etiology and prevention

1. ECC – ETIOLOGY &
PREVENTION

4. What is the need for awareness
???

6. CONSEQUENCE IF LEFT UNTREATED

8. PAIN

9. Aftermat
h

10. SPEECH PROBLEMS

11. ANEMIA

12. PSYCHOLOGICAL PROBLEMS

13. LOSS OF SLEEP PSYCHOLOGICAL IMPACT

14. Buccal space infection

15. CONSEQUENCES

19. What's the hurdle for practice.
flight or fight

23. Post the patient to general
anesthesia…!!

24. CONSEQUENCES BEYOND THE CHILD
• ECC may add to family stress, particularly when it affects
child’s behaviour, sleeplessness, or pickiness at meals
and has been associated with increased risk of
domestic violence.
• Parents need to adjust their work and other obligations
to care for and comfort their child suffering from dental
pain which has both direct and indirect impact.

26. PREVALENCE
• World
ENGLAND
12%
USA
11%
ASIA
36 %
INDIA
54%

27. Place Year Investigators Sample size &
age group
% of
prevalence
Mean dmft Mean dmfs
Anganwadis of
Wardha district
2011 Abhay M Sample size of
330 children
aged between
2-5 years
31.81
Bangalore 2012 Prashanth
Prakash,
1,500 children
aged between
8 and 48
months
27.5 8.54
Prevalence of ECC in
INDIA

28. 0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
total child
population
children of 0-6year
old
ECC prevalence varies from population to population; however, children of disadvantaged
subpopulations, regardless of race, ethnicity or culture, have been found to be most vulnerable.

30. Prevention is better than cure

33. Oral health
= overall health

35. PRESENT DAY AWARENESS

36. STAKEHOLDERSin
prevention
PAEDIATRICIAN GENERAL
PRACTIONER
(PHYSICIANS)
TEACHERS
PARENTS
GYNAECOLOGIST
DENTIST
HEAD START

38. PARTNERSHIP
PARTNERSHIP WITHIN AND AMONG THE VARIOUS STAKE HOLDERS ARE KEY TO
IMPLEMENTING IMPROVED ORAL HEALTH IN INFANTS AND TODDLE

39. DENTAL INDUSTRY ROLE
• The most valuable role of dental industry is in its
ability to reach consumers/ parents with
important oral health messages.
• Stake holders and dental industry together helps
in shaping the important messages that will
ultimately improve access to care for children
• The most important message is the need for
early intervention.

40. • For example, teaching parents about the caries
process and not just the result of caries in the
form of cavities, can be promulgated in a
significant way by dental industry.
• As new products are created that manage
caries, the need to educate the consumers
about the dental caries progression and its
regression will be the hands of dental industry.

41. MEDIA
•Similar role as dental industry.
•Create an ultimate change in consumer behavior
than scientific lectures in improving oral health for
children
“wouldn’t you rather have a rinse than drill?”
•SOCIAL MEDIAS are important tool in spreading the
world about early childhod oral health

42. MEDICAID:
• Early and periodic screening, diagnosis and
treatment program.
• This is an ADA supported program.
• It has the potential for bringing millions of
indigent children and youth into the dental care
system.

43. Health
educati
on
Health
promoti
on
Professional
health services
Policy
regulation
resources
FRAMEWORK FOR THE PREVENTION OF ECC

44. ANTICIPATORY GUIDANCE
PROACTIVE COUNSELLING OF PARENTS AND PATIENTS ABOUT DEVELOPMENTAL CHANGES THAT
WILL OCCUR IN THE INTERVAL BETWEEN HEALTH SUPERVISION VISITS THAT INCLUDES
INFORMATION ABOUT DAILY CARETAKING SPECIFIC TO THAT UPCOMING INTERVAL.

46. PRIMARY PREVENTION
Risk assessment
to identify
families at high
risk for their
children to
develop ECC
Timely delivery of
anticipatory
guidance
Family desire to
receive comprehend
and then implement
preventive health
care measures

47. RISK ASSESSMENT TOOLS FOR CHILDREN
AAPD CARIES RISK ASSESSMENT TOOL
• Divides risk categories into child history, clinical evaluation, and supplemental
professional assessment.
• Can be used from infancy through adolescence by dental and non-dental health
care providers.
CARIES MANAGEMENT BY RISK ASSESSMENT (CAMBRA)
• Identifies risk and protective factors via parent interview and clinical examination.

48. ORAL HEALTH LITERACY
• The degree to which individuals have the capacity to obtain
process and understand basic oral health information and
services needed to make appropriate decisions.
• It is important to identify the families with low oral health
literacy skills as these children are most likely at risk for
future decay and these parents are more likely to experience
barriers to adequate education.
Risk assessment to identify families at high risk for their children to
develop ECC

49. FIRST LEVEL OF PREVENTION:
* Maternal overall health not only affects infants future oral health but also overall
health.
* The purpose of prenatal education is to provide the family with information regarding
their babies dental development, infectious nature of dental caries, diet and nutrition,
oral hygiene and recommended preventive measures.

