good morningdental.subharti.org/pedodontics_lectures/ecc.pdf · the disease of early childhood...

Good morning

Dr. Noopur Kaushik, Subharti Dental College, SVSU

Low self confidence

Speech

Mastication


Early childhood caries

Dr. Noopur Kaushik Reader

Dept. of Pediatric & Preventive Dentistry


Nursing caries (1966)

Tooth clearing neglect (1996)

Infant and childhood dental decay (1998)

ECC (1998)

MDSMD


The disease of early childhood caries 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).

AAPD (2008)


From ages 3 through 5, 1 or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth or a decayed, missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces constitutes S-ECC.

AAPD(2008)


WHY DO WE NEED

EARLY INTERVENTION?

By the time the child reports to the dental clinic, the carious process has already begun.

Faster progression of caries in the primary than in the permanent dentition.

8

Ismail AI, Sohn W, Lim S, Willem JM. Predictors of dental caries progression in primary teeth. J Dent Res. 2009 Mar;88(3):270-5.


Aim- Prevalence of early childhood caries

Methodology - A random sample of 1,500 children aged between 8 and 48 months were selected from various parts of urban Bangalore. The status of dental caries was recorded according to the World Health Organization (WHO) criteria

Conclusion - The prevalence of ECC in preschool children was 27.5%, while the mean deft was 0.854.

Prakash P, Subramaniam P, Durgesh BH, Konde S. Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: A cross-sectional

study. European Journal of Dentistry. 2012;6(2):141-152.


Classification

Mild Moderate Severe


Type – I (Mild)

• Existence of isolated carious lesion involving molars and incisors.

• Number of carious teeth increase as cariogenic challenge persisits.


Type –II (Moderate)

• Labiolingual caries affecting maxillary incisors

• Mandibular incisors are not affected


Type – III (Severe)

• Carious lesions affecting all the teeth including lower incisors.

• Condition is rampant.


Developmental stages of ECC

Initial / very mild

Damaged / mild type

of ECC

Deep lesions

Traumatic (severe)


Initial / very mild


Damaged / mild type of ECC


Deep lesions


Traumatic


Etiology


Feeding practices

Prolonged and nocturnal breastfeeding is associated with an increased risk of ECC, especially after the age of 12 months.

Van Palenstein Helderman WH, Soe W, van ‘t Hof MA. Risk factors of early childhood caries in a Southeast Asian population. J Dent Res. 2006;85:85–8. an Palenstein Helderman WH, Soe W, van ‘t Hof MA. Risk factors

of early childhood caries in a Southeast Asian population. J Dent Res. 2006;85:85–8.


• Aim - To explore the socio-behavioural risk factors for ECC in Cambodia.

• Methodology - A sample of 362 primary caregiver were selected. The children were aged between birth and 6 years old and participated in a structured interview and intra-oral examination.

• Conlcusion - The most prominent risk factors for ECC in the present study were lack of tooth brushing and breast-feeding past the age of 2 years.

Turton B, Durward C, Manton D, Bach K, Yos C. Socio-behavioural risk factors for early childhood caries (ECC) in Cambodian preschool children: a pilot study. Eur Arch Paediatr Dent. 2015 Dec

10.


Microbiological risk factors

• S. mutans

• Streptococcus sobrinus

• It is well known that initial acquisition of mutans streptococci (MS) by infants occurs during a well-delineated age range that is being designated as the window of infectivity.

Caufield PW, Cutter GR, Dasanayake AP. Initial Acquisition of Mutans Streptococci by Infants: Evidence for a Discrete Window of Infectivity. J Dent Res. 1993;72:37–45.


• Aim- To detect the presence of microorganisms in children with ECC using real-time Polymerase Chain Reaction (PCR) and to determine if a correlation exists between them

• Methodology- 15 children suffering from ECC and 15 children without ECC, between the ages of 3 to 6 years, were randomly selected from the Department of Paedodontics and Preventive Dentistry. Unstimulated saliva samples were collected from both the study (children with ECC) & control group (children without ECC) real time PCR was done

• Conclusion- Scardovia wiggsiae is one of the predominant microorganism in ECC. Molecular approach of real time PCR can be used for detecting the same in children having ECC.


There is a positive relationship between sugar intake and the incidence of dental caries where fluoridation was minimal and dental hygiene is poor.

Caries risk is greatest if sugars are consumed at high frequency and are in a form that is retained in the mouth for long periods.

Sanders TA. Diet and general health: Dietary counselling. Caries Res. 2004;38(Suppl 1):3–8.


Pacifiers dipped in honey


Socioeconomic factors

ECC is more commonly found in children who live in poverty or in poor economic conditions, who belong to ethnic and racial minorities, who are born to single mothers, whose parents have low educational level, especially those of illiterate mothers.

