Dr. B.N.

RANGEETH MDS 06-May-20

Early Childhood Caries

Dr. B.N. Rangeeth MDS

IV Year Lecture

“The mouth is the gateway to the body

and if the mouth is not healthy, the rest
of the body is not healthy either.”
Carol Berkowitz, DDS

Introduction
• Caries is a biofilm (plaque)-induced acid
demineralization of enamel or dentin, mediated by
saliva
• Younger than 3 yrs, any smooth surface is an
indication of S ECC
– 3 – 5 yrs. – dmfs 1 anterior teeth
– dmfs ≥ 4 - 3 yrs.
– dmfs ≥ 5 – 4 yrs.
– dmfs ≥ 6 – 6 yrs.

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Dr. B.N. RANGEETH MDS 06-May-20

Introduction
• Infants of low socio-economic status, whose diet is
high in sugar and whose mothers have minimal
education are thought to be 32 times more
susceptible to caries
• The oral condition of the primary teeth is a strong
predictor of decay in permanent (secondary) teeth

Risk Groups for Dental Caries

• Children with special health care needs
• Children of mothers with a high caries rate
• Children with demonstrable caries, plaque,
demineralization, and/or staining
• Children who sleep with a bottle or breastfeed
throughout the night
• Later-order offspring
• Children in families of low socioeconomic status

Definitions
• AAPD: ECC is the 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.
• Davies (1998): Complex disease involving maxillary primary
incisors within a month after eruption and spreading rapidly
to other primary teeth is called childhood caries.

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Dr. B.N. RANGEETH MDS 06-May-20

Terminologies
• Nursing caries: Winter (1966)
• Tooth clearing neglect: Moss (1996)
• Infant and early childhood dental decay: Horowitz (1998)
• ECC: Davies (1998)
• MDSMD: Maternally derived Streptococcus mutans disease.

Classification (Wayne H)
• Type I
– Mild-to-moderate
– Existence of isolated carious lesion involving molars and incisors
– Number of carious teeth increase as cariogenic challenge persists
– Cause is usually a combination of cariogenic semi-solid food and lack
of oral hygiene
– Seen in 2–5 years old

Classification (Wayne H)
• Type II
– Moderate-to-severe
– Labiolingual carious lesion affecting maxillary incisors
– Mandibular incisors are not affected
– Use of feeding bottle or at will breastfeeding or a
– combination of both with or without poor oral hygiene
– Seen soon after eruption of teeth

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Dr. B.N. RANGEETH MDS 06-May-20

Classification (Wayne H)
• Type III
– Severe
– Carious lesions affecting all the teeth including
lower incisors
– Cause is cariogenic food and poor oral hygiene
– Condition is rampant

Etiology
• Plaque
• MS
– S. mutans and S. sorbinus
– Produce insoluble glucans from sucrose
– Produce large amount of acid and acid tolerant
– Produces Dextranase allowing invasion of MS
– Adhere to non-shedding surfaces both artificial and
anatomical
– Rate of infection increases with age and no of teeth
– Transmission - saliva

Etiology contd..
• Infant feeding practices
– Feeding bottle

– Breast feeding practices

• Oral hygiene

• Salivary factors
– antimicrobial proteins, including lysozyme, lactoferrin, agglutinins that are likely to be of
significance in dental caries.

– organic compounds, which agglutinate oral bacteria and enhance their removal. These
agglutinins include mucins, agglutinating glycoprotiens, fibronectin, lysozyme and
secretory immunoglobulins

– Salivary flow rate

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Dr. B.N. RANGEETH MDS 06-May-20

Etiology contd..
• Sugars

• Oral clearance of carbohydrates

• Bovine milk
– main components of milk involved in reducing demineralization
and increasing remineralization have been reported to be various
forms of casein, namely μ– casein and sodium caseinate.

• Fluorides

Secondary risk factors

• Immunological factors - sIgA and IgG
• Tooth maturation defects
• Race and Ethinicity
• Acid fruit drink
• Socio economic status
• Dental knowledge
• Stress

Stages of Development

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Dr. B.N. RANGEETH MDS 06-May-20

Clinical Presentation

Prevention
• Varnish application
• Diet counselling
• Oral hygiene education
• Fluoride supplements and dentifrices
• Sealants
• Parental fluoride supplements
• Water fluoridation
• Sugar substitutes
• Prevent transmission
• Community based education

Consequences
• Higher risk of new carious lesion in both primary
and permanent dentition
• Hospitalization and emergency room visits
• Increased treatment cost and time
• Insufficient physical development (especially in
height and weight)
• Lack of adequate nutrition due to early loss of teeth

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Dr. B.N. RANGEETH MDS 06-May-20

Prevention
• Use gauze or a washcloth to wipe infants’ gums and
tongues after feeding.
• Brush toddlers’ teeth after meals or snacks. No toothpaste
until child can spit it out.
• Serve tooth-healthy meals and snacks.
• Watch for children with dental problems.
• Refer families to dental providers.

Barriers
• Involvement
• Early referral to specialist
• Nutritional and socio economic issues
• Dental health insurance packages

Key points
• Dental visit by the child’s first birthday

• Knee to knee exam, if needed

• EDUCATE the caregivers

• Provide small amounts of background info

• Provide SOLUTIONS

• Evaluate the child’s risk

• Evaluate the caregiver’s risk factors

• Provide a PERSONALIZED PLAN for prevention and treatment, if needed.

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Dr. B.N. RANGEETH MDS 06-May-20

Conclusion
Early intervention plays a pivotal role in the prevention of early
childhood caries. The dental team needs to work with pediatricians
to educate parents, primary caregivers and the general public
regarding the importance of maintaining healthy “baby” teeth. ECC
is more than unhealthy “baby” teeth, it the first signs of an
unhealthy child and the general population needs to be aware that
ECC can affect the child’s quality of life.

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