ecc

1. EARLY CHILDHOOD CARIES
MAKAL MADHAV MP
FINAL YEAR PART II
100020257

2. CONTENTS
• Definition
• Classification
• Stages of development of ECC
• Etiology
• Diagnosis
• Prevention
• Management
• conclusion

3. Defintion
AMERICAN ACADEMY OF PEDIATRIC DENTISTRY (AAPD) :
The presence of one or more decayed ( non cavitated , cavitated ) ,
missing ( due to caries ) or filled tooth surface in any primary tooth in a
child 71 months of age or younger .The academy also specifies that , in
children younger than 3 years , any sign of smooth surface caries is
indicative of severe ECC
DAVIS ( 1998 ) : Complex disease involving maxillary primary incisors
within a month after eruption and spreading rapidly to other primary
teeth is called childhood caries

4. • TERMINOLOGY USED FOR ECC
1) Nursing bottle caries
2) Baby bottle tooth decay
3) Nursing bottle syndrome
4) Milk bottle syndrome
5) Tooth clearing neglect -Moss ( 1996)
6) Infant and Early childhood dental decay
- Horowitz
7) MDSMD – Maternally Derived Streptococcus Mutans Disease

5. CLASSIFICATION OF ECC
TYPE I
 Mild to moderate
 isolated caries lesions involving molars and
incisors
 number of carious teeth increase as
cariogenic semi solid food and lack of oral
hygiene
 seen in 2-5 years old

6. Type II :
 moderate to severe
 labiolingual carious lesion affecting
maxillary incisors
 mandibular incisors are not affected
 use of feeding bottle or at will breast
feeding or a combination of both with or
without poor oral hygiene
 seen soon after eruption of teeth

7. Type III
 severe
 Carious lesion involve almost all the
teeth including mandibular incisors
 Usually seen in 3-5 years of age
 cause is a combination of factors and
a poor oral hygiene
 Rampant in nature and involves
immune tooth surface

8. DEVELOPMENTAL STAGES OF ECC
 Stage 1 :
 Initial reversible stage
 10 – 20 months
 Maxillary anterior teeth opaque white
demineralization
In cervical or interproximal region
 no pain

9.  Stage II :
Damaged carious stage
 16-24 months
 lesion in maxillary anterior teeth ,may
spread tp dentin and show yellowish
brown discoloration
 pain on having cold food items

10. Stage III :
 deep lesions
 24-36 months
 depending on time of eruption ,
carogenicity of sweetner and frequecy of its
use ,this stage can be reached in 10-14
months also
 molars are also affected
 frequent complaint of pain due to pulpal
involvement in maxillary incisors

11. Stage 1V :
 Traumatic stage
 36-48 months
 teeth become so weakened by caries
that relatively small force can fracture
 patient may report a history of trauma
 molars are anow associated with
pulpal problems
 maxillary incisors becomes non vital

12. Initially, a demineralization dull,
white area is seen along the
gum line on labial aspect of
maxillary incisors.
These white lesions become
cavities which involve the
neck of the tooth in a ring
like fashion
Finally, the whole crown of
the incisors is destroyed
leaving behind brown-black
root stumps.

13. ETIOLOGY
• Bovine milk,milk formulas, and human breast milk have all seen
implicated nursing caries because of their lactose content
• Basic mechanism of demineralization is same and caries tetralogy is
key in whole process(microbes,substrates,host,time)
• Pathogenic microorganism- streptococcus mutans

14. Etiological agents in
nursing bottle caries
Pathogenic
microorganisms
Substrate
(fermentable
carbohydrates)
Host Time
Other
predisposing
factors

15. • Steptococcus mutans- main microbe that colonizes teeth after it
erupts into oral cavity.
• It is transmitted to infant’s mouth through mother.
• It is more virulent because:-
• It colonizes the teeth
• It produces large amount of acid
• It produces large amount of extracellular polysaccharides that favor
plaque formation.

16. SUBSTRATE
(fermentable carbohydrate)
• Carbohydrates are converted into dextrans by microorganisms.
• In infants & toddlers, the main sources of fermentable carbohydrates
are:
i. Bovine milk or infant formulas
ii. Human milk (breast-feeding at will)
iii. Fruit juices & other sweet liquids
iv. Sweet syrups like vitamin preparations
v. Pacifiers dipped in honey or sugar solution
vi. Chocolates or other sweets

17. HOST
• Teeth act as host for microorganisms
• Hypomineralisation or hypoplasia of teeth increases the susceptibility
of child to caries
• Thin enamel in primary teeth is one of the reasons for early spread of
lesions
• Developmental grooves also may act as plaque retentive areas

18. TIME
• More the time child sleeps with bottle in the mouth the higher is the
risk of caries because the salivary flow and the swallowing reflex
decrease, thus providing more time for accumulation of
carbohydrates in the mouth which are acted upon by microbes to
produce acid leading to caries.

