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EARLY CHILDHOOD CARIES

The document discusses early childhood caries (ECC), defining it as a complex dental disease affecting primary teeth, particularly in children under the age of three. It explores the classification of ECC into three types based on severity, prevalence studies that report varying incidence rates, and environmental factors contributing to its development, including feeding practices and socioeconomic status. The document emphasizes the need for preventive measures, including maintaining oral hygiene, dietary recommendations, and the establishment of a dental home.

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EARLY CHILDHOOD CARIES KOMAL GHIYA
INDEX • DEFINITION • CLASSIFICATION • CONSEQUENCES • IDENTIFYING PATTERNS • PREVALENCE STUDIES • FACTORS • AAPD POLICY • RAPIDD SCALE
• PREVENTIVE TREATMENT • REBALANCING THE ORAL CAVITY • PREVENTING TRANSMISSION • FLUORIDES • ESTABLISHMENT OF DENTAL HOME • ANTICIPATORY GUIDANCE • FOOD DIARY • DIETARY RECOMMENDATIONS
• CARIES RISK ASSESMENT AND MANAGEMENT • ARRESTING CARIOUS LESION • ITR • STAINLESS STEEL CROWN • CONCLUSION • REFERENCES
DEFINITION • DAVIES(1998):COMPLEX DISEASE INVOLVING MAXILLARY PRIMARY INCISORS WITHIN A MONTH AFTER ERUPTION AND SPREADING RAPIDLY TO OTHER PRIMARY TEETH • ISMAIL(1998) EARLY CHILDHOOD CARIES IS OCCURRENCE OF ANY SIGN OF DENTAL CARIES ON THE TOOTH SURFACE DURING FIRST 3 YEARS OF LIFE
• AAPD 2004- “presence of 1 or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger”.
HISTORY • BELTRAMI:REPORTED THIS PATTERN OF EARLY CARIES IN YOUNG CHILDREN IN THE 1930s:BLACK TEETH OF THE VERY YOUNG • 1962:ELIAS FASS:FIRST COMPREHENSIVE DESCRIPTION OF CARIES IN INFANTS,WHICH HE TERMED AS NURSING BOTTLE MOUTH • WINTER 1966:NURSING CARIES • INFANT AND EARLY CHILDHOOD DENTAL DECAY:HOROWITZ 1998 • BABY BOTTLE DECAY:MIN KELLY 1987 • TOOTH CLEARING NEGLECT :MOSS 1996 • MATERNALLY DERIVED STREPTOCOCCUS MUTANS DISEASE • 1994:CENTER FOR DISEASE CONTROL AND PREVENTION RECOMMENDED THE USE OF A TERM EARLY CHILDHOOD CARIES J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
WAYNE H 1999 TYPE –I (MILD TO MODERATE ECC) :  a carious lesion or two involving incisors or molars.  The existence of isolated carious lesion(s) involving molars and incisors  Cause – a combination of cariogenic semi-solid or solid food and lack of oral hygiene.  The number of affected teeth usually increases as the cariogenic challenge persists J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
TYPE – II (MODERATE TO SEVERE ECC) • Labio-lingual carious lesions affecting maxillary incisors, with or without molars depending on the age of the child and stage of the disease and unaffected mandibular incisors. • Cause – inappropriate use of feeding bottle or at will breast feeding or a combination of both, with or without poor oral hygiene. • Poor oral hygiene most probably compounds the cariogenic challenge. • This type of ECC could be found soon after the first teeth erupts. Unless controlled it may proceed to become type III ECC. J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
TYPE III : (SEVERE ECC) • Carious lesions affecting almost all the teeth including the lower incisors. • Cause : a combination of cariogenic food and poor oral hygiene. • This condition is usually found between 3-5 years • The condition is rampant and involves tooth surfaces which are usually unaffected by caries. J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
CHILDREN YOUNGER THAN 3 YEARS OF AGE ANY SIGN OF SMOOTH SURFACE CARIES 3-5 ONE OR MORE CAVITATED,MISSING(DUE TO CARIES),OR FILLED SMOOTH SURFACE IN PRIMARY MAXILLARY ANTERIOR TEETH OR A DECAYED ,MISSING OR FILLED SURFACES(DMFS) SCORE OF GREATER THAN 4 (AGE 3 YEARS),GREATER THAN 5(AGE 4 YEARS) OR GREATER THAN 6(AGE 5 YEARS) Pediatric dentistry- Infanct through adoloscence. Casamassimo,Fields,Mctigue,Nowak.5th edition. Elsevier.Mosby
VEERKAMP AND WEERHEIJM 1995 STAGE AGE FEATURES INITIAL 10-18 MONTHS CERVICALLY AND OCCASIONALLY INTERPROXIMAL AREAS OF CHALKY WHITE DEMINERALIZATION NO PAIN DAMAGED 16-24 MONTHS LESIONS IN THE MAXILLARY ANTERIOR TEETH ,MAY SPREAD TO DENTIN AND SHOW YELLOWISH DISCOLORATION HYPERSENSISTIVITY ON HOT AND COLD FOOD INTAKE DEEP 20-36 MONTHS MOLARS ARE ALSO AFFECTED FREQUENT COMPLAIN OF PAIN PULPALLY INVOLVED MAXILLARY INCISORS TRAUMATIC 30-48 MONTHS TEETH BECOME SO WEEKENED BY CARIES THAT RELATIVELY SMALL FORCES CAN FRACTURE THEM MOLARS ARE NOW ASSOCIATED WITH PULPAL PROBLEM MAXILLARY INCISORS BECOME NONVITAL J BERG,R SLAYTON,E ARLY CHILDHOO D ORAL HEALTH,2 009
CARIES ANALYSIS SYSTEM(DOUGLAS 1994) J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
IDENTIFYING PATTERN CAVITATION ON THE OCCLUSAL SURFACE OF FIRST MOLARS PITS AND FISSURES OF SECOND MOLARS WITH PROGRESSION TO CAVITATION J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
FREQUENTLY OCCURS FOLLOWING THE ERUPTION OF PERMANENT MOLARS AND SUBSEQUENT CLOSING OF SPACE BETWEEN PRIMARY MOLARS J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
PLAQUE ACCUMULATION AT THE GINGIVAL MARGIN GINGIVAL MARGIN WHITE SPOT LESION/DECALCIFICATION CAVITATION OF MAXILLARY INCISORS FOLLOWED BY MAXILLARY FIRST MOLAR,MANDIBULAR FIRST MOLAR,MAXILLARY CANINESAND THEN SECOND MOLARS J BERG,R SLAYTON,EAR LY CHILDHOOD ORAL HEALTH,2009
CONSEQUENCES OF ECC • higher risk of new carious lesions in both the primary and permanent dentitions (O’Sullivan DM 1996) • hospitalizations and emergency room visits(Griffin SO 2000) • high treatment costs(Ladrillo TE 2006) • loss of school days(Edelstein BL 2015) • diminished ability to learn(Blumenshine SL 2008) • reduced oral health-related quality of life(Filstrup SL et al 2003) AAPD REFERENCE MANUAL V 38 / NO 6 16 / 17
PREVALENCE STUDIES P PRAKASH 2012(BANGLORE) 27.5%, Sobha Kuriakose 2015(TRIVANDRUM) 54% H. R. Priyadarshini 2011(BANGLORE) 37.3% R Mahejabeen 2006(DHARWAD) 54.1% DHAR V 2007(UDAIPUR) 46.75% D AGGARWAL 2012(MYSORE) 56.6% A STEPHEN 2015 (TAMILNADU SALEM) 16%
FACTORS ASSOCIATED WITH ECC
BREAST AND BOTTLE FEEDING KOTLOW 1977 BREAST FEEDING AND ECC BEGINNING WITH CASE REPORT S IN 1977 ADA AND AAPD UNRESTRICTED AT WILL NOCTURNAL BREAST FEEDING AFTER ERUPTION OF CHILD’S FIRST TOOTH SHOULD BE AVOIDED AS IT PUTS CHILD TO RISK OF ECC DYE et al 2004 LIDA 2007 KRAMER et al 2007 NO RELATIONSHIP BETWEEN BREAST ,BOTTLE FEEDING JOEL BERG SOME CHILDREN NURSE IN SUCH A WAY THAT EITHER CORRELATE WITH OR LEAD TO ECC
. Brams M,1983, Wendt LK,1996, Ismail 1999 NO ASSOCIATION BETWEEN BREASTFEEDING AND ECC Valaitis R 2000 (1) there is no strong and consistent evidence between breastfeeding and the development of ECC; (2) there is no specific period for weaning, and women should be encouraged to continue breastfeeding for as long as they wish; and (3) rigorous studies are necessary before issuing any public statements correlating breastfeeding with the development of ECC. T KATO 2015 found an association between breast feeding for at least 6 or 7 months and elevated risk of dental caries at age 30 months Neves P.A.M 2016 Breastfeeding did not provoke a decrease in biofilm Ph. Breastfeeding may not contribute to ECC.
HUMAN MILK • HUMAN BREAST MILK HAS A LOWER MINERAL CONTENT,HIGHER CONCENTRATION OF LACTOSE(7% VS 3% )AND LESS PROTEIN (1.2 g VS 3 gm per 100 ml) AS THAT OF BOVINE MILK • THESE DIFFERENCES ARE INSIGNIFICANT IN TERMS OF CARIOGENICITY (DRAKE 1976) • BREASTFEEDING MORE THAN SEVEN TIMES DAILY AFTER 12 MONTHS OF AGE IS ASSOCIATED WITH INCRAESED RISK OF CARIES (LIDA H 2007,MOHEBBI SZ 2008) Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM Community Dent Oral Epidemiol 2008 Aug;36(4):363-9.Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm.
• Frequent night time bottle feeding with milk and ad libitum breast-feeding are associated with, but not consistently implicated in, ECC. • Night time bottle feeding with juice, repeated use of a sippy or no-spill cup • While ECC may not arise from breast milk alone, breast feeding in combination with other carbohydrates has been found in vitro to be highly cariogenic Erickson PR, Mazhari E. Investigation of the role of human breast milk in caries development. Pediatr Dent 1999;21(2):86-90. Reisine S, Douglass JM. Psychosocial and behavioral issues in early childhood caries. Comm Dent Oral Epidem 1998;26(suppl 1):32-44.
PACIFIER HABIT Although the habit of dipping the pacifier in sugar is associated with early colonization by Streptococcus mutans in predentate infants, a systematic review did not find any consistent correlation between the use of pacifiers and the development of ECC, regardless of the length of use of pacifiers and of the introduction of sweeteners or not. Wan AKL,2001 Peressini S 2003 SWEETENED PACIFIERS IS AN IMPORTANT FACTOR IN CAUSING S ECC C NOBILE 2014 ECC is more prevalent in children accustomed sweetened pacifier S GOPAL 2016 2.9% ECC sweetened pacifier Vozza I 2017
INFANT FORMULAS Pamela R. Erickson 1998 INFANTS FORMULA REDUCE PLAQUE PH AND CAUSE ECC K HALLET 2006 Infant bottle-feeding habits (either allowing a child to sip from a bottle during the day or put to sleep at night) cause ECC Olatosi, O. O 2015 INFANT FORMULAS CAUSES 3.5 TIMES MORE ECC THAN BOTTLE FEEDING K HALLET,P ROURKE,PATTERN AND SEVERITY OF ECC,VOLUME 34, ISSUE ,FEBRUARY 2006 ,PAGES 25–35 Olatosi, O. O., et al. "The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution." Nigerian journal of clinical practice 18.4 (2015): 493-501.
SALIVA •PROVIDES THE MAIN HOST DEFENCE •ORGANIC COMPOUNDS WHICH AGGLUTINATE ORAL BACTERIA AND ENHANCE THEIIR REMOVAL •THESE AGGUTININS INCLUDE MUCINS,AGGLUTINATING GLYCOPROTEINS,FIBRONECTIN,L YSOZYME AND SECRETORY IMMUNOGLOBULINS CONTAINS SEVERAL ANTIMICROBIAL PROTEINS INCLUDING LACTOFERRIN ,LYSOZYME,AGGLUTININS •ORAL CLEARANCE ,BUFFERING CAPACITY ALL ARE RESPONSIBLE Thick ropy saliva ,has been found to be associated with ECC DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
