1. Early Childhood Caries (ECC)
Vicky Chen
Tasoula Petrou

2. Early Childhood Caries (ECC) (baby bottle caries)
Form of dental caries that affects the teeth of infants and young children.
Most common chronic infectious childhood disease.
Though not life threatening, may result in pain, function impairment, deterious influence on child growth rate, body weight, ability to thrive-> reduce quality of life
Leading oral health problem of early childhood.

3. Caries

4. ECC is an aggressive form of dental caries that begins on tooth surfaces which are usually not affected by decay, such as labial surfaces of maxillary incisors, in contrast to dental caries which usually involves plaque retentive areas.
Thus it is thought that there may be distinctive risk factors involved in the progression of ECC.

5. Risk Factors
was historically attributed to inappropriate and prolonged bottle use or breastfeeding.
Primary
Secondary:
Bottle feeding
Breastfeeding
Oral Hygiene
Fluoride
Education of the parents
Socioeconomic factors

6. Bottle feeding
when children are allowed to sleep with a bottle in their mouth, has been considered cariogenic. (formulated milk, fruit juices, carbonated beverages).
reduction in salivary flow, thus decreasing salivary neutralization capacity.
prolonged exposure to fermentable carbohydrates.
decrease in plaque pH thus initiating the caries process.

7. Breastfeeding
Despite many advantages (optimal infant nutrition, immunological protection), prolonged breast-feeding apparently carries a risk of developing dental caries or nursing caries.
(WHO) has therefore recommended that children be breastfed until 24 months of age.

8. Oral Hygiene
presence of dental plaque is a high risk factor for developing caries in young children.
children who did not have their teeth cleaned at bedtime had a higher risk of developing ECC.
As young children lack the ability to clean their own teeth effectively, parents are recommended to clean their children’s teeth at least until they reach school age.

9. Fluoride
important for enamel resistance, reducing the amount of minerals lost during demineralization and accelerating remineralization.
Regular tooth-brushing with fluoridated toothpaste and brushing before going to bed.

10. Education of the parents
correlated with the occurrence and severity of ECC in their children.
Milgrom showed that the mother is not only the reservoir of cariogenic bacteria, but that her dental knowledge, behavior, as well as the general care of her child are also some of the factors that contribute to caries risk.

11. Socioeconomic Factors
There is evidence of powerful links between the individual’s socio-economic experience for disadvantaged children and adverse health events.
Children born into low-income families are more likely to have low birth weight which impacts on oral health.
Can further influence health literacy, which, in turn, affects general health.
ECC is more common in children from single parent families and those with parents of low educational level.
In this families, oral health is not ranked highly in priority.

12. Clinical Appearance
affects teeth upon eruption and is associated with a characteristic clinical presentation.
The initial lesions appear as ‘white spots’ on the facial tooth surface of maxillary incisors adjacent to the gingival margin, spreading later to the maxillary molars and mandibular molars.

13. Stage 1: Healthy teeth and gums

14. Stage 2: Chalky, white spots/lines on the tooth near the gum line

15. Stage 3: Yellow / brownish discolouration or cavities.

16. Stage 4: Well advanced decay or loss of tooth structure.

17. Severe case of ECC

18. Consequence
Dental pain, which affects children's regular activities, such as eating, talking, sleeping, and playing.
Additional carious lesions in their primary and permanent dentition.
Loss of the child’s front teeth at an early age.
Further developmental setbacks involving speech articulation as these years are critical for speech development.
Delays in physical development, especially in height and weight.
Decrease in appetite, ultimately resulting in malnutrition.
Psychological trauma from dental procedures required to restore their teeth-poor self-esteem.
Numerous extractions done in GA condition (has its own risks).

19. Treatment
depending on the progression of the disease, the child’s age, as well as the social, behavioral and medical history of the child.
Early stage-close monitoring, fluoride, OHI.
Advanced stage-When cavitation has occurred, more definitive treatment is required.
Early stages of cavitation can be treated restoratively, while advanced stages will require more complicated measures such as strip crowns for the anterior teeth and stainless steel crowns for the posterior teeth.
Pulpectomies or extractions may be indicated.
GA and sedation ( depend on cooperation of child)

20. Childhood and early adolescence are crucial periods in the development of healthy dentition.
Therefore it is essential to prevent the extensive consequences and treatment of ECC.

