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{{Short description|Dental disease of young children}}
{{Short description|Dental disease of young children}}
'''Early childhood caries''' (ECC), formerly known as '''nursing bottle caries''', '''baby bottle tooth decay''', '''night bottle mouth''' and '''night bottle caries''', is a disease that affects teeth in children aged between birth and 71 months.<ref name=":1">Policy on early childhood caries (ECC): Consequences and preventive strategies. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:88-91.https://www.aapd.org/globalassets/media/policies_guidelines/p_eccconsequences.pdf
[[File:Dental Caries Cavity 2 (cropped).JPG|thumb|Dental caries (tooth decay) as seen on a child]]

'''Early childhood caries''' (ECC), formerly known as '''nursing bottle caries''', '''baby bottle tooth decay''', '''night bottle mouth''' and '''night bottle caries''', is a disease that affects teeth in children aged between birth and 71 months.<ref name=Amer>American Academy of Pediatric Dentistry, American Academy of Pediatrics. Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. Pediatr Dent [Internet]. 2016;38(6):52–54. Available from: http://www.ingentaconnect.com/content/aapd/pd/2016/00000038/00000006/art00024</ref><ref name=Feje>Fejerskov O, Edwina A, Kidd M. Dental Caries: The Disease and its Clinical Management. 2nd ed. Oxford; Ames, Iowa: Blackwell Munksgaard;2008.</ref> ECC is characterized by the presence of 1 or more decayed (noncavitated or cavitated lesions), missing (due to [[caries]]), or filled tooth surfaces in any primary tooth.<ref name=Amer /> ECC has been shown to be a very common, transmissible bacterial [[infection]], usually passed from the primary caregiver to the child.<ref name=Feje /><ref name=Else>Elsevier. Early childhood caries: resource centre [Internet]. Elsevier; 2016. Available from: http://earlychildhoodcariesresourcecenter.elsevier.com/</ref> The main [[bacteria]] responsible for dental caries are ''[[Streptococcus mutans]]'' (''S. mutans'') and ''[[Lactobacillus]]''.<ref name=Lock>Locker D. Disparities in oral health‐related quality of life in a population of Canadian children. Community Dent Oral Epidemiol [Internet]. 2007 Oct 1;35(5):348-56. Available: http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0528.2006.00323.x/full DOI: 10.1111/j.1600-0528.2006.00323.x</ref> There is also evidence that supports that those who are in lower [[socioeconomic]] populations are at greater risk of developing ECC.<ref name="Mota">{{Cite journal |last1=Mota-Veloso |first1=Isabella |last2=Soares |first2=Maria Eliza C. |last3=Alencar |first3=Bruna Mota |last4=Marques |first4=Leandro Silva |last5=Ramos-Jorge |first5=Maria Letícia |last6=Ramos-Jorge |first6=Joana |date=2016-01-01 |title=Impact of untreated dental caries and its clinical consequences on the oral health-related quality of life of schoolchildren aged 8–10 years |url=https://doi.org/10.1007/s11136-015-1059-7 |journal=Quality of Life Research |language=en |volume=25 |issue=1 |pages=193–199 |doi=10.1007/s11136-015-1059-7 |pmid=26135023 |s2cid=19164652 |issn=1573-2649}}</ref><ref name=cola>Çolak, H, Dülgergil, ÇT, Dalli, M, Hamidi, MM. Early childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med [Internet]. 2013 Jan 1;4(1):29–38. Available from: http://doi.org/10.4103/0976-9668.107257 DOI: 10.4103/0976-9668.107257</ref>
</ref><ref name="Feje">Fejerskov O, Edwina A, Kidd M. Dental Caries: The Disease and its Clinical Management. 2nd ed. Oxford; Ames, Iowa: Blackwell Munksgaard;2008.</ref> ECC is characterized by the presence of 1 or more decayed (non cavitated or cavitated lesions), missing (due to [[caries]]), or filled tooth surfaces in any primary tooth.<ref name="Lock">{{cite journal |last1=Locker |first1=David |date=2007 |title=Disparities in oral health-related quality of life in a population of Canadian children |url=http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0528.2006.00323.x |journal=Community Dentistry and Oral Epidemiology |volume=35 |issue=5 |pages=348–356 |doi=10.1111/j.1600-0528.2006.00323.x |pmid=17822483}}</ref> ECC has been shown to be a very common, transmissible bacterial [[infection]], usually passed from the primary caregiver to the child.<ref name="Feje" /><ref name="Mota">{{Cite journal |last1=Mota-Veloso |first1=Isabella |last2=Soares |first2=Maria Eliza C. |last3=Alencar |first3=Bruna Mota |last4=Marques |first4=Leandro Silva |last5=Ramos-Jorge |first5=Maria Letícia |last6=Ramos-Jorge |first6=Joana |date=2016-01-01 |title=Impact of untreated dental caries and its clinical consequences on the oral health-related quality of life of schoolchildren aged 8–10 years |url=https://doi.org/10.1007/s11136-015-1059-7 |journal=Quality of Life Research |language=en |volume=25 |issue=1 |pages=193–199 |doi=10.1007/s11136-015-1059-7 |issn=1573-2649 |pmid=26135023 |s2cid=19164652}}</ref> The main [[bacteria]] responsible for dental cavities (dental caries) are ''[[Streptococcus mutans]]'' (''S.mutans'') and ''[[Lactobacillus]]''.<ref name="Mota" /> There is also evidence that supports that those who are in lower [[socioeconomic]] populations are at greater risk of developing ECC.<ref name="cola">{{cite journal |last1=Dülgergil |first1=Çoruht |last2=Dalli |first2=Mehmet |last3=Hamidi |first3=Mehmetmustafa |last4=Çolak |first4=Hakan |date=2013 |title=Early childhood caries update: A review of causes, diagnoses, and treatments |journal=Journal of Natural Science, Biology and Medicine |volume=4 |issue=1 |pages=29–38 |doi=10.4103/0976-9668.107257 |pmc=3633299 |pmid=23633832 |doi-access=free}}</ref><ref name="Mohe">{{cite journal |last1=Mohebbi |first1=Simin Z. |last2=Virtanen |first2=Jorma I. |last3=Murtomaa |first3=Heikki |last4=Vahid-Golpayegani |first4=Mojtaba |last5=Vehkalahti |first5=Miira M. |date=2008 |title=Mothers as facilitators of oral hygiene in early childhood |url=http://onlinelibrary.wiley.com/doi/10.1111/j.1365-263X.2007.00861.x |journal=International Journal of Paediatric Dentistry |volume=18 |issue=1 |pages=48–55 |doi=10.1111/j.1365-263X.2007.00861.x |pmid=18086026}}</ref>[[File:Dental Caries Cavity 2 (cropped).JPG|thumb|Dental caries (tooth decay) as seen on a child]]


== Aetiology ==
== Aetiology ==
Early childhood caries (ECC) is a multi-factorial [[disease]], referring to various risk factors that inter-relate to increase risk of developing the disease. These risk factors include but not limits to, [[cariogenic]] bacteria, diet practices and socioeconomic factors.<ref name= cola /> Normally after 6 months, deciduous teeth begin to erupt means, they are susceptible to tooth decay or dental caries.<ref name=Amer /> In some unfortunate cases, infants and young children have experienced severe tooth decay called ECC. This can result in the child experiencing severe pain, extensive [[dental restoration]]s or [[extraction (dental)|extractions]]. The good news is that ECC is preventable, however, still remains a large burden particularly towards health care expenditure.
Early childhood caries (ECC) is a multifactorial [[disease]],   with risk factors including but not limited to, [[cariogenic]] bacteria, diet practices and socioeconomic factors.<ref name="Mohe" />  Deciduous teeth begin to erupt at 6 months of age, once  visible in the oral cavity they are susceptible to tooth decay or dental caries.<ref name=":1" /> This can result in the child experiencing severe pain, and needing extensive [[dental restoration]]s or tooth [[Extraction (dental)|extractions]].