19. CLINICAL FEATURES
Mandibular molars: at later stage
Maxillary canines & 2nd molars: facial, lingual, proximal surfaces
Maxillary 1st molars: facial, lingual, occlusal, proximal surfaces
Maxillary lateral incisors: facial, lingual, mesial, distal surfaces
Maxillary central incisors: facial, lingual, mesial, distal surfaces

20. • Mandibular anterior teeth are usually spared because of:
I. Protection by tongue
II. Cleansing action of saliva due to presence of the orifice of the duct
of sublingual glands very close to lower incisors.

21. • DIAGNOSIS OF ECC
Health Policy Bureau , Ministry of Health and Welfare
C0 : Caries with only white lesions without visual decay
C1 : Caries in enamel
C2 : Caries in dentin
C3 : Caries with perforation ito pulp
C4 : Caries with existence to root

22. • CARIES ACTIVITY TEST
Cariostat
Blue ( ph 7.0 ) = 0 Green yellow ( 4.4)= 2
Green ( ph 5.4) – 1 Yellow ( 4.0) = 3

23. PREVENTION OF ECC
1) Community based education
2 ) examination and preventive care in dental clinic
3) development of appropriate dietary and self care habits
at home .

24. AAPD RECOMENDATIONS FOR PREVENTION OF
ECC
• Infants shouldnot be put to sleep with a bottle .
• Nocturnal breast feeding should be avoided a
Parents should be encouraged to have infants drink from a cup
•
• Oral hygiene measures should be implemented by the time of eruption of
the first primary tooth .
• An oral health consumption visit is recommended ( educate the parent
and for pravention

25. RAPIDD SCALE
• The readiness assessment of parents concerning infant dental decay
scale was developed to assess a parents stage of change -
precontemplative , contemlative or action with regard to his / her
childs dental health .

26. PROFESSIONAL AND HOME BASED
PREVENTIVE APPROACHES
• No signs of ECC or low ECC risk status
a) Fluoridated dentifrices
b) Review of dietary and oral
hygiene
• Signs of ECC OR high ECC risk status
a) Fluoride varnish
b) Sealants
c) Chlorhexidine varnish
d) Xylitol pacifiers
e) Fluoridated supplements and
dentifrices
f) Dietary counseling

27. MANAGEMENT
• This can be divided into :
1) Discontinuation of the habit
2) Restorative procedures
3) Education

28. • Discontinuation of the habit
< identify the cause
< gradual withdrawal rather than abrupt cessation of the habit
< feeding with cup or spoon is encouraged
< serial dilution of the contents of the bottle with water
• < Clearance of the milk can be aided by intake of water after feed.
• < Infants must be weaned at 12 to 14 months of age .

29. 2) Dietary modifications
• Elimination or gradual reduction of sugar must be done
• Depending on the child age and chewing capacity natural foods like
fruits should be given
• Oral hygiene measures should be implemented

30. RESTORATIVE PROCEDURES
involves thorough excavations followed by placement of sedative
dressings
> patient is then given necessary information regarding oral hygiene
and diet.
> on subsequent visit further treatment are carried out.
small restorations : composite resins , amalgam and GIC
Pulp involvement : indirect or direct pulp capping , pulpotomy ,
pulpectomy as indicated.

31. DENTAL HEALTH EDUCATION
• play an important role both in prevention and treatment of nursing
caries.
Expectant women and mothers should be taught how to take care of
their baby’ s teeth
 regular tooth cleaning twice a day after feeding will have significant
impact

32. TREATMENT : 1ST VISIT
All lesions should be excavated and restored
Indirect pulp capping or pulp therapy procedures can be evaluated by
further investigation
If the abscess is present it can be treated by drainage
X-Rays are advised to assess the condition of succedaneous teeth
collection of saliva for determining the salivary flow & viscosity
Also, application of fluoride topically

33. PARENT COUNCELLING
Parent should be questioned about the child’s feeding habits, nocturnal
bottles, demand for breast-feeding, pacifiers.
Parents should be asked to try weaning the child from using the bottle as
pacifier while in bed.
In case of emotional dependence on the bottle, suggest use of plain or
fluoridated water.
The parents should be instructed to clean the child’s teeth after every feed.
Parents are advised to maintain a diet record of the child for 1 week that
includes the time, amount of food given to the child, the type of the food &
the number of sugar exposures.

34. 2nd VISIT
Should be scheduled 1 week after 1st week.
Analysis of diet chart & explanation of disease process of child’s teeth
Isolate the sugar factors from diet chart & control sugar exposure
Reassess the restoration and redo if needed
Caries activity tests can be started & repeated at monthly interval to
monitor the success of treatment

35. 3rd & SUBSEQUENT VISITS
• Restoring all grossly decayed teeth
• Endodontic treatment
• In case of unrestorable teeth, extraction followed by space maintainer
• Crowns given for grossly decayed & endodontically treated teeth
• Review & recall after every 3 months

36. CONCLUSION
• ECC is a specific term used to describe a unique pattern of dental
decay in infants and toddlers and preschool children
• Proprer reassurance and education is necessary to prevent ECC

37. REFERENCE
• Dentistry of child and adolescent –Mc DONALD
• Text book of pediatric dentistry –Nikhil Marwah
• Principles and practice of pedodontics – Arathi Rao
• Text book of pedodontics –shobha Tandon