Recommended Procedures For The Management Of Early

Childhood Caries Lesions (Scoping Review)

Sri Pandu Utami *, Istighfaroh Irawan **

* Section IKGA , FKG Baiturrahmah, Padang

**Student, FKG Baiturrahmah University , Padang

ABSTRACT
Background: The high prevalence of the disease, coupled with its impact on both the individual and
collective levels, makes it possible for prevention and treatment by ECC to become a public health
problem. The decision to treat ECC should be based on individual (such as risk assessment) and
family (eg, adherence to a patient's caregiver's willingness to change behaviors affecting oral health)
and professional experience. Purpose: What procedures are recommended for the management of
ECC lesions Methods: The method used in this study uses the literature study method. Data was
collected through PubMed, ScienceDirect, Google Scholar and Google database searches. Results :
The caries management plan for each individual is based on reducing caries risk factors and
increasing protective factors with the additional help of behavior modification. Conclusion: This
expert consensus mainly addresses the etiology of ECC, caries risk assessment in children, ECC
prevention and treatment plan, aiming to achieve lifelong oral health.

Keywords: Procedures, recommendations, Kareis , Early Childhood

INTRODUCTION
Millions of children under 6 years of age have early childhood caries (ECC) globally. This
condition is a multifactorial and dynamic disease characterized by “the presence of one or more
decayed (non-cavitated or cavitated lesions), missing (carious) or filled surfaces, in every primary
tooth in children under six years of age. "The prevalence of this condition is closely related to the
age of the child. Thus, while the average prevalence of ECC in children at 1 year of age is 17%,
among those aged 5 years, this rate is higher than 50%. 1
In addition to its high prevalence, ECC is also of concern because of its severe implications
for the quality of life and well-being of children and their families. Children with ECC experience a
different dimension of decline in their lives. Negative impacts can range from difficulty performing
daily activities such as eating and sleeping to problems with growth and development, pain and the
need for hospitalization or visits to the emergency room. These negative impacts can be minimized
by dental treatment under general anesthesia despite the associated morbidity, sedation or non-
pharmacological techniques for behavior management. 2
Despite scientific evidence showing that treatment of ECC has definitive results and is
important for improving the quality of life of children and parents, approximately 621 million children
worldwide have untreated cavitary lesions. Alarming data on dental caries and its non-treatment
may reveal low priority given to children under 6 years of age and failures in primary and
secondary prevention measures. Also, it should be emphasized that treatment is technically
challenging, and is often determined by the extent of the lesion, the behavior of the child and the
cost to the patient/dental reimbursement system. The high prevalence of the disease, coupled with
its impact on both the individual and collective levels, makes it possible that ECC prevention and
treatment will become a public health problem. 3
The decision to treat ECC should be based on individual (such as risk assessment) and family
(eg, adherence to a patient's caregiver's willingness to change behaviors affecting oral health) and
professional experience. To support the decision-making process, several
guidelines/guidelines/policies have been issued. However, given that ECC is a problem affecting
children worldwide, it is important to know whether recommendations are similar across countries
and over time. 4
Based on the background in based on the problem formulation of this Scoping Review is what
is the recommended procedure for the management of ECC lesions? The purpose of this review is
to seek scientific evidence of the following questions: what are the recommended procedures for
the management of ECC lesions?
MATERIALS AND METHODS
The article search strategy in this Scoping Review uses research keywords and includes AND
combinations in in a database search. The key word is procedures, recommendations , careers ,
early childhood. The article selection process uses 3 databases namely Science Direct, Pub M ed ,
and Google Scholar . In the first stage , articles will be filtered based on the 2015 - 2020 range,
abstracts , and free full text using filters from the database. The second stage, namely articles that
enter the first stage of the article selection process will be reviewed based on the inclusion and
exclusion criteria in the article .
Extraction of article data by entering several el variables , such as article title, author, journal
name, volume, number, year, research method, research objectives, conclusions and results which
will be summarized in tabular form . List and definitions research variables whose data are taken
from each article reviewed.
The article selection process uses 3 databases namely Science Direct, Pub M ed , and Google
Scholar . In the first stage , the articles will be filtered based on the 2015-2020 year range ,
abstracts , and free full text using filters from the database. The second stage, namely articles that
enter the first stage of the article selection process will be reviewed based on the inclusion and
exclusion criteria in the article