===Microbial factors===
===Microbial factors===
⚫
The primary cariogenic bacteria involved in ECC are S. mutans and Lactobacillus.<ref name="Mohe" /> The transfer of S. Mutans from mother to infant is well documented. Over time the combination of food debris and bacteria form a biofilm on the tooth surface called [[Dental plaque|plaque]].<ref name="Feje" /> In plaque, the cariogenic microorganisms produce lactic acid as a by-product from fermentable [[carbohydrates]]. Examples of these fermentable carbohydrates include [[fructose]], [[sucrose]] and [[glucose]].<ref name="Mohe" /> Cariogenic bacteria thrive on these sugars and help to weaken the adjacent tooth surface by causing loss of tooth structure (minerals) due to the loss of minerals due to acid production. A poor oral care routine and a diet that is high in fermentable carbohydrates favor acidic attack in the oral cavity. This prolonged acidic exposure allows the net loss of minerals from the tooth.<ref name="Mohe" /> This diminishes the strength of the tooth and is called demineralization. For the outer layer of the tooth ([[Tooth enamel|enamel]]) to reach cavitation, there is a breakdown of the enamel structure  that allows the influx of the cariogenic bacteria. As cavitation progresses into [[dentine]], the dental caries lesion becomes more severe, and this may cause tooth pain .

⚫
The primary cariogenic bacteria involved in ECC are ''S. mutans'' and ''Lactobacillus''.<ref name= cola /> The oral flora in an infant oral cavity is not colonised with normal oral flora until the eruption of the primary [[dentition]] at approximately 6 to 30 months of age. The colonisation of S. Mutans from mother to infant is well documented.<ref name=Mohe>Mohebbi SZ, Virtanen JI, Murtomaa H, Vahid‐GolpayeganI MO, Vehkalahti MM. Mothers as facilitators of oral hygiene in early childhood. Int J Paediat Dent. 2008 Jan 1;18(1):48-55. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-263X.2007.00861.x/full DOI:10.1111/j.1365-263x.2007.00861.x</ref> Over time this combination of food debris and bacteria form a biofilm on the tooth surface called [[Dental plaque|plaque]].<ref name=Feje /> In plaque, the cariogenic microorganisms are those that produce lactic acid as a by-product from fermentable [[carbohydrates]]. Examples of these fermentable carbohydrates include [[fructose]], [[sucrose]] and [[glucose]].<ref name= cola /> Cariogenic bacteria thrive on these sugars and help them to weaken the adjacent tooth surface. A poor oral care routine and a diet that is high in fermentable carbohydrates favour acidic attack in the oral cavity.<ref name= cola /> This prolonged acidic exposure allows the net loss of minerals from the tooth.<ref name= cola /> This diminishes the strength of the tooth and is called demineralisation. For the outer layer of the tooth ([[Tooth enamel|enamel]]) to reach cavitation, there is a breakdown of the enamel matrix that allows the influx of the cariogenic bacteria. As cavitation progresses into [[dentine]], the dental caries is classified severe, this causes ECC.


===Dietary factors===
===Dietary factors===
Diet plays a key role in the process of dental caries. The type of foods along with the frequency at which they are consumed can determine the risk it puts for also developing carious lesions. With new products being put on supermarket shelves with irresistible prices, this can largely influence what people buy. It is common for infants and young children to frequently consume fermentable carbohydrates, in the form of liquids. The consumption of liquids containing fermentable carbohydrate, include drinks such as: [[juice]], breast milk, [[infant formula|formula]], [[soft drink|soda]].<ref name=Amer /> These consumables all have the potential to increase the risk of [[dental caries]] due to prolonged contact between [[sugars]] in the liquid and cariogenic [[bacteria]] on the tooth surface.
Diet plays a key role in the process of dental caries. The type of foods along with the frequency at which they are consumed can determine the risk  for  developing carious lesions.  Infants and young children may  consume fermentable carbohydrates, in the form of liquids such as: fruit [[juice]]s, and [[Soft drink|soda]] pop.<ref name=":1" /> These consumables have the potential to increase the risk of [[dental caries]] due to prolonged contact between [[sugars]] in the liquid and cariogenic [[bacteria]] on the tooth surface. Poor feeding practices without appropriate preventive measures can lead to  ECC.<ref name=":1" /> Frequent and long duration bottle feeding, especially at night, is associated with ECC. This finding can be attributed to the fact that there is less salivary flow at night and hence less capacity for buffering and remineralization.<ref name="Feje" /> Each time a child drinks these liquids, acids attack for 20 minutes or longer. A parent's education and health awareness has a major influence on the caries experience of their child's feeding practices, dietary habits and food choices.<ref name=":1" />
Recent research has shown that breastfeeding does not increase caries risk up to 12 months of age.<ref name=Amer /><ref name=Colg>Colgate Australia. Dental fluoride - what is fluoride? [Internet]. Colgate-Palmolive Company; 2017. Available from: http://www.colgate.com.au/en/au/oc/oral-health/basics/fluoride/article/what-is-fluoride</ref> Poor feeding practices without appropriate preventive measures can lead to a distinctive pattern of caries in susceptible infants and [[toddlers]] commonly known as [[baby bottle]] tooth decay or ECC. Frequent and long duration bottle feeding, especially at night, is associated with ECC.<ref name=Amer /> This finding can be attributed to the fact that there is less salivary flow at night and hence less capacity for buffering and remineralisation.<ref name=Feje /> Each time a child drinks these liquids, acids attack for 20 minutes or longer. A parent's education and health awareness has a major influence on the caries experience of their child - feeding practices, dietary habits and food choices.<ref name=Amer />


===Socioeconomic factors===
===Socioeconomic factors===
⚫
Dental caries still today, remains the most prevalent disease worldwide.<ref name="Semi">Seminario, AL, Ivančaková R. Early childhood caries. Acta medica [Internet]. 2003 May;46(3):91-94. Retrieved from: ftp://orbis.lfhk.cuni.cz/Acta_Medica/2003/AM3_03.pdf</ref> burdening millions of children and continuing  into adulthood with pain and potentially lower quality of life. There are several studies by Locker and Mota-Veloso reporting that there is a two-way relationship that exists between dental caries and levels of education, household income that affect quality of life and social positioning.<ref name="Mota" /> Locker suggested that the relationship between oral disease and health-related quality of life outcomes can be mediated by personal and environmental variables. More health promotion initiatives and policy-making that collaborate directly with the community to increase meeting their needs, should be implemented.<ref name="Lock" />


⚫
While the primary [[etiology]] is due to microbial factors, it is also largely influenced by the social, behavioral and economic determinants in which children are surrounded  including living in a low income earning family. Secondly, having limited access to healthcare and education where important messages about the consumption of cariogenic foods are not being transferred to children or their parents.<ref name="Mohe" /><ref name=":1" /> Efforts should be made to reach rural and remote communities to implement health promotion strategies to increase awareness about diet and oral hygiene.
⚫
Dental caries still today, remains the most prevalent disease worldwide.<ref name=Kawa>Kawashita Y, Kitamura M, Saito T. Early childhood caries. International journal of dentistry [Internet]. 2011 Oct 10;2011. Available from: https://www.hindawi.com/journals/ijd/2011/725320/abs/ DOI: 10.1155/2011/725320</ref> This means the disease is highly preventable, yet it is still burdening millions of children and into adulthood with pain and potentially lower quality of life.<ref name=Mota /> There are several studies by Locker and Mota-Veloso reporting that there is a two-way relationship that exists between dental caries and levels of education, household income that effect quality of life and social positioning.<ref name=Lock /><ref name=Mota /> Locker suggested that the relationship between oral disease and health-related quality of life outcomes can be mediated by personal and environmental variables.<ref name=Lock /> Previous studies have also mentioned that the rate of ECC has decreased. However, these results can tend to dis-include communities where equity still exists. More health promotion initiatives and policy-making that collaborate directly with the community to increase meeting their needs, should be implemented.<ref name=Mota />

⚫
While the primary aetiology is due to microbial factors, it is also largely influenced by the social, behavioral and economic determinants in which children are surrounded by. such factors include living in a low income earning family that may not have the budget to afford visiting a dental clinic. Secondly, having limited access to healthcare and education where important messages about the consumption of carcinogenic foods are not being transferred to children or their parents. Distribution of budget should be made to reach rural and remote communities to implement health promotion strategies to increase awareness about diet and oral hygiene.


