Prevention of Early Childhood Caries .ppt, powerpoint slide

Introduction

Early Childhood Caries (ECC) is defined as the presence of one or more decayed (non-cavitated or cavitated) lesions, missing teeth (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).

Definition and Classification

From ages 3 through 5, one or more cavitated, missing teeth (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 constitute S-ECC.

A child with early childhood caries 1
A child with early childhood caries 2

Impact of Early Childhood Caries

ECC affects the quality of life, productivity, and educational performance of the child. Parents may have to take time off work to take their children to the dentist, resulting in financial implications. Nutrition and subsequent growth and development of the child can also be hindered, as evidenced by a lower body mass index. The American Academy of Pediatric Dentistry (AAPD) recommends that a child makes their first dental visit before their first birthday.

Prevalence of Early Childhood Caries

6.6% in Ile-Ife
9.8% in Enugu
21.2% in Lagos
23.5% in Ibadan

Aetiology

The aetiology of Early Childhood Caries includes:

Sugar
Plaque
Tooth structure
Time

Associated Risk Factors

Associated risk factors for ECC include:

Age of the child
Sex of the child
Socioeconomic strata
Childbirth rank
Feeding practices
Oral hygiene practices
Oral health-seeking behaviors
Enamel defects

Clinical Features

The teeth typically involved include:

Maxillary Central Incisors: labial, lingual, mesial, distal surfaces
Maxillary Lateral Incisors: labial, lingual, mesial, distal surfaces
Maxillary First Molars: labial, lingual, occlusal, proximal surfaces
Maxillary Canines & Second Molars: labial, lingual, proximal surfaces
Mandibular Molars: at later stages

Symptoms of Early Childhood Caries

Discoloration
Pain
Inability to chew
Low body mass index
Abscess formation

Primary Prevention

Primary prevention measures include:

Oral health education and counseling
Oral hygiene instruction:
- Tooth brushing (frequency, supervision, flossing)
Avoid prolonged breastfeeding
Avoid night feeding and bottle feeding
Avoid sugary drinks

Continued Primary Prevention Efforts

Fluoride Application: toothpaste, tablets, gels, varnishes
Fissure Sealants
Utilization of Dental Services: anticipatory guidance
Scaling and Polishing
Oral Health Education at immunization clinics

Secondary Prevention

Secondary prevention measures involve:

Restoration of the carious tooth/teeth
Temporization, GIC restoration, pulp therapy, extraction
Carious lesions restored with glass ionomer cements

Tertiary Prevention/Rehabilitation

Tertiary prevention strategies include:

Crowns
Space maintainers:
- Removable: removable partial dentures
- Fixed: band and loop, crown and loop, lingual arch wire, Nance appliance, distal shoe

Rehabilitation with Stainless Steel Crown

The International Association of Paediatric Dentistry (IAPD) Guidelines indicate that caries management starts in the first year of life and classify interventions as:

Primary: prenatal oral health care, limiting sugar intake/frequency for children under 2 years, avoiding nighttime bottles and breastfeeding after 12 months, optimizing exposure to dietary fluoride, brushing teeth twice daily with fluoridated toothpaste, and regular dental visits.
Secondary: application of fluoride varnish 4 times a year and pit and fissure sealants for susceptible molars.
Tertiary: non-invasive and invasive restorations of cavitated lesions, arrest of caries with silver diamine fluoride, and interprofessional care ensuring access for all infants and toddlers to oral health care.

Recommendations by AAPD

The AAPD recommends the use of 38% Silver Diamine Fluoride (SDF) as part of a chronic disease management protocol, allowing for monitoring of clinical effectiveness, disease control, and risk assessment.

Indications for Silver Diamine Fluoride

High caries-risk patients with active cavitated lesions
Cavitated caries lesions in individuals presenting with behavioral or medical management challenges
Patients with multiple cavitated lesions that may not all be treated in one visit
Difficult-to-treat cavitated dental caries lesions
Patients without access to, or difficulty accessing, dental care
Active cavitated caries lesions with no clinical signs of pulp involvement

Conclusion

Early Childhood Caries is a preventable condition, and caregivers must prioritize the oral health of their children. Dentists need to encourage preventive dental visits for children of all ages. A healthy young mouth will lead to a healthy adult mouth.

References

Folayan, M.O., Kolawole, K.A., Oziegbe, E.O., Oyedele, T., Oshomoji, O.V., Chukwumah, N.M., Onyejaka, N. (2015). Prevalence and early childhood caries risk indicators in preschool children in suburban Nigeria. BMC Oral Health, 15:72. doi:10.1186/s12903-015-0058-y.
Iyun, O.I., Denloye, O.O., Bankole, O.O., Popoola, B.O. (2014). Prevalence and pattern of early childhood caries in Ibadan, Nigeria. Afr J Med Med Sci, 43(3): 239-244.
Onyejaka, N.K., Amobi, E.O. (2016). Risk factors of early childhood caries among children in Enugu, Nigeria. Presqui Bras Odontopediatria Clin. Integrada, 16(1):381-391.
Olatosi, O.O., Inem, V., Sofola, O.O., Prakash, P., Sote, E.O. (2015). The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution. Niger J Clin Pract, 18(4): 493-501.

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