ALLISON RESTAURI, RDH, BSDHEDU 653

11-03-2012

Early Childhood Caries(ECC)

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 removedAND repeated food/drink = decay

Frequent Snacks: Sugary, Sticky,

Starchy

Sipping on Sweet Liquidsin Bottles or Sippy Cups

Bottles in BedFilled with Anything

Except Water

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

University of Washington

Early Childhood Cavities-advanced

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

Daily:Oral Health Routine

Monthly: “Lift the Lip”

Wipe infant’s gums & tongue.Brush when first teeth appear

Check for white spotsor anything unusual.

WDSF WDSF

Prevention at home

University of Washington

Knee to Knee exam

Dental Visit by their First Birthday!

Fluoride Varnish

Dental appointments B4 their first birthdayDaily mouth careHealthy foods and drinks“Lift the Lip”Early Childhood Caries infoNO sippy cups!Fluoride/MI PasteCaregiver needs good oral hygiene

Education for Caregivers

Use gauze or a washcloth to wipe infants’ gums and tongues after feeding.

Brush toddlers’ teeth after meals or snacks. No toothpaste until child can spit it out.

Serve tooth-healthy meals and snacks.

Watch for children with dental problems.

Refer families to dental providers.

Tips for Daycare/Head Start

A Better Approach

Preventive rather than

Reactive

General Oral Hygiene Assessment

No Inflammation

Inflammation

No Plaque Plaque

Compliance Diet

Performance Brushing

Non-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 birthdayKnee to knee exam, if neededEDUCATE the caregiversProvide small amounts of background infoProvide SOLUTIONSEvaluate the child’s risk Evaluate the caregiver’s risk factorsProvide 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.pdf.

2. AAPD. Guidelines on infant oral care. [Retrieved Nov 2, 2012]; Available from: http://www.aapd.org/media/Policies_Guidelines/G_InfantOralHealthCare.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