Contents: Contents NURSING BOTTLE CARIES Introduction Definitions and terminologies Historical background Classification Clinical presentation Etiology and Risk factors Management Prevention EARLY CHILDHOOD CARIES Introduction Definitions and terminologies Historical background Classification Clinical presentation Etiology and Risk factors Management Prevention

Definitions and terminologies: Massler 1945 Rampant Caries is defined as “ suddenly appearing, wide spread, rapidly burrowing type of caries, resulting in early involvement of the pulp and affecting those teeth usually regarded as immune to ordinary decay” Definitions and terminologies

Winter (1966): Winter (1966) Defined rampant caries as “ caries of acute onset involving many or all of the teeth in the areas that are usually not susceptible ”. Further defined as caries being associated with rapid destruction of the crowns with frequent involvement of dental pulp. New lesions per year > 5 lesions /year (Winter) > 10 lesions / year (McDonald)

Kroll 1967: Kroll 1967 Also defined as “ syndrome characterized by a severe caries pattern beginning with the maxillary teeth in a healthy bottle fed infant or toddler” “Nursing Bottle caries”

Terminologies that came into being through the years: : Terminologies that came into being through the years: Nursing caries – Winter 1966 Nursing bottle mouth – Kroll 1967 Nursing bottle syndrome – Shelton 1977 Nursing bottle caries – Tsmtasorius 1987 Baby bottle tooth decay – Min kelly 1987

Milk bottle syndrome – Ripa 1988 Tooth cleaning neglect – Moss 1996 Infant and early childhood dental decay – Horowitz 1998 Early childhood caries – Davies 1998 MDSMD – maternally derived strept . mutans disease

Historical background: Historical background The clinical occurrence of this disease was described as early as the middle of the last century. Les dents noire de toute - petis : black teeth of the very young, Bettrami in the 1930s. First documentation in literature by Dr. Fass in 1967 as Nursing bottle mouth.

PowerPoint Presentation: Etiology of caries is multi factorial: established fact Most of these terms : considered misnomers

Rampant Caries: Rampant Caries

Classification: Classification Based on anatomic site: Crown Caries Root Caries Pit & Fissures Smooth Caries

Based on progression: Based on progression Arrested Caries Progressive Caries Rapidly Progressive Slowly Progressive Nursing Caries Radiating Caries

Based on the virginity of the lesion: Based on the virginity of the lesion Primary Caries Secondary Caries Based on the chronology Early Childhood Caries Adult Caries Adolescent Caries

Based on Type of Dentition : Based on Type of Dentition Caries in Primary Dentition Caries in Mixed Dentition Caries in Permanent Dentition Based on severity Incipient Occult Caries (Hidden Caries ) Cavitations

ETIOLOGY: ETIOLOGY Salivary Deficiency: A. Due to radiation therapy. B. In Stressed children who have tranquilizers C. Xerostomia D.Genetical

Habits:: Habits: Feeding of Child with sweetened Milk through the night. Sweetened Pacifiers Nursing of Child through the night.

Nutrition:: Nutrition: Nutritional deficiency Diet: In Between meal snacking of Cariogenic foods Sucrose Content in Diet. Psychological factors: Emotional disturbance Repressed Emotional fear. This cause decreased salivary flow.

Clinical appearance: Clinical appearance Pattern: Primary dentition: related to order of eruption with exception of mandibular primary incisors Mandibular Incisors: Most resistant

Initial lesion: : Initial lesion: Labial surface of maxillary incisors, close to gingival margins: Whitish area of decalcification/pitting of enamel surface

Type of Lesion or Nature: Type of Lesion or Nature Soft consistency; light yellow in color. Onset and progress : very rapid. Age : Seen at all ages. Including adolescence. Sex : Female > Male

Davies believed that rampant caries should be coined to condition where: : Davies believed that rampant caries should be coined to condition where: Lesion are more than ten in number. High caries experience for the child age. Sudden characteristic feature: New and recurrent carious lesion (10 Months – 6 Months time)

PowerPoint Presentation: Development of caries in otherwise caries immune surface. Extensive loss of tooth structure particularly dentin even though enamel shows little defect. Soft, musty, ivory colored dentinal consistency indicating rapid progression of the lesion.

