infant oral health & ECC

lecture given 8/12/2026

OTC preparations of fluoride rinses

0.05% NaF = 230 ppm

Rx preparations of fluoride rinses

APF, NaF 0.05% daily use

0.2% weekly use

what are the risks of fluoride rinses?

alcohol, F ingestion

when should fluoride rinses be started?

6yo and older

what are indications for fluoride rinses?

orthodontics, radiation, caries- active pt

fluroide-self applied gels/paste

must be prescribed by a dentist or physician

0.4% SnF2- 1000ppm, brush on

1.1% NaF- 5000ppm, brush on, tray

1.1% APF- 5000ppm, brush on, tray

what are the indications for fluoride-self applied gels/paste?

rampant caries

radiation

ortho

when should the first dental visit for a child be?

within 6mo of eruption of the first tooth but no later than the child’s first birthday

why should the first dental visit be so young?

more than 25% of US children have caries before kindergarten

caries rates are increasing in children under than the age of 5, esp in lower SES (30-40%)

caries progression occurs rapidly in children

establish a dental home for continuing care

what happens at an infant dental visit?

review medical history and dental history

perform clinical exam, prophylaxis, fluoride application, and radiographs (as needed)

review oral home care regiment

oral health risk assessment

parental counseling

anticipatory guidance

soft tissue clinical exam

lips, cheeks, tongue, frena, gingiva, palate

dental clinical exam

eruption

caries

development

occlusion

hygiene

prophylaxis

toothbrush (younger than 3yo), or rubber cup prophy (over 3 yo)

scaling (as needed)

flossing (if contacts closed)

fluoride application

how should you do a prophy/exam on an infant?

lap to lap exam

lap to lap exam

let parents know that the infant will cry and it is expected for the infant to be uncooperative

instruct the parent to hold child like they are hugging child

lay child back in your lap

you secure child’s head, parent secures child’s arms and legs

perform exam, prophy and fluoride application within a short timespan (usually under 5 minutes, use toothbrush to help open mouth and as a bite block)

educate parent on proper brushing and flossing technique for child as you are brushing and flossing child’s teeth

what is the most important part of infant dental visits?

parent counseling and anticipatory guidance

what are some parental counseling topics?

oral hygiene, diet, habits, mutans streptococci (MS) transmission, fluoride

what are some anticipatory guidance topics?

eruption sequence, trauma prevention, future dental visits

oral hygiene counseling

parents should be brushing for child as soon as first tooth erupts

use a soft toothbrush

brush twice daily with appropriate size toothbrush

floss when contacts are closed

why should a parent brush their child’s teeth from behind?

provides stability of the pts head

lay child on bed or couch and brush

brush using lap to lap technique

cradle in arms as other adult brushes

when older, have child stand in front of parent or sit in chair with parent behind child

diet counseling

breast milk is better than cow’s milk- breastfeeding has not been shown to cause caries (however breastfeeding more than 7x a day after 12 mo of age is associated with ECC)

nighttime feeding with cow’s milk is associated with caries

frequently drinking milk, juice, and formula in a bottle or sippy cup is associated with increased caries risk (esp if in between meals)

limit sugar intake- juice and milk only at meal times, no soda, limited candy/cookie/other sweets

water in between meals and before bed

oral habit counseling

bottle/sippy cup- should be stopped as soon as possible, associated with higher caries risk

digit and pacifier- normal in infants, discuss stopping habit by age 3 to prevent any skeletal changes from occuring

MS transmission counseling

inform parent of vertical transmission

do not lick pacifier clean

do not test food with same spoon used to feed child

fluoride counseling

ask if pt is taking a fluoride supplement

assess fluoride intake from different sources- tap water, formula, juice, prepared foods

if needed, prescribe fluoride supplementation

recommend fluoride toothpaste at any age

eruption sequence

review which teeth will be erupting by next dental appointment to anticipate teething activity

trauma prevention

falls when children become mobile, play objects, electric cords, car seats

future dental visits

pt should be seen every 6 mo to evaluate oral health and become familiar with dental treatment

anticipate behavior at future visits- children generally do not cooperate until 3-4 yr

