Severe ECC with Soft Tissue Involvement

Brown cavitations occur where enamel is destroyed and the underlying dentin exposed. The infection can then spread through the root of the tooth which contains nerves and then progress into the surrounding soft tissues.

Appearance & Symptoms

  • Multiple dark cavities appear in anterior and posterior teeth
  • Abscesses and draining fistulae
  • Patients may experience pain

Treatment & Referral

  • Urgent dental referral for comprehensive treatment including extractions and/or silver crowns
  • Dietary and oral hygiene counseling
  • Use of fluoride to prevent development of new lesions

Children with severe ECC and soft tissue involvement require extensive dental treatment. Cooperative young children with severe decay may be able to have work done in the dental chair under the care of a dentist skilled in behavior management. Younger and less cooperative children will most likely require treatment in the operating room under general anesthesia with increased risk and cost.

Exposed dentin of maxillary incisors with abscess formation and fistula above the right central incisor


Exposed pulp (pulp polyp) in the right central incisor


Joanna Douglass, BDS, DDS