Early Childhood Caries An insight

Contents
Introduction Definition Epidemiology and Prevalence Other names Classification Etiology & Risk factors Clinical features Prevention Conclusion References

Introduction

Definitions
(DeGrauwe et al., 2004).A great variety of definition and diagnosis of ECC is used worldwide, and a clear classification is still to be developed.
Abid Ismail (1998): ECC is defined as occurrence of any sign of dental caries on the tooth surface during first 3 years of life. (Carino et al., 2003).ECC has also been defined as the presence of any dmf teeth, regardless of being anterior or posterior.

Definitions Contd

Dury et al (1999): the presence of one or more decayed (non cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months age or younger.

Adopted by AAPD (2000)

Epidemology & Prevalence

>40% of children get caries before joining KG. (pierce et al 2002) While collective oral health , the prevalence from 24% to 28% for 2-5 yr olds. (dye et al)
England 6.8 12% and USA 11-53.1%

Epidemology & Prevalence

For 8 48 mnths old in India 44% (Joes & King 2003) Udupi 19.44% & Davangere 19.2% Among Europe, Africa, Asia, Middle east, North America

Epidemology & Prevalence

Filstrup SL, Briskie 2003
In USA, ECC is single most common chronic childhood caries.
X 5 common than Asthma X 7 common than Hay fever X 14 common than Chronic Bronchitis

Other Names for ECC

baby bottle tooth decay, early childhood caries, early childhood dental decay, early childhood tooth decay, comforter caries, maxillary anterior caries Tooth Clearing Neglect MDSMD Maternal Derived Streptococcus Mutans Disease.

Classification
Type 1 : Mild to moderate

Type 2

Moderate to severe

Type 3

Severe

S - ECC

< 3 years 3 through 5 age 3 age 4 age 5

Any sign of smooth surface caries 1 or more cavitated, missing or filled 1 max ant dmf 4 dmf 5 dmf 6

Etiology & Risk Factors

1 Factors

2 Factors

Keys Triad (1960)

Newburn (1982) modified Keys Triad

Colonization starts after eruption or before eruption of 1st tooth? (Tanner 2002, Berkowitz 2006)

Salivary flow rate Salivary viscosity Race and ethnicity Socio economic status Tooth brushing Cognitive factors Dental knowledge Stress Birth weight Chronic illness Host factors
Anatomic characteristic of the tooth Arch form Presence of dental appliance and restoration Composition

Factors

Risk Factors
The most important are probably
high-frequency intake of sugary snacks Frequent intake of drinks sweetened feeding bottles (night) Prolonged contact of enamel with human milk
Remineralization Demineralization

Nocturnal Breast Feeding

Noctunal Breast feeding nocturnal salivary flow lactose in resting saliva Prolonged contact than day time

Demineralzation

Breast Feeding and ECC

Breast Feeding for over 1year beyond tooth eruption may be associated with ECC (Valaitis et al 2000)

Low socio-economic status

Children of Low socio-economic status and of illiterate mothers have 32 times more risk than general population (drury et al 1999)

Disadvantaged Children

Maternal MS
levels of maternal salivary MS, the risk of infant being colonized.

Perinatal Nutrion (Horowitz 1998)

Low birthweight / systemic illness @ neonatal period
Enamel Hypoplasia

Undernutrition / malnutrition @ perinatal period

ECC

Clinical Features
Initial Lesion
Chalky white

As the lesion progressess

 Pattern of involvement follows the sequence eruption of 1 teeth. Usually symmetric

Mand incisors, 1 canines, 1 2nd molars are least involved. If mand incisors were involved indicative of Rampant caries or due to inappropriate use of pacifiers. (Ripa 1988, Tinanoff et al 1997)

Prevention

3 principal measures to prevent ECC: 1) Community-based measures 2) Professional measures and 3) Home-care measures.