Caufield PW, Griffen AL. Dental caries. An infectious and transmissible disease. Pediatr Clin North Am.2000;47:1001–19.


Children with parents in the lowest income group had mean Decayed, Missing, and Filled Teeth (dmft) scores four times as high as children with parents in the highest income group.

Quinonez RB, Keels MA, Vann WF, Jr, McIver FT, Heller K, Whitt JK. Early childhood caries: Analysis of psychosocial and biological factors in a high-risk population. Caries

Res. 2001;35:376–83.


Vertical transmission

Horizontal transmission


Diagnosis

Dull, white de-mineralized enamel that quickly advances to obvious decay along the gingival margin.

First seen on the primary maxillary incisors, and the four maxillary anterior teeth are often involved concurrently.

The decayed hard tissue is clinically evident as a yellow or brown cavitated area.


CONSEQUENCES OF UNTREATED DENTAL CARIES IN CHILDREN


Short term • Pain

• Infection

• Need for extractions

• Need for treatment under GA

• Premature loss of primary molars predisposing to malocclusion


Long term • Poor oral health and dental diseases often

continue into adulthood

• Higher risk of new carious lesions in the other primary teeth and the suceeding permanent dentition


• Altered eating and sleeping habits.

• Risk of hospitalization.

• High treatment costs.

• Loss of school days with the consequent diminished ability to learn.

• Reduced growth and reduced weight gain due to insufficient food consumption.

• Impaired speech development.

• Reduced self-esteem.

Petersen PE, Estupinan-Day S, Ndiaye C. WHO's action for continuous improvement in oral health. Bull World Health Organ. 2005;83:642.


PREVENTION OF EARLY CHILDHOOD CARIES


Community

Homecare

Professional


Prevention of maternal bacterial

transmission to the child • Reduce the bacteria in the mouth of the

mother or primary caregiver. Chemical suppression by use of chlorhexidine gluconate in the form of mouth rinses, gels, and dentifrices has been shown to reduce oral microorganisms.

• Minimizing saliva-sharing activities between children and parents/caregivers limits bacterial transmission.


Oral health education


Professional and home based preventive approaches

• Toothpastes

• Rinses

• Lozenges

• Chewable tablets

• Sealents

• Varnishes


Aim - The purpose of this study was to assess baby and parental satisfaction and plaque-removal efficacy of a novel infant tooth wipe in high caries-risk babies

Methodology - Thirty-five healthy and caries-free infants were selected. A manual toothbrush was used as the control method. Parental satisfaction and baby perceived acceptance were evaluated by a questionnaire.

Conclusion -The Novel Infant Tooth Wipe provides an effective method of plaque removal before the eruption of primary molars.

Galganny-Almeida A, Queiroz MC, Leite AJ. The effectiveness of a novel infant tooth wipe in high caries-risk babies 8 to 15 months old. Pediatr Dent. 2007 Jul-Aug;29(4):337-42.


Policy on Early Childhood Caries (ECC)

(AAPD)


• Reducing the parent’s/sibling’s MS levels to decrease transmission of cariogenic bacteria.

• Minimizing saliva-sharing activities (eg, sharing utensils) to decrease the transmission of cariogenic bacteria.

• Implementing oral hygiene measures no later than the time of eruption of the first primary tooth. Toothbrushing should be performed for children by a parent twice daily, using a soft toothbrush of age-appropriate size


• Providing professionally-applied fluoride varnish treatments for children at risk for ECC.

• Establishing a dental home within six months of eruption of the first tooth and no later than 12 months of age to conduct a caries risk assessment and provide parental education including anticipatory guidance for prevention of oral diseases.

• Working with medical providers to ensure all infants and toddlers have access to dental screenings, counseling, and preventive procedure


• Avoiding high frequency consumption of liquids and/or solid foods containing sugar. In particular: – Sugar-containing beverages (eg, juices, soft drinks,

sweetened tea, milk with sugar added) in a baby bottle or no-spill training cup should be avoided.

– Infants should not be put to sleep with a bottle filled with milk or liquids containing sugars.

– Ad libitum breast-feeding should be avoided after the first primary tooth begins to erupt and other dietary carbohydrates are introduced.

– Parents should be encouraged to have infants drink from a cup as they approach their first birthday. Infants should be weaned from the bottle between 12 to 18 months of age


FACTORS AFFECTING MANAGEMENT OF ECC

45

EXTENT OF THE LESION

AGE OF THE PATIENT

HOW COOPERATIVE THE PATIENT IS


MANAGEMENT

46 Dr. Noopur Kaushik, Subharti Dental College, SVSU

AIMS

Institution of preventive measures procedures

Arrest and

control of the

carious process

Management of existing emergency

Restoration and rehabilitation


FIRST VISIT

1. This phase of treatment constitutes identification of

the cause for counseling of the parent.

