#DEN4001
#D4/S1/W4
#Paediatrics

Early Childhood Caries

ECC

• one or more decayed, missing due to caries or filled tooth surfaces in any primary tooth in a child under the age of 6 years
• in children younger than 3 years, any sign of smooth surface caries is indicative of severe early childhood caries
• dmfs of 4,5,6 in children ages 3,4,5 is severe ECC
• previous terms
  • baby bottle caries
  • nursing bottle decay

Sequela of ECC

• if left to progress
  • pain
  • infection
  • restriction of normal daily activities
  • delayed growth and cognitive development by interfering with nutrition, concentration and school participation
• complex disease with significant negative impacts on children, their families and the health system

Aetiology

• related to tooth resistance factors
• early infection or oral cavity by mutans streptococci
• dietary factors
• aetiological roots in first year of childs life
  normal oral flora
• -> form dental plaque
• -> increase consumption of fermentable carb favours acidogenic and aciduric bacteria
• -> acid attack produced -> demin

interaction between

• biological
• behavioural
• cultural
• social
• environmental

susceptible tooth/host

• predisposition including:
• immunological factors (saliva secreted IgA)
• reduce saliva (acid buffer, oral clearance and minerals)
• immature enamel
• tooth morphology
• defects of tooth tissue (hypoplasia/hypomineralisation
  • can be due to premature birth, low birth weight,
  • pre post natal infection/illness
  • nutritional deficiency
  • variety of environmental pollutants including maternal smoking

cariogenic microorganisms

• mutans streptococci invovled in caries
• MS source is predominantly thought not exclusively from mothers via vertical transmission
• infection with MS can occur at a very young age
• most children colonised by 24months

factors associated with MS colonisation

• frequent sugar exposure
• frequent snacking
• taking sweetened drinks to bed
• sharing food with adults
• high levels of maternal MS, maternal dietary habits and poor oral hygiene

baby bottles

• risk of caries sensitive to interaction of multiple factors including non-bottle dietary practices
• tends to be associated with use of bottle during sleep (with added sweeteners)
• baby bottle beyond 12 months, especially frequent/nocturnal, associated with ECC

breast feeding

• prolonged or on demand breast feeding implicated in development of ECC
• lack of study/data to prove exact
• breastfeeding beyond 12 months, associated with ECC (esp nocturnal/frequent)

fermentable carbohydrates (substrate)

• greater number and frequency of highly sweetened foods and drinks in first year of age are strongly associated with incidence of childhood caries in subsequent years

Management of ECC - Prevention

• reduce availability of refined carbohydrates
  • poor feeding and dietary practices continue despite intensive and prolonged dietary advice
  • feeding practices heavily influenced by cultural factors, social and family norms,
  • parents who find it difficult to differentiate cariogenic potential of many products
  • settling babies while sipping milk / sweet substances
• reduce microbial burden
  • chemical suppression using chlorhexidine and xylitol
    • CHX 1.2% mouth rinse 1 minute per day for 1 week per month for caregiver and children older than 6 years of age
    • xylitol gum for children and maternal chewing
  • prophylactic, toothbrushing or professional
  • restorations
• increase resistance of teeth
  • water fluoridations
  • varnish and gel appropriate dose
  • toothpaste

Management of ECC - INTERVENTIONS

• early assessment
  • parents needs to understand aetiology of ECC, correct OH, importance of dental visits, knowledge and ability to introduce low cariogenic diet
  • improve OH of parent
• risk assessment
  • family values, traditions, lifestyle, culture, social class
  • attitudes of parents and ability to keep children's OH
  • CaMBRA 0-5 tool
• motivational interviewing
  • alter thinking and behaviour
  • encourage behaviour change rather than challenge
  • respect clients thought s and beliefs before providing advice
• therapeutic management
  • CHX mouthrinse
  • fluorides
  • CPP ACP
  • frequent radiographs
  • periodic oral exam
  • xylitol gum
  • fissure sealants
• restorative care
  • ART with GIC
  • hall crown
  • fluoride varnish
• regular reviews/recalls

Policy on ECC

• establish clinic within 6mo of eruption of first tooth and no later than 12 months of age
• modify diet to avoid frequent consumption of sugar
  • eliminate frequent or nocturnal feeding
  • plenty of water
  • avoid sugar under 2
  • no 100% fruit juice before 12mo
  • limited juice after 12mo
• parent brush childs teeth twice a day
• fluoride varnish