COMPLETE REHABILITATION OF MOUTH CAVITY AFTER EARLY CHILDHOOD CARIES TREATMENT : A CASE REPORT

Uvod:Karijes ranog detinjstva je jako ozbiljan zdravstveni problem, kako u zemljama u razvoju tako i u razvijenim zemljama. Ovde je predstavljen klinički slučaj potpunog oporavka od karijesa u ranom detinjstvu. Prikaz slučaja: Petoipogodišnji pacijent muškog pola koga je dovela majka prijavljen je na Odeljenje dečje stomatologije zbog karioznih zuba. Ispitivanje usne duplje utvrdilo je mešovito nicanje zuba sa karijesom: 51, 52, 54, 55, 61, 62, 63, 64, 71, 72, 73, 81, 82, 84, 85 i zubi sa privremenim punjenjem na 74 i 75. Urađena je korekcija glas jonomer cementom na zubima 71, 72, 81, 82, 83. Pulpoktomija je rađena na zubima 51, 52, 61, 62, 63, 74 i 75. Umeci od polietilenskih vlakana (Ribond) su stavljeni na zube 51, 52, 61, 62 i 63. Finalna korekcija sa celuloidnim strip krunicama urađena je na zubima 51, 52, 61 I 62, a kompozitno popravljanje na zubu 63. Krunice od nerđajućeg čelika su postavljene na zubima 74, 75, 84 i 85. Zaključak: Potpuni oporavak usta deteta nakon karijesa u ranom detinjstvu je izazov za dečjeg stomatologa. Pored koristi za oralno zdravlje, oralna rehabilitacija takođe doprinosi poboljšanju opšteg i psihološkog stanja deteta.


Introduction
Early childhood caries (ECC) is a serious dental problem that affects the infants and toddlers.ECC can be defined as the presence of one or more decayed, missing or filled tooth surfaces in any primary tooth in a child 71 months of age or younger 1 .Around 40% of children have dental caries by the age of five, and 8% of two-year-old children have some form of decay or previous restorations 2, 3 .The term ECC was introduced in the 1990s in an attempt to focus attention on the multiple factors such as socioeconomic, psychosocial and behavioral problems that contribute to caries at an early age rather than describe sole causation of inappropriate feeding methods like bottle use and prolonged breastfeeding on demand 4 .
Full mouth rehabilitation including the esthetic restoration of severely mutilated primary teeth has always been a challenge for the dentist for a long time, not only because of the limitations of the available materials and techniques but also because the children who require such restorations are usually among the youngest and least manageable group of patients.However, with the pedodontist's handling the children and availability of newer materials like strip crowns and polyethylene fiber post the treatment modality is improvised in the present scenario.The presented case report describes the full mouth rehabilitation of an emotionally immature patient suffering from early childhood caries presenting with multiple mutilated teeth.

Case Report
A five-and-a-half-year-old male patient accompanied by his mother reported to the department of pediatric dentistry with a chief complaint of severely decayed teeth.The child was a bit shy and less confident.His medical history revealed no systemic, allergic, or immunocompromising illness.The patient was a full-term child, born during a normal delivery.Diet history revealed that patient had a history of bottle feeding and breastfeeding on demand.
Stainless steel crowns were placed on teeth 74, 75, 84 and 85 (Fig. 7).Extraction of teeth 54 and 64 was done under the local anesthesia.Nance palatal arch space maintainer was given in the maxillary arch with stainless steel bands on teeth 55 and 65 (Fig. 8).The patient was advised for regular check-ups.

Discussion
Though the caries prevalence has decreased substantially with the introduction of preventive measures like fluorides, children still continue to present with dental caries.The early carious involvement and gross destruction of the teeth leads to the problems like loss of masticatory efficiency, reduced vertical dimension, compromised esthetics, development of abnormal habits like tongue thrusting and psychological problems.
The full mouth oral rehabilitation of these teeth is a great challenge to the pediatric dentistry.Numerous materials and techniques have been used in the restoration of primary anterior teeth.Glass ionomer cements, amalgams, silicate cements, compomer, composite resins, stainless steel crowns, open face stainless steel crowns, and polycarbonate crowns are frequently used today.Amalgams and stainless steel crowns are contraindicated when esthetics is a major consideration.Recently, zirconium crowns are becoming popular due to its esthetic acceptance.
Silicate cements and resins are indicated for small lesions, but often fail when used to restore larger lesions. 5olycarbonate crowns provide excellent esthetics, but require careful 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. 6In the present case, celluloid preformed crown with composite resin material was used because of its advantage of producing an esthetic result because of shade matching, functional and proven economical restoration.
In children with the primary and the early mixed dentition, stainless steel crowns are an effective type of restoration in managing severely destructed primary molars and permanent molars in children.In primary teeth, the stainless steel crowns are indicated following pulpotomy or pulpectomy and are also applicable for teeth with developmental defects, large carious lesions involving multiple surfaces where amalgam is likely to fail and teeth are likely to fracture. 7The stainless steel crowns are extremely durable, less expensive, and subject to minimal technique sensitivity during placement and offer the advantage of full coronal coverage. 8In the present case, stainless steel crowns were used on teeth 74 and 75 following pulpectomy.Pulpotomy was done in teeth 84 and 85 and was followed by placement of stainless steel crowns which aided in increasing the vertical height of occlusion.
Full mouth rehabilitation of a child with early childhood caries is challenging for pediatric dentist.Apart from the dental benefits, oral rehabilitation also contributes to the improvement of general and psychological wellbeing of the child.
The patient had a Frankl behavior rating one i.e. definitely negative, but was managed using only non-pharmacological behavior management techniques.The patient was carefully dealt with an extraordinary amount of patience and hence required multiple sittings.At the end of treatment, the patient walked out of the department not only with disease free oral cavity but also as a stronger and more confident individual with a positive attitude towards dental treatment.

Conclusion
Full mouth rehabilitation of a child with early childhood caries is challenging for pediatric dentist.Oral rehabilitation also contributes to the improvement of general and psychological wellbeing of the child.