Bottle caries – the group carious damage of milk teeth at children of early age caused by the wrong diet and insufficient hygiene of an oral cavity of the child. Bottle caries affects prisheechny areas of the top cutters and canines and there pass several stages: stage of demineralization, destruction of enamel, destruction enamel connections, deep defeat of solid tissues of tooth. Diagnosis of bottle caries is carried out by the children's stomatologist following the results of survey of an oral cavity of the child and existence of characteristic defeats. At early stages treatment of bottle caries can include performing the remineralizing therapy, silvering of teeth; in the started cases – processing and sealing of carious cavities.
Bottle caries - the early children's caries which is coming to light at children at the age of 1-3 years. Other names of early children's caries – "yaselny", "bottle", "kefiric", "feeding caries", "circular", etc. in a varying degree reflect age at which there is a disease, ways of its emergence and the nature of damage of teeth. The risk of development of bottle caries is directly proportional to duration of chest or bottle feeding of the child: so, at the children sucking a breast or a small bottle till 1 year, caries comes to light in 6% of cases; up to 1,5 years – in 25%; up to 2 years - in 38-40% of cases. The problem of early identification and treatment of bottle caries deserves the closest attention from children's stomatology and pediatrics in general as the complicated forms of pathology can cause damage and death of rudiments of second teeth.
Reasons of bottle caries
At the heart of bottle caries, as well as any other type of caries, focal congestions of bacterial flora which promote a fermentirovaniye of carbohydrates with formation of organic acids and to shift of acid-base balance in the sour party lie. These processes lead to damage of enamel and facilitate penetration of bacteria into dentinny tubules that leads to a softening and destruction of solid tissues of tooth.
Except the general reasons, in development of bottle caries the important role belongs to private factors, namely - to violation of a diet of the child of early age, low level of hygiene of an oral cavity, change of composition of saliva, decrease in protective forces of an organism, presence of chronic diseases at parents of the kid.
It is known that the children receiving natural or artificial feeding "on demand" longer than one year are more subject to development of bottle caries. At the same time especially negatively the night feedings of the child (a breast, mix or the sweetened drinks from a small bottle) promoting a congestion on teeth of the remains of food are reflected in a condition of milk teeth. After night feeding the child falls asleep at once, and for obvious reasons to it nobody cleans teeth. The small amount of saliva which is marked out during sleep is not capable to wash away the food remains, to neutralize bacteria and acids, to fill mineral composition of enamel. Thus, the wrong mode of feeding of the child in combination with lack of adequate hygiene of an oral cavity and hyposecretion of saliva during sleep play a starting role in development of bottle caries.
Besides the reasons of a local order, the contribution to formation of bottle caries is made by the easing of the general immunity connected with infectious diseases (a SARS, intestinal infection, an enteroviral infection, etc.), all-somatic diseases (diabetes etc.). Changes of the general immunity are always followed by decrease in saliva of concentration of immunoglobulins - specific local protective factors, interfere with reproduction of bacteria in an oral cavity. In turn, free development of pathogenic microorganisms, release of toxins by them and sour waste products cause increase in viscosity and decrease in pH of saliva. In acidic environment saliva does not perform the remineralizing function; together with it, calcium easily comes out a mineral component of tooth enamel that besides starts development of bottle caries.
Damage of teeth of the child of early age bottle caries is also promoted dental, gastrointestinal and the ENT SPECIALIST of a disease of parents who at close communication with the child "share" with it the microflora. Presence at parents of a dental plaque, caries, a periodontal disease, gingivit, tonsillitis, chronic gastritis and so forth leads to the fact that the child's organism from the first days of life faces high-virulent pathogenic microflora to which to resist it appears not in forces. Therefore to future mother it is extremely important even before conception or within the program of conducting pregnancy to eliminate all centers of a chronic infection which are available in an organism.
Classification of bottle caries
In dependence of depth and defeat on age of the child allocate 4 stages of bottle caries:
The initial stage (10 - 20 months) – is characterized by emergence on a vestibular and palatal surface of the top cutters of cretaceous spots – the enamel demineralization centers. In prisheechny area the whitish line distinctly is defined. Pain is absent. At this stage bottle caries can be diagnosed by the children's stomatologist only after drying of a surface of the affected tooth therefore parents often do not notice the outlined changes. When holding the relevant treatment-and-prophylactic activities further development of bottle caries at an initial stage can be suspended.