MUTANT STREPTOCOCCI BERKOWITZ 2003,1996 MUTANS STREPTOCOCCI ,PLAQUE AND CARIES ASSOCIATION DOUGLASS 2008 INTERFERING WITH TRANSMISSION MAY HOLD STRONG PROMISE TO REDUCE DISEASE ONSET AND EXPERIENCE Kohler 1988 Children who acquire mutans streptococci by 2 years are at a higher risk to develop caries by age of 4 Berkowitz 1981, berkowitz and jones 1985,caufield 1988 Transmission of bacteria from mother to child being associated with increase risk for caries
VIRULENCE OF MUTANT STREPTOCOCCI SYNTHESIZE ALPHA 1,3 RICH WATER INSOLUBLE GLUCANS FROM SUCROSE(TANZER JM et al 1984) ADHESION AND COLONIZATION AND ENHANCED RATES OF SUGAR DIFFUSION AND ACID PRODUCTION(HOUTE J et al 1985) INTERCELLULAR POLYSACCHARIDE SUPPORT CONTINUAL ACID PRODUCTION DURING PERIODS OF LOW CONCENTRATION OF EXOGENOUS SUBSTRATE MAINTAINS ACTIVITY AND FOSTERS TOOTH DEMINERALIZATION DURING PERIODS OF SLEEP(SPATAFORA G et al 1995) PRODUCES LARGE AMOUNT OF LACTIC ACID WHICH CAUSE DEMINERALIZATION PRODUCTION OF DEXTRANASE ALLOWS INVASION OF M STREPTOCOCCI TO REPLACE S SANGUIS(TANZER JM 1989) DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
TRANSMISSION OF MUTANTS STREPTOCOCCI • CORRELATION BETWEEN SALIVARY MUTANT STREPTOCOCCI COUNTS IN MOTHERS AND THEIR CHILDREN HAVE BEEEN REPORTED • MS MAYBE TRANSMITTED VERTICALLY FROM CAREGIVER TO CHILD THROUGH SALIVARY CONTACT, AFFECTED BY THE FREQUENCY AND AMOUNT OF EXPOSURE • HORIZONTAL TRANSMISSION (EG, BETWEEN OTHER MEMBERS OF A FAMILY OR CHILDREN IN DAYCARE) ALSO OCCURS • SALIVARY CONCENTRATION OF 105 CFU /MM OF MATERNAL SALIVA WERE ASSOCIATED WITH A 52 % INFECTION RATE IN THEIR CHILDREN ,COMPARED TO ONLY 6% INFECTION RATE WHEN MATERNAL SALIVA CONCENTRATION WAS 103 CFU OR BELOW(BERKOWITZ RJ et al 1981) Berkowitz RJ. Mutans streptococci: Acquisition and transmission. Pediatr Dent 2006;28(2):106-9.
DIET MARRIRI 2003 IOWA:4-7 YEARS:SUGARED BEVERAGES SOHN et al 2006 HIGH CARBOHYDRATE SOFT DRINK GROUP HAD HIGHER CARIES DYE et al 2004 NOT EATING BREAKFAST ON A DAILY BASIS AND NOT CONSUMING THE RECOMMENDED 5 FRUIT AND VEGETABLES DAILY Tinanoff NT et al 2002 frequent in between meal consumption of sugar-containing snacks or drinks (eg, juice, formula, soda) increase the risk of caries J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009 Tinanoff NT, Kanellis MJ, Vargas CM. Current understanding of the epidemiology mechanism, and prevention of dental caries in preschool children. Pediatr Dent 2002;24(6):543-51.
• Caries-conducive dietary practices appear to be established by 12 months of age and are maintained throughout early childhood. Douglass JM 2009 • Frequent consumption of between-meal snacks and beverages containing sugars increases the risk of caries due to prolonged contact between sugars in the consumed food or liquid and cariogenic bacteria on the susceptible teeth. Tinanoff NT 2000 Douglass AB, Douglass JM, Krol DM. Educating pediatricians and family physicians in children’s oral health. Academic Pediatr 2009;9(6):452-6. Tinanoff NT, Palmer C. Dietary determinants of dental caries in preschool children and dietary recommendations for preschool children. J Pub Health Dent 2000;60(3): 197-206.
SUGARS • THE MOST WIDELY USED SUGAR SUCROSE IS THE MOST IMPORTANT IN DENTAL CARIES AS IT IS THE ONLY SUBSTRATE USED FOR BACTERIAL GENERATION OF PLAQUE DEXTRANS (NEWBRUN 1982) • SUCROSE,GLUCOSE AND FRUCTOSE FOUND IN FRUIT JUICES AND VIT C DRINKS ARE MORE ASSOCIATED WITH ECC DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
FREQUENCY OF CONSUMPTION INCREASES ACIDITY OF PLAQUE AND ENHANCES ESTABLISHMENT AND DOMINANCE OF THE ACIDURIC MUTANTS STREPTOCOCCI ENAMEL DEMINERALIZATION DECREASES AND INADEQUATE REMINERALIZATION DEMINERALIZTION BECOMES PREDOMINANT MECHANISM DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
ORAL CLEARANCE OF CARBOHYDRATES • HANAKI M et al (1993): CLEARANCE OF GLUCOSE IS SLOWEST ON THE LABIAL SURFACE OF MANDIBULAR MOLARS AND MAXILLARY INCISORS • THIS SHOWS THE PATTERN OF ECC DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
TOOTHBRUSHING • ECC OCCURS ON SURFACES THAT CAN BE EASILY ACCESSIBLE BY ROUTINE TOOTH BRUSHING ,ORAL HYGIENE LEVELS ARE ASSOCIATED WITH ECC • FREQUENCY OF BRUSHING,QUALITY OF PLAQUE REMOVAL ARE ALSO ASSOCIATED WITH THE OCCURRENCE OF ECC J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
TOOTH MATURATION AND DEFECTS • TOOTH IS MOST SUSCEPTIBLE TO CARIES IN THE PERIOD IMMEDIATELY AFTER ERUPTION AND PRIOR TO MATURATION • THIS IN MANY INFANTS A COMBINATION OF RECENTLY IMMATURE ENAMEL IN AN ENVIORNMENT OF CARIOGENIC FLORA WITH FREQUENT INGESTION OF FERMENTABLE CARBOHYDRATES WOULD RENDER THE TOOTH PARTICULARLY SUSCEPTIBLE TO CARIES • THE PRESENCE OF STRUCTURAL DEFECT OF ENAMEL MAY INCREASE CARIES RISK • ENAMEL DEFECTS ARE COMMON IN CHILDREN WITH LOW BIRTHWEIGHT OR SYSTEMIC ILLNESS OR UNDERNUTRITION DURING THE PERINATAL PERIOD J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009 Seow WK. Biological mechanisms of early childhood caries. Community Dent Oral Epidemiol 1998;26(suppl): 8-27.
SOCIOECNOMIC STATUS ANSARI et al 2003 ETIOLOGICAL DETERMINANTS IN PATHOGENESIS OF AVARIETY CONDITIONS INDEPENDENT OF THE BIOLOGICAL FACTOR EDELSTEIN 2002 PRESCHOOLERS IN POVERTY ARE 2 TIMES MORE PRONE THAN AFFLUENT COUNTERPARTS PERES 2005 EARLY LIFE INFLUENCES OF SOCIAL CLASS ,FAMILY INCOME AND PARENTAL EDUCATION A SHAH 2015(KASHMIR) Prevalence of ECC was 39.9% A GADHIANE 2013(WARDHA) 33.48% children were having ECC J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
Infant through adoloscence. Casamassimo,Fields,Mctigue,Nowak.5th edition. Elsevier.Mosby
RACE AND ETHINICITY • MILNES: • INCREASED RISK THAT COULD BE ASSOCIATED WITH CULTURAL NORMS INCLUDING CONCERN FOR ORAL HEALTH • PRENATAL DIET THAT COULD CONTRIBUTE TO ENAMEL HYPOPLASIA • CARE OF PRIMARY TEETH • CHILD REARING PRACTICES • ACCESS TO DENTAL AND MEDICAL CARE • MINORITIES MAY EXPERIENCE SIGNIFICANT BARRIERS TO DENTAL CARE,INCLUDING COST OF CARE AND AVAILABILTY OF ACCESSIBLE SERVICES AAPD.INFANT ORAL HEALTH CARE.PEDIATR DENT,1994;16:29
IMMUNOLOGICAL FACTORS • HOST IMMUNE MECHANISM INCLUDE SPECIFIC IMMUNE FACTORS DERIVED FROM SALIVA SECRETORY IG A,sIgA),OR SERUM AND GINGIVAL CREVICULAR FLUID(IMMUNOGLOBULIN G,IgG) AND NON SPECIFIC ANTIMICROBIAL SYSTEMS DERIVED MAINLY FROM SALIVA • SECRETORY IMMUNOGLOBULIN A MAY INHIBIT BACTERIAL ADHERENCE OR AGGLUTINATION AS WELL AS NEUTRALIZATION OF BACTERIAL ENZYMES • BRANDTZAEG:1973:THE PROTECTIVE EFFECTS OF sIgA IN OTHER MUCOSAL AREAS ARE WELL KNOWN,THERE IS LITTLE EVIDENCE THAT NATURALLY OCCURING sIgA ANTIBODIES PROTECT AGAINST DENTAL CARIES DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
CYCLIC EFFECT OF ECC • CHILDREN AFFLICTED REMAIN AT RISK THROUGHOUT CHILDHOOD EVEN WHEN PREVENTIVE MEASURES ARE TAKEN Pediatric dentistry- Infanct through adoloscence. Casamassimo,Fields,Mctigue,Nowak.5th edition. Elsevier.Mosby
AAPDPOLICY ON EARLY CHILDHOOD CARIES (ECC): UNIQUE CHALLENGES AND TREATMENT OPTIONS 2016 • Beause restorative care to manage ECC often requires the use of sedation and general anesthesia with its associated high costs and possible health risks, and because there is high recurrence of lesions following the procedures, there now is more emphasis on prevention and arrestment of the disease processes. Approaches include methods that have been referred to as: • 1. Chronic disease management, which includes parent engagement to facilitate preventive measures, and temporary restorations to postpone advanced restorative care • 2. Active surveillance, which emphasizes careful monitoring of caries progression and prevention programs in children with incipient lesions. • 3. Interim therapeutic restorations (ITR) that temporarily restore teeth in young children until a time when traditional cavity preparation and restoration is possible. REFERENCE MANUAL V 38 / NO 6 16 / 17
PREVENTION COMMUNITY BASED STRATEGY:EDUCATING MOTHERS IN THE HOPE OF INFLUENCING DIETARY HABITS AS WELL AS THOSE OF INFANTS SECOND:PROVISION OF EXAMINATION AND PREVENTIVE CARE IN DENTAL CLINICS THIRD:DEVELOPMENT OF APPROPRIATE DIETARY AND SELF CARE HABITS AT HOME REFERENCE MANUAL V 38 / NO 6 16 / 17
AAPD GUIDELINES • Avoiding frequent consumption of liquids and/or solid foods containing sugar, in particular: • Sugar-sweetened beverages (e.g., juices, soft drinks, sports drinks, sweetened tea) in a baby bottle or no-spill training cup. • Ad libitum breast-feeding after the first primary tooth begins to erupt and other dietary carbohydrates are introduced. • Baby bottle use after 12-18 months. • Implementing oral hygiene measures no later than the time of eruption of the first primary tooth. Toothbrushing should be performed for children by a parent twice daily, using a soft toothbrush of age-appropriate size. In children under the age of three, a smear or rice-sized amount of fluoridated toothpaste should be used. In children ages three to six, a pea-sized amount of fluoridated toothpaste should be used. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, REFERENCE MANUAL V 38 / NO 6 16 / 17
• 3. Providing professionally-applied fluoride varnish treatments for children at risk for ECC. • 4. Establishing a dental home within six months of eruption of the first tooth and no later than 12 months of age to conduct a caries risk assessment and provide parental education including anticipatory guidance for prevention of oral diseases. • 5. Working with medical providers to ensure all infants and toddlers have access to dental screenings, counseling, and preventive procedures. • 6. Educating legislators, policy makers, and third party payors regarding the consequences of and preventive strategies for ECC. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, REFERENCE MANUAL V 38 / NO 6 16 / 17
PREVENTION OF TRANSMISSION OF BACTERIA • A NON RANDOMIZED STUDY DIVIDED MOTHERS WHO HAD ATLEAST 106 MUTANTS STREPTOCOCCI PER MM OF SALIVA INTO TEST AND CONTROL GROUPS • TEST PROGRAMME INCLUDED PROVISION OF DENTAL EDUCATION,ORAL HYGIENE INSTRUCTIONS,DENTAL TREATMENT,TOOTH CLEANING,APPLICATION OF 2% SODIUM FLUORIDE,FLUORIDE VARNISH • THE CHILDREN WHOSE MOTHERS WERE IN EXPERIMENTAL GROUP HAD A DMFT OF 5.2 WHICH WAS MUCH LOWER THAN CONTROL WHICH WAS 8.6:WANS AND COLLEAGUES Pediatric dentistry Infancy through adoloscence. Casamassimo,Fields,Mctigue,Nowak.5th edition. Elsevier.Mosby
