Early Childhood Caries

1. Early Childhood Caries Chrissy A. Stephan, RDH, MSDH

2. History of Early Childhood Caries (ECC) • 1962: first described as “milk bottle mouth” • 1998: National Institute of Health sponsored “Early Childhood Caries Conference” • Baby Bottle Syndrome • Nursing Bottle Caries • Baby Bottle Tooth Decay

3. 1998 ECC Conference • A better understanding of this disease emerged • Multi-factorial • Related to eruption pattern of teeth • Influenced by frequency of sugar consumption • Ongoing local infection with known bacteria

4. ECC definition • The presence of one or more decayed teeth, missing teeth (due to caries), or filled surfaces in any primary tooth of a child up to age 6 • The MOST common CHRONIC disease in children • 5-8 times more frequently than asthma

5. Severe ECC • Any sign of smooth-surface caries in children younger than 3 years of age • In children 3-5 years, one or more decayed missing filled (dmf) smooth surfaces in primary maxillary anterior teeth or dmf score of ≥4 (age 3), ≥5 (age4), or ≥6 (age 5) surfaces

6. Prevalence • U.S. preschool children of low socioeconomic status • Has increased in children younger than 5 • Children with a history have a high number of teeth affected • Dental caries in preschool children is largely untreated • 70% of dental caries is found in 30% of American children

7. Consequences of ECC • Negative impact on quality of life • Increased direct costs • Relationship with other health problems • PAIN • Less able to engage in regular activities including eating, sleeping, playing, and school activities

8. Risk Factors • Previous caries • Bacteria • Visible plaque • Diet • Enamel defects • Socioeconomic status • Lack of fluoride exposure

9. Previous Caries • Children younger than 6 with a history of caries are considered high risk • White spot lesions--decalcification

10. Bacteria Produce acid, can tolerate and survive in a declining pH environment Can be transmitted vertically or horizontally • Streptococcus mutans • Streptococcus sobrinus • Lactobacilli

11. Bacterial Transmission Vertical Transmission Horizontal Transmission From other family members From other children in school or daycare centers • From primary caregiver (most often mother) to child

12. Visible Plaque • Direct correlation found between MS levels or colonies and plaque scores in children

13. Diet • High frequency sugar intake—common in lower SES • Frequency of meals and snacking • At-will feeding • Prolonged use of a bottle with sweetened fluids or millk • Continuous consumption of sugars

14. Enamel Defects • Individuals with defective enamel have been associated with higher risk of caries in primary teeth • Enamel hypoplasia is considered a reliable predictor in assessment of ECC risk

15. Socioeconomic Status • Low SES a predictive factor • Infants and preschoolers have higher incidence • Decreased access to care • Diminished neighborhood support • Increased family demands • Increased presence of convenience stores as opposed to supermarkets –reduced access to healthy foods • Low education levels

16. Management of ECC