DEFINITION = American Academy of Paediatric Dentistry (AAPD) defines early childhood caries as ‘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.
A window of infectivity 2M**:
- Caufield (1996) stated that there is a window of infectivity between 19 and 33 months during which teeth get infected with S. mutans
- The most beneficial time for vaccination against dental caries would be in infancy before the eruption of teeth.
- This would promote the induction of adherence inhibiting salivary IgA thus delaying colonization of S. mutans.
- With the establishment of early colonizers, there would be a synergistic effect of suppressing the colonization of S.mutans during the period of the window of infectivity.
- A booster dose of vaccination may be required at the time of eruption of first permanent molars
ETIOLOGY AND PATHOGENESIS 3M
- Early colonization of MS is the most imp risk factor for developing ECC – MS transmission can be through the mother or from peers [ other kids]
- MS Colonization of pre dentate children is mostly associated with maternal factors [ high level of MS in the mother, poor OH, and active caries ]
- How is nocturnal bottle feeding/breastfeeding related to ECC?
- When a child is laid to rest, the bottle or breast nipple rests against the palate and the tongue covers the lower incisors [ that’s why they are not affected] –
- As the child becomes sleepy, saliva flow and swallow reflex are reduced
- Sugar remains stagnant around the neck of the teeth
- what practices increase the chance of developing ECC?
- Prolonged nighttime bottle feeding
- On-demand breastfeeding after the age of 1
- Frequent snacking with sugary foods
- Frequent sipping of sugary drinks throughout the day
CLINICAL FEATURES 2M
- ECC = also known as nursing bottle caries, baby bottle tooth decay
- Seen in infants and preschool children [ below the age of 6
- Demineralization at the necks of the upper incisors – mandibular incisors are not affected
- Decay pattern:
- Maxilla: incisors, canines, first molars
- Mandible: canines, first molars
- Lesion progresses to the necks of the teeth and in advanced cases, only a root stump is left
- Why does ECC follow this specific pattern?
- Chronology of primary tooth eruption
- Duration of the deleterious habit [ bottle feeding]
- A muscular pattern of infant sucking
- Very mild: slight demineralization usually at the gingival crest and no cavitation.
- Mild: demineralization in a gingival third of tooth and moderate cavitation.
- Moderate: frank cavitation on multiple tooth surfaces.
- Severe: Widespread destruction of tooth and loss of the clinical crown
- Identify the cause and stop the habit
- Give parental instruction on proper oral hygiene measures + diet counseling
- Decide if the case can be managed in the clinic [ with regular LA or nitrous sedation ] or the child needs GA
- If the case is treated in the clinic: full assessment of all affected teeth to know
- which teeth can be restored
- which need pulp therapy
- which need extractions
|First visit||Second visit||Third visit|
|Immediate excavation of caries followed by temporization Dietary chart Caries activity doneTopical fluoride application doneParent counselling||Examine diet chart Caries activity done again Replace any temporary restoration with permanent restoration||Pulpul procedures Extractions Space maintersRecall the pt every 3 months|
What instructions would you give the parents to a child with ECC?
- STOP NIGHT TIME BOTTLE FEEDING / stop breastfeeding at will after the first tooth erupts
- Feed the child while being held + burp the infant after feeding
- Clean the teeth after each feeding [ wipe the teeth with a wet gauze]
- regularly lift the upper lip to check for signs of demineralization of the upper Interiors
- OH should start with the eruption of the first tooth – wipe the teeth with gauze and for ages 2- 6 brush with low fluoride tooth past [ 400-500 ppm] – parental supervision until the child can properly spit
- Children are encouraged to drink from a cup as they become 1 year old
- Avoid frequent snacking and have regular meals instead
- First dental visit should be combined with immunization dates [ at or before 6 months]
Prevention of ECC ideally begins prenatally:
- give the mother information about diet and OH
- treat the mother’s own oral diseases and lower MS count by mouth rinses and restorative care
- educate the mother on modes of transmission of MS [ don’t lick spoons or pacifiers etc..]