PREVENTING TRANSMISSION • Eliminating saliva-sharing activities (eg, sharing utensils, orally cleansing a pacifier) may help decrease an infant’s or toddler’s acquisition of cariogenic microbes. Berkowitz RJ. Mutans streptococci: Acquisition and transmission. Pediatr Dent 2006;28(2):106-9.
REBALANCING THE ORAL CAVITY High risk patient :rinse 10 ml of 0.12%chlorhexidiene digluconate solution once per day for 1 week every 6 months(feather stone 2006) Since children less than 3 years old will not be pertitnent ,this would be more appropriate for mothers with high caries risk Chlorhexidiene gel:1% applied for 5 minute per day over a period of 2 weeks(zickert 1982) IODINE: lopez et al 1999,2002:topical iodine agents can significantly suppress levels of mutants streptococci XYLITOL:
RAPIDD SCALE • READINESS ASSESSMENT OFPARENTS CONCERNING INFANT DENTAL DECAY(RAPIDD SCALE) • TO ASSESS A PARENT’S STAGE OF CHANGE OF PRECONTEMPLATIVE,CONTEMPLATIVE ,OR ACTION WITH REGARD TO HIS/HER CHILD • BASED ON THE WORK OF PROCHASKA AND DICLEMENTE MEASURES PRO AND CON PARENTAL BELIEFS ABOUT CARING FOR THE CHILD’S TEETH • READINESSS ASSESMENT OF PARENTS CONCERNING INFANTS DENTAL DECAY CONSISTED OF 38 ITEMS ON A FIVE POINT SCALE RANGING FROM STRONGLY AGREE TO STRONGLY DISAGREE Weinstein P, Riedy CA.The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay. ASDC J Dent Child 2001 Mar- Apr;68(2):129-35, 142.
• THE PATIENT OR PRIMAY CARETAKER WAS INSTRUCTED TO SELECT A BOX UNDER ONE OF THE FIVE CATEGORIES AFTER THE INTERVIEWER READ THEM THE QUESTION IN THEIR NATIVE LANGUAGE • EACH OF THE 38 ITEMS WERE PLACED ONTO ONE OF FOUR: • OPENNESS TO HEALTH INFORMATION • VALUING DENTAL HEALTH • CONVENIENCE AND CHANGE DIFFICULTY • CHILD PERMISSIVENESS. Weinstein P, Riedy CA.The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay. ASDC J Dent Child 2001 Mar- Apr;68(2):129-35, 142.
• THE SCORES ARE CALCULATED ,VALUES ARE RANKED AND PERCENTILE IS CALCULATED • THEN DIVIDES INTO PRECONTEMPLATORS,CONTEMPLATORS AND ACTION • USAGE: • USED TO DETERMINE PARENT’S STAGE OF CHANGE FOR THEIR CHILD’S ORAL HEALTH Weinstein P, Riedy CA.The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay. ASDC J Dent Child 2001 Mar-Apr;68(2):129-35, 142.
ESTABLISHMENT OF A DENTAL HOME • Non-dental health care providers who identify ECC should either provide therapy or refer the patient to a licensed dentist for treatment and establishment of a dental home • DENTAL HOME: The dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way.(2015 AAPD) • The dental home should be established no later than 12 months of age and includes referral to dental specialists when appropriate. American Academy of Pediatric Dentistry. Policy on a dental home. Pediatr Dent 2011;33(special issue):24-5
• PERFORM CARIES RISK ASSESSMENT • DEVELOP A TAILORED PLAN TO ANTICIPATE,PREVENT,SUPPRESS CARIES ACTIVITY • GROUNDWORK FOR THE PRACTIONERS TO PREVENT ECC
ANTICIPATORY GUIDANCE • Anticipatory guidance is the process of providing practical, developmentally-appropriate information about children’s health to prepare parents for the significant physical, emotional, and psychological milestones • Topics to be included are oral hygiene and dietary habits, injury prevention, nonnutritive habits, substance abuse, intraoral/perioral piercing, and speech/language development Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents,2016/17
VasudhaSodani 2011 the health professionals lack the adequate knowledge regarding ECC in Vadodara city VasudhaSodani,Sunanda Gsujan, Harsh G Shah,Bhavna Dave,Anticipatory Guidance regarding Early Childhood Caries (ECC) among Health Professionals in Vadodara city, Gujarat Journal of Advanced Oral Research, Vol 2; Issue 3: Oct - Dec 2011
Food Group Portion size considered one serving 1st day 2nd day 3rd day 4th day 5th day Average MILK (milk & cheese) 8 oz (1 cup) milk 1½ c cottage cheese | || ||| | || 2 MEAT (meat, fish, poultry, nuts, dry beans) 2-3 oz lean cooked meat, fish or poultry || | 0 || | 1+ FRUITS and VEGETABLES (including citrus fruits, dark green and deep yellow vegetables) ½ c cooked 1 medium raw || | ||| ||||| 0 2 BREAD and CEREALS (Enriched Or Whole Grain) 1 slice bread ¾ c dry cereal ½ c cooked cereal, rice, noodles, macaroni ||||| ||||||| |||| |||||| ||| 4 FOOD DIARY
Sonia Hernández-Cordero et al BMC Public Health2015:1031:7 DAY DIARY TO BE MORE CORRECT REPRODUCTION OF DIET THAN 24 HR RECALL Comparing a 7-day diary vs. 24 h- recall
SUGAR CLOCK-JHONSON AND BIRKHED:1991 Advanced Dental Nursing, Robert Ireland,2 ND EDITION
SUGAR CLOCK Advanced Dental Nursing, Robert Ireland,2 ND EDITION
DIETARY RECOMMENDATIONS • The American Academy of Pediatrics has recommended children one through six years of age consume no more than four to six ounces of fruit juice per day, from a cup (ie, not a bottle or covered cup) and as part of a meal or snack.(2016/17) • School health education programs and food services to promote nutrition programs that provide well-balanced and nutrient-dense foods of low caries-risk, in conjunction with encouraging increased levels of physical activity • Pediatric dentists and other health care providers who treat children to provide dietary and nutrition counseling (commensurate with their training and experience) in conjunction with other preventive services for their patients American Academy of Pediatrics Committee on Nutrition. Policy statement: The use and misuse of fruit juices in pediatrics. Pediatrics
• Pediatric dentists and other health care providers to recommend or prescribe sugar-free medications whenever possible. Educating parents of the risks of overdose from excessive consumption of candy-like chewable vitamin supplements • Eating a variety of nutrient-dense foods and beverages. • Balancing foods eaten with physical activity to maintain a healthy body mass index. • Maintaining a caloric intake adequate to support normal growth and development and to reach or maintain a healthy weight. • Choosing a diet with plenty of vegetables, fruits, and whole grains and low in fat, saturated (especially transsaturated) fat, and cholesterol. Policy on Dietary Recommendations for Infants, Children, and Adolescents REFERENCE MANUAL V 38 / NO 6 16 / 17
FLUORIDE AGE <0.3 0.3-0.7 >0.7 0-2 0.25 0.00 0.00 2-3 0.50 0.25 0.00 3-16 1.00 0.50 0.25 G NIKIFORUK,UNDERSTANDING DENTAL CARIES,PREVENTION BASIC AND CLINICAL APPROACH,KARGER
FLUORIDE DENTRIFICE • The use of anticariogenic agents, especially twice daily brushing with fluoridated toothpaste and the frequent application of fluoride varnish, may reduce the risk of development and progression of caries. • Using no more than a ‘smear’ or ‘rice-size’ (approximately 0.1 mg fluoride amount of fluoridated toothpaste for children less than three years of age may decrease risk of fluorosis. • Using no more than a ‘pea-size’ (approximately 0.25 mg fluoride) amount of fluoridated toothpaste is appropriate for children aged three to six American Dental Association Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc 2014;145(2):190-191.
• Parents should dispense the toothpaste onto a soft, age- appropriate sized toothbrush and perform or assist with toothbrushing of preschool-aged children. • To maximize the beneficial effect of fluoride in the toothpaste, rinsing after brushing should be kept to a minimum or eliminated altogether. ADA Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc 2014;145(2):190-1.
PROFESSIONALLY APPLIED FLUORIDE • Professionally-applied topical fluoride treatments also are efficacious in reducing prevalence of ECC. • The recommended professionally-applied fluoride treatments for children at risk for ECC who are younger than six years is five percent sodium fluoride varnish (NaFV; 22,500 ppm F) Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, REFERENCE MANUAL V 38 / NO 6 16 / 17
WATER FLUORIDATION • Fluoridation of community drinking water is the precise adjustment of the existing natural fluoride concentration in drinking water to a safe level that is recommended for caries prevention. • The United States Public Health Service has established the optimum concentration for fluoride in the water in the range of 0.7–1.2 mg/L G NIKIFORUK,UNDERSTANDING DENTAL CARIES,PREVENTION BASIC AND CLINICAL APPROACH,KARGER
SILVER DIAMINE FLUORIDE • Silver diamine fluoride (SDF) is a colorless liquid • pH 10 • 24.4% to 28.8% (weight/volume) silver and 5.0% to 5.9% fluoride. • 44,800 ppm F J.C LLODRA 2005 SDF solution was found to be effective for caries reduction in primary teeth and first permanent molars in schoolchildren C.H.CHU 2002 Silver diamine fluoride was found to be effective in arresting dentin caries in primary anterior teeth in pre-school children.
RECOMMENDATIONS FOR PREVENTIVE MANEUVERS FOR ECC INTERVENTIONS TARGET CHLORHEXIDEINE VARNISH HIGH RISK ECC GROUP DIETARY COUNSELLING HIGH RISK ECC GROUP EARLY DETECTION ALL INFANTS BEFORE AGE OF 1 YEAR EDUCATION ALL INFANTS AND TODDLERS EDUCATION HIGH RISK COMMUNITIES FLUORIDE SUPPLEMENTS HIGH RISK GROUPS FLUORIDE DENTRIFICE ALL INFANTS AND TODDLERS FLUORIDE VARNISH HIGH RISK ECC GROUP PRENATAL FLUORIDE SUPPLEMENTS ALL INFANTS AND TODDLERS SEALANTS HIGH RISK ECC GROUP J BERG,R SLAYTON,EAR LY CHILDHOOD ORAL HEALTH,2009 Pediatric dentistry-
WATER FLUORIDATION COMMUNITY XYLITOL SUBSTITUTES HIGH RISK ECC GROUP CONTROL OF MOTHER-INFANT INFECTION WITH CARIOGENIC BACTERIA HIGH RISK ECC GROUP J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009Pediatric dentistry-
CARIES RISK ASSESSMENT AND MANAGEMENT Guideline on Caries- risk Assessme nt and Managem ent for Infants, Children, and Adolescen ts, 2014 REFERENC E MANUAL V 38 / NO 6 16 / 17
Guideline on Caries- risk Assessme nt and Managem ent for Infants, Children, and Adolescen ts, 2014 REFERENC E MANUAL V 38 / NO 6 16 / 17
Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents, 2014 REFERENCE MANUAL V 38 / NO 6 16 / 17
