Rehabilitation of a Child with Severe Early Childhood Caries Under General Anaesthesia: A Case Report

INTRODUCTION

Early childhood caries (ECC) is an established worldwide oral health problem, affecting the infants and pre-schoolers mainly. The primary risk factors for the high prevalence of ECC are improper feeding practices, familial socioeconomic background, lack of parental education, and lack of access to dental care. In children younger than 3 years of age, any sign of smooth surface caries is indicative of severe early childhood caries (S-ECC).

From ages 3 through 5, 1 or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth or a decayed, missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces constitutes S-ECC.¹

Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options by AAPD in 2016 clearly states that the consequences of ECC often include a higher risk of new carious lesions in both the primary and permanent dentitions, hospitalizations and emergency room visits, high treatment cost, loss of school days, diminished ability to learn, and reduced oral health-related quality of life. As restorative care to manage early childhood caries often requires the use of sedation and general anaesthesia with its associated high cost and possible health risks therefore, there is high recurrence of lesions following the procedures, hence now there is more emphasis on prevention and arrestment of the disease.²

The most challenging aspect in the treatment of ECC is that the children are very young and fall in the age group of 2–5 years, due to which the behaviour management on the dental chair is most challenging, most of the times impossible. Hence, preferably such patients are treated under general anaesthesia. The present case report describes a full mouth rehabilitation procedure performed under general anaesthesia of a child who presented with severe early childhood caries.

CASE REPORT

A 4 year old male child, reported with a chief complaint of multiple decayed teeth for a period of more than six months to clinic. The patient's mother complained that the child had numerous carious lesions with spontaneous and provoked pain from eating and brushing. Dietary history revealed the consumption of milk with a bottle for more than 2 years, along with consumption of a sticky diet inclusive of biscuits and junk food.

No significant past medical or dental family history was reported. Whereas both the parents were working representing a relatively high socioeconomic group. The clinical examination disclosed the presence of severe early childhood caries with gross amount of coronal destruction in most of the anterior teeth. Deep caries was seen in 51, 52, 54,61,62,64 indicated for pulpectomy followed by crowns. [Figure 1]

The child exhibited an extremely anxious and apprehensive behaviour during his first working appointment and fell into a definitely negative rating on the Frankle Behaviour Rating scale.

Due to the need of a full mouth rehabilitation procedure and the uncooperative behaviour of the child, the parents were explained about the requirement of treatment to be done under general anaesthesia .The treatment plan was explained to the parents, who signed an approved informed consent form authorising the treatment. A full mouth rehabilitation procedure was carried out under general anaesthesia. Pulpectomy was done on 51, 52, 61, 62 followed by zirconia crown and stainless steel crown was placed on 54, 64, 74. [Figure 2A, 2B]

The patient was kept under observation in the hospital and was discharged the following day. Analgesics were prescribed, instructions regarding the oral hygiene maintenance, soft diet and follow up after one week.

They were instructed to return every 3 months for a follow up. At the 6 month follow up all the crown remained intact with no further carious lesions detected.

DISCUSSION

Early childhood caries remains the most prevalent form of dental caries in infants and children with an established multifactorial etiology, which affects the dentition of the child as it is in its phase of eruption.

The etiology of ECC is mainly attributed to a time-specific interaction of microorganisms with the substrate and the host. Diet and feeding practices also contribute in acquisition of the infection and development of caries. Factors such as high sugar intake, lack of oral hygiene, lack of fluoride exposure and enamel defects are some of the major factors responsible for the development of ECC.³ Hence there is a need for an increase in the awareness and knowledge of this condition amongst parents and caregivers.

Treatment of uncooperative, anxious children is always a major challenge for Pedodontists. General anaesthesia is the treatment of choice for such children, although an expensive one. This treatment modality is the most appropriate choice for performing a full mouth rehabilitation of the child’s dentition in a single visit.^4,5

According to a review article on the different aspects of General Anaesthesia in Paediatric Dentistry by Nahid Ramazani⁶ in 2016 dental rehabilitation under general anaesthesia offers certain advantages such as:

1. Providing effective and a safe mode of treatment in a hospital environment
2. Providing adequate pain control
3. No need of child co-operation
4. It is a more durable and sustainable treatment modality
5. The quality of oral health-life can be used as a method to measure the outcome of dental rehabilitation under general anaesthesia, as significant improvement in the quality of life has been noted following such treatment.

With the current evidence being in support regarding the usage of general anaesthesia for full mouth rehabilitation and our patient fulfilling the criteria with respect to this form of treatment, the choice of performing a full mouth rehabilitation procedure under general anaesthesia was made. The management consisted of, endodontic procedures, full coronal restorations, extractions, management of space, prosthetic, and aesthetic rehabilitation.

Stainless steel crowns were the first line of choice for full coronal restorations for 54, 64, and 74.

CONCLUSION

A Full mouth rehabilitation performed under general anaesthesia can enable children to embrace dental treatment in the future fearlessly and leave them in a position where they may be more amenable towards dental treatment. Thus, a child can benefit from the oral rehabilitation procedure in more than one-way, apart from the various dental benefits, oral rehabilitation also contributes towards the improvement of general and psychological well-being of patients.

REFERENCES