Role of the comforter as an aetiological factor in rampant caries of the deciduous dentition.

This investigation has been stimulated by an apparent increase in the prevalence of rampant caries of the deciduous dentition amongst pre-schoolchildren in the London area. Although there is little universal agreement on a definition of rampant caries, it may be described as a lesion of acute onset involving many or all of the erupted teeth, rapidly destroying coronal tissue, often on surfaces normally immune to decay, and leading to early involvement of the dental pulp. The acute onset of the disease in the deciduous dentition is a notable feature, and occasionally parents are convinced that the teeth have erupted in a carious state. The initial lesion is usually seen within a short time of eruption on the labial surface of the maxillary incisors, close to the gingival margin, where it presents as an area of whitish decalcification or minimal pitting of the enamel surface. This area soon pigments to a light yellow coloration and at the same time extends in size laterally to the approximal surfaces and downwards to the incisal edge. At a more advanced stage, when the dentine is deeply involved, the carious process will often extend around the entire circumference of the crown, leaving only a small area of sound enamel at the incisal edge. Minimal trauma to the tooth at this stage, a frequent occurrence in the toddler, results in a 'pathological' fracture of the crown. Less commonly, the lesions commence on the palatal surfaces of the maxillary incisors, and, in a particularly florid case, they may decay during tooth emergence, with carious involvement of the incisal edges. It is this primary manifestation of the condition on the labial surface of the maxillary incisors that has given rise to the descriptive title of 'labial caries' by James, Parfitt, and Falkner (1957). Occasionally, at this stage, the carious process will undergo