Early Childhood Caries

What is considered Early Childhood Caries (ECC)?

The presence of 1 or more decayed (non-cavitated or cavitated lesions), missing teeth due to caries, or filled tooth surfaces in a child 71 months (6 years) or younger.

When is ECC considered severe?

When caries occur in children younger than 3 years (any sign of smooth surface caries), or in children aged 3–5 with 1 or more cavitated lesions.

What is Type 1 ECC?

Mild to moderate carious lesions involving molars and incisors that increase as the cariogenic challenge persists.

What age is Type 1 ECC seen in?

Ages 2–5 years.

What causes Type 1 ECC?

Lack of oral hygiene and consumption of cariogenic semi-solid or solid food.

What is Type 2 ECC?

Moderate to severe ECC affecting the labiolingual sides of maxillary incisors, with or without molar caries.

When is Type 2 ECC seen?

After the first tooth erupts.

What causes Type 2 ECC?

Inappropriate use of feeding bottles and poor oral hygiene.

What is Type 3 ECC?

Severe ECC involving lesions on all teeth, including the mandibular incisors.

When is Type 3 ECC seen?

Ages 3–5.

What causes Type 3 ECC?

Poor oral hygiene; the condition is rampant in nature.

What are the characteristics of Type 1 ECC (10–20 months)?

Seen in maxillary anterior teeth as opaque white demineralization in the cervical or interproximal region.

What are the characteristics of Type 2 ECC (12–24 months)?

Carious lesions in maxillary anterior teeth with spread to dentine; shows yellowish-brown discoloration.

Does the child have pain in Type 2 ECC?

Yes, pain when consuming cold food items.

What are the characteristics of Type 3 ECC (24–36 months)?

Deep lesions where molars are now affected and pulpal involvement occurs in maxillary incisors.

Where does pain occur in Type 3 ECC?

In the maxillary incisors, because the pulp is affected.

What characterizes Stage 4 ECC (36–48 months)?

A traumatic stage where teeth are so weakened they may fracture under force.

Which teeth are affected in Stage 4 ECC?

Molars with pulpal involvement; maxillary incisors become non-vital.

What are some causes of ECC?

Bovine milk and milk formulas due to lactose content; the basic mechanism involves demineralization caused by microbes and their acidic byproducts.

What is the main pathogenic microorganism in ECC?

Streptococcus mutans.

What substrates are involved in caries development?

Carbohydrates are fermented into dextrans by cariogenic bacteria.

What are the main sources of fermentable carbohydrates in ECC?

Bovine milk, human milk, fruit juices, syrups, pacifiers dipped in honey, and sweets.

How is Streptococcus mutans introduced into an infant's mouth?

The bacteria are transmitted to the infant's mouth from the mother.

What are the virulence factors of Streptococcus mutans?

It colonizes teeth, produces large amounts of acid, and creates extracellular polysaccharides (EPS) that favor plaque formation.

What is one primary structural reason children are prone to caries?

Thin enamel and developmental grooves.

What habit in children can lead to caries over time?

Allowing a child to sleep with a bottle in the mouth, because salivary flow and swallowing decrease during sleep, causing accumulation of carbohydrates for microbial fermentation.

Which teeth are least affected by ECC and why?

Canines (because they erupt later) and mandibular anterior teeth (due to salivary flow and tongue position).

Which tooth being affected is considered an indicator of extremely high caries risk?

The mandibular incisors.

What behavioral and habit factors lead to ECC?

Occurs in all socioeconomic groups; especially in infants with colic pacified by bottle, difficult sleepers, and those with prolonged at-will breastfeeding combined with a cariogenic solid diet.

What happens when cariogenic habits cease?

Caries are arrested, decayed areas can become self-cleansing, and lesions will appear darker.

What is the sequence of teeth affected by ECC?

Maxillary central incisors → maxillary lateral incisors → maxillary 1st molars → maxillary canines and 2nd molars → mandibular molars.

What is the caries risk assessment (diagnosis) scale for ECC?

C0: white lesion without visual decay. C1: caries within enamel. C2: caries into dentine. C3: caries with pulp perforation. C4: caries extending to the root.

What is the main prevention strategy for ECC if started early?

Brushing with a soft toothbrush at first tooth eruption using a rice-sized amount of toothpaste under age 3, and a pea-sized amount from ages 3–6.

What are the AAPD recommendations for prevention of ECC?

Infants should not sleep with a bottle; nocturnal breastfeeding should be avoided; parents should encourage infants to drink from a cup; oral hygiene measures should begin at first tooth eruption; oral health consultation visits should be scheduled.

What is a knee-to-knee exam?

A dental examination technique used for infants where the dentist and caregiver sit knee-to-knee; fluoride varnish is also applied during this visit.

What is the infant feeding routine for under 3 months?

10 feeds in 24 hours, or 6–8 formula feeds in 24 hours.

What is the infant feeding routine for 3–6 months?

3–4 hourly feeds; the early morning (2 AM) feed is eliminated and the infant needs only one overnight feed.

What is the infant feeding routine for 4–6 months?

4 milk feeds per day; solid foods may be introduced.

What is the infant feeding routine for 6–12 months?

4 milk feeds per day with the last one before midnight, plus 3 major solid meals.

What is the infant feeding routine for over 12 months?

No milk feeds required after bedtime; a bedtime ritual of feeding followed by tooth cleaning is recommended.

What are some restorative procedures used for ECC?

Intracoronal tooth-colored restorations; composite resin strip crowns for anterior teeth; stainless steel crowns for posterior teeth; with pulp capping, pulpotomy, or pulpectomy as needed.

What happens when extractions are needed in ECC?

Loss of upper anterior teeth does not cause space loss if the canines have already erupted. If posterior teeth are extracted, parents must be informed of possible space loss.

Does extracting primary teeth affect speech development?

No.

When should a child first visit the dentist?

At their 1st birthday.

What are the key points in managing ECC?

Provide solutions; educate caregivers; create a personalized prevention and treatment plan; schedule follow-up visits every 3 months.