early child caries

1. Early Childhood Caries
(ECC)
Dr.Namanya Rogers . BDS . MAK
Legacy Clinic

3. Outline
• Definition
• Prevalence
• Predisposing factors
• Different terminologies used
• Etiology
• Clinical features
• Complications
• Risk factors & prevention
• Management (Pulpal therapies in primary
dentition)

4. Definition of ECC
• The American Paediatric Dental Association
(APDA) defines ECC as:
• "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 preschool-age child between birth and
71 months of age”
• The term "Severe Early Childhood Caries" refers
to "atypical" or "progressive" or "acute" or
"rampant" patterns of dental caries.

6. Prevalence of ECC
• Its High among low income populations.
• In some developing countries and some
disadvantaged populations of developed
countries, the prevalence rate is as high as
70%.
• In some developed countries, the prevalence
rate is from 1-12%

7. Predisposing factors of ECC
Among the predisposing factors studied are
parental
• Educational status
• Income status
• Employment status
• Occupation
• Socioeconomic status

8. Terminologies used to describe ECC
These include:
• Baby Bottle Tooth Decay
• Early Childhood Caries
• Early Childhood Dental decay
• Early Childhood Tooth decay
• Comforter caries
• Nursing caries
• Maxillary Anterior caries …etc
However ECC is becoming increasingly popular with
dentists and dental researchers

9. Etiology of ECC
• During naptime or bedtime, the substrate
(sugar) and the infectious agent (bacteria) are
present on the teeth for a prolonged time,
allowing demineralization and caries
progression.
• When associated with use of the bottle, ECC
has been shown to first affect the primary
maxillary anterior teeth, followed by primary
molars.

10. Cont’d
• Lower teeth not usually affected due to
protective pooling of saliva and tongue
position during feeds.
• Saliva produced by nearby sublingual and
mandibular glands also buffers.

11. Clinical features
There are four stages in the development of ECC
• Initial stage : appearance of chalky, opaque
demineralization lesions on the smooth surfaces of the
maxillary primary incisors
• Second stage: dentin is exposed and appears soft and
yellow.
• At this stage, the child begins to complain of great
sensitivity to cold

12. Cont’d
• Third stage: involves large, deep lesions on the
maxillary incisors, and pulpal involvement
• The child complains of pain when chewing or getting
his teeth brushed, and of spontaneous pain during the
night.
• Fourth stage: Involves coronal fractures of the anterior
maxillaries as a result of amelodentinal destruction
• Some young children suffer because are unable to
express their toothache complaints.
• They experience sleep deprivation and refuse to eat

13. Complications of ECC

15. Risk factors & prevention of ECC
1.Role of Bacteria
• Because cariogenic bacteria (especially
mutans streptococci) are transmitted soon
after the first teeth erupt
• Decreasing the mother's mutans levels may
decrease the child's risk of developing ECC.
• Parents, including expectant parents, be
encouraged to visit a dentist to ensure their
own oral health.

16. Cont’d
2.Nutrition
• Infants and young children should be provided
with a balanced diet.
• Unrestricted, at-will consumption of liquids,
beverages and foods containing fermentable
carbohydrates (e.g. juice drinks, soft drinks,
milk, and starches) can contribute to decay
after eruption of the first tooth.

17. Cont’d
3.Bottle Feeding
• Unrestricted and at-will intake of sugary liquids during the
day or while in bed should be discouraged.
• Infants should finish their bedtime and naptime bottle
before going to bed.
4.Breast Feeding
• Unrestricted, at-will nocturnal breastfeeding after eruption
of the child's first tooth can lead to an increased risk of
caries.

18. Cont’d
5.Use of a Cup
• Children should be encouraged to drink from a cup by their
first birthday.
• At will, frequent use of a training cup should be
discouraged.
6.Home Care
• Proper oral hygiene practices, such as cleaning an infant's
teeth following consumption of foods, liquids, or
medication containing fermentable carbohydrates, should
be implemented by the time of the eruption of the first
tooth.
• A child's teeth should be periodically checked at home
according to the directions of the dentist.

19. Our next presentation
• Pulp therapies in primary dentition
1.Pulpotomy
2.Pulpectomy
3.Indirect pulp capping

20. Reference
• Policy on Early Childhood Caries (ECC): Classifications,
Consequences, and Preventive Strategies
https://www.aapd.org/research/oral-health-policies--
recommendations/early-childhood-caries-classifications-
consequences-and-preventive-strategies/.Published 2018
by AAPD (American Academy of Paediatric Dentistry)
• Paediatric dentistry,4th edition, Oxford university press
(2012 Great Claredon Street, Oxford OX26DP United
Kingdom, edited by Richard Welbury,Monty S.Duggal and
Marie The’re’se Hosey

21. Thanks