Sequelae of Rampant Caries: Sequelae of Rampant Caries Pain Infection Tongue Thrusting Abnormal Swallowing habits. Speech difficulties

Rampant caries in deciduous dentition: Rampant caries in deciduous dentition TYPES: Rapid Destruction of erupted teeth related to order of tooth eruption. Most common site: Upper deciduous incisors and decidious molars. Individual lesion show decalcification over wide area. Striking feature : Seen in Groups of bottle feeders and also where Resistance of child is low.

Rampant Caries in adults:: Rampant Caries in adults: Rare in Adults Sudden onset after adolescence show that some major alternation has occurred in patient’s oral environment or diet.

Treatment: Treatment THE TYPE OF TREATMENT DEPEND ON : Patient’s and parent’s motivation toward dental treatment. The extent of the decay. The age Co-operation of the child

Initial treatment includes : Initial treatment includes A)Provisional restorations B)Diet assessment C)Oral hygiene instructions D)Home and professional fluoride treatment

A) Provisional Restorations: A) Provisional Restorations Caries stabilization with gross excavation of each carious lesion Provisional restorations should be placed in symptom free teeth with established dentinal caries Minimize the risk of pulpal exposure in future Improve function.

PowerPoint Presentation: However, Patients c acute and severe signs and symptoms of caries Require immediate treatment. If the pulp is still vital : Formocresol pulpotomy Pulp is non-vital : Pulpectomy

B) Diet assessment:: B) Diet assessment: Parents should be educated to reduce the frequency of sucrose consumption by their child, especially, between meals. Consumption of sugar containing foods and beverages should be restricted to meal times.

PowerPoint Presentation: In infants : Bottle feeding habit should be stopped by gradually decreasing bottle contents with water as well as decreasing amount of added sugar over a 2-3 weeks period. Dietary vitamin supplements as well as oral medications must also be included.

C) Oral hygiene instructions: C) Oral hygiene instructions 3 to 5 years olds: Under the age of 8 years: circular scrub technique Eg . Fones technique After 11-12 years : A circular brushing technique Eg . Bass technique Explain the proper brushing technique to the patients by demonstrating the procedure with articulated models of dental arches and brush

D) Fluoride treatment : D) Fluoride treatment Both systemic and topical fluoride treatments are useful for preventing dental caries. The choice depends on the level of fluoride in the drinking water and the stage of development of the dentition.

Recommended fluoride supplement dosage schedule: Recommended fluoride supplement dosage schedule Fluoride level in water concentration (PPM) AGE(YEAR) 0.3 0.3-0.7 . 0.7 0-2 0.25 0.00 0.00 2-3 0.50 0.25 0.00 3-16 1.00 0.50 0.00

Methods of fluoride treatment and other methods for prevention of rampant caries in different age group: Methods of fluoride treatment and other methods for prevention of rampant caries in different age group Primary dentition : 0-5 Years Dietary Advice : Dietary Counseling with parents on good nursing techniques Fluoride Therapy : Tooth Paste Tablets if in area without water fluoridation Professional topical fluoride application every 6 months

PowerPoint Presentation: Plaque Control: Oral hygiene instructions to parents Tooth brushing with parental supervision. ( B) Mixed dentition : 5-12 Years Dietary Advice : Dietary Counseling with parents and patients

PowerPoint Presentation: 1. Fluoride Therapy : Tooth Paste Tablets up to 8 years if in area without water fluoridation. Mouth rinse. 2. Plaque Control: Oral hygiene instructions to parents Tooth brushing with parental supervision. Disclosing Tablets Fissures Sealants (3-6 Months recall)

Permanent dentition : 12 years onwards: Permanent dentition : 12 years onwards 1)Fluoride therapy: Tooth paste Mouth rinse Professional fluoride application every 6 months 2)Plaque control: Oral prophylaxis Oral hygeine instructions Tooth brushing Disclosing tablets Interdental Cleaning with floss or tooth picks.

