Dental Disease:Early Childhood Caries

Unit II: Oral HealthUniversity of Ottawa Faculty of Medicine

Dr. B. Carol Janik Chief, Division of Dentistry

Children’s Hospital of Eastern Ontario

Dr. Stephanie Lauziere Staff Paediatric Dentist

Children’s Hospital of Eastern Ontario

Objectives

Explain the dental caries process and recognize the causes of dental decay

Explain the significance of the multifactorial and transmissible nature of dental caries

Demonstrate infant oral assessment and explain the rationale for early assessment and what is meant by anticipatory guidance

Define Early Childhood Caries (ECC) and discuss the potential consequences and impact on paediatric health

Identify ECC risk factors, recognize early clinical signs of decay through infant oral examination and recognize the need for early intervention

Most Common Forms of Dental Disease

Dental decayCaries, loss of tooth structure

GingivitisInflamed gums

Periodontal diseaseLoss of tooth supporting bone

Bacteria

Dental Plaque

Oral Disease Process

Dental Caries(cavities)

Periodontal Disease

Dental Decay (caries)

Dental Caries is Multifactorial

Susceptible tooth surface poor oral hygiene

Specific microorganisms S. mutans bacteria

Fermentable carbohydrates cariogenic diet, sweetened

beverages

Time frequent/prolonged exposure

For caries to develop four interacting factors must be present:

3 variables in tooth decay

teeth and host

bacteriaFood

teeth and hostLow socioeconomic groups AND

General population

Low birthweight

Systemic illness –neonatal period

Malnutrition/undernutrition – perinatal period

teeth and hostSALIVA : the BLOODSTREAM of the teeth

TEETH are NOT STATIC

Saliva is saturated in CALCIUM, PHOSPHATE

Topical or dietary FLUORIDE

Oral clearanceOral clearance

Buffering activityBuffering activity

RemineralizationRemineralization

3 variables in tooth decayteeth and host

bacteriaFood

Bacteria

STREPTOCOCCIStreptococcus

mutansAcidogenicAciduric

Oral flora is site-specific

Bacteria Transmission

Window of infectivity (18-36 months of age)

High levels of s. mutans (>30%)

VERTICALFamily member-

especially mother

HORIZONTALOther children

3 variables in tooth decayteeth and host

bacteriaFood

SubstrateCariogenicity of sugars

Sucrose – glucose – fructoseSucrose = dextrans = microbial adherence

Lactose = dissacharideLow potential

Substrate Child on medication

Long termHospitalOral hygiene Pediatric med Sucrose content (%w/v)

Amoxil 125mg/5mL 33%

Ceclor 125mg/5mL 60%

Keflex 125mg/5mL 60%

EES 200mg/5mL 32%J Camm -Handout

Dental caries process:

formation of protein coating (pellicle) on tooth enamel

bacteria adhere, forming a sticky mass

fermentation of dietary carbohydrate lowers pH

plaque prevents buffering actions of saliva

demineralization of enamel exposes dentine to acid

dentine erodes and caries reaches the pulp

nerve endings respond to stimuli, signaling pain

Early Childhood Caries (ECC)

Infectious Streptococcus mutans

Transmissible vertical transmission

Preventable proper oral hygiene proper dietary habits

ECC is a virulent form of tooth decay

ECC has detrimental effects on paediatric health

Children may first present for dental care with Severe ECC

Early Childhood Caries (ECC) Defined

“ the presence of 1 or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger ” American Academy of Pediatric Dentistry

formerly known as “ nursing caries”,” baby bottle tooth decay”, “bottle-mouth”, “bottle-rot” …

Determinants of ECC

Oral hygiene status

Prolonged exposure to sweetened beverages, particularly night-feeding

Bacterial infection, high counts of S. Mutans

Enamel defects, hypoplasia

Clinical Presentation: early lesions

begins soon after dental eruption

typically develops on smooth surfaces

appear as chalky white decalcification

Lesions can appear on the lingual surface on otherwise healthy appearing incisors

Clinical Presentation: advancing

virulent caries with

rapid progression

enamel chips away

as lesions advance

Clinical Presentation: rampant

progressively involves molar and cuspid teeth

maxillary and mandibular lesions present

Clinical Presentation: severe

pulpal involvement

abscess, fistula

at risk for cellulitis

Extensively decayed teeth with dental

abscess, can progress to facial cellulitis

Facial Cellulitis

Infection spreading into surrounding tissues

Extensively decayed primary molar with pulpal infection spreading to the developing permanent tooth which can suffer developmental disturbance

ECC and Paediatric Health

ECC progresses rapidly with related health risks

pain, infection, loss of function

affects learning, communication, nutrition, sleep

lower body weight

chronic inflammation

psychological impact

lasting detrimental impact on the dentition

The reality : too many cases of ECC go undiagnosed until

comprehensive or emergency treatment is required

AAPD/CAPD, CDA, AAP recommend: FIRST VISIT BY FIRST

BIRTHDAY for infant oral assessment

Infant Oral Assessment is advocated : to prevent ECC: to

educate parents: to provide anticipatory guidance

The challenge : to get healthcare professionals to accept

the year 1 dental visit

Infant Oral Assessmentthe challenge: first visit by first birthday

Infant Oral Assessment Medical and dental history

record prenatal, perinatal and postnatal periods

Examination recommended in a knee-to-knee position

Provide caries risk assessment and appropriate caries prevention plan behaviour modification tooth protection

Provide anticipatory guidance regarding dental development oral habits injury prevention

Knee-to-knee examination

Allows for child to be held by the parent and view parent face-to-face

Allows the examiner to have control

Enables parent and practitioner to view simultaneously

Use mouth-prop or toothbrush as required

Caries risk assessment

The following factors should be considered:

Clinical evidence of current or previous disease

Dietary habits, especially frequency of sugary food and drink consumption

Social history, socioeconomic status

Use of anticariogenic agent, fluoride

Plaque control, oral hygiene

Salivary composition and flow

Medical history, status

Anticipatory guidance

In addition to caries prevention, early assessment provides an opportunity for evaluation and guidance regarding:

dental development

oral habits

injury prevention

Dental neglect …

… caries detection and prevention is an essential component in the overall

care and protection of children

Managing ECC

Infant oral assessment is essential

ECC is the most common chronic infective disease among children

ECC is a significant public health problem

ECC is preventable; rampant caries is difficult and costly to treat

ECC may constitute dental neglect if left untreated

Treatment is always indicated to avoid undesirable outcomes

Treatment of ECC

ECC involves unique treatment challenges:young age of patientvolume of treatment

ECC requires advanced behaviour management techniques:

general anaesthesiasedation

ECC involves substantial treatment costs

ECC is Preventable

• early dental assessment

• proper oral hygiene

• proper dietary habits

• regular dental care

for further information:

Dr. B. Carol Janik

cjanik@cheo.on.ca

Dr. Stephanie Lauziere

slauziere@cheo.on.ca

Questions

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