DEFINITION = American Academy of Paediatric Dentistry (AAPD) defines early childhood caries as ‘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 of age or younger.

A window of infectivity 2M**:

1. Caufield (1996) stated that there is a window of infectivity between 19 and 33 months during which teeth get infected with S. mutans 
2. The most beneficial time for vaccination against dental caries would be in infancy before the eruption of teeth. 
3. This would promote the induction of adherence inhibiting salivary IgA thus delaying colonization of S. mutans. 
4. With the establishment of early colonizers, there would be a synergistic effect of suppressing the colonization of S.mutans during the period of the window of infectivity. 
5. A booster dose of vaccination may be required at the time of eruption of first permanent molars 

ETIOLOGY AND PATHOGENESIS 3M

1. Early colonization of MS is the most imp risk factor for developing ECC – MS transmission can be through the mother or from peers [ other kids] 
2. MS Colonization of pre dentate children is mostly associated with maternal factors [ high level of MS in the mother, poor OH, and active caries ] 
3. How is nocturnal bottle feeding/breastfeeding related to ECC? 
   1. When a child is laid to rest, the bottle or breast nipple rests against the palate and the tongue covers the lower incisors [ that’s why they are not affected] – 
   2. As the child becomes sleepy, saliva flow and swallow reflex are reduced
   3. Sugar remains stagnant around the neck of the teeth 
4. what practices increase the chance of developing ECC?
   1. Prolonged nighttime bottle feeding
   2. On-demand breastfeeding after the age of 1
   3. Frequent snacking with sugary foods
   4. Frequent sipping of sugary drinks throughout the day

CLINICAL FEATURES 2M

1. ECC = also known as nursing bottle caries, baby bottle tooth decay 
2. Seen in infants and preschool children [ below the age of 6
3. Demineralization at the necks of the upper incisors – mandibular incisors are not affected
4. Decay pattern:

5. Maxilla: incisors, canines, first molars 
6. Mandible: canines, first molars

5. Lesion progresses to the necks of the teeth and in advanced cases, only a root stump is left
6. Why does ECC follow this specific pattern? 
   1. Chronology of primary tooth eruption
   2. Duration of the deleterious habit [ bottle feeding]
   3. A muscular pattern of infant sucking
7. STAGES
   1. Very mild: slight demineralization usually at the gingival crest and no cavitation.
   2. Mild: demineralization in a gingival third of tooth and moderate cavitation.
   3. Moderate: frank cavitation on multiple tooth surfaces.
   4. Severe: Widespread destruction of tooth and loss of the clinical crown 

MANAGEMENT 6M

1. Identify the cause and stop the habit
2. Give parental instruction on proper oral hygiene measures + diet counseling
3. Decide if the case can be managed in the clinic [ with regular LA or nitrous sedation ] or the child needs GA
4. If the case is treated in the clinic: full assessment of all affected teeth to know 
   1. which teeth can be restored
   2. which need pulp therapy
   3. which need extractions

First visit	Second visit	Third visit
Immediate excavation of caries followed by temporization Dietary chart Caries activity doneTopical fluoride application doneParent counselling	Examine diet chart Caries activity done again Replace any temporary restoration with permanent restoration	Pulpul procedures Extractions Space maintersRecall the pt every 3 months

What instructions would you give the parents to a child with ECC? 

1. STOP NIGHT TIME BOTTLE FEEDING / stop breastfeeding at will after the first tooth erupts
2. Feed the child while being held + burp the infant after feeding
3. Clean the teeth after each feeding [ wipe the teeth with a wet gauze]
4. regularly lift the upper lip to check for signs of demineralization of the upper Interiors
5. OH should start with the eruption of the first tooth – wipe the teeth with gauze and for ages 2- 6 brush with low fluoride tooth past [ 400-500 ppm] – parental supervision until the child can properly spit
6. Children are encouraged to drink from a cup as they become 1 year old
7. Avoid frequent snacking and have regular meals instead
8. First dental visit should be combined with immunization dates [ at or before 6 months]

Prevention of ECC ideally begins prenatally: 

1. give the mother information about diet and OH
2. treat the mother’s own oral diseases and lower MS count by mouth rinses and restorative care
3. educate the mother on modes of transmission of MS [ don’t lick spoons or pacifiers etc..]