2. Parent counseling.

3. Enquiry of child's feeding habits, specially

regarding the use of nocturnal bottles, on

demand breast feeding, pacifiers dipped in

sweetening agents.

4. Oral hygiene instructions.


5. All active lesions to be excavated and restored,

either permanently or with IRM

6. Topical Fluoride application.


7. Radiographic examination to evaluate

the succedaneous teeth.

8. Caries activity test and Saliva flow test.

9. Advised to maintain diet chart for one

week.


SECOND VISIT

Analysis of the diet chart and explanation of the

disease process.

Isolate the sugar factors from the diet chart and

control sugar exposure.

Reassess the restoration, replace any temporary

restorations with permanent ones.

Caries activity tests can be started and repeated every

month to monitor the success of treatment.


THIRD VISIT

• Permanent / semi permanent restoration of

grossly decayed teeth.

• Pulpal procedures.

• Extraction and space maintainers.

• An aggressive protocol to full mouth

rehabilitation is required in children with ECC

and usually under GA.

52


Recall

• Children with S-ECC must be reviewed to detect any changes. Recall intervals are based on the outcome of their caries risk assessment.

• Children with obvious signs of active oral disease or its predisposing factors should be reviewed at 3 monthly intervals until well controlled.


Pharmacological management like :

SEDATION GENERAL ANAESTHESIA

VARIOUS TREATMENT OPTIONS FOR

AN UNCOOPERATIVE CHILD WITH ECC


G.A AND ITS HEALTH BENEFITS

1) Extensive dental rehabilitation in children experiencing dental pain and difficulties in eating and sleeping.

2) Facilitating dental care for children with dental fear or the ones with special health care needs.

AAPD, 2012


Conclusion

ECC is a disease of multifactorial origin. Considering the severity of progression of lesion, care must be made that the dental professional take requisite steps to curb the disease. Both preventive and therapeutic management can simultaneously help lower its incidence and redirect the child towards a better and healthy living.


References • Ismail AI, Sohn W, Lim S, Willem JM. Predictors of dental caries

progression in primary teeth. J Dent Res. 2009 Mar;88(3):270-5. • Prakash P, Subramaniam P, Durgesh BH, Konde S. Prevalence of

early childhood caries and associated risk factors in preschool children of urban Bangalore, India: A cross-sectional study. European Journal of Dentistry. 2012;6(2):141-152.

• Van Palenstein Helderman WH, Soe W, van ‘t Hof MA. Risk factors of early childhood caries in a Southeast Asian population. J Dent Res. 2006;85:85–8. an Palenstein Helderman WH, Soe W, van ‘t Hof MA. Risk factors of early childhood caries in a Southeast Asian population. J Dent Res. 2006;85:85–8


References • Turton B, Durward C, Manton D, Bach K, Yos C. Socio-

behavioural risk factors for early childhood caries (ECC) in Cambodian preschool children: a pilot study. Eur Arch Paediatr Dent. 2015 Dec 10.

• Caufield PW, Cutter GR, Dasanayake AP. Initial Acquisition of Mutans Streptococci by Infants: Evidence for a Discrete Window of Infectivity. J Dent Res. 1993;72:37–45.

• Sanders TA. Diet and general health: Dietary counselling. Caries Res. 2004;38(Suppl 1):3–8.


References • Caufield PW, Griffen AL. Dental caries. An infectious and

transmissible disease. Pediatr Clin North Am.2000;47:1001–19. • Quinonez RB, Keels MA, Vann WF, Jr, McIver FT, Heller K, Whitt JK.

Early childhood caries: Analysis of psychosocial and biological factors in a high-risk population. Caries Res. 2001;35:376–83.

• Petersen PE, Estupinan-Day S, Ndiaye C. WHO's action for continuous improvement in oral health. Bull World Health Organ. 2005;83:642.

• Galganny-Almeida A, Queiroz MC, Leite AJ. The effectiveness of a novel infant tooth wipe in high caries-risk babies 8 to 15 months old. Pediatr Dent. 2007 Jul-Aug;29(4):337-42.


References • Evans RW, Dennison PJ. The Caries Management System:

an evidence based preventive strategy for dental practitioners. Application for children and adolescents. Aust Dent J. 2009 Dec;54(4):381-9.

• Sheller B, Williams BJ, Hays K, Mancl L. Reasons for repeat dental treatment under general anesthesia for the healthy child. Pediatr Dent. 2003;25:546–52.

• Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the dmft: The human and economic cost of early childhood caries. J Am Dent Assoc. 2009;140:650–7.


Thank you Dr. Noopur Kaushik, Subharti Dental College, SVSU

good morningdental.subharti.org/pedodontics_lectures/ecc.pdf · the disease of early childhood...

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