from shobha tandon and nikhil marwah

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PRESENTED BY: GAURAV D. JINNANI

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Contents
• Definition
• Terminologies
• epidemiology
• Classification
• Developmental stages of ECC
• Primary etiological risk factor
• Secondary etiological risk factor
• Prevention of ECC

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Definition
AAPD:The disease of early childhood caries is
the presence of one or more
decayed,missing,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 surfaces caries is indicative of
severe early childhood caries.from ages 3
through 5 ,one or more cavitated,missing or
filled smooth surfaces in primary maxillary
anterior teeth or decayed,missing,or filled
score of >4(age3),>5(age4),or >6(age 5)
surfaces constitutes S-ECC.

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Terminologies for Early
Childhood Caries
• Nursing caries: Winter(1966)
• Tooth clearing neglect: Moss(1996)
• Infant and early childhood dental
decay: Horowitz(1998)
• Early childhood caries: Davies(1998)
• MDSMD: Maternally derived
streptococcus mutans disease.

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Classification
• Classification of ECC by Wayne
Type 1 •Mild to moderate
•Existence of isolated carious lesion involving molars and incisors
•Number of carious teeth increases as cariogenic challenge
persists
•Cause is usually a combination of cariogenic semisolid food and
lack of oral hygiene.
•Seen in 2-5 years old.
Type 2 Moderate to severe
Labiolingual carious lesion affecting maxillary incisors
Mandibular incisors are not affected
Use of feeding bottle or at will breastfeeding or a combination of
both with or without poor oral hygiene
Seen soon after eruption of teeth

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Classification
Type 3 Severe
Carious lesion affecting all the teeth including lower
incisors
Cause is cariogenic food and poor oral hygiene
Condition is rampant

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MILD MODERATE SEVERE

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Stage Clinical features Age Features
I Initial reversible
stage
10-
18months
Cervically and occasionally
interproximal areas of chalky white
demineralization.
No pain.
II Damaged carious
stage
18-
24months
Lesion in maxillary anterior
teeth,may spread to dentin and
show yellowish brown
discoloration.
Pain on having cold food.
III Deep lesion 24-
36months
Depending on time of
eruption,cariogenicity of sweetner
and frequency of its use this stage
can reach in 10-14months also.
Molars are also affected
Frequent complaint of pain
Pulpal involvement in maxillary
incisors
IV Traumatic stage 36-
48months
Teeth becomes so weakened
Report of history of trauma

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 Pathogenic microorganism
 Substrate(Fermentable
carbohydrate)
 Host
 Time

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 Streptococcus mutans
 Transmitted to the infant’s mouth primarily
through mother.(vertical transmission)
 Considered more virulent
 It is seen that a child’s infection is nine times
greater when maternal salivary count is
greater than 100,000 colony forming units
per ml.
 It is more common in rapid and smooth
surface caries and less common in pit and
fissure caries.

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 Carbohydrates are utilized by
microorganisms to form dextrans which
Adhere organisms to tooth surface
Cause organic acid to demineralize the
tooth.

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 Teeth acts as a host for microorganisms.
 Hypomineralized or hypoplasia of the
teeth increases the susceptibility of the
child to caries.
 Thin enamel in the primary teeth is one of
the reasons for early spread of lesions.
 Developmental grooves act as the
plaque retentive areas.

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 It is an important factor that determines
caries activity.
 More the time child sleeps with bottle in
the mouth,higher is the risk of caries.

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 Definition: condition attributable to frequent prolonged
contact with bottle containing sweet beverages or milk.
 Clinical features:
 It affects primary teeth in following sequence:
a. Maxillary central incisors: Facial, Lingual, Mesial and Distal
surfaces
b. Maxillary lateral incisors: Facial, Lingual, Mesial and Distal
surfaces
c. Maxillary first molars: Facial, Lingual, Occlusal and Proximal
surfaces
d. Maxillary canine and second molars: Facial, Lingual and
Proximal surfaces
e. Mandibular molars: At later stage
 Mandibular anterior teeth are usually spared because:

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Initially a demineralized dull,white
area is seen along the gum line on
the labial aspect of maxillary incisors,
which is undetected by the parents.
These white lesions become cavities
which involve the neck of the tooth in
a ring like lesion.
Finally the whole crown of the incisors is
destroyed leaving behind brown black
root stumps

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 The child with nursing caries has an
increased risk of developing caries even
in the permanent dentition.
 The child with caries is also susceptible to
other health hazards.
 The treatment may prove to be financial
burden for some parents.

