Definition

of ECC and sECC Other names previously used Etiology of ECC Clinical appearance of ECC Epidemiology of ECC Complications of ECC Management of ECC

Presence of 1 or more Decayed (cavitated or non-cavitated) Missing due to caries Filled tooth surface In any primary tooth in a child of 71 months of age or younger

*Any sign of smooth surface caries in child younger than3 years of age *From age of 3 through 5 the presence of decayed, missing and filled tooth surface in any primary teeth. *DMF4 at age of 3 DMF5 at age of 4 DMF6 at age of 5

-Nursing bottle syndrome - Nursing bottle mouth - Nursing mouth decay - Nursing caries - Bottle propping caries - Milk bottle syndrome - Baby bottle tooth decay (bbtd) - Baby bottle mouth

For many years , it has been recognized that after the eruption of 1st primary tooth begins, exclusively bottle feeding and/or prolonged bottle or breast feeding is associated with nursing bottle caries as sever form of caries.

However recognizing that this clinical presentation was not consistently associated with poor feeding practices and that caries was an infectious disease

AAPD adopted the new term Early Childhood Caries (ECC) (during the 1998 NIH sponsored ECC conference)to reflect better its multifactorial etiology

It is a multifactorial , complex disease resulting from imbalance of multiple risk factors and protective factors over time.

Cariogenic bacteria

Susceptible host

Cariogenic diet

Saliva

Mutans streptococci especially streptococcus mutans and streptococcus sorbinus as they can colonize tooth surface and produce acids at a faster speed than capacity of neutralization of biofilm in an environment below critical enamel PH(5.5) The severity of ECC is directly related to early establishment of MS in infants Caries is a transmissable , infectious disease understanding acquisition of cariogenic micro-organisms is necessary to improving preventive strategies

Vertical transmission Horizontal transmission

From caregiver (mother) to the child The major reservoir from which children acquire cariogenic bacteria is their mother saliva. So ECC is also known as maternally Derived Streptococcus Mutans disease (MDSMD)

The success of transmission and resultant colonization of maternal MS may be related to several factors Magnitude of inoculum Frequency of small dose inoculum . Minimum infective dose
Infants whose mothers have high level of MS(result of untreated caries)are at a higher risk of acquiring MS earlier than others.

This also may occur by transmission of MS from members of family or group of daycare due to sharing of saliva contaminated objects

Sucrose is most important type as it turns non cariogenic and anti-cariogenic food into cariogenic (caries producing)

Experimentally human milk have been proven not to be cariogenic because: it doesnt decrease PH of oral cavity significantly in breastfed infants it promotes enamel remineralization Single exposure isnt the problem but frequent , prolonged contact of these substances is a major problem.

ECC is associated with inappropriate feeding pattern: child is put to sleep at afternoon nap times or at night with a nursing bottle holding milk or sugar containing beverages . child fall asleep (salivary flow decreased during sleep & clearance of liquid from oral cavity is slowed) and the liquid become pooled around teeth which provide an excellent culture medium for acidogenic MS. Also prolonged use of pacifier dipped in honey

There are some risk factors such as: o yet immature post-eruptive enamel o Presence of enamel defects (enamel hypoplasia) o Morphology & genetic characters of teeth o crowding

 It

is the major defense system of host against caries through: I. Flow of saliva (that remove food and bacteria). II. Buffering capacity (against acid produced) III. Mineral reservoir of calcium and phosphate ions (for enamel remineralization). IV. Contain antibacterial substances. these factors decrease during sleeping thus increasing tooth susceptibility to caries. Any disease affecting the flowabilty or viscosity of saliva has an impact on incidence of caries

Typical and follow a definite pattern where there is early carious involvement of: upper anterior teeth. upper and lower primary 1st molar. sometimes lower canine.(following sequence of primary teeth eruption) Mandibular anterior teeth are un affected as they are mostly protected by tongue and saliva from mandibular salivary gland

Early onset of caries attack ,or may appear years after stoppage of bottle/breast feeding. May be more sever unilaterally depend on which side child sleeps.

It is a specific form of rampant decay of primary teeth.

Rampant Caries Definition

ECC

Suddenly appearing wide spread Type of rampant caries. affect immune surface of teeth Presence of one or more resulting in early pulped involvement. decayed, missed (due to caries) or filled in child 71 months.

Etiology

Still not known

Nursing habits.

Onset
Distribution Teeth affected

Affect any age

Bilateral All teeth affected Even immune areas-lower ant)

Affect children under 6 years.

Can be unilateral Most affected maxillary anterior Lower anterior not effected.

TINATOF,1997,confirmed that children with parents in lower income group had mean dmf 4 times those whose parents are in a higher income groups Ismail ,2003 found that socioeconomic status can have an impact on environment, availability of food , access to proper health care and education of children and parents about oral health

RAMOS-GOMEZ ET AL 2OO2,found strong inverse relation between mothers level of education and presence of ECC as subjects demonstrated prolonged feeding habits because their mothers indicated that they dont know when weaning should occur.