CARIES MANAGEMENT PROTOCOL FOR 1-2 YEAR OLDS Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents, 2014 REFERENCE MANUAL V 38 / NO 6 16 / 17
CARIES MANAGEMENT PROTOCOL FOR 3-5 YEAR OLDS Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents, 2014 REFERENCE MANUAL V 38 / NO 6 16 / 17
CARIES MANAGEMENT PROTOCOL >=6 Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents, 2014 REFERENCE MANUAL V 38 / NO 6 16 / 17
• Legends for Tables 4-6 • a Salivary mutans streptococci bacterial levels. • THETA Interim therapeutic restoration. • χ Periodic monitoring for signs of caries progression. • γ Parental supervision of a “pea sized” amount of toothpaste. • X Parental supervision of a “smear” amount of toothpaste. • λ Indicated for teeth with deep fissure anatomy or developmental d Need to consider fluoride levels in drinking water. defects. • e Careful monitoring of caries progression and prevention program. • μ Less concern about the quantity of toothpaste
ITR • Interim therapeutic restorations (ITR), using materials such as glass ionomers that release fluoride, are efficacious in both preventive and therapeutic approaches • Definitive restorative treatment in young children, in many cases, can be postponed by use of ITR or silver diamine fluoride treatments. 2016:AAPD • The ITR procedure involves removal of caries using hand or rotary instruments with caution not to expose the pulp. Leakage of the restoration can be minimized with maximum caries removal from the periphery of the lesion. • Following preparation, the tooth is restored with an adhesive restorative material such as glass ionomer or resin-modified glass ionomer cement Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options 2016,2014 Yip HK, Smales RJ, Ngo HC, Tay FR, Chu F. Selection of restorative materials for the atraumatic restorative treatment (ART) approach: A review. Spec Care Dent 2001; 21(6):216-221
ARRESTING ACTIVE LESIONS • ALL RESTORATIONS AND TREATMENT DONE UNDER GA OR CONCIOUS SEDATION • IF NOT THEN EXCAVATE GROSS CARIOUS LESION • INTERIM THERAPEUTIC RESTORATION • GIVES TIME FOR DESIGNING TREATMENT PLAN • STOPS THE PROGRESSION OF CARIES • DECREASES THE BACTERIAL COUNT DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
• The use of ITR has been shown to reduce the levels of cariogenic oral bacteria (e.g., Mutans Streptococci, lactobacilli) in the oral cavity immediately following its placement. • However, this level may return to pretreatment counts over a period of six months after ITR placement if no other treatment is provided Policy on Interim Therapeutic Restorations (ITR), 2013, REFERENCE MANUAL V 38 / NO 6 16 / 17
STAINLESS STEEL CROWN • Stainless steel crowns often are indicated to restore teeth with large carious lesions and extensive white spot lesions and, at early age, are less likely than other restorations to require retreatment:2014 • large carious lesions, interproximal lesions, and extensive white spot lesions since stainless steel crowns are less likely than other restorations to require retreatment:2016 Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options,2014,AAPD
CONCLUSION • THUS ECC IS A MULTIFACTORIAL DISEASE WHOSE PREVENTION IS OF UTMOST IMPORTANCE AND TREATMENT COMPRISES OF RAPID AND ACTIVE MANAGEMENT OF LESIONS
REFERENCES • Prakash P, Subramaniam P, Durgesh BH, Konde S. Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: A cross-sectional study. European Journal of Dentistry. 2012;6(2):141-152. • Kuriakose S, Prasannan M, Remya KC, Kurian J, Sreejith KR. Prevalence of early childhood caries among preschool children in Trivandrum and its association with various risk factors. Contemporary Clinical Dentistry. 2015;6(1):69-73. • Priyadarshini HR, Hiremath SS, Puranik M, Rudresh SM, Nagaratnamma T. Prevalence of early childhood caries among preschool children of low socioeconomic status in Bangalore city, India. Journal of International Society of Preventive & Community Dentistry. 2011;1(1):27-30. doi:10.4103/2231- 0762.86384.
• J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009Pediatric dentistry- • Infant through adoloscence. Casamassimo,Fields,Mctigue,Nowak.5th edition. Elsevier.Mosby • DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY • AAPD REFERENCE MANUAL V 38 / NO 6 16 / 17 • Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM Community Dent Oral Epidemiol 2008 Aug;36(4):363-9.Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm. • Erickson PR, Mazhari E. Investigation of the role of human breast milk in caries development. Pediatr Dent 1999;21(2):86-90. • Reisine S, Douglass JM. Psychosocial and behavioral issues in early childhood caries. Comm Dent Oral Epidem 1998;26(suppl 1):32-44.
• Berkowitz RJ. Mutans streptococci: Acquisition and transmission. Pediatr Dent 2006;28(2):106-9 • Tinanoff NT, Kanellis MJ, Vargas CM. Current understanding of the epidemiology mechanism, and prevention of dental caries in preschool children. Pediatr Dent 2002;24(6):543-51. • Douglass AB, Douglass JM, Krol DM. Educating pediatricians and family physicians in children’s oral health. Academic Pediatr 2009;9(6):452-6. • Tinanoff NT, Palmer C. Dietary determinants of dental caries in preschool children and dietary recommendations for preschool children. J Pub Health Dent 2000;60(3): 197-206. • Seow WK. Biological mechanisms of early childhood caries. Community Dent Oral Epidemiol 1998;26(suppl): 8-27.
• Aasim Farooq Shah, Manu Batra, Vikram Aggarwal, Subha Soumya Dany, Prashant Rajput, Tushika Bansal low socioeconomic status in district Srinagar, Jammu and Kashmir,IAIM 2015;2(3):8-13 • Prevalence and determinant of early childhood caries among the children attending the Anganwadis of Wardha district, India Gaidhane Abhay M, Patil Manoj, Khatib Nazli, Zodpey Sanjay, Zahiruddin Quazi Syed Year : 2013 | Volume: 24 | Issue Number: 2 | Page: 199-205 • Dental caries prevalence among preschool children of Hubli: Dharwad city Mahejabeen R, Sudha P, Kulkarni S S, Anegundi R Year : 2006 | Volume: 24 | Issue Number: 1 | Page: 19-22
• Dhar V, Jain A, Van Dyke T E, Kohli A. Prevalence of dental caries and treatment needs in the school-going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent 2007;25:119-21 • Nilza M. E. Ribeiro; Manoel A. S. Ribeiro, J. Pediatr. (Rio J.) vol.80 no.5 suppl. Porto Alegre Nov. 2004,Breastfeeding and early childhood caries: a critical review • Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM Community Dent Oral Epidemiol 2008 Aug;36(4):363-9.Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm.
• Iida H, Auinger P, Billings RJ, Weitzman M Association between infant breastfeeding and early childhood caries in the United States Pediatrics. 2007 Oct;120(4):e944-52. • Weinstein P, Riedy CA.The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay. ASDC J Dent Child 2001 Mar-Apr;68(2):129-35, 142. • Pamela R. Erickson, Kelly L. McClintock, Nicole Green, S Jamilla LaFleu,Estimation ofthe caries-related risk associated with infant formulas, Pediatric Dentistry -20.’Z 1998
• Norman Tinanoff, DDS, MS David M. O’Sullivan, BS Early childhood caries: overview and recent findings, Pediatric Dentistry - 19:1, 1997 • K HALLET,P ROURKE,PATTERN AND SEVERITY OF ECC,VOLUME 34, ISSUE ,FEBRUARY 2006 ,PAGES 25–35 • Çolak H, Dülgergil ÇT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. Journal of Natural Science, Biology, and Medicine. 2013;4(1):29-38. • G NIKIFORUK,UNDERSTANDING DENTAL CARIES,PREVENTION BASIC AND CLINICAL APPROACH,KARGER • Prevalence and Predictors of Early Childhood Caries in 3- to 6-year-old South Indian Children – A Crosssectional Descriptive Study Satya Gopala /Vinay Chandrappab /Uloopi Kadidalc /Chandrasekhar Rayalad / Madhuri Vegesna, Oral Health & Preventive Dentistry,2014
• Vozza I, Capasso F, Marrese E, Polimeni A, Ottolenghi L. Infant and Child Oral Health Risk Status Correlated to Behavioral Habits of Parents or Caregivers: A Survey in Central Italy. Journal of International Society of Preventive & Community Dentistry. 2017;7(2):95-99. • Sonia Hernández-Cordero et al BMC Public Health201515:1031:7 DAY DIARY TO BE MORE CORRECT REPRODUCTION OF DIET THAN 24 HR RECALL • Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents,2016/17 • VasudhaSodani,Sunanda Gsujan, Harsh G Shah,Bhavna Dave,Anticipatory Guidance regarding Early Childhood Caries (ECC) among Health Professionals in Vadodara city, Gujarat Journal of Advanced Oral Research, Vol 2; Issue 3: Oct - Dec 2011
• AAPD.INFANT ORAL HEALTH CARE.PEDIATR DENT,1994;16:29 • Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, REFERENCE MANUAL V 38 / NO 6 16 / 17 • Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options 2016,2014 • Yip HK, Smales RJ, Ngo HC, Tay FR, Chu F. Selection of restorative materials for the atraumatic restorative treatment (ART) approach: A review. Spec Care Dent 2001; 21(6):216-221 • Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options,2014,AAPD
• Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents, 2014 REFERENCE MANUAL V 38 / NO 6 16 / 17 • G NIKIFORUK,UNDERSTANDING DENTAL CARIES,PREVENTION BASIC AND CLINICAL APPROACH,KARGER • Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents,2016/17 • Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, REFERENCE MANUAL V 38 / NO 6 16 / 17 • ADA Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc 2014;145(2):190-1
• American Dental Association Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc 2014;145(2):190-191 • American Academy of Pediatrics Committee on Nutrition. Policy statement: The use and misuse of fruit juices in pediatrics. Pediatrics 2001;107(5):1210-3. Reaffirmed October, 2006. • Advanced Dental Nursing, Robert Ireland,2 ND EDITION • Weinstein P, Riedy CA.The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay. ASDC J Dent Child 2001 Mar-Apr;68(2):129-35, 142.
• Llodra, J. C., et al. "Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial." Journal of dental research 84.8 (2005): 721-724. • Rosenblatt, A., T. C. M. Stamford, and R. Niederman. "Silver diamine fluoride: a caries “silver-fluoride bullet”." Journal of dental research 88.2 (2009): 116-125.