RESULTS
Search results for articles with evidence sources using 3 databases, namely Google Scholar ,
PubMed and Science Direct , 5 articles were obtained . The process of searching for articles and
selecting articles consists of several stages. The first stage is to conduct an initial search on the
online PubMed and Science Direct databases and Google Scholar using the final keywords and
queries that have been determined. The second stage, namely the article l is filtered based on the
title and abstract according to the inclusion and exclusion criteria . Results of screening full-text
remaining 8 relevant articles to be used as sources of evidence.

Science Direct PubMed Google Scholar

(n=1853) (n= 787) (n=910)

Overall search results

(n=3,550)

Double article
(n=10 )

Article screening (title and Excluded articles after title and

abstract) abstract screening
(n= 3538) (n = 1,545)
Off topic
Not published between 2015-2022
Assessment of the feasibility of Inaccessible articles
full text articles Articles other than English and
(n= 113) Indonesian
Article other than original paper

Articles excluded after full-text reading

(n = 110) The research results are not
Article to be reviewed appropriate
(n= 8)

Figure 1. Results of the Selection of Evidence Sources

 The results of each source of evidence are carried out by listing the author's name, year of publication, publisher, title of the article and the
research results of each article that will be reviewed in the form of a table .

Table 2. Results for each source of evidence

No. Writer Year Title Publisher Results
1 Christian H. 2020 How to Intervene in the 2020 S. Karger AG, Basel Caries In children, caries management requires adequate oral hygiene
Spliteth . et.al Caries Process in Res DOI: 10.1159/000507692 and daily application of fluoride through dentifrices, confirmed by
Children: A Joint ORCA caregivers, and especially for prevention of ECC, emphasis on
and EFCD Expert Delphi reducing sugar intake is needed. These noninvasive
Consensus Statement interventions are also suitable for stopping or controlling lesions
initial dentinal caries or even cavities in the absence of
irreversible pulpitis . Varnish fluoride or silver shut up fluoride can
be added as an additive. In pits and fissures , composite resin
materials can be used as preventive sealants and for
restorations defect oriented minimally invasive . On molars
Deciduous , preformed metal crowns are more successful than
multi-surface fillings , especially in caries -active patients . With
high caries activity , lesions multiple , and limited cooperation,
caries control must consist of vigorous measures with high
success rates, even including extraction in some cases. This
applies especially to treatments carried out under general
anesthesia .
2. J. Ku¨hnisch, 2016 Best clinical practice Eur Arch Paediatr Dent (2016) After a systematic review and seminar results, it was concluded
et.al. guidance for management 17:3–12 DOI 10.1007/s40368-015- that detection Visual and radiographic caries should be used as
of early caries lesions in 0218-4 the basic diagnostic approach to locate, assess and monitor
children and young adults: lesions non- cavitated caries in primary and permanent teeth . As
an EAPD policy document another important evaluation step, risk assessment caries should
be performed at the child's first dental visit, and reassessments
should be made regularly. It is widely accepted that the lesion
Non- cavity caries can be managed non- invasively in most
cases. The spectrum of action includes a low cariogenicity tooth-
friendly diet , daily and appropriate biofilm management, home
and in-office/dental surgery use of fluoride and sealing
techniques . Conclusions Detection and management of non-
cavitated caries is an important aspect of preventive dentistry.
Therefore, EAPD encourages oral health service providers and
caregivers to implement preventive practices that can stop caries
early and improve the dental health of individuals and
communities.
3. John D. B. 2021 Evidence-Based Caries Frontiers in Oral Health | Caries Management Based on Risk Assessment : Individualized
Featherstone, Management www.frontiersin.org 1 April 2021 | patient care guidelines are given based on risk status caries ,