Comprehensive restorative treatment : Comprehensive restorative treatment Restorative strategies for rampant caries are: 1)Early caries with minimal loss of enamel: Weekly professional applied topical fluoride therapy 2)Extensive cavitation with no pulpal involvement: Anterior teeth Acid- etched composite resin restorations Pedo - strip crowns Glass-ionomer cement restorations

PowerPoint Presentation: Posterior teeth Posterior composite cement restorations Glass-ionomer cement restorations Stainless steel crowns 3)Extensive cavitation with pulpal involvement Pulpotomy or pulpectomy , where appropriate, followed by permanent restoration Extraction followed by space maintainer or partial complete dentures

Early Childhood caries: Early Childhood caries

Definition: Defined 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. (AAPD 2003)

Defined as an occurrence of any sign of dental caries on the tooth surface during first 3 years of life. (Ismail 1998)

"Severe Early Childhood Caries" refers to "atypical" or "progressive" or "acute" or "rampant" patterns of dental caries.

INTRODUCTION: Dental caries is caused by an interaction between acidogenic bacteria, a carbohydrate substrate which is frequently sucrose, and host susceptibility. The acidogenic and acid-tolerant bacterial species Streptococcus mutans is recognized to be the primary pathogen in early childhood caries .

2) S.mutans is detected in caries-free populations but is not detected in all cases of childhood caries, suggesting that other species may be cariogenic pathogens.

PowerPoint Presentation: ECC is a particularly virulent type of dental caries characterized by overwhelming infectious challenge and is associated with unusual dietary practices.

Advanced forms of this disease, Severe ECC can destroy the primary dentition and is the major reason for hospital visits for young children and also disproportionately affects disadvantaged ethnic and socioeconomic groups and can affect over 50% of the children in these groups.

Culture studies have demonstrated a strong association of S.mutans with severe ECC and also reported significant associations with S.parasanguinis, S.salivarius, Lactobacillus casei, Actinomyces viscosus

Wyne H(1999) proposed a classification of each type of ECC including a common clinical picture, probable etiology and range of age affected.

PowerPoint Presentation: TYPE I- Mild to moderate ECC Isolated lesions involving molars and incisors

Cause is a combination of cariogenic semisolid food and poor oral hygiene

Found commonly in 2 -5 years.

TYPE II- Moderate to severe ECC Labio lingual carious lesions involving maxillary incisors, with/with out molar involvement Etiology is feeding bottle or at-will breast feeding and poor oral hygiene Occurs after eruption of 1 st tooth

PowerPoint Presentation: TYPE III- Severe ECC Affects all teeth including mandibular incisors Implicated cause is a combination of cariogenic diet and poor oral hygiene Rapidly progressing condition Involves the surfaces that are usually considered caries resistant

PowerPoint Presentation: * S-ECC : specific term :atypical, progressive, acute or rampant. (Brodeur, Galarneau 2006) S-ECC is considered as an incidence of ECC under specific conditions. ( Gangon 1984)

PowerPoint Presentation: Tanner AC , Mathney JM , Kent RL , Chalmers NI , Hughes CV , Loo CY , Pradhan N , Kanasi E , Hwang J , Dahlan MA , Papadopolou E , Dewhirst FE (2011) conducted a study to evaluate the Cultivable Anaerobic Microbiota of severe early childhood caries and have detected significant association of S.mutans, L.casei and Actinomyces species along with other range of microbiota.

PowerPoint Presentation: Becker MR , Paster BJ , Leys EJ , Moeschberger ML , Kenyon SG , Galvin JL , Boches SK , Dewhirst FE , Griffen AL (2002) conducted Molecular analysis of bacterial species associated with childhood caries and confirmed the high levels and caries association of S.mutans, S.salivarius and S.parasanguinis by checkerboard and clonal analysis. 4

Clinical Features: Clinical Features Harris and Garcia Godoy (1999) classified ECC according to its clinical picture of the stages of development This was initially given by Veerkamp (1995) as the ‘Developmental perspective of Nursing bottle caries’.

