Minor thesis:

SEVERITY LEVEL OF
EARLY CHILDHOOD CARIES
IN CHILDREN 24 – 60
MONTHS OLD
in Klinik Pergigian Peadiatrik, Hospital Raja Permaisuri
Bainun, Perak, Malaysia in January 2009

Name: Nur Nashrah Abdul Munil

NPM: F10054009

First Mentor: Drg. Willyanti S, Sp. Ped

Second Mentor: Drg. Eka Chemiawan, Mkes., AIFO
 Research Background

Early Childhood Caries

Early Childhood Caries or ECC

is term used to describe dental
caries presenting in the primary
dentition of young children.
(Welbury, et al., 2005)
 Research Background

Etiology
• consumption of liquids
containing fermentable
carbohydrates (juice,
milk)

• Poor feeding practices

without appropriate
preventive measures

• Frequent bottle feeding

at night
 Research Background

If untreated??
Early Childhood
Caries

GENERAL
HEALTH
PSYCHOLOGICAL

DENTAL
Pulp Necrosis

Extraction /
Early exfoliation Periapical
Abscess
 Research Background

Research Done Before…

• London : 8% from 602 children at the
age of 12 to 60 months (Winter, et al, 1971).

• Bandung : 35.2% from 1390 children at

age 8-36 months (Sasrawati, 2003)

• Malaysia :87.71% from all children at

age 60months old (Oral Health Division, Ministry of Health
Malaysia, 1997).
 Research Background

Why I choose
Perak,Malaysia?

• Research shows that in Malaysia the

prevalence is high in 1997 and has
decreased in 2005

• To find out the severity level of ECC

due to very high prevalence of caries in
Malaysia.
 Problem Identification

• How is the severity level of

ECC in children 24 to 60
months of age in the
research field?
 Research Purpose

• give more information to:

- Klinik Pergigian Peadiatrik Ipoh
- Perak Oral Health Community
- the community of Ipoh
- FKG UNPAD.
- early data for the next research
in the community
 Aims
• Improve teeth & oral health
condition in children.

• Educate oral health of the adults and

children in the community

• Guide the community to have a

program to prevent ECC
 Benefits
• To plan an efficient and effective
strategy for dentists & parents in
order to take good care of the
children’s teeth and oral hygiene.

• To improve community services on

educating the parent and children
Conceptual Framework
Modern children
lifestyle

Bad Oral Hygiene

bacteria
+ Susceptible
surface

EARLY CHILHOOD
CARIES
Research Method
• descriptive with surveying
technique

Location & Time of Study

• January 2009
• In Klinik Pergigian Peadiatrik
Hospital Raja Permaisuri Bainun
Ipoh, Perak, Malaysia
 Population & Sample

• Age between 24-60 months old

• Healthy

• Suffering Early Childhood Caries

 Variables

• Early Childhood Caries

• Severity Level of Early Childhood Caries

• Age of the children's (months)

 Operational Definitions
Early Childhood Caries :
term to describe caries in primary dentition.
Caries is consider present when explorer
catches or resists removal after insertion into
pit and fissure and softness at base, opacity
or loss of normal translucency and softened
enamel that can be scraped with explorer
• Presence of ECC
- smooth-surface caries
- white spot lesion
- brown or different opacities
- cavitated
* shallow
* deep
 The severity level in ECC can be
classified as 3 types listed below
(Wyne, 1999):

a) Type I (mild to moderate)

-maxillary incisors, or surface of the
molars or both + caries lesion is
present with isolated condition,
-other teeth is still in healthy condition
b) Type II (moderate to severe)
- affecting labiopalato surfaces of
maxillary incisors, with or without molars,
- unaffected mandibular incisors.

c) Type III (severe)

- lesion affects almost all teeth including
the mandibular incisors.
 Research Background

Types of ECC (WYNE, 1999)

• Type I (mild)

• Type II (moderate)

• Type III (severe)

• Age of the children is use according
to the month & year born.

• children age >15days from the birth

date is consider older by a month
 Materials

• Mouth Mirror • Sterilization box

• Tweezers • Checking forms

• Explorer • Informed Consent

• Alcohol 70% • Gloves

• Pen torch light • Mask

 Research Procedures
Ask inform consent from parents/caregivers and
fill in the form with name & age of the child.

A child is seated with sufficient light to the mouth.