No. Writer Year Title Publisher Results
et.al for All Ages-Practical Volume 2 | Article 657518 clinical examination results and patient responses to questions at
Guidelines CRA. These guidelines are based on results successfully
documented in several clinical outcome studies and clinical
trials . Includes a review of successful caries management
procedures for children and adults as previously published, with
additional emphasis on the correct use of silver diamine fluoride
(SDF) for children. The caries management plan for each
individual is based on reducing risk factors caries and increased
protective factors with the additional help of behavior
modification. Altering the caries balance advantageously coupled
with minimal intervention restorative dentistry , where
appropriate. This method is suitable for the management of
dental caries in all patients.
4 Jing Zou, 2022 Expert consensus on early International Journal of Oral So, it is important to improve parents' oral health and health care
et.al childhood caries Science (2022) 14:35 awareness, establish dental home care in early childhood, and
management create individual caries management plans. Dental intervention
according to the minimally invasive concept must be carried out
to treat dental caries . This expert consensus is mainly on the
etiology of ECC, risk assessment caries in children, ECC
prevention and treatment plan, aiming to achieve lifelong oral
health .
5 Thana 2021 Strategic Management of Frontiers in Public Health Public education on the importance of primary teeth and effective
Sitthisettapon Early Childhood Caries in www.frontiersin.org 1 June 2021 | brushing with fluoride toothpaste (primary prevention), routine
g , et.al. Thailand: A Critical Volume 9 | Article 664541 check-ups and detection ECC lesions and early intervention
Overview (secondary prevention), insertion of non- invasive preventive
restorations using restorative treatment cost-effective traumatic
(ART) or simplified and modified (SMART) ART ( tertiary
prevention ), and, finally, an effective follow-up and monitoring
system. It is hoped that this three-level approach to ECC
management will improve not only oral health but also children's
overall health.
6 Keys, T. et.a 2019 Carious lesion Australian Dental Journal 2019; 64: In this study, 887 responses were received. On the lesion With
management in children 282–292 'enamel-limited' caries , the dentist most frequently intervenes in
and adolescents by primary teeth aproximal (365, 41.1%), followed by occlusal
Australian dentists permanent teeth (295, 33.3%) and approximal (244, 27.5%), and
occlusal primary teeth (203, 22.9%) lesions surface caries . Age,
university graduation , state of practice , decade of graduation
and frequency of treatment of children between 6 and 15 years
of age are significant demographic factors that affect thresholds
restorative .
No. Writer Year Title Publisher Results
7 Splieth, CH. 2020 How to Intervene in the Caries Res 2020;54:297–305 DOI: The decline in caries has led to a more polarized distribution of
Et.al. Caries Process in 10.1159/000507692 the disease in children and adolescents along a social gradient
Children: A Joint ORCA which must be taken into account when managing the caries
and EFCD Expert Delphi process at all levels, such as individuals, groups or populations.
Consensus Statement Control or reduction of caries activity is the basis for successful
caries management. In children, caries management requires
adequate oral hygiene and daily application of fluoride through
dentifrices, confirmed by caregivers, and especially for
prevention of ECC, emphasis on reducing sugar intake is
needed. These noninvasive interventions are also suitable for
stopping or controlling lesions initial dentinal caries or even
cavities in the absence of irreversible pulpitis . Varnish fluoride or
silver shut up fluoride can be added as an additive. In pits and
fissures , composite resin materials can be used as preventive
sealants and for restorations defect oriented minimally invasive .
On molars Deciduous , preformed metal crowns are more
successful than multi-surface fillings , especially in caries -active
patients . With high caries activity , lesions multiple , and limited