The education, occupation and income of families also greatly affects the quality of life. Children greatly rely on their parents or guardians for help concerning their health and well-being.<ref name=Semi>Seminario, AL, Ivančaková R. Early childhood caries. Acta medica [Internet]. 2003 May;46(3):91-94. Retrieved from: ftp://orbis.lfhk.cuni.cz/Acta_Medica/2003/AM3_03.pdf</ref> Studies have shown that families of lower socioeconomic status are less likely to regularly attend the dentist and access preventive dental resources.<ref name=Twet>Twetman S. Caries prevention with fluoride toothpaste in children: an update. Eur Arch Paediatr Dent [Internet]. 2009 Sep 1;10(3):162-8. Available from: http://go.galegroup.com/ps/anonymous?p=AONE&sw=w&issn=18186300&v=2.1&it=r&id=GALE%7CA227281634&sid=googleScholar&linkaccess=fulltext&authCount=1&isAnonymousEntry=true</ref> ECC also has an accumulative effect for those that live in rural areas.<ref name=Twet />
The education, occupation and income of families also greatly affects the quality of life. Children greatly rely on their parents or guardians for help concerning their health and well-being.<ref name="Semi" /> Studies have shown that families of lower socioeconomic status are less likely to regularly attend the dentist and access preventive dental resources. ECC also has an accumulative effect for those that live in rural areas.<ref name="Twet">Twetman S. Caries prevention with fluoride toothpaste in children: an update. Eur Arch Paediatr Dent [Internet]. 2009 Sep 1;10(3):162-8. Available from: http://go.galegroup.com/ps/anonymous?p=AONE&sw=w&issn=18186300&v=2.1&it=r&id=GALE%7CA227281634&sid=googleScholar&linkaccess=fulltext&authCount=1&isAnonymousEntry=true</ref>


== Prevention ==
== Prevention ==
Early childhood caries can be prevented through the combination of the following: adhering to a healthy nutritional diet, optimal plaque removal, use of fluoridation on the tooth surface once erupted, care taken by the mother during the pre-natal and peri-natal period and regular dental visits. The following are recommendations to help prevent ECC.
Early childhood caries can be prevented through the combination of the following: adhering to a healthy nutritional diet, optimal plaque removal, use of fluoridation on the tooth surface once erupted, care taken by the mother during the prenatal and perinatal period and regular dental visits. The following are recommendations to help prevent ECC.


===Adequate diet===
===Adequate diet===
Dietary habits and the presence of cariogenic bacteria within the oral cavity are an important factor in the risk of ECC. ECC is commonly caused by bottle feeding, frequent snacking and a high sugar diet.<ref name=Kawa />
Dietary habits and the presence of cariogenic bacteria within the oral cavity are an important factor in the risk of ECC. ECC is commonly caused by bottle feeding, frequent snacking and a high sugar diet.<ref name="Kawa">{{cite journal |last1=Kawashita |first1=Yumiko |last2=Kitamura |first2=Masayasu |last3=Saito |first3=Toshiyuki |date=2011 |title=Early Childhood Caries |journal=International Journal of Dentistry |volume=2011 |pages=1–7 |doi=10.1155/2011/725320 |pmc=3191784 |pmid=22007218 |doi-access=free}}</ref>


In regards to preventing ECC through bottle feeding, it is fundamental not to allow the child to sleep using 'sippy cups' or bottles as this is a large factor contributing to baby bottle decay/caries.<ref name=Semi /> This is highly encouraged as it prevents continuous exposure to non-milk extrinsic sugars and therefore the potential progression of caries – this means the oral cavity can return to a neutral pH and therefore decreased acidity.<ref name=Amer /> These researches also suggest trying to introduce cups to children as they approach their first birthday and to reduce the use of a bottle.
In regards to preventing ECC through bottle feeding, it is fundamental not to allow the child to sleep using 'sippy cups' or bottles as this is a large factor contributing to baby bottle decay/caries.<ref name=Semi /> This is highly encouraged as it prevents continuous exposure to non-milk extrinsic sugars and therefore the potential progression of caries – this means the oral cavity can return to a neutral pH and therefore decreased acidity.<ref name=":1" /> These researches also suggest trying to introduce cups to children as they approach their first birthday and to reduce the use of a bottle. A low-sugar and high nutritional diet is recommended for both the mother and the child especially during breastfeeding, and it is also recommended to avoid frequent snacking.<ref name=Kawa />
A low-sugar and high nutritional diet is recommended for both the mother and the child especially during breastfeeding, and it is also recommended to avoid frequent snacking.<ref name=Kawa />


A 2019 Cochrane review concluded that there is a 15% drop in risk of developing ECC when mothers with infants or pregnant women are given advice on a healthy child diet and feeding practices.<ref>{{Cite journal|last1=Riggs|first1=Elisha|last2=Kilpatrick|first2=Nicky|last3=Slack-Smith|first3=Linda|last4=Chadwick|first4=Barbara|last5=Yelland|first5=Jane|last6=Muthu|first6=M S|last7=Gomersall|first7=Judith C|date=2019-11-20|editor-last=Cochrane Oral Health Group|title=Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries|journal=Cochrane Database of Systematic Reviews|volume=2019|issue=11|language=en|doi=10.1002/14651858.CD012155.pub2|pmid=31745970|pmc=6864402}}</ref>
A 2019 Cochrane review concluded that there is a 15% drop in risk of developing ECC when mothers with infants or pregnant women are given advice on a healthy child diet and feeding practices.<ref>{{Cite journal|last1=Riggs|first1=Elisha|last2=Kilpatrick|first2=Nicky|last3=Slack-Smith|first3=Linda|last4=Chadwick|first4=Barbara|last5=Yelland|first5=Jane|last6=Muthu|first6=M S|last7=Gomersall|first7=Judith C|date=2019-11-20|editor-last=Cochrane Oral Health Group|title=Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries|journal=Cochrane Database of Systematic Reviews|volume=2019|issue=11|language=en|doi=10.1002/14651858.CD012155.pub2|pmid=31745970|pmc=6864402}}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/38753314|date = June 2024}}