21. Study in New Zealand
In 2009 just over half of 5 year old NZ children were caries free.
An average of just over 48 percent had experienced dental caries by the end of preschool years.

22. Prevention
Improving oral health is one of the 13 population health objectives for the Ministry of Health and District Health Boards (DHBs) in the New Zealand Health Strategy
It is supported by the strategic vision for oral health Good Oral Health for All, for Life (Ministry of Health 2006).

23. Good Oral Health for All for Life
Primary health care services and professionals/ PHOs
GPs and practice nurses
provide early anticipatory guidance (in the first six months) about the prevention of dental caries. “Lift the Lip”
Lead maternity carers
preventive oral health behaviours, including breast feeding, bottle feeding issues, tooth brushing and the importance of parental oral health.
School dental service

24. School dental service
Oral health professionals include dentists, dental therapists, dental hygienists and dental assistants.
provide:
Free dental services to children from 0 to 17 years of age (until their 18th birthday).
preventive advice and guidance to reduce the risk of future dental caries.
preventive treatments, including the use of fluoride varnish to reduce the risk of dental caries.
treatment services, including dental fillings and extraction of teeth.

25. DenLite

26. Dental Denlite Project

27. Why?? Effective preventive measure Efficiency of service delivery
Creating a friendly experience
Making SDS of easier access

28. Friendly Dental Therapist

29. DenLite Assessments

31. Check for… Oral soft, hard tissue and occlusion (abnormal or health)
Teeth (presence,shape,position,mobility,plaque and cavitation.)
DenLite assessment may stop with first indication of further clinical treatment.

32. For children that need treatment..
Consent form is issued and appointment will be made for treatment to be done at the school dental clinic.

33. Success of DenLite The Denlite project has resulted in:
Improved access to pre-school dental care
Increased parents and pre-school staff’s knowledge of oral health issues and preventative measures
Improved efficiency of service delivery by working collaboratively with other services. (e.g.Plunket Health Nurses)

34. Success of DenLite Won the Waikato DHB Best of Health Award 2004.
The judges said, “The project focused on a national health priority to improve oral health and significantly increased the numbers of children being enrolled with the dental service – which in turn will have a significant flow-on effect on their education and ongoing health status.”
“The highly collaborative and innovative project created linkages across a variety of agencies and communities that had not previously existed and created a model that can be used in other parts of New Zealand.”
DenLite programme has also been included in the Waikato community oral health proposal as an important way of improving preschool oral health.

35. Conclusion
ECC is preventable and manageable with the right information and skills.
A closer co-operation between healthcare professionals, dental therapists and paediatric dentists is required.
Distribution of preventive health care literature, early referral and prompt treatment of the children with the signs of decay can help improve oral /dental health of children, thus improving their overall well being.

36. Reference and Bibliography
American Academy of Paediatric Dentistry. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. URL:
Berkowitz RJ Causes, treatment and prevention of early childhood caries: a microbiologic perspective. Journal of the Canadian Dental Association 69(5): 304–7.
Davies GM, Duxbury JT, Boothman NJ, et al Challenges associated with the evaluation of a dental health promotion programme in a deprived urban area. Community Dental Health 24: 117–21.
Gussy MG, Waters E, Kilpatrick NM A qualitative study exploring barriers to a model of shared care for pre-school children’s oral health. British Dental Journal 201(3): 165–70.
Gussy MG, Waters E, Walsh O, et al Early childhood caries. Current evidence for aetiology and prevention. Journal of Paediatrics and Child Health 42: 37–43.
Hallett KB, O’Rourke PK Social and behavioural determinants of early childhood caries. Australian Dental Journal 48(1): 27–33.
Lee M, Dennison PJ Water fluoridation and dental caries in 5- and 12-year-old children from Canterbury and Wellington. New Zealand Dental Journal 100(1): 10–5.
Ministry of Health a. Reducing Inequalities in Health. Wellington: Ministry of Health.
Ministry of Health b. Well Child – Tamariki Ora National Schedule. URL:
Ministry of Health a. Child Oral Health Services Service Specification. URL:
Ministry of Health b. DHB Toolkit Improve Oral Health. URL:

37. Thank you for your attention!