cooperation, caries control must consist of vigorous measures
with high success rates, even including extraction in some cases.
This applies especially to treatments carried out under general
anesthesia .
8 Tinanoff N, 2019 Early childhood caries Int J Paediatr Dent. 2019;29:238– Early childhood caries is associated with frequent consumption
et.al epidemiology, aetiology, 248. of environmental sugars attached to enamel, acid-producing
risk assessment, bacteria in complex biofilms , as well as defects in enamel
societal burden, development. The seriousness , social costs, and impact on
management, education, quality of life of dental caries in pre-school children are
and policy: Global enormous. Worldwide data show that ECC continues to be highly
perspective prevalent, but rarely treated. Approaches to reducing prevalence
include interventions starting in a child's first year of life,
evidence- and risk -based management, and reimbursement
systems that encourage preventive care.
Result Synthesis
Results of research conducted by several previous researchers regarding the recommended
procedure for the management of ECC lesions?
Results of research conducted by Christian H. Splieth . et al . Presented the results of his
study that the polarization of caries distribution in countries that had achieved a reduction in major
caries resulted in the majority of children with few or no lesions . detected caries , while a minority
group still showed extensive tooth decay due to caries .
Ku¨hnisch , et al (2016) mentioned that recommend Clinical trials are developed by
consensus and are based on the best available evidence. This statement applies to children
without medical problems that affect their ability to receive dental care and to children without
dental disorders. 5
The results of research conducted by John DB Featherstone, et al . revealed the results of his
research that one of the recommended antimicrobial chemical therapies in children 6 years and
older and in adults as part of a caries management plan is mouthwash . chlorhexidine . Advocacy
and promotion of the first visit is critical in preventing early childhood caries and laying the
foundation for good oral health throughout the life cycle. 6
According to Jing Zou , et al (2022) revealed that the risk assessment model caries in children
Caries -risk assessment (CRA) is an important part of children's dental health care. It refers to the
identification and analysis of certain factors that are thought to be associated with dental caries
and to propose personalized preventive and therapeutic strategies for individuals to reduce the risk
. dental caries . 7
Furthermore, the results of research conducted by Thanya Sitthisettapong , et.al. (2021)
stated the results of his research related to ECC PREVENTION STRATEGIES that According to
the WHO Expert Consultation on Public Health Interventions on ECC, recommendations for health
promotion and management should be based on three levels of community prevention , namely:
primary, secondary and tertiary prevention. 8
key. T et al , (2019) mentioned in their research results that a clinical and radiographic photo
lesion caries was administered to participants to assess their visual judgment ability, with the
distribution of diagnoses by dentists; Management options presented at Slightly preferred non-
surgical management (50.2%). 9
According to Xiao, et al (2019) wrote in his research results that the etiology of ECC has been
clear for many years and is present globally with an identical pattern, namely, high intake of dietary
sugar often through feeding bottles and inadequate or non-existent oral hygiene practices leading
to relatively atypical , rapidly progressing carious bouts starting with the smooth surfaces of the
upper anterior teeth in young children. Because fluorides have been shown to be very successful
in caries prevention , they should be used from an early age. 10
The results of research conducted by Tinanoff , et al (2019) state that primary prevention for
ECC needs to start before the start of the disease and is the key to reducing the prevalence of
ECC worldwide. Timely delivery of educational information and preventive therapy to
parents/caregivers has been shown to be effective in reducing the prevalence of ECC. 1