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In this document
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Introduction to ECC, its definition, classification, prevalence studies, and consequences.

Recommendations on preventive treatment, establishing a dental home, and managing carious lesions.

Definitions from different sources highlighting the onset and classification of dental caries in young children.

Historical descriptions and classifications of ECC, detailing the progression and manifestations in children.

Patterns of caries progression in children under 5, detailing surface involvement and age-related features.

Analysis of patterns of caries development, including patterns in molar eruption and gingival health.

Impacts of ECC, including risk of additional lesions and economic effects derived from prevalence studies.

Factors leading to ECC, including dietary habits like breastfeeding and bottle-feeding implications.

Evidence on breastfeeding's relation to ECC, focusing on dietary factors that contribute to dental health.

Impact of infant formula on plaque pH and ECC risk, highlighting the importance of dietary choices.

Involvement of Mutans streptococci in caries progression, detailing virulence and transmission mechanisms.

Dietary practices linked to ECC, addressing patterns of sugar consumption, oral hygiene, and clearance.

Effectiveness of oral hygiene practices, including tooth brushing and its timing related to caries susceptibility.

The role of socioeconomic status in the prevalence of ECC, emphasizing access to care and education.

Impact of host immune responses on caries development and the importance of preventive policies.

Overview of AAPD guidelines for preventing ECC via education, dietary recommendations, and oral hygiene.

Tailored strategies to prevent bacterial transmission associated with ECC, using community-based education.

Prevention programs targeting high-risk families, focusing on dental care access and parental readiness.

Guidelines for establishing a dental home to monitor and manage infants’ oral health.

Guidance for parents on oral health principles and dietary habits to prevent ECC.

Use of food diaries for tracking dietary intake as a preventive measure against ECC.

Guidelines by the American Academy of Pediatrics on dietary practices to mitigate ECC risk.

Usage of fluoride in different forms as a preventive measure against ECC.

Protocols for assessing and managing caries in children, focusing on minimal intervention strategies.

Utilization of ITR for managing caries in young children, discussing materials and strategies.

Understanding ECC as a multifactorial disease that requires rapid management and preventive care.

Comprehensive references cited throughout the presentation, backing the discussed content.