Community based measures

Water Fluoridation National educational programs Community based oral health education programs
- Wider coverage of population - Lower cost - Reduce inequalities in childrens oral health

 Parents education Diet counseling

Topical fluoride if needed

Application of fissure sealants

Regular recalls
Motivational Interviewing. Preventive dental programs for mothers Use of anti-bacterial agents

 Elimination of cariogenic food items from the diet

Substitution with tooth friendly food Discouraging bottle feeding at night Falling asleep with pacifiers should be stopped Digital or baby tooth brushing as the teeth erupts Regular visit to dental clinic once in six months.

Dental Health Education DHE (in general)

DHE by professionals + Regular home visit Motivational Interviewing Fluoride tooth paste NaF tablets Counselling + Fluoride varnish applications (twice/yr) Fall-asleep-pacifier with 0.25mg NaF CHX varnish Topical application of 10% Povidone Iodine every 2 months Probiotic (among 3-4yr old) Maternal preventive dental health program Maternal use of Xylitol Gum (compared with CHX & F varnish)

AAPD Policy statement Prevention of ECC

1) Reducing the mothers/primary caregivers/sibling(s) MS levels (ideally during the prenatal period) to decrease transmission of cariogenic bacteria. 2) Minimizing saliva-sharing activities (eg, sharing utensils) between an infant or toddler and his family/cohorts. 3) Implementing oral hygiene measures no later than the time of eruption of the first primary tooth. If an infant falls asleep while feeding, the teeth should be cleaned before placing the child in bed. Tooth brushing of all dentate children should be performed twice daily with a fluoridated toothpaste and a soft, age-appropriate sized toothbrush. Parents should use a smear of toothpaste to brush the teeth of a child less than 2 years of age. For the 2-5 year old, parents should dispense a pea-size amount of toothpaste and perform or assist with their childs tooth brushing.

Comparison of a smear (left) with a pea-sized (right) amount of toothpaste.

AAPD Policy Statement Contd

4) Establishing a dental home within 6 months of eruption of the first tooth and no later than 12 months of age to conduct a caries risk assessment and provide parental education including anticipatory guidance for prevention of oral diseases. 5) Avoiding caries-promoting feeding behaviors. In particular: Infants should not be put to sleep with a bottle containing fermentable carbohydrates. Ad libitum breast-feeding should be avoided after the first primary tooth begins to erupt and other dietary carbohydrates are introduced. Parents should be encouraged to have infants drink from a cup as they approach their first birthday. Infants should be weaned from the bottle at 12 to 14 months of age. Repetitive consumption of any liquid containing fermentable carbohydrates from a bottle or no-spill training cup should be avoided. Between-meal snacks and prolonged exposures to foods and juice or other beverages containing fermentable carbohydrates should be avoided.

Conclusion

References
Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies (AAPD revised 2008) Guideline on Infant Oral Health Care (AAPD 2009) Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options (AAPD 2008)

Topical antimicrobial therapy in the prevention of early childhood caries: a follow-up report (Lydia Lopez, DDS, MPH Robert Berkowitz, DDS Charles Spiekerman, PhD Phillip Weinstein, PhD)

 The High Incidence of Early Childhood Caries in Kindergartenage Children (Jean-Marc Brodeur, DDS, MSc, PhD Chantal Galarneau, DMD, MSc, PhD) (JODQ 2006)
Importance of Early Diagnosis of Early Childhood Caries (Souad Msefer, DCD, DSO, Cert. Pedo.) (JODQ 2006) Prevention of Early Childhood Caries (ECC) (Daniel Kandelman, DDS, Nabil Ouatik, DMD) (JODQ supplement 2006) Pit and Fissure Sealants: An Important Adjunct in the Control of Childhood Caries Charles Dixter, BSc, DDS, Cert. Pedo. Aaron Dudkiewicz, BSc, DDS, Cert. Pedo. Irwin Fried, DDS, MS, Cert. Pedo, FRCD(C) Textbook of Pediatric Dentistry: Nikhil Marwah