DISCUSSION

Recommendations regarding the treatment of cavitary caries dentine lesions at the site
level
NRCC achieve results comparable to conventional direct restorations . NRCC can only be
used for adherent patients ( recommendation strength : weak; consensus : agree 50%, neutral
37%, disagree 12%*; median: 7; * ≠ 100% due to rounding). 11

Lesion Management Early Caries

Appropriate management of the disease depends on the correct diagnosis and assessment of
caries , and is further influenced by the CRA of each child of the patient. Follow a caries
management strategy current , most of the lesions Early caries requires non- invasive treatment .
In contrast to this mainstream management strategy, few early lesions may be detected visually in
the mouth may be clinically related to caries that has progressed into dentin, which may require
operative intervention to protect dentin and pulp. 5
General Considerations for Successful Caries Management
Risk level assessment caries for lesions future caries is an important first step in managing
dental caries and monitoring the improvement of oral health over time. All children should be given
their first oral examination at the time of eruption of their first tooth or before 1 year of age to
ensure early intervention and prioritize prevention over restoration . Successful management of
dental caries requires a risk -based approach to formulate individualized treatment plans using a
chronic disease management model, which aims to target specific biological and environmental
(including social) risk factors that contribute to the establishment and multifactorial development of
this disease. 6

Caries Management in Children Aged 0-6 Years

Fluoride has played a key role in reducing dental caries , and its use for caries prevention and
management is significantly safe and effective. Low levels of fluoride in plaque and saliva help
remineralize demineralized enamel and prevent demineralization of healthy enamel. It also
prevents caries through a mechanism that affects the metabolic activity of cariogenic bacteria .
High levels of fluoride cause a substance like a calcium film temporary fluoride on the enamel
surface. In cases where the pH value decreases due to acid formation, fluoride is liberated and can
be used to remineralize enamel or influence bacterial metabolism. The most cost-effective way to
provide fluoride to the public is through drinking water fluoridation . In the United States, water
fluoridation is carried out at a rate of 0.7–1.2mg L1. 12

ECC Prevention Strategy

According to the WHO Expert Consultation on Public Health Interventions against ECC,
recommendations for health promotion and management should be based on three levels of
community prevention , namely: primary, secondary and tertiary prevention . 13
As mentioned, the importance of inter-professional collaboration in the management of ECC
and the subsequent delivery of healthcare services should not be overlooked. This can start at the
puskesmas and then go through various stages, especially at community hospitals. For example,
risk assessment caries for non-dental health care providers prepared by the AAPD (American
Academy of Pediatric Dentistry) can be modified for this purpose, as it can be applied by doctors,
nurses or other health workers only through observation and interviews. After that, children at risk
High caries can be referred to appropriate oral health services at the adjacent or regional dental
clinic. An added advantage of this is that dentists or dental therapists can work with doctors or
pediatricians and nutritionists to control ECC and non-communicable diseases (NCDs) such as
diabetes and obesity. 8

Prevention Recommendations
varnish application or fluoride gel use is recommended for teeth, individuals, groups, or
populations with risk , activity, or prevalence higher caries ( recommendation strength : moderate;
consensus : agree 87%, neutral 12%, disagree 0%*; median: 9; * ≠ 100% due to rounding). 11

Community Management ECC

Community programs for managing ECC generally target the community high risk , low
socioeconomic, and disadvantaged using existing caries prevention methods . Culturally
competent programs with community-based participation and alignment with people's culture have
been successful in reducing ECC in indigenous , low-income, and migrant communities worldwide.
Similarly, personal approaches such as home visits and telephone contact can reduce ECC by
increasing caregivers' health literacy and self-efficacy to change behavior to improve their infants'
oral health. Increased knowledge, however, may not improve oral health behavior or reduce
increased caries . 1
CONCLUSION
Caries management requires adequate oral hygiene and daily application of fluoride through
dentifrices, confirmed by caregivers, and especially for ECC prevention, emphasis on reducing
sugar intake is needed. These noninvasive interventions are also suitable for stopping or
controlling lesions initial dentinal caries or even cavities in the absence of irreversible pulpitis . The
detection and management of non- cavitated caries is an important aspect of preventive dentistry.
Therefore, EAPD encourages oral health service providers and caregivers to implement preventive
practices that can stop caries early and improve the dental health of individuals and communities.
caries management plan for each individual is based on reducing risk factors caries and
increased protective factors with the additional help of behavior modification. Altering the caries
balance advantageously coupled with minimal intervention restorative dentistry , where
appropriate. This method is suitable for the management of dental caries in all patients. This expert
consensus is mainly on the etiology of ECC, risk assessment caries in children, ECC prevention
and treatment plan, aiming to achieve lifelong oral health . It is hoped that this three-level approach
to ECC management will improve not only oral health but also children's overall health.
Forming partnerships with non-dental primary care providers, for example, general
practitioners, paediatricians and midwives to integrate oral health promotion into general health
care can help increase infants' access to early preventive screening and referral for dental care.
Partnerships with nursery school staff to conduct school-based oral examinations and tooth
brushing have reduced ECC in many socially disadvantaged communities around the world .

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