EARLY CHILDHOOD CARIES

  • 1.
  • 2.
    INDEX • DEFINITION • CLASSIFICATION •CONSEQUENCES • IDENTIFYING PATTERNS • PREVALENCE STUDIES • FACTORS • AAPD POLICY • RAPIDD SCALE
  • 3.
    • PREVENTIVE TREATMENT •REBALANCING THE ORAL CAVITY • PREVENTING TRANSMISSION • FLUORIDES • ESTABLISHMENT OF DENTAL HOME • ANTICIPATORY GUIDANCE • FOOD DIARY • DIETARY RECOMMENDATIONS
  • 4.
    • CARIES RISKASSESMENT AND MANAGEMENT • ARRESTING CARIOUS LESION • ITR • STAINLESS STEEL CROWN • CONCLUSION • REFERENCES
  • 5.
    DEFINITION • DAVIES(1998):COMPLEX DISEASEINVOLVING MAXILLARY PRIMARY INCISORS WITHIN A MONTH AFTER ERUPTION AND SPREADING RAPIDLY TO OTHER PRIMARY TEETH • ISMAIL(1998) EARLY CHILDHOOD CARIES IS OCCURRENCE OF ANY SIGN OF DENTAL CARIES ON THE TOOTH SURFACE DURING FIRST 3 YEARS OF LIFE
  • 6.
    • AAPD 2004-“presence of 1 or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger”.
  • 7.
    HISTORY • BELTRAMI:REPORTED THISPATTERN OF EARLY CARIES IN YOUNG CHILDREN IN THE 1930s:BLACK TEETH OF THE VERY YOUNG • 1962:ELIAS FASS:FIRST COMPREHENSIVE DESCRIPTION OF CARIES IN INFANTS,WHICH HE TERMED AS NURSING BOTTLE MOUTH • WINTER 1966:NURSING CARIES • INFANT AND EARLY CHILDHOOD DENTAL DECAY:HOROWITZ 1998 • BABY BOTTLE DECAY:MIN KELLY 1987 • TOOTH CLEARING NEGLECT :MOSS 1996 • MATERNALLY DERIVED STREPTOCOCCUS MUTANS DISEASE • 1994:CENTER FOR DISEASE CONTROL AND PREVENTION RECOMMENDED THE USE OF A TERM EARLY CHILDHOOD CARIES J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
  • 8.
    WAYNE H 1999 TYPE–I (MILD TO MODERATE ECC) :  a carious lesion or two involving incisors or molars.  The existence of isolated carious lesion(s) involving molars and incisors  Cause – a combination of cariogenic semi-solid or solid food and lack of oral hygiene.  The number of affected teeth usually increases as the cariogenic challenge persists J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
  • 9.
    TYPE – II(MODERATE TO SEVERE ECC) • Labio-lingual carious lesions affecting maxillary incisors, with or without molars depending on the age of the child and stage of the disease and unaffected mandibular incisors. • Cause – inappropriate use of feeding bottle or at will breast feeding or a combination of both, with or without poor oral hygiene. • Poor oral hygiene most probably compounds the cariogenic challenge. • This type of ECC could be found soon after the first teeth erupts. Unless controlled it may proceed to become type III ECC. J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
  • 10.
    TYPE III :(SEVERE ECC) • Carious lesions affecting almost all the teeth including the lower incisors. • Cause : a combination of cariogenic food and poor oral hygiene. • This condition is usually found between 3-5 years • The condition is rampant and involves tooth surfaces which are usually unaffected by caries. J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
  • 11.
    CHILDREN YOUNGER THAN3 YEARS OF AGE ANY SIGN OF SMOOTH SURFACE CARIES 3-5 ONE OR MORE CAVITATED,MISSING(DUE TO CARIES),OR FILLED SMOOTH SURFACE IN PRIMARY MAXILLARY ANTERIOR TEETH OR A DECAYED ,MISSING OR FILLED SURFACES(DMFS) SCORE OF GREATER THAN 4 (AGE 3 YEARS),GREATER THAN 5(AGE 4 YEARS) OR GREATER THAN 6(AGE 5 YEARS) Pediatric dentistry- Infanct through adoloscence. Casamassimo,Fields,Mctigue,Nowak.5th edition. Elsevier.Mosby
  • 12.
    VEERKAMP AND WEERHEIJM1995 STAGE AGE FEATURES INITIAL 10-18 MONTHS CERVICALLY AND OCCASIONALLY INTERPROXIMAL AREAS OF CHALKY WHITE DEMINERALIZATION NO PAIN DAMAGED 16-24 MONTHS LESIONS IN THE MAXILLARY ANTERIOR TEETH ,MAY SPREAD TO DENTIN AND SHOW YELLOWISH DISCOLORATION HYPERSENSISTIVITY ON HOT AND COLD FOOD INTAKE DEEP 20-36 MONTHS MOLARS ARE ALSO AFFECTED FREQUENT COMPLAIN OF PAIN PULPALLY INVOLVED MAXILLARY INCISORS TRAUMATIC 30-48 MONTHS TEETH BECOME SO WEEKENED BY CARIES THAT RELATIVELY SMALL FORCES CAN FRACTURE THEM MOLARS ARE NOW ASSOCIATED WITH PULPAL PROBLEM MAXILLARY INCISORS BECOME NONVITAL J BERG,R SLAYTON,E ARLY CHILDHOO D ORAL HEALTH,2 009
  • 13.
    CARIES ANALYSIS SYSTEM(DOUGLAS1994) J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
  • 14.
    IDENTIFYING PATTERN CAVITATION ONTHE OCCLUSAL SURFACE OF FIRST MOLARS PITS AND FISSURES OF SECOND MOLARS WITH PROGRESSION TO CAVITATION J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
  • 15.
    FREQUENTLY OCCURS FOLLOWINGTHE ERUPTION OF PERMANENT MOLARS AND SUBSEQUENT CLOSING OF SPACE BETWEEN PRIMARY MOLARS J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
  • 16.
    PLAQUE ACCUMULATION ATTHE GINGIVAL MARGIN GINGIVAL MARGIN WHITE SPOT LESION/DECALCIFICATION CAVITATION OF MAXILLARY INCISORS FOLLOWED BY MAXILLARY FIRST MOLAR,MANDIBULAR FIRST MOLAR,MAXILLARY CANINESAND THEN SECOND MOLARS J BERG,R SLAYTON,EAR LY CHILDHOOD ORAL HEALTH,2009
  • 17.
    CONSEQUENCES OF ECC •higher risk of new carious lesions in both the primary and permanent dentitions (O’Sullivan DM 1996) • hospitalizations and emergency room visits(Griffin SO 2000) • high treatment costs(Ladrillo TE 2006) • loss of school days(Edelstein BL 2015) • diminished ability to learn(Blumenshine SL 2008) • reduced oral health-related quality of life(Filstrup SL et al 2003) AAPD REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 18.
    PREVALENCE STUDIES P PRAKASH2012(BANGLORE) 27.5%, Sobha Kuriakose 2015(TRIVANDRUM) 54% H. R. Priyadarshini 2011(BANGLORE) 37.3% R Mahejabeen 2006(DHARWAD) 54.1% DHAR V 2007(UDAIPUR) 46.75% D AGGARWAL 2012(MYSORE) 56.6% A STEPHEN 2015 (TAMILNADU SALEM) 16%
  • 19.
  • 20.
    BREAST AND BOTTLEFEEDING KOTLOW 1977 BREAST FEEDING AND ECC BEGINNING WITH CASE REPORT S IN 1977 ADA AND AAPD UNRESTRICTED AT WILL NOCTURNAL BREAST FEEDING AFTER ERUPTION OF CHILD’S FIRST TOOTH SHOULD BE AVOIDED AS IT PUTS CHILD TO RISK OF ECC DYE et al 2004 LIDA 2007 KRAMER et al 2007 NO RELATIONSHIP BETWEEN BREAST ,BOTTLE FEEDING JOEL BERG SOME CHILDREN NURSE IN SUCH A WAY THAT EITHER CORRELATE WITH OR LEAD TO ECC
  • 21.
    . Brams M,1983, Wendt LK,1996,Ismail 1999 NO ASSOCIATION BETWEEN BREASTFEEDING AND ECC Valaitis R 2000 (1) there is no strong and consistent evidence between breastfeeding and the development of ECC; (2) there is no specific period for weaning, and women should be encouraged to continue breastfeeding for as long as they wish; and (3) rigorous studies are necessary before issuing any public statements correlating breastfeeding with the development of ECC. T KATO 2015 found an association between breast feeding for at least 6 or 7 months and elevated risk of dental caries at age 30 months Neves P.A.M 2016 Breastfeeding did not provoke a decrease in biofilm Ph. Breastfeeding may not contribute to ECC.
  • 22.
    HUMAN MILK • HUMANBREAST MILK HAS A LOWER MINERAL CONTENT,HIGHER CONCENTRATION OF LACTOSE(7% VS 3% )AND LESS PROTEIN (1.2 g VS 3 gm per 100 ml) AS THAT OF BOVINE MILK • THESE DIFFERENCES ARE INSIGNIFICANT IN TERMS OF CARIOGENICITY (DRAKE 1976) • BREASTFEEDING MORE THAN SEVEN TIMES DAILY AFTER 12 MONTHS OF AGE IS ASSOCIATED WITH INCRAESED RISK OF CARIES (LIDA H 2007,MOHEBBI SZ 2008) Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM Community Dent Oral Epidemiol 2008 Aug;36(4):363-9.Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm.
  • 23.
    • Frequent nighttime bottle feeding with milk and ad libitum breast-feeding are associated with, but not consistently implicated in, ECC. • Night time bottle feeding with juice, repeated use of a sippy or no-spill cup • While ECC may not arise from breast milk alone, breast feeding in combination with other carbohydrates has been found in vitro to be highly cariogenic Erickson PR, Mazhari E. Investigation of the role of human breast milk in caries development. Pediatr Dent 1999;21(2):86-90. Reisine S, Douglass JM. Psychosocial and behavioral issues in early childhood caries. Comm Dent Oral Epidem 1998;26(suppl 1):32-44.
  • 24.
    PACIFIER HABIT Although thehabit of dipping the pacifier in sugar is associated with early colonization by Streptococcus mutans in predentate infants, a systematic review did not find any consistent correlation between the use of pacifiers and the development of ECC, regardless of the length of use of pacifiers and of the introduction of sweeteners or not. Wan AKL,2001 Peressini S 2003 SWEETENED PACIFIERS IS AN IMPORTANT FACTOR IN CAUSING S ECC C NOBILE 2014 ECC is more prevalent in children accustomed sweetened pacifier S GOPAL 2016 2.9% ECC sweetened pacifier Vozza I 2017
  • 25.
    INFANT FORMULAS Pamela R.Erickson 1998 INFANTS FORMULA REDUCE PLAQUE PH AND CAUSE ECC K HALLET 2006 Infant bottle-feeding habits (either allowing a child to sip from a bottle during the day or put to sleep at night) cause ECC Olatosi, O. O 2015 INFANT FORMULAS CAUSES 3.5 TIMES MORE ECC THAN BOTTLE FEEDING K HALLET,P ROURKE,PATTERN AND SEVERITY OF ECC,VOLUME 34, ISSUE ,FEBRUARY 2006 ,PAGES 25–35 Olatosi, O. O., et al. "The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution." Nigerian journal of clinical practice 18.4 (2015): 493-501.
  • 26.
    SALIVA •PROVIDES THE MAIN HOSTDEFENCE •ORGANIC COMPOUNDS WHICH AGGLUTINATE ORAL BACTERIA AND ENHANCE THEIIR REMOVAL •THESE AGGUTININS INCLUDE MUCINS,AGGLUTINATING GLYCOPROTEINS,FIBRONECTIN,L YSOZYME AND SECRETORY IMMUNOGLOBULINS CONTAINS SEVERAL ANTIMICROBIAL PROTEINS INCLUDING LACTOFERRIN ,LYSOZYME,AGGLUTININS •ORAL CLEARANCE ,BUFFERING CAPACITY ALL ARE RESPONSIBLE Thick ropy saliva ,has been found to be associated with ECC DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
  • 27.
    MUTANT STREPTOCOCCI BERKOWITZ 2003,1996MUTANS STREPTOCOCCI ,PLAQUE AND CARIES ASSOCIATION DOUGLASS 2008 INTERFERING WITH TRANSMISSION MAY HOLD STRONG PROMISE TO REDUCE DISEASE ONSET AND EXPERIENCE Kohler 1988 Children who acquire mutans streptococci by 2 years are at a higher risk to develop caries by age of 4 Berkowitz 1981, berkowitz and jones 1985,caufield 1988 Transmission of bacteria from mother to child being associated with increase risk for caries
  • 28.
    VIRULENCE OF MUTANTSTREPTOCOCCI SYNTHESIZE ALPHA 1,3 RICH WATER INSOLUBLE GLUCANS FROM SUCROSE(TANZER JM et al 1984) ADHESION AND COLONIZATION AND ENHANCED RATES OF SUGAR DIFFUSION AND ACID PRODUCTION(HOUTE J et al 1985) INTERCELLULAR POLYSACCHARIDE SUPPORT CONTINUAL ACID PRODUCTION DURING PERIODS OF LOW CONCENTRATION OF EXOGENOUS SUBSTRATE MAINTAINS ACTIVITY AND FOSTERS TOOTH DEMINERALIZATION DURING PERIODS OF SLEEP(SPATAFORA G et al 1995) PRODUCES LARGE AMOUNT OF LACTIC ACID WHICH CAUSE DEMINERALIZATION PRODUCTION OF DEXTRANASE ALLOWS INVASION OF M STREPTOCOCCI TO REPLACE S SANGUIS(TANZER JM 1989) DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
  • 29.
    TRANSMISSION OF MUTANTS STREPTOCOCCI •CORRELATION BETWEEN SALIVARY MUTANT STREPTOCOCCI COUNTS IN MOTHERS AND THEIR CHILDREN HAVE BEEEN REPORTED • MS MAYBE TRANSMITTED VERTICALLY FROM CAREGIVER TO CHILD THROUGH SALIVARY CONTACT, AFFECTED BY THE FREQUENCY AND AMOUNT OF EXPOSURE • HORIZONTAL TRANSMISSION (EG, BETWEEN OTHER MEMBERS OF A FAMILY OR CHILDREN IN DAYCARE) ALSO OCCURS • SALIVARY CONCENTRATION OF 105 CFU /MM OF MATERNAL SALIVA WERE ASSOCIATED WITH A 52 % INFECTION RATE IN THEIR CHILDREN ,COMPARED TO ONLY 6% INFECTION RATE WHEN MATERNAL SALIVA CONCENTRATION WAS 103 CFU OR BELOW(BERKOWITZ RJ et al 1981) Berkowitz RJ. Mutans streptococci: Acquisition and transmission. Pediatr Dent 2006;28(2):106-9.
  • 30.
    DIET MARRIRI 2003 IOWA:4-7YEARS:SUGARED BEVERAGES SOHN et al 2006 HIGH CARBOHYDRATE SOFT DRINK GROUP HAD HIGHER CARIES DYE et al 2004 NOT EATING BREAKFAST ON A DAILY BASIS AND NOT CONSUMING THE RECOMMENDED 5 FRUIT AND VEGETABLES DAILY Tinanoff NT et al 2002 frequent in between meal consumption of sugar-containing snacks or drinks (eg, juice, formula, soda) increase the risk of caries J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009 Tinanoff NT, Kanellis MJ, Vargas CM. Current understanding of the epidemiology mechanism, and prevention of dental caries in preschool children. Pediatr Dent 2002;24(6):543-51.
  • 31.
    • Caries-conducive dietarypractices appear to be established by 12 months of age and are maintained throughout early childhood. Douglass JM 2009 • Frequent consumption of between-meal snacks and beverages containing sugars increases the risk of caries due to prolonged contact between sugars in the consumed food or liquid and cariogenic bacteria on the susceptible teeth. Tinanoff NT 2000 Douglass AB, Douglass JM, Krol DM. Educating pediatricians and family physicians in children’s oral health. Academic Pediatr 2009;9(6):452-6. Tinanoff NT, Palmer C. Dietary determinants of dental caries in preschool children and dietary recommendations for preschool children. J Pub Health Dent 2000;60(3): 197-206.
  • 32.
    SUGARS • THE MOSTWIDELY USED SUGAR SUCROSE IS THE MOST IMPORTANT IN DENTAL CARIES AS IT IS THE ONLY SUBSTRATE USED FOR BACTERIAL GENERATION OF PLAQUE DEXTRANS (NEWBRUN 1982) • SUCROSE,GLUCOSE AND FRUCTOSE FOUND IN FRUIT JUICES AND VIT C DRINKS ARE MORE ASSOCIATED WITH ECC DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
