Early childhood caries (ECC) as the presences of one or more decayed (noncavitated or cavitated), missing (as a result of caries), or filled tooth surface in any primary tooth in a child 71 months of age or younger.

1. Early Childhood Caries
Dr. Alvi Fatima
Jr I
Department of Pediatric and Preventive Dentistry
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2. Content
Definition of Early childhood caries
Terminologies for Early Childhood Caries
Classification of Early childhood caries
Developmental stages of Early childhood caries
Primary etiology risk factor of Early childhood caries
Secondary risk factor of Early childhood caries
Clinical features
Prevention of Early childhood caries
Management
Barriers in Early childhood caries
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3. Definition
The American Academy of Pediatric Dentistry (AAPD)
defines Early childhood caries (ECC) as the presences
of one or more decayed (noncavitated or cavitated),
missing (as a result of caries), or filled tooth surface in
any primary tooth in a child 71 months of age or
younger.
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4. The AAPD also specifies that, in children
younger than 3 years of age, any sign of
smooth-surface caries in indicative of sever early
childhood caries
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5. Davies (1998)- complex disease involving maxillary
primary incisors with in a month of eruption and spreading
rapidly to other primary teeth is called childhood caries.
Abid Ismail (1998) – early childhood caries is defined as
occurrence of any sign of dental caries on the tooth
surface during first three years of life.
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6. Terminologies
1) Nursing bottle caries
2) Baby bottle tooth decay
3) Nursing bottle syndrome
4) Milk bottle syndrome
5) Tooth clearing neglect -Moss ( 1996)
6) Infant and Early childhood dental decay – Horowitz
7) Early Childhood Caries –Davies (1998)
8) MDSMD – Maternally Derived Streptococcus Mutans Disease
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7. Classification of Early
Childhood caries - by Wayne H
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8. Type I
Mild to moderate
Existence of isolated caries lesions involving molars and
incisors
Number of carious teeth increase as cariogenic challenge
persists
Cause is usually a combination of cariogenic semi solid
food and lack of oral hygiene
Seen in 2-5 years old
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9. Type II
Moderate to severe
Labiolingual carious lesion affecting maxillary incisors
Mandibular incisors are not affected
Use of feeding bottle or at will breast feeding or a
combination of both with or without poor oral hygiene
Seen soon after eruption of teeth
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10. Type III
Severe
Carious lesion involve almost all the teeth including
mandibular incisors
Usually seen in 3-5 years of age
Cause is a combination of factors and a poor oral
hygiene
Rampant in nature and involves immune tooth surface
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11. DEVELOPMENTAL
STAGES OF ECC
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12. Stage 1
Clinical stage –
Irreversible stage
Age – 10-18
months
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13. Features –
Cervically and occlusionally
interproximal areas of chalky white
dimineralization
No pain
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14. Stage 2
Clinical Stage -
Damaged carious
stage
Age - 18-24 months
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15. Features –
lesion in maxillary anterior teeth,
may spread to dentin and show
yellowish
pain on having cold food items
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16. Stage 3
Clinical stage- deep
lesions
Age 24-36 months
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17. Features
Depending on time of eruption, carogenicity of
sweetener and frequency of its use, this stage
can be reached in 10 -14 months also
Molars are also affected
Frequent complaint of pain
Pulpal involvement in maxillary incisors
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18. Stage 4
Clinical stage
Traumatic stage
Age - 36-48
months
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19. Featues –
teeth become so weakened by caries that
relatively small force can fracture them
patient may report a history of trauma
molars are now associated with pulpal
problems
maxillary incisors becomes non vital
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20. 20

21. Primary etiology risk factor
of Early childhood caries
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22. Dental plaque
Mutans streptococci
Infant feeding pattern
Tooth brushing
Salivary factor
Sugars
Oral clearance of carbohydrates
Bovine milk
Human milk
Fluoride
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23. Secondary risk factor of
Early childhood caries
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24. Immunological factor
Tooth maturation and defects
Race and esthetics
Acid fruit drinks
Socioeconomic status
Dental knowledge
Strees
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25. Etiology
Bovine milk, milk formulas, and human breast milk have
all seen implicated nursing caries because of their lactose
content
Basic mechanism of demineralization is same and caries
tetralogy is key in whole process(microbes, substrates,
host, time)
Pathogenic microorganism- streptococcus mutans
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26. Steptococcus mutans
Main microbe that colonizes teeth after it erupts into oral
cavity.
It is transmitted to infant’s mouth through mother.
It is more virulent because
It colonizes the teeth
It produces large amount of acid
It produces large amount of extracellular
polysaccharides that favor plaque formation.
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27. Substrate (fermentable carbohydrate)
Carbohydrates are converted into
dextrans by microorganisms.
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28. In infants & toddlers, the main sources of fermentable
carbohydrates are
1. Bovine milk or infant formulas
2. Human milk (breast-feeding at will)
3. Fruit juices & other sweet liquids
4. Sweet syrups like vitamin preparations
5. Pacifiers dipped in honey or sugar solution
6. Chocolates or other sweets
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29. Host
Teeth act as host for microorganisms
Hypomineralisation or hypoplasia of teeth increases
the susceptibility of child to caries
Thin enamel in primary teeth is one of the reasons for
early spread of lesions
Developmental grooves also may act as plaque
retentive areas
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30. Time
More the time child sleeps with bottle in the mouth the
higher is the risk of caries because the salivary flow and
the swallowing reflex decrease.
