Dental caries is a common chronic infectious disease resulting from cavity-making bacteria that break down sugars to produce acid, which gradually breaks down tooth structure.1 Caries can affect a few teeth at a time but since many factors impact its spread, it can be silent and rapid in its progression. Cases where progression is rapid and affects more than ten teeth it is called “rampant caries”.2
Rampant caries are defined as an instantaneously forming, widespread, rapid excavating type of tooth decay that causes exposure of the nerve within the pulp.3
Types of rampant caries
- Nursing bottle rampant caries - Present in infants or early childhood it is known as nursing bottle caries
- Adolescent rampant caries - Rampant caries occurring in adolescent age is called adolescent rampant caries. Some children habitually put toffees, chocolates, and biscuits in their mouths overnight and sleep. Adolescent rampant caries has the same pattern as that of rampant caries
- Xerostomia-induced rampant caries (Dry mouth) - Decreased function of the salivary gland is the main cause of xerostomia-induced rampant caries.4 Adults and the elderly are affected by this form of rampant caries which can be caused by ageing, radiation therapy, or certain medications5
Causes of rampant caries
In infants (early childhood)
Putting a baby to sleep whilst bottle feeding with formula is the main reason for rampant caries in infants. Toddlers develop rampant caries when they drink formula milk, milk, or fruit juice in a bottle or a sippy cup before falling asleep and going to bed.
This is also known as baby bottle tooth decay or nursing bottle caries. Formula milk contains sugary contents which get broken down by the bacteria to release acid. The acid leads to demineralization (breakdown of the hard tooth structure) and cavity formation. Cavities on the teeth look like brownish discolouration. Upper front teeth are affected more than the lower ones as these are protected by the tongue.5,6
In adolescents (adults)
The main cause of rampant caries are consumption of high-sugar and very acidic drinks. Multiple cavities may be a sign of poor nutrition in adults. Teenagers must increase their intake of water and limit their sugar consumption along with daily brushing habits.6
In xerostomia (dry mouth)
Dry mouth and low saliva are the main reasons for rampant caries in older adults. As saliva flow decreases with age, the natural cleansing process is reduced, and the chances of getting cavities increase.6
Signs and symptoms of rampant dental caries
Rampant caries refers to more than ten teeth being affected by tooth decay. Rampant caries is defined as a rapidly progressing, widespread, tooth decay. The upper teeth often show the telltale signs of discolouration and loss of tooth structure.5
Below are the images of rampant caries in children and adults.4,7
Management and treatment for rampant caries
Prevention of nursing bottle caries
- Do not give a bottle of formula milk or juice during bedtime or nap time
- Avoid nursing before bedtime, and provide them with water in a bottle
- While bottle-feeding avoid high-sugar or synthetic milk
- Do not make a habit of sweet or sugar solution-containing pacifiers
- Instead of bottles make a habit of drinking from a cup as it reduces the direct contact of liquid with the front teeth
- Focus on brushing and good oral hygiene
- Wiping an infant's gum with wet cotton or cloth can be beneficial
- Taking dentist guidance for prophylactic varnishes (caries vaccine) has a significant role in the prevention of caries
Treatment
- Cavity filling with fluoride-releasing cements
- Extraction of teeth with very large cavities
- Restoration with prosthesis after extraction7,10
Prevention of adolescent rampant caries
- Overlooking the prevention and treatment of caries in children can lead to rampant caries in adolescent
- Maintain a low-sugar diet
- Avoid sugar-containing soft drinks
- Breaking the habit of putting toffees, chocolates, and biscuits in the mouth before bedtime
- Brush twice daily and maintain good oral hygiene
- Use of fluoride containing toothpaste and varnish
Treatment
- Restore non-cavitated white lesions on the tooth surface by applying a resin filling material combined with fluoride treatment
- Restorative treatment with suitable material according to the progress of the caries
- Removal of the tooth with a very large cavity that cannot be restored5,7,8
Prevention of xerostomia-induced rampant caries
- Do not use alcohol-containing mouthwash as it can cause further drying of the mouth
- Minimize coffee intake
- Stop smoking
- Avoid sugar, acid-containing food and drinks
- Brush teeth twice daily and maintain oral hygiene
- Use xylitol-containing mouthwash
- Apply prescription-strength fluoride gel to prevent tooth decay
- Use a saliva replacement agent to provide moisture in the mouth
Treatment
- A dentist will recommend fluoride-containing toothpaste, dry mouth gel, medicated mouth rinse, and sugar-free gum (to increase the flow of saliva)9,11,12
FAQs
How can I prevent rampant caries?