caries risk assessment

should be performed on every pt

helps to create individualized preventive and restorative plans

early childhood caries

dull, white, demineralized enamel that quickly advances to obvious decay along the gingival margin

the presence of 1 or more decayed (noncavitated or cavitated), missing (due to caries) or filling tooth surface in any primary tooth in a child under the age of 6 yo

severe ECC

any sign of smooth surface caries in a child younger than 3 yo

1 or more cavitated, missing (due to caries) or filled smooth surfaces in primary maxillary anterior teeth in children ages 3-5

decayed, missing, or filled surface score greater than or equal to 4 (age 3), 5 (age 4), or 6 (age 5)

what is the etiology of ECC?

bacteria, primarily mutans streptococci (MS), that metabolizes sugars to produce acid which over time demineralizes tooth structure

previously called nursing bottle caries and baby bottle tooth decay indicating some of the factors that cause ECC

dietary factors increase risk for caries, but are not the direct cause of caries

stats of ECC

high rates in poor and near poor US preschool children

largely untreateed in children under 3 yo

often multiple teeth are affected by the time it is diagnosed

MS colonization

can start from birth

originally thought to only occur when teeth are present- now known that MS can colonize soft tissue, including the tongue, in infants before tooth eruption

colonization increases once teeth erupt

MS transmission

dental caries is a non-communicable disease

caused by imbalance of oral microbiome

in infants, transmission of MS is often vertical- from mother/caregiver to child, lowering MS levels in caregivers delays transmission to infants

transmission can also be horizontal- between family members or other children (daycare)

eliminate saliva sharing activities

what caregiver factors are associated with vertical transmission?

MS salivary levels, oral hygiene, periodontal disease, snacking frequency, socioeconomic status

percentage of children colonized with MS (increases/decreases) with age

there is a relationship between age of colonization and ________ in children

increases

caries experience

dietary influence on ECC

frequent nighttime bottle feeding with milk and nighttime breast-feeding associated with ECC

other dietary practices that increase ECC risk- nighttime bottle feeding with juice, use of sippy cup, frequent in between meal consumption of sugary snacks and drinks

what are the consequences of ECC?

higher risk of carious lesions in primary and permanent teeth

increased hospital and ER visits

increased treatment cost

risk for delayed physical growth and development

loss of school days

diminished ability to learn

diminished oral health-related quality of life

how is ECC diagnosed?

visual exam

radiographs usually not needed to make diagnosis, used to determine extent of caries and presence of periapical pathology

which teeth are most affected by ECC?

4 maxillary incisors

initially present as smooth surface lesions

which teeth are rarely affected by ECC?

mandibular incisors

after maxillary incisors, what is the common sequence of affected teeth with ECC?

primary molars- maxillary then mandibular

what are treatment options for ECC?

in dental chair- depends on child’s age/behavior, may not be definitive treatment (interim therapeutic restorations), may require protective stabilization (papoose, parental/assistant restraint, lap to lap treatment)

sedation or GA- depends on amount of treatment needed, full mouth rehab in young children often necessitates treatment in the operating room under GA, need to weigh risk and benefits

if a pt is undergoing sedation or GA, what restorations should you perform?

definitive

composite or crowns on anterior teeth

stainless steel crown (SSC) on posterior teeth

need to keep in mind pt compliance, oral hygiene, and longevity of restorations when deciding which restoration is best for children

ECC stats from fanciscan childrens

78.6% ECC children compared to 29% control children had detectable decay at subsequent recall visits

children with ECC showed a mean number of 3.19 ± 3.25 new cavities compared to a mean of only 0.8 ± 1.57 new lesions in the control group

16.7% ECC children required retreatment under GA within 2 yrs

what are the clincal outcomes for ECC?

23% of children treated under GA requireded subsequent treatment

52% with new smooth surface lesions following rehab under GA

57% of treated subjects required treatment for new decay within 6-24 mo

short term clinical outcomes for restorative treatment of ECC are often poor

what are the treatment goals of ECC?

stabilize dental disease

return oral cavity to health

educate parents and pts on maintaining good oral health- diet, oral hygiene

goal is to prevent all dental caries through early visits with parental education