  • 33.
    FREQUENCY OF CONSUMPTION INCREASESACIDITY OF PLAQUE AND ENHANCES ESTABLISHMENT AND DOMINANCE OF THE ACIDURIC MUTANTS STREPTOCOCCI ENAMEL DEMINERALIZATION DECREASES AND INADEQUATE REMINERALIZATION DEMINERALIZTION BECOMES PREDOMINANT MECHANISM DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
  • 34.
    ORAL CLEARANCE OFCARBOHYDRATES • HANAKI M et al (1993): CLEARANCE OF GLUCOSE IS SLOWEST ON THE LABIAL SURFACE OF MANDIBULAR MOLARS AND MAXILLARY INCISORS • THIS SHOWS THE PATTERN OF ECC DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
  • 35.
    TOOTHBRUSHING • ECC OCCURSON SURFACES THAT CAN BE EASILY ACCESSIBLE BY ROUTINE TOOTH BRUSHING ,ORAL HYGIENE LEVELS ARE ASSOCIATED WITH ECC • FREQUENCY OF BRUSHING,QUALITY OF PLAQUE REMOVAL ARE ALSO ASSOCIATED WITH THE OCCURRENCE OF ECC J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
  • 36.
    TOOTH MATURATION ANDDEFECTS • TOOTH IS MOST SUSCEPTIBLE TO CARIES IN THE PERIOD IMMEDIATELY AFTER ERUPTION AND PRIOR TO MATURATION • THIS IN MANY INFANTS A COMBINATION OF RECENTLY IMMATURE ENAMEL IN AN ENVIORNMENT OF CARIOGENIC FLORA WITH FREQUENT INGESTION OF FERMENTABLE CARBOHYDRATES WOULD RENDER THE TOOTH PARTICULARLY SUSCEPTIBLE TO CARIES • THE PRESENCE OF STRUCTURAL DEFECT OF ENAMEL MAY INCREASE CARIES RISK • ENAMEL DEFECTS ARE COMMON IN CHILDREN WITH LOW BIRTHWEIGHT OR SYSTEMIC ILLNESS OR UNDERNUTRITION DURING THE PERINATAL PERIOD J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009 Seow WK. Biological mechanisms of early childhood caries. Community Dent Oral Epidemiol 1998;26(suppl): 8-27.
  • 37.
    SOCIOECNOMIC STATUS ANSARI etal 2003 ETIOLOGICAL DETERMINANTS IN PATHOGENESIS OF AVARIETY CONDITIONS INDEPENDENT OF THE BIOLOGICAL FACTOR EDELSTEIN 2002 PRESCHOOLERS IN POVERTY ARE 2 TIMES MORE PRONE THAN AFFLUENT COUNTERPARTS PERES 2005 EARLY LIFE INFLUENCES OF SOCIAL CLASS ,FAMILY INCOME AND PARENTAL EDUCATION A SHAH 2015(KASHMIR) Prevalence of ECC was 39.9% A GADHIANE 2013(WARDHA) 33.48% children were having ECC J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009
  • 38.
  • 39.
    RACE AND ETHINICITY •MILNES: • INCREASED RISK THAT COULD BE ASSOCIATED WITH CULTURAL NORMS INCLUDING CONCERN FOR ORAL HEALTH • PRENATAL DIET THAT COULD CONTRIBUTE TO ENAMEL HYPOPLASIA • CARE OF PRIMARY TEETH • CHILD REARING PRACTICES • ACCESS TO DENTAL AND MEDICAL CARE • MINORITIES MAY EXPERIENCE SIGNIFICANT BARRIERS TO DENTAL CARE,INCLUDING COST OF CARE AND AVAILABILTY OF ACCESSIBLE SERVICES AAPD.INFANT ORAL HEALTH CARE.PEDIATR DENT,1994;16:29
  • 40.
    IMMUNOLOGICAL FACTORS • HOSTIMMUNE MECHANISM INCLUDE SPECIFIC IMMUNE FACTORS DERIVED FROM SALIVA SECRETORY IG A,sIgA),OR SERUM AND GINGIVAL CREVICULAR FLUID(IMMUNOGLOBULIN G,IgG) AND NON SPECIFIC ANTIMICROBIAL SYSTEMS DERIVED MAINLY FROM SALIVA • SECRETORY IMMUNOGLOBULIN A MAY INHIBIT BACTERIAL ADHERENCE OR AGGLUTINATION AS WELL AS NEUTRALIZATION OF BACTERIAL ENZYMES • BRANDTZAEG:1973:THE PROTECTIVE EFFECTS OF sIgA IN OTHER MUCOSAL AREAS ARE WELL KNOWN,THERE IS LITTLE EVIDENCE THAT NATURALLY OCCURING sIgA ANTIBODIES PROTECT AGAINST DENTAL CARIES DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
  • 41.
    CYCLIC EFFECT OFECC • CHILDREN AFFLICTED REMAIN AT RISK THROUGHOUT CHILDHOOD EVEN WHEN PREVENTIVE MEASURES ARE TAKEN Pediatric dentistry- Infanct through adoloscence. Casamassimo,Fields,Mctigue,Nowak.5th edition. Elsevier.Mosby
  • 42.
    AAPDPOLICY ON EARLYCHILDHOOD CARIES (ECC): UNIQUE CHALLENGES AND TREATMENT OPTIONS 2016 • Beause restorative care to manage ECC often requires the use of sedation and general anesthesia with its associated high costs and possible health risks, and because there is high recurrence of lesions following the procedures, there now is more emphasis on prevention and arrestment of the disease processes. Approaches include methods that have been referred to as: • 1. Chronic disease management, which includes parent engagement to facilitate preventive measures, and temporary restorations to postpone advanced restorative care • 2. Active surveillance, which emphasizes careful monitoring of caries progression and prevention programs in children with incipient lesions. • 3. Interim therapeutic restorations (ITR) that temporarily restore teeth in young children until a time when traditional cavity preparation and restoration is possible. REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 43.
    PREVENTION COMMUNITY BASED STRATEGY:EDUCATINGMOTHERS IN THE HOPE OF INFLUENCING DIETARY HABITS AS WELL AS THOSE OF INFANTS SECOND:PROVISION OF EXAMINATION AND PREVENTIVE CARE IN DENTAL CLINICS THIRD:DEVELOPMENT OF APPROPRIATE DIETARY AND SELF CARE HABITS AT HOME REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 44.
    AAPD GUIDELINES • Avoidingfrequent consumption of liquids and/or solid foods containing sugar, in particular: • Sugar-sweetened beverages (e.g., juices, soft drinks, sports drinks, sweetened tea) in a baby bottle or no-spill training cup. • Ad libitum breast-feeding after the first primary tooth begins to erupt and other dietary carbohydrates are introduced. • Baby bottle use after 12-18 months. • Implementing oral hygiene measures no later than the time of eruption of the first primary tooth. Toothbrushing should be performed for children by a parent twice daily, using a soft toothbrush of age-appropriate size. In children under the age of three, a smear or rice-sized amount of fluoridated toothpaste should be used. In children ages three to six, a pea-sized amount of fluoridated toothpaste should be used. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 45.
    • 3. Providingprofessionally-applied fluoride varnish treatments for children at risk for ECC. • 4. Establishing a dental home within six months of eruption of the first tooth and no later than 12 months of age to conduct a caries risk assessment and provide parental education including anticipatory guidance for prevention of oral diseases. • 5. Working with medical providers to ensure all infants and toddlers have access to dental screenings, counseling, and preventive procedures. • 6. Educating legislators, policy makers, and third party payors regarding the consequences of and preventive strategies for ECC. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 46.
    PREVENTION OF TRANSMISSIONOF BACTERIA • A NON RANDOMIZED STUDY DIVIDED MOTHERS WHO HAD ATLEAST 106 MUTANTS STREPTOCOCCI PER MM OF SALIVA INTO TEST AND CONTROL GROUPS • TEST PROGRAMME INCLUDED PROVISION OF DENTAL EDUCATION,ORAL HYGIENE INSTRUCTIONS,DENTAL TREATMENT,TOOTH CLEANING,APPLICATION OF 2% SODIUM FLUORIDE,FLUORIDE VARNISH • THE CHILDREN WHOSE MOTHERS WERE IN EXPERIMENTAL GROUP HAD A DMFT OF 5.2 WHICH WAS MUCH LOWER THAN CONTROL WHICH WAS 8.6:WANS AND COLLEAGUES Pediatric dentistry Infancy through adoloscence. Casamassimo,Fields,Mctigue,Nowak.5th edition. Elsevier.Mosby
  • 47.
    PREVENTING TRANSMISSION • Eliminatingsaliva-sharing activities (eg, sharing utensils, orally cleansing a pacifier) may help decrease an infant’s or toddler’s acquisition of cariogenic microbes. Berkowitz RJ. Mutans streptococci: Acquisition and transmission. Pediatr Dent 2006;28(2):106-9.
  • 48.
    REBALANCING THE ORALCAVITY High risk patient :rinse 10 ml of 0.12%chlorhexidiene digluconate solution once per day for 1 week every 6 months(feather stone 2006) Since children less than 3 years old will not be pertitnent ,this would be more appropriate for mothers with high caries risk Chlorhexidiene gel:1% applied for 5 minute per day over a period of 2 weeks(zickert 1982) IODINE: lopez et al 1999,2002:topical iodine agents can significantly suppress levels of mutants streptococci XYLITOL:
  • 49.
    RAPIDD SCALE • READINESSASSESSMENT OFPARENTS CONCERNING INFANT DENTAL DECAY(RAPIDD SCALE) • TO ASSESS A PARENT’S STAGE OF CHANGE OF PRECONTEMPLATIVE,CONTEMPLATIVE ,OR ACTION WITH REGARD TO HIS/HER CHILD • BASED ON THE WORK OF PROCHASKA AND DICLEMENTE MEASURES PRO AND CON PARENTAL BELIEFS ABOUT CARING FOR THE CHILD’S TEETH • READINESSS ASSESMENT OF PARENTS CONCERNING INFANTS DENTAL DECAY CONSISTED OF 38 ITEMS ON A FIVE POINT SCALE RANGING FROM STRONGLY AGREE TO STRONGLY DISAGREE Weinstein P, Riedy CA.The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay. ASDC J Dent Child 2001 Mar- Apr;68(2):129-35, 142.
  • 50.
    • THE PATIENTOR PRIMAY CARETAKER WAS INSTRUCTED TO SELECT A BOX UNDER ONE OF THE FIVE CATEGORIES AFTER THE INTERVIEWER READ THEM THE QUESTION IN THEIR NATIVE LANGUAGE • EACH OF THE 38 ITEMS WERE PLACED ONTO ONE OF FOUR: • OPENNESS TO HEALTH INFORMATION • VALUING DENTAL HEALTH • CONVENIENCE AND CHANGE DIFFICULTY • CHILD PERMISSIVENESS. Weinstein P, Riedy CA.The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay. ASDC J Dent Child 2001 Mar- Apr;68(2):129-35, 142.
  • 51.
    • THE SCORESARE CALCULATED ,VALUES ARE RANKED AND PERCENTILE IS CALCULATED • THEN DIVIDES INTO PRECONTEMPLATORS,CONTEMPLATORS AND ACTION • USAGE: • USED TO DETERMINE PARENT’S STAGE OF CHANGE FOR THEIR CHILD’S ORAL HEALTH Weinstein P, Riedy CA.The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay. ASDC J Dent Child 2001 Mar-Apr;68(2):129-35, 142.
  • 52.
    ESTABLISHMENT OF ADENTAL HOME • Non-dental health care providers who identify ECC should either provide therapy or refer the patient to a licensed dentist for treatment and establishment of a dental home • DENTAL HOME: The dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way.(2015 AAPD) • The dental home should be established no later than 12 months of age and includes referral to dental specialists when appropriate. American Academy of Pediatric Dentistry. Policy on a dental home. Pediatr Dent 2011;33(special issue):24-5
  • 53.
    • PERFORM CARIESRISK ASSESSMENT • DEVELOP A TAILORED PLAN TO ANTICIPATE,PREVENT,SUPPRESS CARIES ACTIVITY • GROUNDWORK FOR THE PRACTIONERS TO PREVENT ECC
  • 54.
    ANTICIPATORY GUIDANCE • Anticipatoryguidance is the process of providing practical, developmentally-appropriate information about children’s health to prepare parents for the significant physical, emotional, and psychological milestones • Topics to be included are oral hygiene and dietary habits, injury prevention, nonnutritive habits, substance abuse, intraoral/perioral piercing, and speech/language development Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents,2016/17
  • 55.
    VasudhaSodani 2011 thehealth professionals lack the adequate knowledge regarding ECC in Vadodara city VasudhaSodani,Sunanda Gsujan, Harsh G Shah,Bhavna Dave,Anticipatory Guidance regarding Early Childhood Caries (ECC) among Health Professionals in Vadodara city, Gujarat Journal of Advanced Oral Research, Vol 2; Issue 3: Oct - Dec 2011
  • 56.
    Food Group Portionsize considered one serving 1st day 2nd day 3rd day 4th day 5th day Average MILK (milk & cheese) 8 oz (1 cup) milk 1½ c cottage cheese | || ||| | || 2 MEAT (meat, fish, poultry, nuts, dry beans) 2-3 oz lean cooked meat, fish or poultry || | 0 || | 1+ FRUITS and VEGETABLES (including citrus fruits, dark green and deep yellow vegetables) ½ c cooked 1 medium raw || | ||| ||||| 0 2 BREAD and CEREALS (Enriched Or Whole Grain) 1 slice bread ¾ c dry cereal ½ c cooked cereal, rice, noodles, macaroni ||||| ||||||| |||| |||||| ||| 4 FOOD DIARY
  • 57.
    Sonia Hernández-Cordero etal BMC Public Health2015:1031:7 DAY DIARY TO BE MORE CORRECT REPRODUCTION OF DIET THAN 24 HR RECALL Comparing a 7-day diary vs. 24 h- recall
  • 58.
    SUGAR CLOCK-JHONSON AND BIRKHED:1991 AdvancedDental Nursing, Robert Ireland,2 ND EDITION
  • 59.
    SUGAR CLOCK Advanced DentalNursing, Robert Ireland,2 ND EDITION
  • 60.
    DIETARY RECOMMENDATIONS • TheAmerican Academy of Pediatrics has recommended children one through six years of age consume no more than four to six ounces of fruit juice per day, from a cup (ie, not a bottle or covered cup) and as part of a meal or snack.(2016/17) • School health education programs and food services to promote nutrition programs that provide well-balanced and nutrient-dense foods of low caries-risk, in conjunction with encouraging increased levels of physical activity • Pediatric dentists and other health care providers who treat children to provide dietary and nutrition counseling (commensurate with their training and experience) in conjunction with other preventive services for their patients American Academy of Pediatrics Committee on Nutrition. Policy statement: The use and misuse of fruit juices in pediatrics. Pediatrics
  • 61.