===Optimal plaque removal===
===Optimal plaque removal===
On eruption of the first primary tooth in a child, tooth brushing and cleaning should be performed by an adult.<ref name=Amer /> This is important as the [[Dental plaque|plaque]] that attaches to the surface of the tooth has bacteria that have the ability to cause [[caries]] (decay) on the tooth surface.
On eruption of the first primary tooth in a child, tooth brushing and cleaning should be performed by an adult.<ref name=":1" /> This is important as the [[Dental plaque|plaque]] that attaches to the surface of the tooth has bacteria that have the ability to cause [[caries]] (decay) on the tooth surface. It is recommended to brush children's teeth twice daily using a soft bristled, age and size appropriate toothbrush and if indicated age appropriate amount of fluoridated toothpaste.<ref name="Colg">Colgate Australia. Dental fluoride - what is fluoride? [Internet]. Colgate-Palmolive Company; 2017. Available from: http://www.colgate.com.au/en/au/oc/oral-health/basics/fluoride/article/what-is-fluoride</ref> It is suggested that it is suitable to brush children's teeth until they reach the approximate age of 6 years; when they will begin to develop  adequate dexterity and cognition needed for adequate brushing by themselves. It is encouraged to watch children brushing their teeth until they are competently able to brush.
It is recommended to brush children's teeth using a soft bristled, age and size appropriate toothbrush and age appropriate toothpaste twice daily, however children below the age of two usually don't require toothpaste.<ref name=Mohe /> These researches also suggest that it is suitable to brush children's teeth until they reach the approximate age of 6; where they will begin to learn adequate dexterity and cognition needed for adequate brushing by themselves. It is encouraged to watch children brushing their teeth until they are competently able to brush appropriately alone.


===Fluoride===
===Fluoride===
[[Fluoride]] is a natural mineral that naturally occurs throughout the world – it is also the active ingredient of many toothpastes specifically for its remineralizing effects on enamel, often repairing the tooth surface and reducing the risk of caries.<ref name=Colg />
[[Fluoride]] is a natural mineral that naturally occurs throughout the world – it is also the active ingredient of many toothpastes specifically for its remineralizing effects on enamel, often repairing the tooth surface and reducing the risk of caries.<ref name="Colg" /> The use of fluoridated toothpaste is highly recommended by dental professionals; whereby studies suggest that the correct daily use of fluoride on the dentition of children has a high caries-preventive effect and therefore has potential to prevent ECC.<ref name="Twet" /> However, it is important to use fluoridated toothpastes correctly; in children under the age of three years, a smear or
rice-sized amount of fluoridated toothpaste should be
The use of fluoridated toothpaste is highly recommended by dental professionals; whereby studies suggest that the correct daily use of fluoride on the dentition of children has a high caries-preventive effect and therefore prevents has potential to prevent ECC.<ref name=Twet /> However, it is important to use fluoridated toothpastes correctly; children below the age of two do not usually require toothpaste unless they are already at a high risk of ECC as diagnosed by a dental professional, and therefore it is recommended to use a small sized 'smear' of toothpaste to incorporate fluoride, with caution removing the toothpaste from within the mouth and not allowing the child to swallow the substances.<ref name=Mohe />
used. In children between the ages of three and six, a pea-sized amount of fluoridated toothpaste should be used. The child should be monitored until they can brush well. The child should be taught to spit the toothpaste out after brushing.<ref name=":1" />


===Pre-natal and peri-natal period===
===Pre-natal and peri-natal period===
Prevention of early childhood caries begins before the baby is born; women are advised to maintain a well-balanced diet of high nutritional value, especially during the third trimester and within the infants first year of life.<ref name=Semi /> This is since enamel undergoes maturation; if the diet is not sufficient, a common condition that may occur is [[enamel hypoplasia]].
Prevention of early childhood caries begins before the baby is born; women are advised to maintain a well-balanced [[Healthy diet|diet]] of high nutritional value during pregnancy.<ref name="Kawa" /> This is important since teeth start developing before birth  if the diet is not sufficient, a  condition called developmental dental defect may occur  including [[enamel hypoplasia]].<ref name="Cauf">{{cite journal |last1=Caufield |first1=P.W. |last2=Li |first2=Y. |last3=Bromage |first3=T.G. |date=2012 |title=Hypoplasia-associated Severe Early Childhood Caries – A Proposed Definition |journal=Journal of Dental Research |volume=91 |issue=6 |pages=544–550 |doi=10.1177/0022034512444929 |pmc=3348067 |pmid=22529242}}</ref> Enamel hypoplasia is a developmental defect of enamel that occurs during tooth development, mainly pre-natal or during early childhood. Teeth affected by enamel hypoplasia are at a higher risk of caries since there is an increased loss of minerals and therefore the tooth surface is able to breakdown more easily in comparison to a non-hypoplastic tooth.
Enamel hypoplasia is a developmental defect of enamel that occurs during tooth development, mainly pre-natally or during early childhood.<ref name=Cauf>Caufield PW, Li Y, Bromage TG. Hypoplasia-associated severe early childhood caries–a proposed definition. J Dent Res [Internet]. 2012 Jun 1;91(6):544-50. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0022034512444929 DOI:10.1177/0022034512444929</ref> Teeth affected by enamel hypoplasia are commonly at a higher risk of caries since there is an increased loss of minerals and therefore the tooth surface is able to breakdown more easily than in comparison to a non-hypoplastic tooth.<ref name=Cauf /> It is therefore suggested to the mother to maintain a [[healthy diet]] since evidence suggests malnourishment during the perinatal period increases the risk of hypoplastic teeth in an infant.<ref name=Kawa />


===Dental visits===
===Dental visits===
It is recommended to parents and caregivers to take their children to a dental professional for examination as soon as the first few teeth start to erupt into the oral cavity.<ref name=Kawa /> The dental professional will assess all the present dentition for early carious demineralization and may provide recommendations to the parents or caregivers the best way to prevent ECC and what actions to take.<ref name=Kawa />
It is recommended thar parents and caregivers take their children to a dental professional for examination at six months of age and no later than the child's first birthday.<ref name=":1" /> The dental professional will examine  the child's teeth and provide recommendations to the parents or caregivers regarding the best way to prevent ECC and what actions to take.<ref name=":1" /> Studies suggest that children who have attended visits within the first few years of life (an early preventive dental visit) potentially experience less dental related issues and incur lower dental related costs throughout their lives.<ref name=Sava>{{cite journal | doi=10.1542/peds.2003-0469-f | title=Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs | date=2004 | last1=Savage | first1=Matthew F. | last2=Lee | first2=Jessica Y. | last3=Kotch | first3=Jonathan B. | last4=Vann | first4=William F. | journal=Pediatrics | volume=114 | issue=4 | pages=e418–e423 | pmid=15466066 | s2cid=14276166 }}</ref>
Studies suggest that children who have attended visits within the first few years of life (an early preventive dental visit) potentially experience less dental related issues and incur lower dental related costs throughout their lives.<ref name=Sava>Savage MF, Lee JY, Kotch JB, Vann WF. Early preventive dental visits: effects on subsequent utilization and costs. Pediatrics [Internet]. 2004 Oct 1;114(4):418-23. Available from: http://pediatrics.aappublications.org/content/pediatrics/114/4/e418.full.pdf DOI:10.1542/peds.2003-0469-f</ref>


== Treatment ==
== Treatment ==


=== Early detection and risk assessment ===
=== Early detection and risk assessment ===
The approach to managing Early Childhood Caries involves a combination of restoring or removing the decayed teeth. Dentists also focus heavily on early intervention strategies, which include the application of protective fluoride treatments directly to the teeth, guiding families through proper dental care routines, and offering nutritional advice to prevent further decay. During the initial dental visit, which plays a pivotal role, the dentist evaluates the child's dietary and oral hygiene habits. By doing so, they can identify behaviours that may contribute to tooth decay. These assessments take into account the child’s age and their social, behavioural, and medical background.
The approach to managing Early Childhood Caries involves a combination of restoring or removing the decayed teeth. Dentists also focus heavily on early intervention strategies, which include the application of protective fluoride treatments directly to the teeth, guiding families through proper dental care routines, and offering nutritional advice to prevent further decay. During the initial dental visit, which plays a pivotal role, the dentist evaluates the child's dietary and oral hygiene habits. By doing so, they can identify behaviours that may contribute to tooth decay. These assessments take into account the child's age and their social, behavioural, and medical background.


