early childhood caries
DESCRIPTION
ecc, cariesTRANSCRIPT
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Early Childhood Caries – An insight
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Contents
IntroductionDefinitionEpidemiology and PrevalenceOther namesClassificationEtiology & Risk factorsClinical featuresPreventionConclusionReferences
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Introduction
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Definitions
• (DeGrauwe et al., 2004).A great variety of definition and diagnosis of ECC is used worldwide, and a clear classification is still to be developed.
• Abid Ismail (1998): ECC is defined as occurrence of any sign of dental caries on the tooth surface during first 3 years of life.
• (Carino et al., 2003).ECC has also been defined as the presence of any dmf teeth, regardless of being anterior or posterior.
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Definitions Contd…
• Dury et al (1999): 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 child 71 months age or younger.
Adopted by AAPD (2000)
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Epidemology & Prevalence
• >40% of children get caries before joining KG. (pierce et al 2002)
• While collective oral health , the prevalence from 24% to 28% for 2-5 yr olds. (dye et al)
• England 6.8 – 12% and USA 11-53.1%
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Epidemology & Prevalence
• For 8 – 48 mnths old in India – 44% (Joes & King 2003)
• Udupi – 19.44% & Davangere 19.2%
• Among Europe, Africa, Asia, Middle east, North America ……
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Epidemology & Prevalence
• Filstrup SL, Briskie 2003
• In USA, ECC is single most common chronic childhood caries.– X 5 common than Asthma– X 7 common than Hay fever– X 14 common than Chronic Bronchitis
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Other Names for ECC
• baby bottle tooth decay, • early childhood caries, • early childhood dental decay, • early childhood tooth decay, • comforter caries, • maxillary anterior caries• Tooth Clearing Neglect• MDSMD – Maternal Derived Streptococcus
Mutans Disease.
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Classification
Type 1 : Mild to moderate
Type 2 : Moderate to severe
Type 3 : Severe
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S - ECC
< 3 years Any sign of smooth surface caries
3 through 5 1 or more cavitated, missing or filled 1° max’ ant’
age 3 dmf ≥ 4
age 4 dmf ≥ 5
age 5 dmf ≥ 6
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Etiology & Risk Factors
• 1 Factors
• 2 Factors
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Keys Triad (1960)1
° fa
ctor
s
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Newburn (1982)modified Keys Triad
1° f
acto
rs
Colonization starts after eruption or before eruption of 1st tooth?(Tanner 2002, Berkowitz 2006)
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• Salivary flow rate• Salivary viscosity• Race and ethnicity • Socio economic status• Tooth brushing• Cognitive factors• Dental knowledge• Stress • Birth weight• Chronic illness • Host factors
– Anatomic characteristic of the tooth– Arch form– Presence of dental appliance and restoration– Composition
2 ° F
acto
rs
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Risk Factors
The most important are probably– high-frequency intake of sugary snacks – Frequent intake of drinks– sweetened feeding bottles (night)
Prolonged contact of enamel with human milk
Remineralization Demineralization
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•Noctunal Breast feeding•↓ nocturnal salivary flow
•↑ lactose in resting saliva•Prolonged contact than day time
• ↑ Demineralzation
Risk
Fac
tors
Nocturnal Breast Feeding
Breast Feeding for over 1year beyond tooth eruption may be associated with ECC (Valaitis et al 2000)
Breast Feeding and ECC
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• Children of Low socio-economic status and of illiterate mothers have 32 times more risk than general population (drury et al 1999)
Risk
Fac
tors
Low socio-economic status
Disadvantaged Children
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Maternal MS ↑ levels of maternal salivary MS,↑ the risk of infant being colonized.
Risk
Fac
tors
Enamel Hypoplasi
a
Low birthweight / systemic illness @ neonatal
period
Undernutrition / malnutrition
@ perinatal period
ECC
Perinatal Nutrion (Horowitz 1998)
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Clinical Features
• Initial Lesion– Chalky white
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As the lesion progressess…
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• Pattern of involvement follows the sequence eruption of 1° teeth.
• Usually symmetric
• Mand’ incisors, 1° canines, 1° 2nd molars are least involved.
• If mand’ incisors were involved – indicative of Rampant caries or due to inappropriate use of pacifiers. (Ripa 1988, Tinanoff et al 1997)Se
quen
ce o
f inv
olve
men
t
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Prevention
3 principal measures to prevent ECC:• 1) Community-based measures• 2) Professional measures and • 3) Home-care measures.
