Rampant Caries: What It Is and What It Isn't

This article provides a concise overview of the historical development,
epidemiology, diagnosis, and management of rampant caries, with particular
attention to its continued relevance in public oral health and high-risk
populations. We discuss how the term has evolved from its original use in
paediatric dentistry to encompass severe and rapidly progressing patterns of
dental decay affecting medically, socially, and behaviourally vulnerable
groups, including individuals with substance dependence, chronic disease,
disability, or limited access to dental care. We also examine the limitations of
existing epidemiological data due to inconsistent diagnostic criteria and
highlight the importance of recognising aggressive patterns of disease
progression that extend beyond conventional caries classifications.

NEW DEFINITION OF RAMPANT CARIES

A central contribution of this article is an updated operational definition and
classification framework for rampant caries. Although the term is sometimes
regarded as historical or poorly standardised, we argue that it remains
clinically and publicly relevant because it identifies patients with extensive
disease burden and urgent treatment needs. The proposed classification
emphasises both disease extent and lesion distribution rather than relying
only on total caries counts. In children and adolescents, the definition includes
involvement of multiple maxillary incisors, reflecting the characteristic
pattern seen in severe early childhood disease. In adults, it identifies
widespread caries affecting multiple teeth, particularly when smooth-surface
lesions are present in recognised high-risk groups.

From an operative perspective, our definition of “rampant” caries based
on a single dental inspection includes dental caries affecting: 1. two or
more maxillary incisors in children and adolescents 2. five or more teeth
(or 15% of teeth in partially edentulous patients) including at least two
teeth with caries on smooth surfaces, in adults from at risk groups.

By introducing a pragmatic and clinically oriented definition, the article
supports improved triaging, public health prioritisation, epidemiological
consistency, and management of patients with severe destructive caries
patterns.