=== Tailored treatment based on caries risk ===
=== Tailored treatment based on caries risk ===
For children identified as having a low risk of tooth decay, the focus is on monitoring and preventive care rather than immediate dental treatments. Regular dental visits are encouraged to identify any new signs of decay early on. Early stages of decay (white spots) and initial enamel damage are managed with non-invasive preventive methods and are closely watched over time. High-risk children typically need more intensive treatment. This may include early restorative work to repair and address any existing decay to prevent further deterioration of the teeth. Since ECC affects children under the age of 5 years, dental treatments under general anesthesia may be necessary in select cases.<ref>{{Cite journal |last1=Weninger |first1=Alyssa |last2=Seebach |first2=Erica |last3=Broz |first3=Jordyn |last4=Nagle |first4=Carol |last5=Lieffers |first5=Jessica |last6=Papagerakis |first6=Petros |last7=Da Silva |first7=Keith |date=2022-01-06 |title=Risk Indicators and Treatment Needs of Children 2–5 Years of Age Receiving Dental Treatment under General Anesthesia in Saskatchewan |journal=Dentistry Journal |volume=10 |issue=1 |pages=8 |doi=10.3390/dj10010008 |pmid=35049606 |issn=2304-6767 |doi-access=free }}</ref> However, there's a notable concern with this method: despite the initial success of the treatment, decay can recur, with some cases reported as early as 6 months post-treatment​.<ref>{{Cite journal |last1=Amin |first1=M. |last2=Nouri |first2=R. |last3=ElSalhy |first3=M. |last4=Shah |first4=P. |last5=Azarpazhooh |first5=A. |date=2015-01-27 |title=Caries recurrence after treatment under general anaesthesia for early childhood caries: a retrospective cohort study |url=http://dx.doi.org/10.1007/s40368-014-0166-4 |journal=European Archives of Paediatric Dentistry |volume=16 |issue=4 |pages=325–331 |doi=10.1007/s40368-014-0166-4 |pmid=25619862 |s2cid=256369402 |issn=1818-6300}}</ref>
For children identified as having a low risk of tooth decay, the focus is on monitoring and preventive care rather than immediate dental treatments. Regular dental visits are encouraged to identify any new signs of decay early on. Early stages of decay (white spots) and initial enamel damage are managed with non-invasive preventive methods and are closely watched over time. High-risk children typically need more intensive treatment. This may include early restorative work to repair and address any existing decay to prevent further deterioration of the teeth. Since ECC affects children under the age of 5 years, dental treatments under general anesthesia may be necessary in select cases.<ref>{{Cite journal |last1=Weninger |first1=Alyssa |last2=Seebach |first2=Erica |last3=Broz |first3=Jordyn |last4=Nagle |first4=Carol |last5=Lieffers |first5=Jessica |last6=Papagerakis |first6=Petros |last7=Da Silva |first7=Keith |date=2022-01-06 |title=Risk Indicators and Treatment Needs of Children 2–5 Years of Age Receiving Dental Treatment under General Anesthesia in Saskatchewan |journal=Dentistry Journal |volume=10 |issue=1 |pages=8 |doi=10.3390/dj10010008 |pmid=35049606 |pmc=8775244 |issn=2304-6767 |doi-access=free }}</ref> However, there's a notable concern with this method: despite the initial success of the treatment, decay can recur, with some cases reported as early as 6 months post-treatment.<ref>{{Cite journal |last1=Amin |first1=M. |last2=Nouri |first2=R. |last3=ElSalhy |first3=M. |last4=Shah |first4=P. |last5=Azarpazhooh |first5=A. |date=2015-01-27 |title=Caries recurrence after treatment under general anaesthesia for early childhood caries: a retrospective cohort study |url=http://dx.doi.org/10.1007/s40368-014-0166-4 |journal=European Archives of Paediatric Dentistry |volume=16 |issue=4 |pages=325–331 |doi=10.1007/s40368-014-0166-4 |pmid=25619862 |s2cid=256369402 |issn=1818-6300}}</ref>


=== Silver diamine fluoride ===
=== Silver diamine fluoride ===
Line 62: Line 57:
SDF is known for its cost-effectiveness and ease of application. It effectively halts decay but does not rebuild the tooth structure; hence, a tooth treated with SDF may still require a filling or crown to restore its shape and function. One notable downside is the black staining of the decayed areas after SDF application. Despite this, the discoloration can be masked with a white filling material, a cosmetic concern that may be less significant for baby teeth that will eventually be replaced by permanent teeth.
SDF is known for its cost-effectiveness and ease of application. It effectively halts decay but does not rebuild the tooth structure; hence, a tooth treated with SDF may still require a filling or crown to restore its shape and function. One notable downside is the black staining of the decayed areas after SDF application. Despite this, the discoloration can be masked with a white filling material, a cosmetic concern that may be less significant for baby teeth that will eventually be replaced by permanent teeth.


The quick application process of SDF makes it particularly beneficial for young children and patients who find it difficult to remain still during dental procedures, potentially reducing the need for sedation or general anesthesia. However, the usage of SDF is not without debate. Further high-quality research is required to fully understand its effectiveness, necessity, and potential adverse effects​​​​​​.<ref>{{cite journal |last1=Crystal |first1=Yasmi |last2=Niederman |first2=Richard |date=Jan 2019 |title=Evidence-Based Dentistry Update on Silver Diamine Fluoride |journal=Dental Clinics of North America |volume=63 |issue=1 |pages=45–68 |doi=10.1016/j.cden.2018.08.011 |pmc=6500430 |pmid=30447792}}</ref><ref>{{cite journal |last1=Horst |first1=Jeremy |last2=Ellenikiotis |first2=Hellene |last3=UCSF Silver Caries Arrest Committee |last4=Milgrom |first4=Peter |date=Jan 2016 |title=UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications, and Consent |journal=Journal of the California Dental Association |volume=44 |issue=1 |pages=16–28 |doi=10.1080/19424396.2016.12220962 |pmc=4778976 |pmid=26897901}}</ref> This consideration gains importance in the context of FDA advisories regarding the use of general anesthetics and sedation in young children​​.<ref>{{cite web |last1=U.S. Food &Drug Administration |date=18 June 2019 |title=FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women |url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-review-results-new-warnings-about-using-general-anesthetics-and |access-date=21 February 2020 |website=[[Food and Drug Administration]]}}</ref> Nonetheless, the American Dental Association endorses SDF as an effective means to manage dental decay in a conservative manner​​.<ref>{{cite web |last1=American Dental Association Center for Evidence-Based Dentistry |title=Nonrestorative Treatments for Carious Lesions Clinical Practice Guideline |url=https://ebd.ada.org/en/evidence/guidelines/nonrestorative-treatments-for-caries-lesions |access-date=21 February 2020}}</ref>
The quick application process of SDF makes it particularly beneficial for young children and patients who find it difficult to remain still during dental procedures, potentially reducing the need for sedation or general anesthesia. However, the usage of SDF is not without debate. Further high-quality research is required to fully understand its effectiveness, necessity, and potential adverse effects.<ref>{{cite journal |last1=Crystal |first1=Yasmi |last2=Niederman |first2=Richard |date=Jan 2019 |title=Evidence-Based Dentistry Update on Silver Diamine Fluoride |journal=Dental Clinics of North America |volume=63 |issue=1 |pages=45–68 |doi=10.1016/j.cden.2018.08.011 |pmc=6500430 |pmid=30447792}}</ref><ref>{{cite journal |last1=Horst |first1=Jeremy |last2=Ellenikiotis |first2=Hellene |last3=UCSF Silver Caries Arrest Committee |last4=Milgrom |first4=Peter |date=Jan 2016 |title=UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications, and Consent |journal=Journal of the California Dental Association |volume=44 |issue=1 |pages=16–28 |doi=10.1080/19424396.2016.12220962 |pmc=4778976 |pmid=26897901}}</ref> This consideration gains importance in the context of FDA advisories regarding the use of general anesthetics and sedation in young children.<ref>{{cite web |last1=U.S. Food &Drug Administration |date=18 June 2019 |title=FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women |url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-review-results-new-warnings-about-using-general-anesthetics-and |access-date=21 February 2020 |website=[[Food and Drug Administration]]}}</ref> Nonetheless, the American Dental Association endorses SDF as an effective means to manage dental decay in a conservative manner.<ref>{{cite web |last1=American Dental Association Center for Evidence-Based Dentistry |title=Nonrestorative Treatments for Carious Lesions Clinical Practice Guideline |url=https://ebd.ada.org/en/evidence/guidelines/nonrestorative-treatments-for-caries-lesions |access-date=21 February 2020}}</ref>