It is prevented by limiting the consumption of sugar and acid-containing food and beverages. Maintaining good oral hygiene. Yearly dental checks are recommended.
Who is at risk of rampant caries?
Infants and young children are at risk of rampant caries due to bottle-feeding habits at night and bedtime. Keeping sugar-containing chocolates and toffies in the mouth for long periods of time makes them more prone to rampant caries. Primary teeth (milk teeth) have low strength which makes them more prone to rapidly progressing tooth decay caries progress rapidly.
What can I expect if I have rampant caries?
Rampant caries mostly affect the upper front teeth, this can cause much embarrassment. The process causes discolouration and weakening of the tooth structure which leads to the breaking of the teeth.
When should I see a doctor?
You should see a doctor as soon as you observe a small brownish pit-like lesion on your upper front teeth.
Summary
Rampant caries is a condition which can occur at any age. However, infants and young children are more susceptible to it due to their dietary habits. Since it is a rare condition, the chances of getting affected are very low. Different preventive measures apply to every age group. Good oral hygiene including brushing twice daily, flossing, and low sugar-containing dietary habits can prevent the condition.
Rampant dental caries involves esthetic, functional and psychological problems. Treatment requires motivation and cooperation from the patient as dietary and lifestyle changes are essential to prevent further progression of the disease. Functional and aesthetic restoration is time consuming and expensive. Proper diagnosis, treatment planning, and systematic execution of the treatment plan will result in excellent clinical results.
Professional dental treatments like restorative modalities, fluoride application on smooth surfaces of the affected teeth, and pit and fissure sealants, are the most effective dental strategies with proven efficacy in the clinical setting.
References
- Rathee M, Sapra A. Dental caries. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Dec 21]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK551699/
- Rampant caries: causes, risk factors, and management - ezza dental care [Internet]. 2021 [cited 2023 Dec 21]. Available from: https://ezzadentalcare.com/caries/
- Anil Kumar S, Radhakrishnan V, Sandhu HS, Sahoo NK. Full mouth rehabilitation of a case of rampant caries using a twin-stage procedure. Med J Armed Forces India [Internet]. 2015 Dec [cited 2023 Dec 21];71(Suppl 2):S429–34. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705153/
- Namita, Rai R. Adolescent rampant caries. Contemp Clin Dent [Internet]. 2012 Apr [cited 2023 Dec 28];3(Suppl1):S122–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354805/
- Rampant caries - what are they? | colgate® in [Internet]. [cited 2023 Dec 28]. Available from: https://www.colgate.com/en-in/oral-health/cavities/rampant-caries-what-are-they
- Jain DA. Rampant dental caries in children from 2-5 years of age [Internet]. scanO (formerly DentalDost). 2019 [cited 2023 Dec 28]. Available from: https://scano.app/rampant-dental-caries-in-children/
- Dental A. Early childhood caries treatment & tips | alux dental [Internet]. Alux Dental - Best Dental Hospital In Hyderabad | Dental Clinic. 2019 [cited 2024 Jan 4]. Available from: https://aluxdental.com/early-childhood-caries/
- Online open access dental magazine, journal, publication, dentistry journal [Internet]. [cited 2024 Jan 4]. Available from: https://www.guident.net/articles/endodontics/MANAGEMENT-OF-ADOLESCENT-RAMPANT-CARIES-THROUGH-ESTHETIC-ENDO---RESTORATION-.html
- Xerostomia and dental caries and how to treat - dion health [Internet]. [cited 2024 Jan 4]. Available from: https://www.dionhealth.com/blog/xerostomia-and-dental-caries-and-how-to-treat
- Rampant caries | effective solution | city dental hospital # 1 [Internet]. 2021 [cited 2024 Jan 6]. Available from: https://www.rajkotdentist.com/effective-solutions-for-rampant-caries/
- Xerostomia(Dry mouth) [Internet]. [cited 2024 Jan 7]. Available from: https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/xerostomia
- Dry mouth treatment: how your dentist can help | colgate® [Internet]. [cited 2024 Jan 7]. Available from: https://www.colgate.com/en-us/oral-health/dry-mouth/dry-mouth-treatment-how-your-dentist-can-help