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 under the age of 6, and in children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). One or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth (ages 3-5), four or more decayed, missing, or filled (DMF) score (age 3), five or more DMF (age 4), or six or more DMF (age 5) surfaces also constitutes S-ECC.
Epidemiologic data from national surveys clearly indicate that ECC is highly prevalent and increasing in poor and near poor U.S. preschool children. Those children with caries experience have been shown to have high numbers of teeth affected, and these cavities are largely untreated in children under age. The consequences of ECC include a higher risk of new cavities in both the primary and permanent dentition, hospitalizations and emergency room visits, increased treatment costs, suggestions of delayed physical development, loss of school days and increased days with restricted activity, diminished ability to learn , and diminished oral health-related quality of life.
Dental caries is chronic disease resulting from an imbalance of multiple risk factors and protective factors over time. In general, this disease is due to tooth adherent bacteria that metabolize sugars to produce acid, which over time demineralizes tooth structure. Newly erupted teeth, because of immature enamel, and teeth with enamel hypoplasia may be at higher risk of developing caries.
ECC is a transmissible infectious disease
; and understanding the acquisition of cariogenic microbes improves preventive strategies. Microbial risk markers for ECC primarily include mutans streptococci (MS), but other microorganism may play a role. MS may be vertically transmitted from caregiver to child through salivary contact, affected by the frequency of and the amount of exposure. Infants whose mothers have high levels of MS, a result of untreated caries, are at greater risk of acquiring the organism earlier than children whose mothers have low levels. Horizontal transmission (eg, between other members of a family or children in daycare) also occurs and eliminating saliva-sharing activities (i.e., sharing utensils, orally cleansing a pacifier) may help decrease an infant’s or toddler’s acquisition of cariogenic microbes.
Current best practice includes recommending twice-daily use of fluoridated toothpaste for children at caries risk residing in optimally fluoridated or fluoride-deficient communities. A ‘smear’ of fluoridated toothpaste (grain size) for children less than 3 years of age may decrease risk of fluorosis. A ‘pea-size’ amount of toothpaste is appropriate for children aged 3 through 5 years. Parents should dispense the toothpaste onto a soft, age-appropriate sized toothbrush and perform or assist with tooth brushing of preschool-aged children. To maximize the beneficial effect of fluoride in the toothpaste, rinsing after brushing should be kept to a minimum or eliminated altogether.
In association with the microbial etiology is high frequency sugar consumption. Frequent bottle feeding or training cup feeding with sugar containing drinks, and breastfeeding ad libitum have been associated with, but not consistently implicated with ECC. While ECC may not arise from breast milk alone, breast feeding in combination with other carbohydrates has been found in vitro to be highly cariogenic. The American Academy of Pediatrics has recommended children 1-6 years of age consume no more than 4-6 ounces of fruit juice per day, from a cup (ie, not a bottle or covered cup) and as part of a meal or snack.
Preventive interventions for ECC should be initiated within the first year of life, including dietary and oral hygiene counseling, topical fluoride varnish applications, and referral of children at caries risk to a dentist are critical. Because infants and toddlers are seen so frequently for medical appointments in their first few years of life, these preventive approaches may be implemented with the help of non-dental medical providers.