The stage of superficial caries (16-24 months) – is characterized by formation of defect within tooth enamel and a dentine exposure. Superficial caries affects not only prisheechny areas of cutters and canines, but also proximal and okklyuzionny surfaces of the top painters. The carious centers have light yellow or brownish color, there is a giperesteziya of teeth. Superficial bottle caries demands preparation and sealing of a cavity.
The stage of average caries (20-36 months) – is characterized by destruction of enamel and partially tooth dentine. Is followed by formation of the deep centers of defeat in area of the top cutters, superficial caries – on painters of the top jaw; initial caries – on painters lower and canines of the top jaw. At this stage performing treatment of average caries is required.
The stage of deep caries (30-48 months) – is characterized by defeat of enamel and the most part of dentine of cutters of the top jaw. Defeat of painters of the top jaw reaches a stage of average caries; canines and the second painters of the top jaw, and also the first painters of the lower jaw – superficial caries. At this stage of bottle caries the child suffers from a toothache, sleeps badly, refuses meal. The dental help consists in treatment of deep caries, according to indications – surgical or orthopedic treatment.
Symptoms of bottle caries
At bottle caries at the child first of all the top cutters and canines are surprised that it is connected with the sucking mechanism: at capture of a breast or a pacifier language of the child covers teeth of the lower jaw whereas the top foreteeth directly contact to food. Exactly here the dental plaque and the food remains more accumulates. At bottle caries pathological process extends tsirkulyarno, i.e. on a circle of a koronkovy part of tooth, mainly in the neck having the weakest mineralization.
Progressing of bottle caries is followed by formation of yellowy-brown and brown-black spots on teeth, hypersensibility of teeth to cold, hot, sour, sweet food, a toothache. Not esthetic type of foreteeth spoils a charming children's smile, and the persistiruyushchy infection can affect rudiments of second teeth. Owing to anatomo-physiological features carious process quickly extends not only on all surface of tooth, but also to the next teeth (multiple caries), and also deep into fabrics with development of a pulpitis and periodontitis. In the started cases bottle caries leads to premature loss of the first teeth.
Diagnosis of bottle caries
Bottle caries is distinguished on the basis of data of careful inspection of an oral cavity of the child by the children's stomatologist by means of a mirror and the probe. For increase in results of survey techniques of drying of a surface of tooth, a stomatoskopiya in ultra-violet light, vital coloring of teeth are used that does spots brighter and noticeable.
Serve as criteria of diagnosis: the age of the child is younger than 3 years, night feedings, primary damage of the upper 4-6 teeth, signs of insufficient hygiene of an oral cavity, etc. In need of diagnostics of complications of bottle caries the X-ray analysis of teeth is carried out.
Differential diagnosis of bottle caries needs to be carried out with anomalies of structure of tissues of teeth - imperfect amelogenez and a hypoplasia of enamel, and also other types of caries of milk teeth.
Treatment of bottle caries
Treatment of bottle caries at children of early age is the difficult task demanding establishment of contact of the doctor with the child, use of adequate anesthesia, is frequent – the general anesthesia.
At an initial stage of bottle caries the silvering method – putting the solution containing silver ions on the struck surface of tooth is applied. It is the temporary measure allowing to suspend progressing of bottle caries. However side effect of such preventive measures is the permanent coloring of teeth in black color resulting in unacceptable esthetic result. Therefore now children's stomatologists at this stage of bottle caries after preliminary professional hygiene of teeth carry out the remineralizing therapy - local applications of fluorinated medicines.
In stages of superficial, average and deep defeat complex treatment of caries is shown. At considerable destruction of milk teeth their removal or restoration by means of special metalcomposite or zirconium children's crowns can be required.
Forecast and prevention of bottle caries
Uncured bottle caries can lead to deterioration of life of the child, serious problems with second teeth. The teeth affected with bottle caries cannot perform in full the physiological functions that is followed by chewing process violation, gastrointestinal diseases, defects of the speech, violation of eruption of second teeth etc.
As measures of prevention of bottle caries serve the correct hygienic care of the first teeth of the child, feeding restriction with mixes and milk at night, timely transfer of the child to firm food, use of treatment-and-prophylactic toothpastes, regular visit of the children's stomatologist, since the moment of eruption of the first teeth.