The surrounding of the mouth is cleaned up with

gauze to increase visibility.

A brief intra oral examination is conducted

 Research Procedures

non cavitated lesion, the opacities of the tooth white,

brown or dark patches on tooth surface

cavitated lesion, explore the tooth surface if there are

cavities. explorer -catches into the cavity

Inspect if there is any missing and filled tooth due to

caries

Data is then recorded in the form.

 Data Analysis
• Severity level is determine according to
Wyne, 1999.
• Collected, noted and rearranged in table &
graphic

• Percentage formula:
Percentage = F x 100%
N
F = Frequency (Total patients in each type of severity level)
N = Total patients with ECC
 Results
Severity No. Of Percentage
Level Children %
Type I 11 17.19

Type II 19 29.68

Type III 34 53.13

Total 64 100

Table 1: Severity Level of ECC in 64 children in KPP,HRPB,Perak.

 Results

35

30 34

25

20

15 19
Type I
Type II
10
11 Type III
5

0
No. of Children

Graphic 1 : Severity level of ECC (number) in 64 children

suffering ECC in KPP,HRPB,Perak.
 Results

17.19%
53.13%
29.68%

Type I (mild-mod)
Type II(mod-sev)
Type III(severe)

Graphic 2: Severity level of ECC (percentage) in 64 children

suffering ECC in KPP,HRPB,Perak.
 Results

• Severity level of ECC in Klinik Pergigian

Peadiatrik Hospital Raja Permaisuri
Bainun is severe with 53.13% suffering
type III (severe) from the total
children suffering ECC in the clinic at
that moment.
 Discussion
• type III (severe) ECC is the highest
number of children – 34 children.

• The reason of high percentage in type III

ECC in the research area might be due to:

– Lack of OHE implementation

– Diet and eating habits
– Wrong technique of feeding practices
– Parent’s mind set
– Psychological, attitude & normal development
 Discussion

OHE implementation

 When the prevalence is getting lower,

the government assumes that their
implementation on oral health education
is effective but the effectiveness in
controlling the severity level of ECC is
still not being done properly (MOH, Malaysia
2005)
 Discussion

Diet and eating habits

 microorganism activity in the oral cavity

as the result of high frequency of
consuming drinks and foods containing
sugar (Houwink,1993).
 Discussion

Technique of feeding practices

 Most affected children sleep with their

parents, suckle during the night and are
often being breast fed at 2-or more
years of age. It is important to
appreciate that this does not imply that
normal breastfeeding up to around 1year
of age is bad for teeth, but that
prolonging on-demand feeding beyond
that age carries a risk of causing dental
caries (Welbury, et al., 2005)
 Technique of feeding practices Discussion

• factor of ECC is depending on the way

the children holding the nursing bottle
containing sugary liquid while sleeping in
a long period of time (Dalimunthe, 1998).

• The usage pacifier and fake-nipple to

comfort the child before they sleep or
when they cries will also helps in ECC
formation. Candida yeast that builds up
on pacifiers has been found to promote
cavity formation to a great degree
(Ollila, et al,. 1998).
 Discussion
Parent’s mind set

 parent’s trend of mind set. Many

parents feel that primary teeth are not
as important as secondary teeth since
they will be lost relatively quickly (Shanna,
2005).
 Discussion
Psychological, attitude & normal development

• In 1 to 3-year-old infants, the specific

immune system, particularly
immunoglobulins in saliva, is immature.
Poor oral hygiene will therefore favor
the establishment of cariogenic
microflora such as Streptococcus
mutans (Axelsson, 2006).
 Discussion
Psychological, attitude & normal development

• The psychological of the 2 to 5 year old

children is said to be independent
likeable. They show interest like
dressing up, brushing hair and wanting to
brush their teeth by themselves (Lesia, 1995).

• In the normal human development stage,

children in these range age also resist
parental demand (Myers, 1999).
 Conclusion
• Severity level of ECC in Klinik Pergigian
Peadiatrik Hospital Raja Permaisuri
Bainun is severe with 53.13% suffering
type III (severe) from the total
children suffering ECC in the clinic at
that moment and this condition needs to
be controlled.
 Suggestions
• Parents in the clinic should be educated
more on dental health

• Ministry of Health in Malaysia should

improve oral health education
implementation in Perak

• Early prevention should be done at an

early age
…thank
you…