EARLY CHILDHOOD

CARIES
 EARLY CHILDHOOD CARIES

AAPD
DEFINITION:
• ECC is the presence of one or more
decayed (non cavitated or cavitated
lesions), missing (due to caries), or
filled tooth surfaces in any primary
tooth in a child 71 months of age or
younger.
CLASSIFICATION by Wyne
DEVELOPMENTAL STAGES
ETIOLOGY OF DENTAL CARIES
 ETIOLOGICAL RISK FACTORS
PRIMARY SECONDARY
• Dental plaque • Tooth maturation and
• Mutans Streptococci defects
• Infant feeding patterns • Race and ethnicity
• Tooth brushing • Acid fruit drink
• Salivary factors • Socioeconomic status
• Sugars
• Dental knowledge
• Oral Clearance of
carbohydrates
• Stress
• Bovine milk • Other factors
• Human milk
• Fluorides
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Mutans Streptococci
Salivary Factors
• Streptococcus mutans (SM) and Streptococcus
sobrinus are the most common microorganisms associated • Sucrose, glucose and fructose found in fruit juices
with ECC.
and Vitamin C drinks as well as in solids are the main
• Lactobacilli also participate in the development of
caries lesions and play an important role in lesion sugars associated with infant caries.
progression, but not its initiation.
• Increased frequency and total time the sugar is in the

Infant feeding pattern mouth, increases the potential for enamel

• Reports suggest that putting a child to bed with a baby demineralization and there is in inadequate time for

bottle is a widespread behavior, seen in 18-85% remineralization by saliva.

parents. Oral Clearance
• Length of contact with the bottle at night time is also • In infants with ECC. the sleep time consumption
important. of sugars is another common characteristic.
Tooth brushing
• The low salivary flow during sleep decreases oral
• Increased frequency and better oral hygiene clearance of the sugars and increases the length of
levels associated with low caries levels in preschool
children. contact time between the plaque and the substrate.
Bovine milk
• Milk contain casein.
• α-casein act as inhibitors of mutans streptococci
adherence to saliva coated hydroxyapatite .

Human milk
• Compared to bovine milk, human breast milk has a
lower mineral content, higher concentration of lactose
(7% vs 3%), and less protein (1.2 g vs 3.3 g per
100 ml), but these differences are probably
insignificant in terms of cariogenicity.

Flourides
Even at very low concentration, fluoride can affect the
demineralization process in carious lesion by decreasing the
rate of subsurface dissolution and enhancing the deposition
of fluoridated apatite in the surface zone.
  Window of Infectivity:

◦ First window of infectivity: 7-31months (Caufield, Cutter, & Dasanayake, 1993; Li &
Caulfield, 1995).
◦ Second window of infectivity in permanent teeth :6-12 years
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 MANAGEMENT
• Management of existing
emergency
• Arrest & control of the carious
Aims: process
• Institution of preventive procedure
• Restoration & rehabilitation

Factors • Extent of the lesion

affecting • Age of the patient
management • Behavioral problems due to young
age of the child
:
 TREATMENT: 1ST VISIT

• Caries risk assessment This phase consist of treatment of

lesion, identification of cause for
• All lesions should be excavated and restored parent counseling
• Indirect pulp capping or pulp therapy
procedures can be evaluated by further
investigation
• If the abscess is present it can be treated by
drainage
• X-Rays are advised to assess the condition of
succedaneous teeth collection of saliva for
determining the salivary flow & viscosity
• Also, application of fluoride topically.
 PARENTS COUNSELLING
Parent should be questioned about the child’s feeding habits,
nocturnal bottles, demand for breast-feeding, pacifiers.

Parents should be asked to try weaning the child from using

the bottle as pacifier while in bed.

In case of emotional dependence on the bottle, suggest use of

plain or fluoridated water.

The parents should be instructed to clean the child’s teeth

after every feed.

Parents are advised to maintain a diet record of the child for 1

week that includes the time, amount of food given to the child,
the type of the food & the number of sugar exposures.
 2ND VISIT

Should be scheduled 1 week after 1 st visit.

• Analysis of diet chart & explanation of
disease process of child’s teeth
• Isolate the sugar factors from diet chart &
control sugar exposure
• Reassess the restoration and redo if
needed
• Caries activity tests can be started &
repeated at monthly interval to monitor the
success of treatment
 3RD SUBSEQUENT VISIT

 Restoring all grossly decayed teeth

 Endodontic treatment
 In case of unrestorable teeth, extraction followed
by space maintainer
 Crowns given for grossly decayed &
endodontically treated teeth
 Review & recall after every 3 months
 PREVENTION

• Encourage dental visits within 6 months of eruption of the first tooth and
no later than 12months of age.
• Good dietary practice guidelines should be given
• Tooth paste with fluoride
• Sealing of all pits & fissure caries
• Professional fluoride programs
• Systemic fluoride in drinking water
PROFESSIONAL AND HOME BASED PREVENTION APPROACHES
 EARLY CHILDHOOD
RAMPANT CARIES
CARIES
Specific form of rampant caries. Acute, widespread caries with early pulpal
involvement of teeth which are usually immune
to decay.
Age of occurrence
Age of occurrence
In infants & toddlers
Seen at all ages
Dentition involved
Dentition involved
Affects the primary
dentition
Both primary &
permanent dentition
Characteristic
feature
Characteristic feature

Specific pattern is Surfaces considered immune to decay are

seen involved. Thus, mandibular incisors are
 EARLY CHILDHOOD
RAMPANT CARIES
CARIES
Etiology Etiology
Etiology

More multifactorial with all the essential

Bottle feeding before sleep factors involved are not just feeding practices

Frequent snacks, excessive sticky

refined carbohydrates
Pacifiers dipped in honey
Decreased salivary flow
Prolonged at-will beast-feeding
Genetic background
Treatment
Treatment
In early stage- topical fluoride application &
education Require pulp therapy

Directed toward maintenance of the teeth till

the transition occurs Long term treatment

Prevention Prevention

Dental Health Education at a mass level

Education of the parents involving people of all ages
THANK YOU