Early Childhood Caries: A Case Report of an Extensive Rehabilitation

Abstract

A 3-year-old (and 11 month) male child, with the complaint of multiple decayed teeth for a period of four months, presented for treatment in the Paediatric Dentistry Clinic, School of Dentistry of the Federal University of Rio Grande do Sul (UFRGS) Brazil. The patient's mother complained that the child had many carious lesions and had spontaneous and provoked pain from eating and brushing. In the anamnesis and dietary diary, she reported that the patient drank from a sugared baby bottle twice a day and had the habit of eating sugary foods throughout the day. No significant past medical or dental family history was reported. Fluoride dentifrice was being used since the patient was two years of age. The family had a monthly income below the current minimum wage, representing a very low socioeconomic level.The clinical examination revealed an extensive carious coronal destruction in all the upper incisors, whitish-opaque rough spot lesions in enamel of the occlusal surface of teeth #55 and #65, soft cavity in dentin in tooth #53, and extensive coronal destruction of teeth #54 and #64 [Table/ Fig-1]. In the mandibular arch, teeth #75, #74, #84 and #85 showed rough and opaque enamel breakdown and soft cavity in dentin, teeth #73 and #83 had whitish opaque rough spot lesions in enamel. The initial Visible Plaque Index (VPI) was 47% and the initial Gingival Blood Index (GBI) was 13% [1]. Radiographic examination also matched with the clinical diagnosis of ECC.Initially, the proposed treatment was functional oral rehabilitation, starting with restorative treatment of cavitated lesions by selective caries removal technique for teeth #53, #54, #64, #74, #75, #84 and #85. For teeth #52, #51, #61 and #62, the extraction and the installation of an upper fixed prosthesis with stock teeth were indicated. For the treatment of whitish opaque rough spot lesions in enamel, the topical application of 1.23% fluoride gel was indicated over four weekly sessions. A treatment plan was developed and explained to the patient's mother, who signed an approved informed consent form authorising the treatment as well as disclosure and publishing of this case report.All procedures were performed under local anaesthesia, to avoid pain and discomfort, and rubber dam isolation was done in each quadrant in one session. Teeth #53, #75, #74, #84 and #85 were restored using the universal adhesive system (3M Espe ® , Brazil) and composite resin Z350 (3M Espe ® , Brazil) in WD, A1D and A1B colours. FluroShield resin sealant (Dentsply ® , Brazil) was used on the occlusal surfaces of teeth #55 and #65 to block rough and opaque enamel breakdown. Teeth 54 and 64, were sealed with a cover of Resin Flow (3M Espe ® , Brazil) in A1 colour, to re-establish the patient's oral health condition. Due to the loss of vertical dimension of the patient, there was insufficient space to allow reconstruction with composite resin.Root extraction of teeth #52, #51, #61 and #62 were performed under local anaesthesia in a single session. Two weeks after healing, an alginate im...