Early Childhood Caries

(ECC)
ALLISON RESTAURI, RDH, BSDH
EDU 653
11-03-2012
 Purpose

 Explain what ECC is in scientific terms

 Provide background information
 Provide statistics

 Explain ECC in layman terms

 Provide strategies to reduce ECC

 In a dental setting
 Daycare/Head Start program
 Tips for caregivers
 Learning Objectives

 Learner will be able to explain ECC

 Learner will be able to provide strategy

recommendations for caregivers

 Learner will realize that ECC is at epidemic levels

 Learners will be able to recognize ECC on photos

 AAPD Definition of ECC

Caries is a biofilm (plaque)-induced acid demineralization of

enamel or dentin, mediated by saliva. The disease of
early childhood caries (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. In children younger than 3
years of age, any sign of smooth-surface caries is indicative
of severe early childhood caries (S-ECC). 1
 What to tell the caregiver

Germs (plaque) not removed

AND repeated food/drink = decay

Bottles in Bed
Filled with Anything
Except Water

Sipping on
Frequent Snacks: Sweet Liquids
Sugary, Sticky, in Bottles or
Starchy Sippy Cups
Provide a visual for the caregiver
 ECC epidemic!

 The Centers for Disease Control and Prevention (CDC)

report that dental caries is possibly the most prevalent
infectious disease in United States children and 40% of
children have caries by kindergarten.1

 The general population as a whole is affected by caries, but

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. 1
 ECC epidemic cont’d!

 The decay rate among 2-5 year olds, especially in minorities

and individuals with a lower income, are going untreated
and the lack of prevention is increasing. This problem is
cumulative and the untreated decay of primary (baby) teeth
can lead to lack of physical development in height and
weight, lack of ability to learn, and increased treatment
costs.2
 The oral condition of the primary teeth is a strong predictor
of decay in permanent (secondary) teeth.3
Early Childhood Caries-
white spot lesions
Early Childhood Cavities-advanced

University of Washington
Severe ECC and an abscess
 Transmission

Streptococcus mutans are the primary microbiological

agent in the disease. The disease process begins with the
transmission of the bacteria to the child, usually from the
primary caretaker, or mother. Mothers with untreated
dental disease present a very high risk to their children.
Any mother at a high or moderate caries risk can spread
Streptococcus mutans to their child under the age of 3.4
 Prevention at home

Daily: Monthly:
Oral Health Routine “Lift the Lip”

WDSF WDSF

Wipe infant’s gums & tongue. Check for white spots

Brush when first teeth appear or anything unusual.
Dental Visit by their First Birthday!

Fluoride Varnish

Knee to Knee exam

University of Washington
 Education for Caregivers

 Dental appointments B4 their first birthday

 Daily mouth care
 Healthy foods and drinks
 “Lift the Lip”
 Early Childhood Caries info
 NO sippy cups!
 Fluoride/MI Paste
 Caregiver needs good oral hygiene
 Tips for Daycare/Head Start

 Use gauze or a washcloth to  Serve tooth-healthy

wipe infants’ gums and
tongues after feeding.
 Brush toddlers’ teeth after
meals or snacks. No
toothpaste until child can
spit it out.
meals and snacks.
 Watch for children with
dental problems.
 Refer families to dental
providers.
A Better Approach

Preventive
rather than
Reactive
 General Oral Hygiene Assessment

No Plaque Plaque

Compliance Diet
No
Inflammation

Performance Non-
Inflammation Brushing Compliance
 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

 Prevention Plan

 Providing how to advice rather than just telling the

patient to change a behavior will be helpful in
achieving the desired changes, therefore decreasing
the patient’s caries risk.

 Assessing the patients’ caries risk will assist the

clinician in providing a comprehensive, customized
prevention plan.
 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.
 Take Away Message

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. 5

“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
 References-(notes on PPT)

1. AAPD. Policy on early childhood caries (ECC): classifications,

consequences and preventive strategies. [Retrieved Nov 2, 2012];
Available from:
http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.p
df.
2. AAPD. Guidelines on infant oral care. [Retrieved Nov 2, 2012]; Available
from:
http://www.aapd.org/media/Policies_Guidelines/G_InfantOralHealthCar
e.pdf.
3. Siew C, Strock S. Assessing a potential risk factor for enamel fluorosis. J
Am Dent Assoc. 2009 Oct;140(10):1201-1328. AAPD. Policy on use of
caries-risk assessment tool (CAT) for infants, children and adolescents.
[Retrieved Nov 1, 2012]; Available from:
http//www.aapd.org/media/policies_guidelines/p_cariesriskassess.pdf.
 References cont’d-(notes on PPT)

4. ADA. Statement on early childhood caries. [Retrieved Nov 2, 2012];

Available from:
http://www.ada.org/prof/resources/positions/statements/caries.asp.

5. Berkowitz, C. Calgary’s child magazine. [Retrieved Nov 3, 2012];

http://www.bluetoad.com/display_article.php?id=571543.
 Picture References-(notes on PPT)

 University of Washington-slide #10, 13, 14

 Bryan Williams, DDS-slide #9, 11
 Kevin J. Hale, DDS-slide #18