Thus providing more time for accumulation of
carbohydrates in the mouth which are acted upon by
microbes to produce acid leading to caries.
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31. Other predisposing factors
Overindulgences of parents
Crowded homes
Child who has less sleep
Malnutrition
Iron deficiency
Low birth-weight infants (less than 2500g)
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32. Clinical features
A. Maxillary central incisors: facial, lingual, mesial, distal surfaces
B. Maxillary lateral incisors: facial, lingual, mesial, distal surfaces
C. Maxillary 1st molars: facial, lingual, occlusal, proximal surfaces
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33. Maxillary canines & 2nd molars: facial, lingual,
proximal surfaces
Mandibular molars: at later stage
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34. Maxillary central incisors: facial, lingual, mesial, distal
surfaces
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35. Maxillary canines & 2nd molars: facial, lingual,
proximal surfaces
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36. Mandibular anterior teeth
are usually spared
because of:
Protection by tongue
Cleansing action of
saliva due to presence
of the orifice of the duct
of sublingual glands
very close to lower
incisors.
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37. Prevention of Early
Childhood Caries
• Community based education
• Examination and preventive care in dental clinic
• Development of appropriate dietary and self care
habits at home .
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38. AAPD RECOMENDATIONS FOR PREVENTION OF
ECC
Infants shouldn't be put to sleep with a bottle .
Nocturnal breast feeding should be avoided, parents
should be encouraged to have infants drink from a cup
Oral hygiene measures should be implemented by the
time of eruption of the first primary tooth .
An oral health consumption visit is recommended
educate the parent and for prevention
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39. RAPIDD SCALE
The Readiness Assessment of Parents Concerning Infant
Dental Decay (RAPIDD) Scale was developed to/assess
a parents stage of change - precontemplative,
contemplative or action with regard to his / her child’s
dental health .
RAPIDD consisted of 38 items with response on five point
scale ranging from strongly- agree to strongly disagree
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40. Each of the 38 items were placed in one of the four
constructs
1) Openness to health information
2) Valuing dental health
3) Convenience and change difficulty
4) Child permissiveness
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41. PROFESSIONAL AND HOME BASED
PREVENTIVE APPROACHES
No signs of ECC or low ECC risk status
a) Fluoridated dentifrices
b) Review of dietary and oral hygiene
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42. Signs of ECC OR high ECC risk status
a) Fluoride varnish
b) Sealants
c) Chlorhexidine varnish
d) Xylitol pacifiers
e) Fluoridated supplements and dentifrices
f) Dietary counseling
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43. MANAGEMENT
• Management of existing emergency
• Arrest and control of other carious process
• Restore and rehabilitation
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44. • Discontinuation of the habit
Gradual withdrawal rather than abrupt cessation of
the habit
Feeding with cup or spoon is encouraged
Serial dilution of the contents of the bottle with
water
Clearance of the milk can be aided by intake of
water after feed.
Infants must be weaned at 12 to 14 months of age .
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45. Dietary modifications
Elimination or gradual reduction of sugar must be
done
Depending on the child age and chewing capacity
natural foods like fruits should be given
Oral hygiene measures should be implemented
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46. Factors affecting management
• Extent of lesion
• Age of the patient
• Behavioral problems due to the age of the
patient
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47. Treatment can be divided in three visits
First visit
• All lesions should be excavated and restored
• Indirect pulp capping or pulp therapy procedures
can be evaluated by further investigation
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48. • If the abscess is present it can be treated by
drainage
• X-Rays are advised to assess the condition of
succedaneous teeth collection of saliva for
determining the salivary flow & viscosity
• Also, application of fluoride topically
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49. PARENT COUNCELLING
Parent should be questioned about the child’s feeding
habits, nocturnal bottles, demand for breast-feeding,
pacifiers.
Parents should be asked to try weaning the child from
using the bottle as pacifier while in bed.
In case of emotional dependence on the bottle,
suggest use of plain or fluoridated water.
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50. The parents should be instructed to clean the child’s
teeth after every feed.
Parents are advised to maintain a diet record of the
child for 1 week that includes the time, amount of food
given to the child, the type of the food & the number of
sugar exposures.
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51. 2nd VISIT
Should be scheduled 1 week after 1st week.
Analysis of diet chart & explanation of
disease process of child’s teeth
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52. Isolate the sugar factors from diet chart &
control sugar exposure
Reassess the restoration and redo if
needed
Caries activity tests can be started &
repeated at monthly interval to monitor the
success of treatment
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53. 3rd & SUBSEQUENT VISITS
• Restoring all grossly decayed teeth
Endodontic treatment
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54. In case of unrestorable teeth,
extraction followed by space maintainer
Crowns given for grossly decayed &
endodontically treated teeth
Review & recall after every 3 months
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55. Barriers in early
childhood caries
Lack of involvement and commitment from dental
and health organizations.
The dental community lacks a shared vison of the
definition of the problem , how to prevent it and who
is responsible for planning and implementation.
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56. The is no integrated plan to fight the social, economic
and nutritional issues facing people in low socioeconomic
group.
There is weak direct support for research on
epidemiology, etiology and prevention of ECC.
Dental health is mot a priority of most programs and
insurance package.
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