In developing countries , ECC is a critical problem due to increase of other factors as: -low economic -mal nutrition -decreased level of education Which lead to increased prevalence to reach as high as 70%

Untreated caries may lead to - pain - loss of school days and increased days with restricted activities. -dental infection may lead to life threatening facial spaces which result in medical emergencies requiring hospitalization and antibiotics. - early loss of primary dentition. - affect speech articulation -malnutrition and GIT disorders - decreased self esteem (weintraub,1998)

1. 2. 3. 4. 5. 6. 7. 8.

Alter feeding and eating habits Delay colonization of teeth Ensure adequate fluoride Establish dental care Application of dental sealant Follow up Behavioral and educational programs Use of xylatol

A- practice: Investigators recommend that from birth the infant should be held while feeding( the child who fall asleep should be burped & then placed to bed . AAPD discourage breast/bottle feeding after 1 year of age.

If the nursing habit is discontinued at 1.5-2 years of age, newly erupted canines and 1st primary molars Minimally or not affected erupted 2nd molar not effected.

B-frequency of feeding: AAPD states that frequent feeding at night and frequent use of spill proof drinking cups is associated with ECC AAPD recommend that : - infants should not be put to bed with baby bottle -ad libitum breast feeding at night should be avoided after eruption of first tooth. Parents cant stop feeding their children nutritious food but they can regulate when & how often they are exposed to sugar hits

C-choosing healthy food: -AAPD endores policy of AAP on breast feeding and use of human milk as breast feeding ensures *best possible health *best development and psychological outcome for infants -AAPD no longer include breast feeding among cariogenic factors

Use only water in the bottle during nap or bed time Diet counseling help parents change their children diatry behaviors to favor low or noncariogenic snacks & limit sweet food to meal times . such recommendations must be realistic and based on family diatry behaviors*

-suppressing maternal reservoir of MS via dental rehabilitation and anti microbial treatment can prevent or delay infant inoculation . ideally those intervention would be initiated in prenatal period. Also mothers should be instructed to avoid sharing spoon with child and use water to clean a pacifier instead of cleaning it in her mouth

Systemic fluoridation: Community water fluoridation is the most important type as it is effective, can reach people of different socioeconomic status, safe and of low cost. Topical fluoridation: -home applied as using fluoridated tooth paste and mouth rinses* -professionally applied as fluoride varnish*( ADA recommendations of twice a year for moderate caries risk children and 4 times a year for high risk ones

A- anticipatory guidance: ECC can be prevented by parents early counseling i.e. children should receive their 1st dental examination between 6 & 12 months when sECC is not likely to have developed so that parents should be educated to practice good oral hygiene measures for their children and avoid inappropriate feeding habits also this help identify infants who are most at risk of ECC and apply early preventive intervention

B- improve oral hygiene: Fluoridated tooth paste :* -MARINHO ET AL.2003 stated that it is the most cost-effective way in the prevention. -used twice daily, with amounts appropriate to the age, specially before bed so that a high concentration of fluoride in saliva is maintained for longer period. Flossing should be started as soon as contact between teeth is achieved

C-definitive treatment of existing disease: Depending on progression of caries , there are various disease states of which each require appropriate treatment 1-very early sign of beginning of teeth demineralization: typically visualized as chalky white spots or lines

Reversible , caries progression can be avoided with proper care (fluoride application and diet changes)

2- once the teeth become cavitated restoration or fillings are required* 3-significant Decay 4-pulp involvement more serious treatment as SSC or veneers

Pulp therapy or extraction+ space maintance

To perform treatment safely , effectively and efficiently , the practioner caring for child with ECC often employ advanced behavior guidance techniques . these may include protective stabilization and/or sedation or general anesthesia.

Occlusal pits and fissures sealant professionally applied to act as a physical barrier between tooth surface and food debris and bacteria It is applied on newly erupted molars of older children ( at age of 6) Sealants dont protect against ECC which occur from birth to 71 months it only protect against future caries in the permanent dention

AAPD recommend dental check up at least twice a year for most children and more frequent visits for other children as needed. This will help to: -evaluate effectiveness of control program -asses oral hygiene -asses improvement of dietary habits -detect and restore carious lesions. - Topical application of fluoride

7-behavioral and education programs

WEINSTEIN,1998,stated that providing parents with information ,especially about benefits of changing parental practices will help some of them to be open to possibility of changing Also educating parents self-examination techniques on children will help to determine decay in children teeth which is important secondary prevention.

Programs should focus on educating adults because young children are dependent on adults (parent or caregiver) for their daily needs behaviors to prevent ECC truly rest on the responsibility of adults and how much they are willing to make changes

In a comprehensive report prepared for oral health sub committee of healthy mothers-healthy babies coalition , Ripa states : Priority needs to be given to a major national educational program directed toward educating the public about ECC The educational program must involve direct contact with pregnant women , parents and caregivers in population subgroups with high ECC prevalence

a study by THORILD ET AL, 2006, found that: The transmission of MS from highly colonized mothers to their off springs could be delayed or stopped by maternal use of xylitol containing chewing gum during period of eruption of primary teeth.

McDonald and Averys dentistry (ninth edition)

WWW.ADA.ORG www.aapd.org www.cda.org Journal of young investigators Principles of pediatric dentistry Wikipedia , the free encyclopedia