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Aims
 Management of existing emergency
 Arrest and control of the carious process
 Institution of preventive procedures
 Restoration and rehabilitation
Factors affecting management:
 Extent of the lesion
 Age of the patient
 Behavioral problems

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1st visit:
 All lesions should be excavated and restored.
 Indirect pulp capping or pulp therapy
procedures can be evaluated by further
investigation.
 If abscess is present it can be treated through
drainage.
 X-rays are advised to assess the condition of
the succedaneous teeth.
 Collection of saliva for determining the salivary
flow and viscosity.
 Application of fluoride topically.

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 Parents should be questioned about
child’s feeding habits.
 Should be asked to try weaning the child
from using the bottle as a pacifier while
in bed.
 Should be instructed to clean the child’s
teeth after every feed.
 Adviced to maintain a diet record for 1
week.

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2nd visit
 Analysis of diet chart and explanation of
the disease process of the child’s teeth with
a simple equation.
 Isolate sugar factors from the diet chart and
control sugar exposure by intelligent use.
 Reassess the restoration and redo if
needed.
 Caries activity tests can be started and
repeated at monthly intervals to monitor
success of treatment.

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3rd and subsequent visit:
 Restoring all grossly decayed teeth
 Endodontic treatment
 In case of unrestorable teeth, extractions
can be done followed by space
maintenance.
 Crowns can be given for grossly
decayed or endodontically treated
teeth.
 Review and recall after every 3months.

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 Early screening for signs of caries
development, starting from the first year
of life,could identify infants and toddlers
showing the risk of developing early
childhood caries.
 3 general approach:
Community based
Professional based
Home based

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 Massler(1945) defined rampant caries as
suddenly appearing widespread ,rapidly
spreading,burrowing type of
caries,resulting in early involvement of
pulp and affecting those teeth,which
are usually regarded as immune to
decay.

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Difference between
Nursing Bottle Caries and
Rampant Caries

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Nursing bottle caries Rampant caries
type/nature Specific form of rampant caries
acute generalized spread of
caries & pulpal involvement in
selected teeth of dentition.
Acute genaralized spread of
caries and pulpal
involvement in all teeth.
Age Infants and toddler At any age, both primary and
permanent teeth are involved
and no specific teeth in
particular
etiology Feeding children with milk bottles
while the child is lying down or
sleeping breast feeding whenever
the child asks & at will for
prolonged duration of time.Use of
pacifier which are coated with
honey or any artificial sweeteners
to stop baby from crying.it
involves only feeding factor.
Frequent intake of sweet
sugary & sticky food substitute
throughout the day
decreasesd water intake
through the day & decreases
salivary flow.Genetic
predilection if seen in parents
or family.it is combination of
many factor.

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Nursing bottle caries Rampant caries
Characteristi
c features
Specific teeth are involved
mandibular incisor are not
affected at all(because of
constant flow of saliva from
submandibular gland & constant
cleansing movement of tongue.
No specific teeth are
involved.all teeth are equally
involved .
It can be seen at any age.
Treatment It depends on the stage & time of
detection& intervention by
parents & dentist .if diagnosed at
an early stage fluoride
application and parent
education is needed.
Pulpectomy , pulpotomy &
space maintainer are decided
based on signs/ symptoms until
transition occurs.
It depends on the stage of
intervention.
Early intervention requires
removal of caries and
restoration/crowns
depending on stage of tooth
decay.
In case of pulp involvement
pulp therapy/root canal
treatment is required.

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Dentition:0-5 years
 Therapy :Toothpaste
Fluoride tablets, if in area without
water fluoridation
Professional topical fluoride
application
every 6 months
 Control: Oral hygiene instructions to parents
Toothbrushing with parental
supervision
6 month recall

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Dentiton 5-12 years
 Advice: diet counseling with parents and
patients
 Therapy: toothpaste
fluoride tablets up to 8 years if in
area without water fluoridation.
mouth rinse
professional topical fluoride
application
every 6 months.

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 Control: oral hygiene instructions to patient
toothbrushing without parental
supervision.
sealants
6 months recall
permanent dentition: 12 years onwards
 Advice: diet counseling with parents and
patients

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 Therapy: toothpaste
mouth rinse
professional topical fluoride
application every 6 months
 control: oral hygiene instructions to
patient
toothbrushing
interdental cleaning with floss
sealants

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 Sobha Tondon-Textbook of pedodontics
2nd edition.
 Nikhil Marwah-Textbook of Pediatric
Dentistry 3rd edition.

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