EARLY

CHILDHOO
D CARIES
Agojo, Dona
Cruz, Crisha
Salamat, Renzy
 Table of contents

01 ENAMEL 03 EARLY CHILDHOOD

CARIES
FORMATION

DENTAL
02 CARIES 04 GENERAL
RECOMMENDATIONS
 1
Objecti
ENAMEL

ves
FORMATION
OVERVIEW
Enamel formation, called amelogenesis, is a vital process carried out by ameloblasts.
These cells produce enamel matrix proteins, then remove them for precise
hydroxyapatite-based inorganic material formation. The structure consists of prismatic
rods and interrod enamel, with each rod formed by a single ameloblast. Mature enamel
contains EMP peptides and has unique morphological and biomechanical properties.
It's composed of 95% minerals, 1-2% organic material, and 2-4% water, making it a
strong and durable tooth component.
- Enamel formation of primary teeth begins
with incisors at 11-14 weeks of fetal life.

- Processes include matrix formation and

calcification, starting in utero and
completed by the third postnatal month.

- Defects in enamel can act as a

permanent record of prenatal or early
postnatal insults.
- Birth causes the formation of the
neonatal line, a narrow line of hypoplasia
visible in primary incisors and molars.

- Conditions contributing to hypoplastic or

hypocalcified defects include systemic
maternal disorders, systemic neonate
disorders, and possibly transient
hypocalcemia.

- Hypoplastic dental defects can be

difficult to distinguish from caries caused
by excessive bottle nursing.
 2
Objecti
DENTAL

ves
CARIES
- Hood dental disease studies in the 1980s showed a decline
in dental caries prevalence among children up to 12 years
old in Western countries.

- A more recent study questioned the 50% caries-free

characterization of U.S. schoolchildren, considering decayed
primary teeth and averaging young children.

- When primary teeth decay is included, roughly half of

children experience decay before first grade.

- The prevalence of dental caries increases steadily with age,

affecting five out of six high school graduates.

- Dental caries is caused by the demineralization of dental

enamel due to organic acids produced by carbohydrate
metabolism by oral microorganisms.
 MULTIFACTORIAL DISEASE FACTORS

MICROORGANISM
- Streptococcus mutans (S. mutans) is the primary culprit.
- Infants without erupted teeth don't have S. mutans in their oral cavity.
- Transmission from parents to infants may occur through contact.

SUBSTRATE
- Carbohydrates in the diet provide microorganisms with substrate
for acid production.
- Sucrose is considered the "archcriminal" of dental caries.
 MULTIFACTORIAL DISEASE FACTORS
HOST- ENAMEL
- Susceptible host allows microorganisms to adhere, colonize, and metabolize
carbohydrates.
- Pit and fissure areas of molar teeth are highly susceptible.
- Smooth enamel surfaces are not prone to caries development.
- Mature tooth enamel is more acid-resistant than immature enamel.

TIME ELAPSED
- Elapsed time influences the other three factors.
- Longer exposure to fermentable carbohydrates increases acid
production and caries risk.
 SALIVA
- Saliva acts as a crucial factor in balancing
the development or prevention of dental
caries.

- It plays a role similar to blood in

maintaining the well-being of body cells, but
specifically for tooth enamel.

- Enamel depends on saliva for essential

functions, such as supplying nutrients,
removing waste, and safeguarding the
enamel surface.
 BENEFICIAL ACTIONS OF
SALIVA
1. Speeding oral clearance of food particles and dissolving sugars
2. Facilitating the removal of insoluble carbohydrates from the mouth by salivary
enzymes
3. Neutralizing organic acids produced by plaque bacteria by salivary buffers
4. Inhibiting demineralization and enhancing remineralization by the action of
salivary minerals on tooth structure
5. Recycling ingested fluoride into the mouth
6. Discouraging the growth of bacteria
7. Inhibiting both mineral loss and the adhesion of bacteria by adsorption of
salivary proteins to tooth surface
 3
Objecti
EARLY

ves
CHILDHOOD
CARIES
Early Childhood Caries

• Term now recommended by the Centers

for Disease Control and Prevention to
describe a unique pattern of carious
lesions in infants, toddlers, and
preschool children
• Baby-bottle tooth decay and nursing
caries
• Clinically, the decay is first found in the
maxillary primary incisors, later it
spreads to the maxillary molars,
mandibular molars, and r a r e l y t h e
mandibular incisors
 Factors
1. The chronology of primary tooth eruption -
teeth that erupt early are most affected.
Therefore the maxillary incisors are affected
most in younger infants and toddlers
2. The duration of the harmful habit - The
longer sweet liquid remains around the
teeth, the more likely it is that it will be
metabolized by oral microorganisms
3. The pattern of the muscular activity of the
sucking infant - weak muscular activity
results in the teeth being bathed in an
increasingly large pool of liquid that cannot
be effectively washed out by the available
saliva
Four factors:
○ Microorganisms
○ Substrate
○ Host
○ Time