50. MOTIVATIONAL INTERVIEW
BRIEF COUNSELLING APPROACH THAT FOCUSSES ON THE SKILLS NEEDED TO MOTIVATE
OTHERS AND PROVIDES STRATEGIES TO MOVE PATIENTS FROM INACTION TO ACTION

51. RISK DETERMINANTS
CLINICAL
DENTAL HISTORY- Children
with dental extractions or
restorations in the past 1 year
should be considered as high
risk.
DECALCIFIED AREAS- White
spot lesions
ENAMEL DEFECTS- Hypoplasia
BACTERIA-Vertical
transmission
BEHAVIOURAL
ORAL HYGIENE AND DIET
GENERAL HEALTH
SYSTEMIC HEALTH STATUS:
children with CP,
gastroesophageal reflux has
increased risk for caries.
THERAPIES AND
MEDICATIONS: radiation and
chemotherapy
SOCIOCULTURAL AND PHYSICAL
ENVIORNMENT
Poverty, caregivers education level,
single parents , more children inn the
family

52. • Counsel parents and mothers of infants and
children at high risk for dental caries.
• Goals of MI counselling section is to establish
rapport with parents or mothers and then
provide and discuss a menu of options for
infant oral health and caries preventive
behaviour

53. AAPD has given recommendations on anticipatory guidance, bottle-feeding
habits to prevent ECC, and infant/toddler oral hygiene care.
Avoiding caries-promoting feeding behaviors
Infants should not be put to sleep with a bottle containing fermentable
carbohydrates.
Ad libitum breastfeeding 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 at 12-14 months of age.
Repetitive consumption of any liquid containing fermentable carbohydrates
from a bottle or no-spill training cup should be avoided.
Between-meal snacks and prolonged exposures to foods and juice or other
beverages containing fermentable carbohydrates should be avoided.

54. PEDIATRICIANS LEVEL

58. PARENTS LEVEL-
Should be advised the earlier their child’s teeth erupts the more risk for the child
for early dental caries.
ECC first presents as white spots or lines on maxillary incisors and can
progress to cavities .
• INCIPIENT LESION

59. WHILE SLEEPING
• Clean pacifier
• Bottle with water

62. INFANT FORMULA
FLUORIDE CONTENT RANGES FROM 0.1mg TO 0.3mg /L
Non milk based formulas have higher fluoride content because the calcium that is added to
formulas contains fluorides

63. • Baby cups should be used from 6 months of age .
• It reduces the amount of sugar inside the mouth

66. • Cheese raw fruits

67. • Parents should clean infants gums with moistened cloth or finger sponge.
• Tooth brushing should commence with the eruption of first tooth
• Instructions on oral hygiene for child should be devoted to parents

68. Supervise tooth brushing at all times and brush child's teeth
themselves at least once a day until 8 yrs of age

69. FLUORIDE USE
CHILDREN UNDER THE AGE OF THREE, A ‘SMEAR’ OR
‘RICE-SIZE’ AMOUNT OF FLUORIDATED TOOTHPASTE.
ALL CHILDREN AGES THREE TO SIX, A ‘PEA-SIZE’
AMOUNT OF FLUORIDATED TOOTHPASTE.
UNDER THE AGE OF THREE, A ‘SMEAR’ OR
‘RICE-SIZE’ AMOUNT OF FLUORIDATED
TOOTHPASTE.
AGES THREE TO SIX, A ‘PEA-SIZE’ AMOUNT
OF FLUORIDATED TOOTHPASTE.

71. Parents readiness for behavioral changes has 4 stages
PRECONTEMPLATION: Unaware or in denial of the condition or
the risk of ECC
CONTEMPLATIVE STAGE: Acknowledge the presence of ECC
but are ambivalent or may be considering the steps they want to take
part in addressing ECC.
PREPARATION /ACTION: Parent may take action by seeking
treatment or preventive oral health practices
MAINTENANCE: Parents are then concerned about maintaining
their child’s oral health and avoidance recurrence
PARENTAL ATTITUDES OF INFANT ORAL HEALTH

72. RISK ASSESSMENT TOOLS FOR CHILDREN
DUNDEE CARIES RISK ASSESSMENT MODEL
• Includes previous carious experience, socioeconomic status, health care
workers opinion, oral MS counts.
CARIOGRAM
• Uses pie chart to show individuals overall caries risk and relative contributors
to overall risk.
• Provides individualized strategies for management of dental caries
• Accessible online via 13 different languages

74. DENTAL HOME

75. COMPREHENSIVE CARE-Primary prevention, Secondary
prevention, and all phases of treatment are provided.

76. FAMILY CENTERED-UNBIASED COMPLETE INFORMATION IS
GIVEN IN AN ONGOING BASIS

77. THANK YOU