=== Stainless steel crowns ===
=== Stainless steel crowns ===
When it comes to repairing teeth affected by Early Childhood Caries, the extent of tooth decay will guide the choice of treatment. For moderate to severe decay, stainless steel crowns are a common option. These crowns are ready-made and can be tailored to fit over a child’s primary molar. The crowns are then fixed in place to restore the tooth. An alternative method for fitting these crowns is the [[Hall Technique]], which does not require the decayed parts of the tooth to be removed first.
When it comes to repairing teeth affected by Early Childhood Caries, the extent of tooth decay will guide the choice of treatment. For moderate to severe decay, stainless steel crowns are a common option. These crowns are ready-made and can be tailored to fit over a child's primary molar. The crowns are then fixed in place to restore the tooth. An alternative method for fitting these crowns is the [[Hall Technique]], which does not require the decayed parts of the tooth to be removed first.


=== Atraumatic restorative treatment (ART) ===
=== Atraumatic restorative treatment (ART) ===
For less invasive treatments, Atraumatic Restorative Treatment (ART) is an option. ART involves the partial removal of decayed tooth material with hand tools and sealing the cavity with a bonding material. This approach is particularly suitable for young patients because it is quicker and less likely to cause distress. It’s also beneficial when maintaining a tooth is important for spacing in the mouth, paving the way for permanent teeth to erupt properly in the future​​. However, it’s important to note that while ART is a valuable treatment, especially in areas where dental facilities are limited, studies suggest that fillings done with ART may be more prone to failure compared to those done with more traditional methods​​. Despite this, ART remains a recommended practice for managing tooth decay in young children under challenging conditions​​.<ref name=":0">{{Cite journal |last1=Dorri |first1=Mojtaba |last2=Martinez-Zapata |first2=Maria José |last3=Walsh |first3=Tanya |last4=Marinho |first4=Valeria Cc |last5=Sheiham Deceased |first5=Aubrey |last6=Zaror |first6=Carlos |date=December 28, 2017 |title=Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries |journal=The Cochrane Database of Systematic Reviews |volume=12 |issue=3 |pages=CD008072 |doi=10.1002/14651858.CD008072.pub2 |issn=1469-493X |pmc=6486021 |pmid=29284075}}</ref>
For less invasive treatments, Atraumatic Restorative Treatment (ART) is an option. ART involves the partial removal of decayed tooth material with hand tools and sealing the cavity with a bonding material. This approach is particularly suitable for young patients because it is quicker and less likely to cause distress. It's also beneficial when maintaining a tooth is important for spacing in the mouth, paving the way for permanent teeth to erupt properly in the future. However, it's important to note that while ART is a valuable treatment, especially in areas where dental facilities are limited, studies suggest that fillings done with ART may be more prone to failure compared to those done with more traditional methods. Despite this, ART remains a recommended practice for managing tooth decay in young children under challenging conditions.<ref name=":0">{{Cite journal |last1=Dorri |first1=Mojtaba |last2=Martinez-Zapata |first2=Maria José |last3=Walsh |first3=Tanya |last4=Marinho |first4=Valeria Cc |last5=Sheiham Deceased |first5=Aubrey |last6=Zaror |first6=Carlos |date=December 28, 2017 |title=Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries |journal=The Cochrane Database of Systematic Reviews |volume=12 |issue=3 |pages=CD008072 |doi=10.1002/14651858.CD008072.pub2 |issn=1469-493X |pmc=6486021 |pmid=29284075}}</ref>


== References ==
== References ==

Latest revision as of 04:47, 5 July 2024

Early childhood caries (ECC), formerly known as nursing bottle caries, baby bottle tooth decay, night bottle mouth and night bottle caries, is a disease that affects teeth in children aged between birth and 71 months.[1][2] ECC is characterized by the presence of 1 or more decayed (non cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth.[3] ECC has been shown to be a very common, transmissible bacterial infection, usually passed from the primary caregiver to the child.[2][4] The main bacteria responsible for dental cavities (dental caries) are Streptococcus mutans (S.mutans) and Lactobacillus.[4] There is also evidence that supports that those who are in lower socioeconomic populations are at greater risk of developing ECC.[5][6]

Dental caries (tooth decay) as seen on a child

Aetiology

[edit]

Early childhood caries (ECC) is a multifactorial disease,   with risk factors including but not limited to, cariogenic bacteria, diet practices and socioeconomic factors.[6]  Deciduous teeth begin to erupt at 6 months of age, once  visible in the oral cavity they are susceptible to tooth decay or dental caries.[1] This can result in the child experiencing severe pain, and needing extensive dental restorations or tooth extractions.

Microbial factors

[edit]

The primary cariogenic bacteria involved in ECC are S. mutans and Lactobacillus.[6] The transfer of S. Mutans from mother to infant is well documented. Over time the combination of food debris and bacteria form a biofilm on the tooth surface called plaque.[2] In plaque, the cariogenic microorganisms produce lactic acid as a by-product from fermentable carbohydrates. Examples of these fermentable carbohydrates include fructose, sucrose and glucose.[6] Cariogenic bacteria thrive on these sugars and help to weaken the adjacent tooth surface by causing loss of tooth structure (minerals) due to the loss of minerals due to acid production. A poor oral care routine and a diet that is high in fermentable carbohydrates favor acidic attack in the oral cavity. This prolonged acidic exposure allows the net loss of minerals from the tooth.[6] This diminishes the strength of the tooth and is called demineralization. For the outer layer of the tooth (enamel) to reach cavitation, there is a breakdown of the enamel structure  that allows the influx of the cariogenic bacteria. As cavitation progresses into dentine, the dental caries lesion becomes more severe, and this may cause tooth pain .

