Early Childhood Caries & Fissure Sealants – Review Flashcards

Question-and-Answer flashcards covering definitions, aetiology, risk factors, stages, complications, prevention, management of Early Childhood Caries, and key information on fissure sealants.

What is the clinical definition of Early Childhood Caries (ECC)?

The presence of ≥1 decayed (cavitated or non-cavitated), missing (due to caries), or filled surface in any primary tooth of a child ≤71 months (≤6 years) old.

How is Severe Early Childhood Caries (S-ECC) defined for children under 3 years of age?

Any sign of smooth-surface caries on any primary tooth in a child <3 years old.

What dmft thresholds classify S-ECC at ages 3, 4 and 5 years?

dmft >4 at age 3; dmft >5 at age 4; dmft >6 at age 5.

List four common synonyms for Early Childhood Caries.

Nursing-bottle caries, Baby-bottle tooth decay, Nursing-bottle syndrome, Milk-bottle syndrome (others include Night-bottle caries, Maternally derived S. mutans disease).

Give three functional reasons why preservation of primary teeth is important.

Mastication, speech development, space maintenance for permanent teeth (also aesthetics and elimination of infection).

Name the two principal bacterial species involved in caries development.

Mutans streptococci (especially Streptococcus mutans) and Lactobacilli.

Which four prerequisites are required for caries to develop?

Susceptible tooth surface, cariogenic bacteria, fermentable substrate, and sufficient time.

What is the primary route of early acquisition of Streptococcus mutans by infants?

Vertical transmission from the mother or primary caregiver.

State two major feeding-related risk factors for ECC.

Nocturnal bottle feeding and on-demand breastfeeding used as a pacifier.

Why does nocturnal bottle feeding promote ECC?

Reduced salivary flow and absent swallow reflex during sleep allow milk to pool, enabling prolonged acid attack on tooth surfaces.

Which primary teeth are typically spared in ECC and why?

Mandibular incisors, because they are protected by the tongue and saliva from sublingual/submandibular ducts.

Describe Step 1 in the development of ECC.

Primary infection with Streptococcus mutans.

At what approximate age does the ‘Initial (reversible) Stage’ of ECC typically appear and how does it present?

10–20 months; opaque-white demineralisation on cervical or inter-proximal surfaces of maxillary anterior teeth.

Which clinical signs characterise the ‘Damaged (carious) Stage’ of ECC?

Yellow-brown discoloration, enamel discontinuity, caries into dentine, and possible discomfort with cold foods.

What complication is common in the ‘Deep Lesion’ stage of ECC (20–36 months)?

Pulpal involvement causing pain on brushing and mastication.

List three systemic or developmental complications associated with untreated ECC.

Malnutrition/weight loss, speech and learning problems, potential early cardiovascular vessel damage (from oral bacteria).

According to AAPD, should infants be put to sleep with a bottle?

No—bottles (including milk or juice) should never be used for sleeping or comfort.

At what age should children transition from bottle to cup use?

Around the first birthday (12–14 months).

Give two recommendations to parents to reduce bacterial transmission of S. mutans to infants.

Avoid sharing spoons or kissing on the mouth; maintain parents’ own oral hygiene with brushing, flossing and antibacterial agents/xylitol gum.

Outline two key elements of dietary counselling in ECC management.

Gradual withdrawal of sugary liquids/snacks and substitution with natural, less cariogenic foods such as whole fruits.

Which restorative materials are commonly used for small carious lesions in primary teeth?

Composite resin, glass ionomer cement, or dental amalgam.

Define Rampant Caries and relate it to ECC.

Sudden, widespread, rapidly progressing caries involving many teeth including surfaces normally resistant; ECC is a form of rampant caries in young children.

What is a fissure sealant?

A resin material applied to occlusal surfaces to seal pits and fissures, isolating them from the oral environment and preventing caries.

Approximately what percentage of caries in 5- to 17-year-olds originates in pits and fissures?

About 84 %.

List three properties of an ideal fissure sealant.

Biocompatible, high retention on enamel, high resistance to abrasion and wear.

State two main aims of applying fissure sealants.

Prevent bacterial colonisation of pits and fissures and block nutrients from reaching any bacteria present.

Which patients are prime candidates for fissure sealants?

Children with extensive caries in the primary dentition or special-needs children at high caries risk.

Name two tooth surfaces commonly selected for sealant placement.

Deep occlusal pits of molars and buccal pits of mandibular molars (also palatal pits of maxillary incisors).

Differentiate between self-curing and light-curing fissure sealants in terms of activation.

Self-curing use a chemical activator (benzoyl peroxide/tertiary amine) to release free radicals; light-curing polymerise when exposed to curing light.

What acid concentration is typically used to etch enamel before sealant placement?

37 % phosphoric acid.

List the basic procedural steps for fissure sealant placement in correct order.

Clean tooth, isolate, acid etch, rinse/dry, apply bonding agent & sealant, cure, check occlusion, apply topical fluoride.

How often should sealants be reviewed for retention or loss?

Every 6 months.

Give two advantages of fissure sealants for patients.

Painless, highly effective caries prevention resulting in smoother, easier-to-clean surfaces.

Provide two commercial examples of self-curing sealants.

Delton (clear) and Concise (white) (others: Johnson & Johnson, Dialin).

Provide two commercial examples of light-curing sealants.

Nuva-Seal (clear) and Prisma-Shield (tooth-coloured) (others: Nuva-Cote, Visco-Seal).

Why is space maintenance sometimes needed after extraction of severely affected primary teeth?

Early loss can lead to space loss and mal-alignment of permanent successors.

What behavioural strategy helps wean a child off bedtime bottle use without abrupt cessation?

Serial dilution of bottle contents with water until only water remains.

Name two systemic diseases that reduce salivary flow and may contribute to rampant caries.

Sjogren’s syndrome and sarcoidosis (also radiation-induced xerostomia).

Which stage of ECC is often painless and discovered only by a dentist’s examination?

Stage I – Initial (reversible) stage.

How does the side a child sleeps on influence ECC pattern?

Teeth on the dependent (lower) side experience more pooling of liquid and are more affected.

What immediate dental interventions are prioritised before definitive restorative care in ECC?

Emergency treatments of pain, abscesses, or cellulitis.

Explain why mandibular incisors are usually spared in ECC.

They are exposed to continuous saliva flow and covered by the tongue, limiting contact with cariogenic liquids.

Which topical sweetener in chewing gum can help reduce mutans streptococci in parents?

Xylitol.

What change in colour may indicate arrested ECC after causative factors are removed?

Affected enamel/dentine turn dark brown, signifying remineralisation.

List three biologic factors that predispose infants to ECC.

Early implantation of cariogenic bacteria, immature host defence, and feeding/oral hygiene behaviours.

Which fissure depth characteristic increases susceptibility to caries and need for sealant?

Deep, narrow pits and fissures that are inaccessible to toothbrush bristles.