic disadvantage in which malnutrition may result in the formation of enamel of lower resistance to caries attack.

Since the condition can begin soon after the primary maxillary incisor erupt, it is essential that parents and all personnel involved in the health and welfare of infants be shown how to recognize its early signs so that appropriate secondary preventive measures can be instituted.

Educational interventions have had weak to modest success and professional and home-based intervention have not been tested sufficiently in young populations.

While there is adequate data to establish that nursing bottle caries a serious problem in disadvantaged communities, the extent of its prevalence in general population is largely uncertain.
 

Leave Comment

Free Dental Consultation