Dietary factors

[edit]

Diet plays a key role in the process of dental caries. The type of foods along with the frequency at which they are consumed can determine the risk  for  developing carious lesions.  Infants and young children may  consume fermentable carbohydrates, in the form of liquids such as: fruit juices, and soda pop.[1] These consumables have the potential to increase the risk of dental caries due to prolonged contact between sugars in the liquid and cariogenic bacteria on the tooth surface. Poor feeding practices without appropriate preventive measures can lead to  ECC.[1] Frequent and long duration bottle feeding, especially at night, is associated with ECC. This finding can be attributed to the fact that there is less salivary flow at night and hence less capacity for buffering and remineralization.[2] Each time a child drinks these liquids, acids attack for 20 minutes or longer. A parent's education and health awareness has a major influence on the caries experience of their child's feeding practices, dietary habits and food choices.[1]

Socioeconomic factors

[edit]

Dental caries still today, remains the most prevalent disease worldwide.[7] burdening millions of children and continuing  into adulthood with pain and potentially lower quality of life. There are several studies by Locker and Mota-Veloso reporting that there is a two-way relationship that exists between dental caries and levels of education, household income that affect quality of life and social positioning.[4] Locker suggested that the relationship between oral disease and health-related quality of life outcomes can be mediated by personal and environmental variables. More health promotion initiatives and policy-making that collaborate directly with the community to increase meeting their needs, should be implemented.[3]

While the primary etiology is due to microbial factors, it is also largely influenced by the social, behavioral and economic determinants in which children are surrounded  including living in a low income earning family. Secondly, having limited access to healthcare and education where important messages about the consumption of cariogenic foods are not being transferred to children or their parents.[6][1] Efforts should be made to reach rural and remote communities to implement health promotion strategies to increase awareness about diet and oral hygiene.

The education, occupation and income of families also greatly affects the quality of life. Children greatly rely on their parents or guardians for help concerning their health and well-being.[7] Studies have shown that families of lower socioeconomic status are less likely to regularly attend the dentist and access preventive dental resources. ECC also has an accumulative effect for those that live in rural areas.[8]

Prevention

[edit]

Early childhood caries can be prevented through the combination of the following: adhering to a healthy nutritional diet, optimal plaque removal, use of fluoridation on the tooth surface once erupted, care taken by the mother during the prenatal and perinatal period and regular dental visits. The following are recommendations to help prevent ECC.

Adequate diet

[edit]

Dietary habits and the presence of cariogenic bacteria within the oral cavity are an important factor in the risk of ECC. ECC is commonly caused by bottle feeding, frequent snacking and a high sugar diet.[9]

In regards to preventing ECC through bottle feeding, it is fundamental not to allow the child to sleep using 'sippy cups' or bottles as this is a large factor contributing to baby bottle decay/caries.[7] This is highly encouraged as it prevents continuous exposure to non-milk extrinsic sugars and therefore the potential progression of caries – this means the oral cavity can return to a neutral pH and therefore decreased acidity.[1] These researches also suggest trying to introduce cups to children as they approach their first birthday and to reduce the use of a bottle. A low-sugar and high nutritional diet is recommended for both the mother and the child especially during breastfeeding, and it is also recommended to avoid frequent snacking.[9]

A 2019 Cochrane review concluded that there is a 15% drop in risk of developing ECC when mothers with infants or pregnant women are given advice on a healthy child diet and feeding practices.[10][needs update]

Optimal plaque removal

[edit]

On eruption of the first primary tooth in a child, tooth brushing and cleaning should be performed by an adult.[1] This is important as the plaque that attaches to the surface of the tooth has bacteria that have the ability to cause caries (decay) on the tooth surface. It is recommended to brush children's teeth twice daily using a soft bristled, age and size appropriate toothbrush and if indicated age appropriate amount of fluoridated toothpaste.[11] It is suggested that it is suitable to brush children's teeth until they reach the approximate age of 6 years; when they will begin to develop  adequate dexterity and cognition needed for adequate brushing by themselves. It is encouraged to watch children brushing their teeth until they are competently able to brush.

Fluoride

[edit]

Fluoride is a natural mineral that naturally occurs throughout the world – it is also the active ingredient of many toothpastes specifically for its remineralizing effects on enamel, often repairing the tooth surface and reducing the risk of caries.[11] The use of fluoridated toothpaste is highly recommended by dental professionals; whereby studies suggest that the correct daily use of fluoride on the dentition of children has a high caries-preventive effect and therefore has potential to prevent ECC.[8] However, it is important to use fluoridated toothpastes correctly; in children under the age of three years, a smear or rice-sized amount of fluoridated toothpaste should be used. In children between the ages of three and six, a pea-sized amount of fluoridated toothpaste should be used. The child should be monitored until they can brush well. The child should be taught to spit the toothpaste out after brushing.[1]

Pre-natal and peri-natal period

[edit]

Prevention of early childhood caries begins before the baby is born; women are advised to maintain a well-balanced diet of high nutritional value during pregnancy.[9] This is important since teeth start developing before birth  if the diet is not sufficient, a  condition called developmental dental defect may occur  including enamel hypoplasia.[12] Enamel hypoplasia is a developmental defect of enamel that occurs during tooth development, mainly pre-natal or during early childhood. Teeth affected by enamel hypoplasia are at a higher risk of caries since there is an increased loss of minerals and therefore the tooth surface is able to breakdown more easily in comparison to a non-hypoplastic tooth.

Dental visits

[edit]

It is recommended thar parents and caregivers take their children to a dental professional for examination at six months of age and no later than the child's first birthday.[1] The dental professional will examine  the child's teeth and provide recommendations to the parents or caregivers regarding the best way to prevent ECC and what actions to take.[1] Studies suggest that children who have attended visits within the first few years of life (an early preventive dental visit) potentially experience less dental related issues and incur lower dental related costs throughout their lives.[13]

Treatment

[edit]

Early detection and risk assessment

[edit]

The approach to managing Early Childhood Caries involves a combination of restoring or removing the decayed teeth. Dentists also focus heavily on early intervention strategies, which include the application of protective fluoride treatments directly to the teeth, guiding families through proper dental care routines, and offering nutritional advice to prevent further decay. During the initial dental visit, which plays a pivotal role, the dentist evaluates the child's dietary and oral hygiene habits. By doing so, they can identify behaviours that may contribute to tooth decay. These assessments take into account the child's age and their social, behavioural, and medical background.

Tailored treatment based on caries risk

[edit]

For children identified as having a low risk of tooth decay, the focus is on monitoring and preventive care rather than immediate dental treatments. Regular dental visits are encouraged to identify any new signs of decay early on. Early stages of decay (white spots) and initial enamel damage are managed with non-invasive preventive methods and are closely watched over time. High-risk children typically need more intensive treatment. This may include early restorative work to repair and address any existing decay to prevent further deterioration of the teeth. Since ECC affects children under the age of 5 years, dental treatments under general anesthesia may be necessary in select cases.[14] However, there's a notable concern with this method: despite the initial success of the treatment, decay can recur, with some cases reported as early as 6 months post-treatment.[15]

Silver diamine fluoride

[edit]

In managing Early Childhood Caries, dental professionals also have Silver Diamine Fluoride (SDF), a dual-action liquid that combats tooth decay. SDF combines the bacteria-battling power of silver with the tooth-strengthening properties of fluoride. This solution is brushed directly onto the affected areas, eliminating the immediate need for drilling and making it a less invasive treatment option.

SDF is known for its cost-effectiveness and ease of application. It effectively halts decay but does not rebuild the tooth structure; hence, a tooth treated with SDF may still require a filling or crown to restore its shape and function. One notable downside is the black staining of the decayed areas after SDF application. Despite this, the discoloration can be masked with a white filling material, a cosmetic concern that may be less significant for baby teeth that will eventually be replaced by permanent teeth.

The quick application process of SDF makes it particularly beneficial for young children and patients who find it difficult to remain still during dental procedures, potentially reducing the need for sedation or general anesthesia. However, the usage of SDF is not without debate. Further high-quality research is required to fully understand its effectiveness, necessity, and potential adverse effects.[16][17] This consideration gains importance in the context of FDA advisories regarding the use of general anesthetics and sedation in young children.[18] Nonetheless, the American Dental Association endorses SDF as an effective means to manage dental decay in a conservative manner.[19]

Stainless steel crowns

[edit]

When it comes to repairing teeth affected by Early Childhood Caries, the extent of tooth decay will guide the choice of treatment. For moderate to severe decay, stainless steel crowns are a common option. These crowns are ready-made and can be tailored to fit over a child's primary molar. The crowns are then fixed in place to restore the tooth. An alternative method for fitting these crowns is the Hall Technique, which does not require the decayed parts of the tooth to be removed first.

