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The Challenges of Early Childhood Caries

Posted by THE NEXTDDS on Wed, Dec 21, 2016 @ 12:02 PM

ecc-1.jpgEarly Childhood Caries (ECC) is defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child. The ADA recognizes that Early Childhood Caries is a significant public health problem in selected populations and is also found throughout the general population.1 Because they are inhibited by age and need to be cared for by their parents, infants and toddlers can sometimes lack proper dental care at a critical time in their lives. Other factors that force adults to miss appointments (e.g., cost, lack of insurance) can also play a part in a child’s lack of proper oral hygiene. However, there are even still more reasons why ECC has become an important healthcare issue.

Breastfeeding

Early Childhood Caries is unique because the patient's maxillary incisors are at greatest risk for decay, while mandibular incisors are often unaffected due to the child’s tongue suckling protecting them. In addition to a bottle habit or extensive and prolonged breastfeeding, these conditions also can also be known as nursing caries. At any rate, nursing toddlers must have their teeth brushed with toothpaste and receive proper oral hygiene even prior to the eruption of the first tooth, and recommendations for a proper diet should be provided at the first dental visit.2

Toothbrushing

As aforementioned, infants and young children are not capable of taking care of their teeth on their own and require parental supervision. To parents, dentists must emphasize the importance of maintaining their infant’s teeth, both to desensitize the oral cavity now, and to prepare them for future treatment. Over time, young children will be responsive to the method.

A good instructional technique involves seating the parent with the child standing between their legs and reclining his or her head backward onto their lap. The parent should embrace the child’s head in a stable position with one hand and proceed to brush the child’s teeth using a soft toothbrush with double-rounded bristles with the other. A gentle, tiny dab of fluoridated toothpaste should be used to clean the gums and teeth.

Fluoride

ecc-2.jpgFluoride should be introduced to the ECC patient in order to delay or prevent the progression of carious lesions,3 as children less than three should not be treated with sedation or other invasive treatment. Topical fluoride varnishes in a resin or synthetic base should be applied to the patient's tooth surfaces in order to prevent the process of cavity formation. This varnish-based application can help minimize the risk of inadvertent fluoride consumption.

Although the primary side effect of fluoride varnishes has been the temporary yellow-brown tooth discoloration apparent when adhering, this effect has been eliminated in new tooth-colored varnishes.4 Varnish application should be repeated at six months, or three-month intervals for high-risk children.

Establishing a proper oral hygiene regimen5 as early as possible for infants and young children will both work to decrease the potential of severe ECC and all the complications that lie with it, as well as allow the infants to become accustomed to their routine care and eventual dental visits. Assessing and managing the risk involved with dental caries is a key aspect of being a dentist, and despite the challenges that many children and infants face in lieu of healthy oral care, treatment is essential for maintaining overall wellness.

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References

[1] Statement on Early Childhood Caries. American Dental Association. http://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-early-childhood-caries. Accessed December 7, 2016.

[2] Nunn ME, Braunstein NS, Kaye EAK, Dietrich T, Garcia RI, Henshaw MM. Healthy Eating Index Is a Predictor of Early Childhood Caries. Journal of Dental Research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774803/. Published April 2009. Accessed December 7, 2016.

[3] Larsen CD, Daronch M, Moursi AM. Caries Prevention for Kids. Dimensions of Dental Hygiene. http://www.dimensionsofdentalhygiene.com/2013/02_February/Features/Caries_Prevention_for_Kids.aspx. Published February 2013. Accessed December 5, 2016.

[4] Kupietzky A. Early Childhood Caries. THE NEXTDDS. http://www.thenextdds.com/Articles/Early-Childhood-Caries/. Published December 13, 2010. Accessed December 5, 2016.

[5] Margolis F. Tricks or Treatments: Techniques for Managing Adolescent Patients. THE NEXTDDS. http://www.thenextdds.com/Articles/Tricks-or-Treatments--Techniques-for-Managing-Adolescent-Patients/. Published August 31, 2012. Accessed December 5, 2016.

Tags: Early Childhood Caries, caries, dental caries, caries management

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