Rampant caries is a clinical condition defined by rapidly advancing dental decay on a majority of the teeth. Typically, when a patient presents to our office and there are substantial areas of decay on 1/3 or more of the teeth, we begin to get concerns that what we might be seeing is a case of rampant caries.
The theory behind this disease entity is suggests that open cavities retain large quantities of acid producing bacteria. Once levels of this type of bacteria get sufficient, the breakdown of tooth structure advances quickly.
High sugar consumption in the form of simple sugars and complex sugars can also exacerbate the condition. Very often, patient experiencing this type of decay will be found to have poor oral hygiene and consume significant quantities of soda or sweetened beverages throughout the day. The combination of acid producing bacteria left on the teeth in the form of plaque and a significant sugar source is bad enough, but the addition of carbonic acid (soda water) and / or citric acid (lemon juice) also lowers the pH of the mouth.
While our saliva has a unique ability to neutralize acids in the mouth, it takes saliva a time to achieve neutral pH status. Consuming soda every five or ten minutes throughout the day keeps this neutral pH environment from being established.
Teeth, being made from calcium, will breakdown in an acidic environment. In fact, our teeth's calcium structure is always in a state of flux. During acidic periods the calcium flows out from the tooth. When the oral environment neutralizes, calcium returns into the calcium matrix that makes up the teeth. As long as the outflow of calcium does not become too extreme, the matrix or structure of the tooth's enamel doesn't change. However, if too much calcium leaves the enamel matrix, the structure can begin to lose its crystalline form. Then when calcium salts in the saliva attempts to re-mineralize the tooth, it forms a chalky, amorphous looking enamel that is very opaque--unlike normal enamel which is somewhat translucent. This type of de-mineralized enamel which is called a "white spot lesion" is much more susceptible to decay. Further episodes of demineralization that get severe can easily cause cavitation to occur.
Rampant decay must be treated very aggressively if the battle is to be won. Typically, a dentist will resort to the following methodology to treat rampant decay:
1. Immediate evaluate the home care of the patient, give oral hygiene instruction, give the patient disclosing tablets to evaluate plaque control and ensure that flossing is instituted.
2. Immediately deploy prescription anti-microbial rinses, such a chlorhexidine gluconate. This will help to control the bacterial load and to helpfully change the type of bacteria that predominate the oral environment.
3. Once a month of chlorhexidine gluconate rinse is done, prescription fluoride gel is then employed 2 to 3 times a day. After good plaque removal has occurred, a strip of fluoride gel is placed on the brush and distributed over the teeth for one minute. Care should be taken to thoroughly spit out the excess fluoride, so little to none is swallowed.
4. Quick and methodic removal of decay must be instituted. Closing up large cavities with temporary fillings and quick treatment is essential to a successful outcome. Should open decay persist, new decay can arise on previously healthy tooth structure, so that treatment is never complete. In such cases the mouth deteriorates until all the teeth are lost.
5. Tight recall examinations and dental cleanings at 3 months intervals are in order. The use of sealants, topical fluoride and cavity varnish can also help.
Individuals suffering from rampant decay can easily acquire treatment plans with $10,000 or more in restorative treatment. Typically, insurance plans limit the benefits a patient can receive to a few thousand or less a year. Patients relying on insurance plans to pay for such significant portions of treatment when it comes to rampant decay are usually surprised just how little a normal dental insurance plan will pay for. Patients who are confronted with large treatment plans in association with rampant decay must begin to seek out some type of financing or have some financial resources to deal with the significant restorative care needed.
In short, good home care, limit sugars in the diet, add fluoride and work quickly to eliminate decay--this is the secret of success when dealing with rampant decay.