    • Pediatric dentistsand other health care providers to recommend or prescribe sugar-free medications whenever possible. Educating parents of the risks of overdose from excessive consumption of candy-like chewable vitamin supplements • Eating a variety of nutrient-dense foods and beverages. • Balancing foods eaten with physical activity to maintain a healthy body mass index. • Maintaining a caloric intake adequate to support normal growth and development and to reach or maintain a healthy weight. • Choosing a diet with plenty of vegetables, fruits, and whole grains and low in fat, saturated (especially transsaturated) fat, and cholesterol. Policy on Dietary Recommendations for Infants, Children, and Adolescents REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 62.
    FLUORIDE AGE <0.3 0.3-0.7>0.7 0-2 0.25 0.00 0.00 2-3 0.50 0.25 0.00 3-16 1.00 0.50 0.25 G NIKIFORUK,UNDERSTANDING DENTAL CARIES,PREVENTION BASIC AND CLINICAL APPROACH,KARGER
  • 63.
    FLUORIDE DENTRIFICE • Theuse of anticariogenic agents, especially twice daily brushing with fluoridated toothpaste and the frequent application of fluoride varnish, may reduce the risk of development and progression of caries. • Using no more than a ‘smear’ or ‘rice-size’ (approximately 0.1 mg fluoride amount of fluoridated toothpaste for children less than three years of age may decrease risk of fluorosis. • Using no more than a ‘pea-size’ (approximately 0.25 mg fluoride) amount of fluoridated toothpaste is appropriate for children aged three to six American Dental Association Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc 2014;145(2):190-191.
  • 64.
    • Parents shoulddispense the toothpaste onto a soft, age- appropriate sized toothbrush and perform or assist with toothbrushing of preschool-aged children. • To maximize the beneficial effect of fluoride in the toothpaste, rinsing after brushing should be kept to a minimum or eliminated altogether. ADA Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc 2014;145(2):190-1.
  • 65.
    PROFESSIONALLY APPLIED FLUORIDE •Professionally-applied topical fluoride treatments also are efficacious in reducing prevalence of ECC. • The recommended professionally-applied fluoride treatments for children at risk for ECC who are younger than six years is five percent sodium fluoride varnish (NaFV; 22,500 ppm F) Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 66.
    WATER FLUORIDATION • Fluoridationof community drinking water is the precise adjustment of the existing natural fluoride concentration in drinking water to a safe level that is recommended for caries prevention. • The United States Public Health Service has established the optimum concentration for fluoride in the water in the range of 0.7–1.2 mg/L G NIKIFORUK,UNDERSTANDING DENTAL CARIES,PREVENTION BASIC AND CLINICAL APPROACH,KARGER
  • 67.
    SILVER DIAMINE FLUORIDE •Silver diamine fluoride (SDF) is a colorless liquid • pH 10 • 24.4% to 28.8% (weight/volume) silver and 5.0% to 5.9% fluoride. • 44,800 ppm F J.C LLODRA 2005 SDF solution was found to be effective for caries reduction in primary teeth and first permanent molars in schoolchildren C.H.CHU 2002 Silver diamine fluoride was found to be effective in arresting dentin caries in primary anterior teeth in pre-school children.
  • 68.
    RECOMMENDATIONS FOR PREVENTIVE MANEUVERSFOR ECC INTERVENTIONS TARGET CHLORHEXIDEINE VARNISH HIGH RISK ECC GROUP DIETARY COUNSELLING HIGH RISK ECC GROUP EARLY DETECTION ALL INFANTS BEFORE AGE OF 1 YEAR EDUCATION ALL INFANTS AND TODDLERS EDUCATION HIGH RISK COMMUNITIES FLUORIDE SUPPLEMENTS HIGH RISK GROUPS FLUORIDE DENTRIFICE ALL INFANTS AND TODDLERS FLUORIDE VARNISH HIGH RISK ECC GROUP PRENATAL FLUORIDE SUPPLEMENTS ALL INFANTS AND TODDLERS SEALANTS HIGH RISK ECC GROUP J BERG,R SLAYTON,EAR LY CHILDHOOD ORAL HEALTH,2009 Pediatric dentistry-
  • 69.
    WATER FLUORIDATION COMMUNITY XYLITOLSUBSTITUTES HIGH RISK ECC GROUP CONTROL OF MOTHER-INFANT INFECTION WITH CARIOGENIC BACTERIA HIGH RISK ECC GROUP J BERG,R SLAYTON,EARLY CHILDHOOD ORAL HEALTH,2009Pediatric dentistry-
  • 70.
    CARIES RISK ASSESSMENTAND MANAGEMENT Guideline on Caries- risk Assessme nt and Managem ent for Infants, Children, and Adolescen ts, 2014 REFERENC E MANUAL V 38 / NO 6 16 / 17
  • 71.
    Guideline on Caries- risk Assessme nt and Managem entfor Infants, Children, and Adolescen ts, 2014 REFERENC E MANUAL V 38 / NO 6 16 / 17
  • 72.
  • 73.
    CARIES MANAGEMENT PROTOCOLFOR 1-2 YEAR OLDS Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents, 2014 REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 74.
    CARIES MANAGEMENT PROTOCOLFOR 3-5 YEAR OLDS Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents, 2014 REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 75.
    CARIES MANAGEMENT PROTOCOL>=6 Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents, 2014 REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 76.
    • Legends forTables 4-6 • a Salivary mutans streptococci bacterial levels. • THETA Interim therapeutic restoration. • χ Periodic monitoring for signs of caries progression. • γ Parental supervision of a “pea sized” amount of toothpaste. • X Parental supervision of a “smear” amount of toothpaste. • λ Indicated for teeth with deep fissure anatomy or developmental d Need to consider fluoride levels in drinking water. defects. • e Careful monitoring of caries progression and prevention program. • μ Less concern about the quantity of toothpaste
  • 77.
    ITR • Interim therapeuticrestorations (ITR), using materials such as glass ionomers that release fluoride, are efficacious in both preventive and therapeutic approaches • Definitive restorative treatment in young children, in many cases, can be postponed by use of ITR or silver diamine fluoride treatments. 2016:AAPD • The ITR procedure involves removal of caries using hand or rotary instruments with caution not to expose the pulp. Leakage of the restoration can be minimized with maximum caries removal from the periphery of the lesion. • Following preparation, the tooth is restored with an adhesive restorative material such as glass ionomer or resin-modified glass ionomer cement Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options 2016,2014 Yip HK, Smales RJ, Ngo HC, Tay FR, Chu F. Selection of restorative materials for the atraumatic restorative treatment (ART) approach: A review. Spec Care Dent 2001; 21(6):216-221
  • 78.
    ARRESTING ACTIVE LESIONS •ALL RESTORATIONS AND TREATMENT DONE UNDER GA OR CONCIOUS SEDATION • IF NOT THEN EXCAVATE GROSS CARIOUS LESION • INTERIM THERAPEUTIC RESTORATION • GIVES TIME FOR DESIGNING TREATMENT PLAN • STOPS THE PROGRESSION OF CARIES • DECREASES THE BACTERIAL COUNT DENTISTRY FOR THE CHILD AND ADOLOSCENT. MCDONALD, DEAN, AVERY. 10TH EDITION. ELSEVIER .MOSBY
  • 79.
    • The useof ITR has been shown to reduce the levels of cariogenic oral bacteria (e.g., Mutans Streptococci, lactobacilli) in the oral cavity immediately following its placement. • However, this level may return to pretreatment counts over a period of six months after ITR placement if no other treatment is provided Policy on Interim Therapeutic Restorations (ITR), 2013, REFERENCE MANUAL V 38 / NO 6 16 / 17
  • 80.
    STAINLESS STEEL CROWN •Stainless steel crowns often are indicated to restore teeth with large carious lesions and extensive white spot lesions and, at early age, are less likely than other restorations to require retreatment:2014 • large carious lesions, interproximal lesions, and extensive white spot lesions since stainless steel crowns are less likely than other restorations to require retreatment:2016 Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options,2014,AAPD
  • 81.
    CONCLUSION • THUS ECCIS A MULTIFACTORIAL DISEASE WHOSE PREVENTION IS OF UTMOST IMPORTANCE AND TREATMENT COMPRISES OF RAPID AND ACTIVE MANAGEMENT OF LESIONS
  • 82.
    REFERENCES • Prakash P,Subramaniam P, Durgesh BH, Konde S. Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: A cross-sectional study. European Journal of Dentistry. 2012;6(2):141-152. • Kuriakose S, Prasannan M, Remya KC, Kurian J, Sreejith KR. Prevalence of early childhood caries among preschool children in Trivandrum and its association with various risk factors. Contemporary Clinical Dentistry. 2015;6(1):69-73. • Priyadarshini HR, Hiremath SS, Puranik M, Rudresh SM, Nagaratnamma T. Prevalence of early childhood caries among preschool children of low socioeconomic status in Bangalore city, India. Journal of International Society of Preventive & Community Dentistry. 2011;1(1):27-30. doi:10.4103/2231- 0762.86384.
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    • Dhar V,Jain A, Van Dyke T E, Kohli A. Prevalence of dental caries and treatment needs in the school-going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent 2007;25:119-21 • Nilza M. E. Ribeiro; Manoel A. S. Ribeiro, J. Pediatr. (Rio J.) vol.80 no.5 suppl. Porto Alegre Nov. 2004,Breastfeeding and early childhood caries: a critical review • Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM Community Dent Oral Epidemiol 2008 Aug;36(4):363-9.Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm.
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    • Iida H,Auinger P, Billings RJ, Weitzman M Association between infant breastfeeding and early childhood caries in the United States Pediatrics. 2007 Oct;120(4):e944-52. • Weinstein P, Riedy CA.The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay. ASDC J Dent Child 2001 Mar-Apr;68(2):129-35, 142. • Pamela R. Erickson, Kelly L. McClintock, Nicole Green, S Jamilla LaFleu,Estimation ofthe caries-related risk associated with infant formulas, Pediatric Dentistry -20.’Z 1998
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    • Norman Tinanoff,DDS, MS David M. O’Sullivan, BS Early childhood caries: overview and recent findings, Pediatric Dentistry - 19:1, 1997 • K HALLET,P ROURKE,PATTERN AND SEVERITY OF ECC,VOLUME 34, ISSUE ,FEBRUARY 2006 ,PAGES 25–35 • Çolak H, Dülgergil ÇT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. Journal of Natural Science, Biology, and Medicine. 2013;4(1):29-38. • G NIKIFORUK,UNDERSTANDING DENTAL CARIES,PREVENTION BASIC AND CLINICAL APPROACH,KARGER • Prevalence and Predictors of Early Childhood Caries in 3- to 6-year-old South Indian Children – A Crosssectional Descriptive Study Satya Gopala /Vinay Chandrappab /Uloopi Kadidalc /Chandrasekhar Rayalad / Madhuri Vegesna, Oral Health & Preventive Dentistry,2014
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    • Vozza I,Capasso F, Marrese E, Polimeni A, Ottolenghi L. Infant and Child Oral Health Risk Status Correlated to Behavioral Habits of Parents or Caregivers: A Survey in Central Italy. Journal of International Society of Preventive & Community Dentistry. 2017;7(2):95-99. • Sonia Hernández-Cordero et al BMC Public Health201515:1031:7 DAY DIARY TO BE MORE CORRECT REPRODUCTION OF DIET THAN 24 HR RECALL • Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents,2016/17 • VasudhaSodani,Sunanda Gsujan, Harsh G Shah,Bhavna Dave,Anticipatory Guidance regarding Early Childhood Caries (ECC) among Health Professionals in Vadodara city, Gujarat Journal of Advanced Oral Research, Vol 2; Issue 3: Oct - Dec 2011
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    • AAPD.INFANT ORALHEALTH CARE.PEDIATR DENT,1994;16:29 • Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, REFERENCE MANUAL V 38 / NO 6 16 / 17 • Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options 2016,2014 • Yip HK, Smales RJ, Ngo HC, Tay FR, Chu F. Selection of restorative materials for the atraumatic restorative treatment (ART) approach: A review. Spec Care Dent 2001; 21(6):216-221 • Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options,2014,AAPD
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    • Guideline onCaries-risk Assessment and Management for Infants, Children, and Adolescents, 2014 REFERENCE MANUAL V 38 / NO 6 16 / 17 • G NIKIFORUK,UNDERSTANDING DENTAL CARIES,PREVENTION BASIC AND CLINICAL APPROACH,KARGER • Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents,2016/17 • Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, REFERENCE MANUAL V 38 / NO 6 16 / 17 • ADA Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc 2014;145(2):190-1
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    • American DentalAssociation Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc 2014;145(2):190-191 • American Academy of Pediatrics Committee on Nutrition. Policy statement: The use and misuse of fruit juices in pediatrics. Pediatrics 2001;107(5):1210-3. Reaffirmed October, 2006. • Advanced Dental Nursing, Robert Ireland,2 ND EDITION • Weinstein P, Riedy CA.The reliability and validity of the RAPIDD scale: readiness assessment of parents concerning infant dental decay. ASDC J Dent Child 2001 Mar-Apr;68(2):129-35, 142.
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    • Llodra, J.C., et al. "Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial." Journal of dental research 84.8 (2005): 721-724. • Rosenblatt, A., T. C. M. Stamford, and R. Niederman. "Silver diamine fluoride: a caries “silver-fluoride bullet”." Journal of dental research 88.2 (2009): 116-125.