1. AAPD. Policy on early childhood caries (ECC): classifications, consequences and preventive strategies. [retrieved Nov 1, 2012] Available from:http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.pdf.
2. AAPD. Guidelines on infant oral care. [retrieved Nov 1, 2012] Available from: http://www.aapd.org/media/Policies_Guidelines/G_InfantOralHealthCare.pdf.
2. AAPD. Policy on early childhood careis (ECC):classifications, consequences and preventive strategies. [retrieved Nov 2, 2012]; Available from http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.pdf3. Siew C, Strock S. Assessing a potential risk factor for enamel fluorosis. J Am Dent Assoc. 2009 Oct;140(10):1201-1328.
Picture provided by Bryan William, DDS
Picture provided by University of Washington
Picture provided by Bryan Williams, DDS
University of Washington
University of Washington
Kevin J. Hale, DDS
Statement by Carol Berkowitz DDS, past president of the AAPD
Early Childhood Caries
Early Childhood Caries (ECC) ALLISON RESTAURI, RDH, BSDH EDU 653 11-03-2012
Purpose Explain what ECC is in scientific terms Provide background information Provide statistics Explain ECC in layman terms Provide strategies to reduce ECC In a dental setting Daycare/Head Start program Tips for caregivers
Learning Objectives Learner will be able to explain ECC Learner will be able to provide strategy recommendations for caregivers Learner will realize that ECC is at epidemic levels Learners will be able to recognize ECC on photos
AAPD Definition of ECCCaries is a biofilm (plaque)-induced acid demineralization of enamel or dentin, mediated by saliva. The disease of early childhood caries (ECC) is the presence of 1 or more decayed(noncavitated or cavitated lesions), missing (due tocaries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger. In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). 1
What to tell the caregiver Germs (plaque) not removed AND repeated food/drink = decay Bottles in Bed Filled with Anything Except Water Sipping onFrequent Snacks: Sweet Liquids Sugary, Sticky, in Bottles or Starchy Sippy Cups
ECC epidemic! The Centers for Disease Control and Prevention (CDC) report that dental caries is possibly the most prevalent infectious disease in United States children and 40% of children have caries by kindergarten.1 The general population as a whole is affected by caries, but infants of low socio-economic status, whose diet is high in sugar and whose mothers have minimal education are thought to be 32 times more susceptible to caries. 1
ECC epidemic cont’d! The decay rate among 2-5 year olds, especially in minorities and individuals with a lower income, are going untreated and the lack of prevention is increasing. This problem is cumulative and the untreated decay of primary (baby) teeth can lead to lack of physical development in height and weight, lack of ability to learn, and increased treatment costs.2 The oral condition of the primary teeth is a strong predictor of decay in permanent (secondary) teeth.3
Transmission Streptococcus mutans are the primary microbiological agent in the disease. The disease process begins with thetransmission of the bacteria to the child, usually from the primary caretaker, or mother. Mothers with untreated dental disease present a very high risk to their children. Any mother at a high or moderate caries risk can spread Streptococcus mutans to their child under the age of 3.4
Prevention at home Daily: Monthly: Oral Health Routine “Lift the Lip” WDSF WDSFWipe infant’s gums & tongue. Check for white spotsBrush when first teeth appear or anything unusual.
Dental Visit by their First Birthday! Fluoride VarnishKnee to Knee exam University of Washington
Education for Caregivers Dental appointments B4 their first birthday Daily mouth care Healthy foods and drinks “Lift the Lip” Early Childhood Caries info NO sippy cups! Fluoride/MI Paste Caregiver needs good oral hygiene
Tips for Daycare/Head Start Use gauze or a washcloth to Serve tooth-healthy wipe infants’ gums and meals and snacks. tongues after feeding. Watch for children with Brush toddlers’ teeth after dental problems. meals or snacks. No toothpaste until child can Refer families to dental spit it out. providers.
A Better ApproachPreventive rather than Reactive
General Oral Hygiene Assessment No Plaque Plaque Compliance DietNoInflammation Performance Non-Inflammation Brushing Compliance
Risk Groups for Dental Caries Children with special health care needs Children of mothers with a high caries rate Children with demonstrable caries, plaque, demineralization, and/or staining Children who sleep with a bottle or breastfeed throughout the night Later-order offspring Children in families of low socioeconomic status
Prevention Plan Providing how to advice rather than just telling the patient to change a behavior will be helpful in achieving the desired changes, therefore decreasing the patient’s caries risk. Assessing the patients’ caries risk will assist the clinician in providing a comprehensive, customized prevention plan.
Key Points Dental visit by the child’s first birthday Knee to knee exam, if needed EDUCATE the caregivers Provide small amounts of background info Provide SOLUTIONS Evaluate the child’s risk Evaluate the caregiver’s risk factors Provide a PERSONALIZED PLAN for prevention and treatment, if needed.
Take Away Message Early intervention plays a pivotal role in the prevention of early childhood caries. The dental team needs to work with pediatricians to educate parents, primary caregivers and the general public regarding the importance of maintaining healthy “baby” teeth. ECC is more than unhealthy “baby” teeth, it the first signs of an unhealthy child and the general population needs to be aware that ECC can affect the child’s quality of life. 5“The mouth is the gateway to the body and if the mouth is not healthy, the rest of the body is not healthy either.” Carol Berkowitz, DDS
References-(notes on PPT)1. AAPD. Policy on early childhood caries (ECC): classifications,consequences and preventive strategies. [Retrieved Nov 2, 2012];Available from:http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.pdf.2. AAPD. Guidelines on infant oral care. [Retrieved Nov 2, 2012]; Availablefrom:http://www.aapd.org/media/Policies_Guidelines/G_InfantOralHealthCare.pdf.3. Siew C, Strock S. Assessing a potential risk factor for enamel fluorosis. JAm Dent Assoc. 2009 Oct;140(10):1201-1328. AAPD. Policy on use ofcaries-risk assessment tool (CAT) for infants, children and adolescents.[Retrieved Nov 1, 2012]; Available from:http//www.aapd.org/media/policies_guidelines/p_cariesriskassess.pdf.
References cont’d-(notes on PPT)4. ADA. Statement on early childhood caries. [Retrieved Nov 2, 2012];Available from:http://www.ada.org/prof/resources/positions/statements/caries.asp.5. Berkowitz, C. Calgary’s child magazine. [Retrieved Nov 3, 2012];http://www.bluetoad.com/display_article.php?id=571543.
Picture References-(notes on PPT) University of Washington-slide #10, 13, 14 Bryan Williams, DDS-slide #9, 11 Kevin J. Hale, DDS-slide #18