● Cow’s milk and mother’s milk contain

lactose, composed of glucose and
fructose, both of which enhance
cariogenic bacteria colonization and
acid production
● Some studies report on ECC in
children who were feed with cow’s
milk only and some on ECC in
children who were only breastfeed
● It has also been found that the high
concentrations of calcium and
phosphate in milk are caries
protective
• In addition to having sweet liquids from bottles, affected children are often
given pacifiers dipped in sweets; an association has been established between
the use of these comforters and ECC
•
PREVELANCE
Preschool-age children with ECC are less available for dental
examination than are older children
• Because the patterns of infant feeding habits are largely
culturally and ethnically influenced, survey samples of children
from such cultural or ethnic backgrounds will be similarly
skewed. For all these reasons it is difficult to make an analogy
from the prevalence of ECC in one country with its prevalence
in another country
• The reported prevalence of ECC may also be influenced by the
fact that infants are difficult to examine
• It is generally accepted that the prevalence of ECC in
predominantly Westerntype cultures is about 5%
• In certain populations a higher prevalence has been found. In
the United States, Hardwick and colleagues57 reported a 21%
prevalence of ECC for urban Hispanic children younger than 5
years
• In children age 25 to 27 months, caries of the maxillary central
incisors was most prevalent on the mesial and distal surfaces
(nearly 6%), and among 31- to 33-month-olds, prevalence on
these surfaces was nearly 10%.
 DISEASE PROGRESSION
• Initially the teeth are seen to have white spots
that are usually decalcification lesions, which
may become frank lesions or caries within 6
months to 1 year
• Such decalcification lesions do not necessarily
progress to cavities because the process may be
reversed and the teeth may become
remineralized
• This study compared the pregnancies of the
mothers of two groups of age-matched children
with similar eating and feeding habits-they all
were feed from bottles containing sweet liquids.
Compared with the pregnancies of mothers of
children with healthy teeth, the pregnancies of
the mothers of children with ECC involved more
cases of vaginal bleeding, premature uterine
contractions, episodes of viral or bacterial
infections, and other indications of high-risk
pregnancies
• ECC is known to be characterized microbiologically by dense
oral populations of mutans streptococci
• The bottle still must be considered as a risk factor, and to
eliminate the baby bottle as a cause of or at least a risk
factor for ECC would be premature
• A recent study on caries among Arizona infants and
toddlers has revealed some interesting findings: Use of an
infant feeding bottle was common; nearly 45% of 13- to
36-month-olds reported still using a bottle.
• Among children age 25 to 38 months, a significant
relationship between night-time bottle use and maxillary
anterior caries was found. Of those children with maxillary
anterior caries, 46% slept with a bottle.
• Furthermore, no relationship between night-time bottle use
and posterior caries patterns was found in either age group
TREATMENT
• Sedation is generally indicated for children
who are uncooperative, fearful of the
dental environment, or unable to cope
because of other reasons
• GA may be preferred in treating young
uncooperative children with extensive
caries, rather than subjecting them to
numerous sedation visits, because of an
increased sensitization of children to
repeated stressful procedures with
accompanying decreased cooperative
behaviour.
• In any case, before any invasive treatment
is undertaken, the first necessary step in
treating ECC, as recommended by most
practitioners and educators, is to stop the
deleterious habit of unrestrained bottle
nursing
 PREVENTION
• Teaching oral self-care is
extremely frustrating for health
educators
• Most traditional stand-alone
health educational approaches
provide general inf o r m a t i o n
about ECC, focus on the bottle
as the risk factor, and
recommend immediate
substitution of the cup for the
bottle at all feedings by 12
months
• In fact, some authors have
suggested that changing oral
hygiene measures may be a
more effective prevention
strategy for ECC than
attempting to modify diet
FUTURE PREVENTIVE BEHAVIOR OF
CHILDREN
AND THEIR PARENTS
• It was hypothesized that because GA is a more radical
and dramatic mode of treatment, parents of those children
would change their families’ dental health behaviors to
avoid future dental disease and the subsequent treatment
• However, some preventive behaviors regarding children’s
dental health, such as decreasing sweet consumption and
brushing of children‘s teeth by parents, were more
frequently adopted among the families of children treated
using GA
• Brushing and dental caries among infants and toddlers
are not directly correlated: no significant association was
f ound bet ween f requency of brushing a n d c a r i e s
prevalence among 13- to 24-month-olds, but an inverse
relationship was found in 25- to 36-month olds
 THE FETUS Is ALSO A PATIENT
• The quality of intrauterine life affects the quality of the infant’s teeth, dental
health educators should educate women who may experience complications
during pregnancy or delivery about the dangers of ECC and how to avoid it.
• The rapid progress in medicine and the increasing ability of modern medicine to
maintain high-risk pregnancies, as well as to keep newborns alive after
complicated or instrumental deliveries, have resulted in many more infants
whose teeth may be affected and could be more vulnerable to dental caries
• It is important to warn parents and prospective parents that maternal diseases
and complications during pregnancy and delivery may predispose their
fetus/infant’s teeth to ECC
 4
Objecti
GENERAL
RECOMMENDATI0NS:
CARIES PREVENTION

ves
IN INFANTS AND
CHILDREN
 GENERAL RECOMMENDATI0NS:CARIES
PREVENTION IN INFANTS AND CHILDREN

HOME CARE
- CONSISTENT VISITS TO THE
DENTIST
- EFFECTIVE ORAL HYGIENE
- USE OF HOME-FLUORIDE
MODALITIES
 CONSISTENT VISITS TO THE
DENTIST
Dentist with the opportunity to teach the parents
to wipe their infant’s teeth clean with a small
piece of gauze held between their fingers.
EFFECTIVE ORAL HYGIENE
infant’s teeth should be
brushed twice daily, with the
whole dentition being
brushed both after breakfast
and before bedtime.
 USE OF HOME-FLUORIDE
MODALITIES
Fluoride rinse solutions are
used to provide the tooth
enamel surface with a
constant supply of fluoride
ions, which help remineralize
initial carious lesions
 GENERAL RECOMMENDATI0NS:CARIES
PREVENTION IN INFANTS AND CHILDREN
PROFESSIONAL DENTAL
CARE
- ORAL HYGIENE INSTRUCTION

- FLUORIDE GEL OR VARNISH

APPLICATION

- PIT AND FISSURE SEALANTS

- DIET COUNSELING