Atraumatic restorative treatment (ART)

[edit]

For less invasive treatments, Atraumatic Restorative Treatment (ART) is an option. ART involves the partial removal of decayed tooth material with hand tools and sealing the cavity with a bonding material. This approach is particularly suitable for young patients because it is quicker and less likely to cause distress. It's also beneficial when maintaining a tooth is important for spacing in the mouth, paving the way for permanent teeth to erupt properly in the future. However, it's important to note that while ART is a valuable treatment, especially in areas where dental facilities are limited, studies suggest that fillings done with ART may be more prone to failure compared to those done with more traditional methods. Despite this, ART remains a recommended practice for managing tooth decay in young children under challenging conditions.[20]

References

[edit]
  1. ^ a b c d e f g h i j k Policy on early childhood caries (ECC): Consequences and preventive strategies. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:88-91.https://www.aapd.org/globalassets/media/policies_guidelines/p_eccconsequences.pdf
  2. ^ a b c d Fejerskov O, Edwina A, Kidd M. Dental Caries: The Disease and its Clinical Management. 2nd ed. Oxford; Ames, Iowa: Blackwell Munksgaard;2008.
  3. ^ a b Locker, David (2007). "Disparities in oral health-related quality of life in a population of Canadian children". Community Dentistry and Oral Epidemiology. 35 (5): 348–356. doi:10.1111/j.1600-0528.2006.00323.x. PMID 17822483.
  4. ^ a b c Mota-Veloso, Isabella; Soares, Maria Eliza C.; Alencar, Bruna Mota; Marques, Leandro Silva; Ramos-Jorge, Maria Letícia; Ramos-Jorge, Joana (2016-01-01). "Impact of untreated dental caries and its clinical consequences on the oral health-related quality of life of schoolchildren aged 8–10 years". Quality of Life Research. 25 (1): 193–199. doi:10.1007/s11136-015-1059-7. ISSN 1573-2649. PMID 26135023. S2CID 19164652.
  5. ^ Dülgergil, Çoruht; Dalli, Mehmet; Hamidi, Mehmetmustafa; Çolak, Hakan (2013). "Early childhood caries update: A review of causes, diagnoses, and treatments". Journal of Natural Science, Biology and Medicine. 4 (1): 29–38. doi:10.4103/0976-9668.107257. PMC 3633299. PMID 23633832.
  6. ^ a b c d e f Mohebbi, Simin Z.; Virtanen, Jorma I.; Murtomaa, Heikki; Vahid-Golpayegani, Mojtaba; Vehkalahti, Miira M. (2008). "Mothers as facilitators of oral hygiene in early childhood". International Journal of Paediatric Dentistry. 18 (1): 48–55. doi:10.1111/j.1365-263X.2007.00861.x. PMID 18086026.
  7. ^ a b c Seminario, AL, Ivančaková R. Early childhood caries. Acta medica [Internet]. 2003 May;46(3):91-94. Retrieved from: ftp://orbis.lfhk.cuni.cz/Acta_Medica/2003/AM3_03.pdf
  8. ^ a b Twetman S. Caries prevention with fluoride toothpaste in children: an update. Eur Arch Paediatr Dent [Internet]. 2009 Sep 1;10(3):162-8. Available from: http://go.galegroup.com/ps/anonymous?p=AONE&sw=w&issn=18186300&v=2.1&it=r&id=GALE%7CA227281634&sid=googleScholar&linkaccess=fulltext&authCount=1&isAnonymousEntry=true
  9. ^ a b c Kawashita, Yumiko; Kitamura, Masayasu; Saito, Toshiyuki (2011). "Early Childhood Caries". International Journal of Dentistry. 2011: 1–7. doi:10.1155/2011/725320. PMC 3191784. PMID 22007218.
  10. ^ Riggs, Elisha; Kilpatrick, Nicky; Slack-Smith, Linda; Chadwick, Barbara; Yelland, Jane; Muthu, M S; Gomersall, Judith C (2019-11-20). Cochrane Oral Health Group (ed.). "Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries". Cochrane Database of Systematic Reviews. 2019 (11). doi:10.1002/14651858.CD012155.pub2. PMC 6864402. PMID 31745970.
  11. ^ a b Colgate Australia. Dental fluoride - what is fluoride? [Internet]. Colgate-Palmolive Company; 2017. Available from: http://www.colgate.com.au/en/au/oc/oral-health/basics/fluoride/article/what-is-fluoride
  12. ^ Caufield, P.W.; Li, Y.; Bromage, T.G. (2012). "Hypoplasia-associated Severe Early Childhood Caries – A Proposed Definition". Journal of Dental Research. 91 (6): 544–550. doi:10.1177/0022034512444929. PMC 3348067. PMID 22529242.
  13. ^ Savage, Matthew F.; Lee, Jessica Y.; Kotch, Jonathan B.; Vann, William F. (2004). "Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs". Pediatrics. 114 (4): e418–e423. doi:10.1542/peds.2003-0469-f. PMID 15466066. S2CID 14276166.
  14. ^ Weninger, Alyssa; Seebach, Erica; Broz, Jordyn; Nagle, Carol; Lieffers, Jessica; Papagerakis, Petros; Da Silva, Keith (2022-01-06). "Risk Indicators and Treatment Needs of Children 2–5 Years of Age Receiving Dental Treatment under General Anesthesia in Saskatchewan". Dentistry Journal. 10 (1): 8. doi:10.3390/dj10010008. ISSN 2304-6767. PMC 8775244. PMID 35049606.
  15. ^ Amin, M.; Nouri, R.; ElSalhy, M.; Shah, P.; Azarpazhooh, A. (2015-01-27). "Caries recurrence after treatment under general anaesthesia for early childhood caries: a retrospective cohort study". European Archives of Paediatric Dentistry. 16 (4): 325–331. doi:10.1007/s40368-014-0166-4. ISSN 1818-6300. PMID 25619862. S2CID 256369402.
  16. ^ Crystal, Yasmi; Niederman, Richard (Jan 2019). "Evidence-Based Dentistry Update on Silver Diamine Fluoride". Dental Clinics of North America. 63 (1): 45–68. doi:10.1016/j.cden.2018.08.011. PMC 6500430. PMID 30447792.
  17. ^ Horst, Jeremy; Ellenikiotis, Hellene; UCSF Silver Caries Arrest Committee; Milgrom, Peter (Jan 2016). "UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications, and Consent". Journal of the California Dental Association. 44 (1): 16–28. doi:10.1080/19424396.2016.12220962. PMC 4778976. PMID 26897901.
  18. ^ U.S. Food &Drug Administration (18 June 2019). "FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women". Food and Drug Administration. Retrieved 21 February 2020.
  19. ^ American Dental Association Center for Evidence-Based Dentistry. "Nonrestorative Treatments for Carious Lesions Clinical Practice Guideline". Retrieved 21 February 2020.
  20. ^ Dorri, Mojtaba; Martinez-Zapata, Maria José; Walsh, Tanya; Marinho, Valeria Cc; Sheiham Deceased, Aubrey; Zaror, Carlos (December 28, 2017). "Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries". The Cochrane Database of Systematic Reviews. 12 (3): CD008072. doi:10.1002/14651858.CD008072.pub2. ISSN 1469-493X. PMC 6486021. PMID 29284075.
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