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Management of Non-acute BBTD
Baby Bottle Tooth Decay (BBTD)
is the severe manifestation of Early
Childhood Caries, otherwise called S-ECC. There are
two main types of S-ECC, namely acute and non-acute. There are different
treatments available for both. This article brings out the important treatment
modes for non-acute BBTD or S-ECC.
• Conservative Treatment
Mostly the cases of non-acute S-ECC are without any symptoms. They will
not show any outward signs. The carious lesions will get arrested. So
in these cases, a therapy is unnecessary. Nevertheless, the caries must
be checked to ensure that they stay only in the non-proliferative stages
until exfoliation.
• Preventive Treatment
In all cases, prevention is better than cure. But it is the most toughest
of all jobs. In this case, a multifactorial approach is more suitable
for preventing S-ECC. The re-mineralization strategies are very important
to be followed every time. These strategies comprise of
1. Topical fluoride application
2. Diet counseling
3. Sugar-free chewing gums
4. Awareness and education regarding oral health
5. Professional application and benefits of fluoride varnishes
Upon employment of all these timely, prevention can be easier.
• Restorative Treatment
The main function of restorative treatment is to get rid of cavitations,
which toughens the job of plaque removal, thus encouraging extension of
caries. Restorative treatment must accompany preventive treatment all
the time, depending upon the child’s risk factors like age.
The selection of restorative materials is mainly based on the following
factors.
1. The site where the caries has developed and its extent
2. The cooperative ability of the child
3. The time or period when the restoration is needed to last
4. The type of analgesia employed in the treatment
The control of initial caries and its stabilization can be accomplished
by employing the following: (1) glass ionomer cement, (2) silver cement
or (3) zinc oxide eugenol cements. The most commonly employed materials
to re-establish the child’s primary teeth are dental amalgam, glass ionomer
cements, resin-based composites and stainless steel or nickel chrome extra-coronal
crown.
More widespread techniques and procedures in addition to the employment
of sensitive materials are available with general anaesthesia. Likewise,
maximum cooperation as well as moisture control can be attained. The restorative
treatment differs based on the selection of materials.
In case of the caries type being occlusal, in the initial stages, preventive
resin restoration or composites with better isolation can give good retention
as compared to glass ionomers. In the advanced stages,
1. Fissure sealant is not very effective, but caries into dentine must be
removed and later restored.
2. Amalgam, composites, composers or glass ionomers can be employed for
restoring cavities.
3. Amalgam is the best in case of more extensive caries, but the risk of
mercury related hazards are yet to be discovered.
4. Stainless steel crowns are very effective to especially restore deciduous
molars with extensive caries.
In case of approximal caries, in the initial stages, fluoride varnish can
help in slowing or stopping the progress of the lesions. In the advanced
stages, composite resin is apt for restoring small or moderate sized class
II cavities and amalgams or stainless steel crowns for more extensive ones.
In case of smooth surface caries, preventive
care is suggested rather than treatment. However, adhesive
materials can be employed owing to the cavities being wide and shallow.
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