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• Water Fluoridation• National educational programs• Community based oral health
education programs
Com
mun
ity b
ased
mea
sure
s
- Wider coverage of population- Lower cost- Reduce inequalities in
children’s oral health
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• Parents education
• Diet counseling
• Topical fluoride if needed
• Application of fissure sealants
• Regular recalls
• Motivational Interviewing.
• Preventive dental programs for mothers
• Use of anti-bacterial agents
Prof
essi
onal
car
e
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• Elimination of cariogenic food items from the diet
• Substitution with tooth friendly food
• Discouraging bottle feeding at night
• Falling asleep with pacifiers should be stopped
• Digital or baby tooth brushing as the teeth erupts
• Regular visit to dental clinic once in six months.
Hom
e ca
re
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Dental Health Education – DHE (in general)
DHE by professionals + Regular home visit
Motivational Interviewing
Fluoride tooth paste
NaF tablets
Counselling + Fluoride varnish applications (twice/yr)
Fall-asleep-pacifier with 0.25mg NaF
CHX varnish
Topical application of 10% Povidone Iodine every 2 months
Probiotic (among 3-4yr old)
Maternal preventive dental health program
Maternal use of Xylitol Gum (compared with CHX & F varnish)
Com
pari
son
of P
reve
ntive
mea
sure
s
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AAPD Policy statement – Prevention of ECC
1) Reducing the mother’s/primary caregiver’s/sibling(s) MS levels (ideally during the prenatal period) to decrease transmission of cariogenic bacteria.
2) Minimizing saliva-sharing activities (eg, sharing utensils) between an infant or toddler and his family/cohorts.
3) Implementing oral hygiene measures no later than the time of eruption of the first primary tooth.
• If an infant falls asleep while feeding, the teeth should be cleaned before placing the child in bed.
• Tooth brushing of all dentate children should be performed twice daily with a fluoridated toothpaste and a soft, age-appropriate sized toothbrush. Parents should use a ‘smear’ of toothpaste to brush the teeth of a child less than 2 years of age. For the 2-5 year old, parents should dispense a ‘pea-size’ amount of toothpaste and perform or assist with their child’s tooth brushing.
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Comparison of a smear (left) with a pea-sized (right) amount of toothpaste.
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AAPD Policy Statement Contd…
4) Establishing a dental home within 6 months of eruption of the first tooth and no later than 12 months of age to conduct a caries risk assessment and provide parental education including anticipatory guidance for prevention of oral diseases.
5) Avoiding caries-promoting feeding behaviors. In particular:• Infants should not be put to sleep with a bottle containing fermentable carbohydrates. • Ad libitum breast-feeding should be avoided after the first primary tooth begins to erupt and other dietary carbohydrates are introduced. • Parents should be encouraged to have infants drink from a cup as they approach their first birthday. Infants should be weaned from the bottle at 12 to 14 months of age. •Repetitive consumption of any liquid containing fermentable carbohydrates from a bottle or no-spill training cup should be avoided. •Between-meal snacks and prolonged exposures to foods and juice or other beverages containing fermentable carbohydrates should be avoided.
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Conclusion
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References• Policy on Early Childhood Caries (ECC): Classifications,
Consequences, and Preventive Strategies (AAPD revised 2008)
• Guideline on Infant Oral Health Care (AAPD 2009)
• Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options (AAPD 2008)
• Topical antimicrobial therapy in the prevention of early childhood caries: a follow-up report (Lydia Lopez, DDS, MPH Robert Berkowitz, DDS Charles Spiekerman, PhD Phillip Weinstein, PhD)
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• The High Incidence of Early Childhood Caries in Kindergarten-age Children (Jean-Marc Brodeur, DDS, MSc, PhD Chantal Galarneau, DMD, MSc, PhD) (JODQ 2006)
• Importance of Early Diagnosis of Early Childhood Caries (Souad Msefer, DCD, DSO, Cert. Pedo.) (JODQ 2006)
• Prevention of Early Childhood Caries (ECC) (Daniel Kandelman, DDS, Nabil Ouatik, DMD) (JODQ supplement -2006)
• Pit and Fissure Sealants: An Important Adjunct in the Control of Childhood Caries Charles Dixter, BSc, DDS, Cert. Pedo. Aaron Dudkiewicz, BSc, DDS, Cert. Pedo. Irwin Fried, DDS, MS, Cert. Pedo, FRCD(C)
• Textbook of Pediatric Dentistry: Nikhil Marwah