STAGE I- Very mild or Initial stage : STAGE I- Very mild or Initial stage Appearance of chalky opaque deminerization lesions on smooth surfaces Between 10-20 months of age Distinctive white line can be distinguished Lesions are reversible at this stage But frequently go unrecognized by the parent

Stage II- mild : Stage II- mild Shows deminerization in gingival third of the tooth and moderate cavitation Dentin gets involved when the rapid development causes the enamel to collapse Exposed dentin appears soft and yellow Child is 16-24 months of age He complains of sensitivity to temp change

Stage III- moderate : Stage III- moderate Frank cavitation of multiple tooth surfaces is seen With large deep lesions on max incisors and pulpal irritation Age group affected is 20-36 months History of spontaneous pain Frequent cases of pulpal involvement

Stage IV- severe : Stage IV- severe Clinically widespread destruction of the tooth and partial to complete loss of clinical crown Characterized by coronal fracture of anterior maxillaries due to amelodentinal destruction Maxillary incisors are usually necrotized Occurs between 30-48 months Child experiences severe pain and discomfort

Differences: Differences Rampant caries -seen in all ages -primary & permanent dentition -involves least prone surfaces -rapid appearance -long term and extensive treatment required Nursing caries -seen in infants and toddlers -primary teeth involved -specific pattern of attack -Improper feeding habits -early detection- prevention -maintenance till transition

Which tooth is hit the hardest??: Which tooth is hit the hardest?? Maxillary incisors First primary molars Due to their early eruption and vulnerable position Canines and second primary molars Very seldom due to their late eruption Mandibular incisors - Spared due to protection by tongue and salivary secretions Their involvement indicates the improper use of pacifiers or a case of rampant caries

Etiology and Risk factors : Etiology and Risk factors The pattern of decay and attack on the tooth depends on: Timing of tooth eruption Time span between frequency of substrate intake Type of muscle movement the child makes while sucking The etiology is the interaction of the following variables Pathogenic microorganisms in the mouth Fermentable carbohydrates Susceptible host

Micro flora: Micro flora Acquisition: microflora begins at birth. The mother : important role in transmitting bacteria

PowerPoint Presentation: Berkowitz, Turner and Green (1981) performed an experiment to show that mouth to mouth transmission takes place between mothers and their children. The infant shows the acquisition of a genotype of S. mutans identical to that of the mother’s. Caufield and Walker (1989)

PowerPoint Presentation: Most intimate contact (sharing utensils, kissing, etc.,.) Tasting and blowing on child’s food before feeding Spends the most time with the child

PowerPoint Presentation: Maternal child ’s saliva transmission of cariogenic micro flora even before the eruption of teeth The concentration of S. mutans ranges from 30% to 50% of the total cultivable plaque flora in children with ECC Heavy infection by S. mutans of more than one clonal type reflects high frequency of sugar consumption. ( Alabusa et al 1996 )

Substrate: Substrate From birth until 6 months of age, the child receives nutrition from mother Lactose Though it is a sugar it is least cariogenic and does not cause dental caries under normal circumstances At-will breast feeding, i.e. increased frequency of sugar consumption as and when desired, results in initiation of dental caries

PowerPoint Presentation: Bottle feeding follows breast feeding. Caries promoting sugars contained in fruit juices and infant formula preparations are metabolized by the acidogenic bacteria thus resulting in demineralization of enamel This use of nursing bottles and sippy cups enhance the frequency of exposure

Mother’s milk vs. Bovine milk: Mother’s milk vs. Bovine milk

Mother’s milk has various advantages: : Mother’s milk has various advantages: the suction movements required for extracting milk provide optimal development for the maxillary teeth , thus ensuring sufficient space for each tooth and hence no overlapping. the infant is in the capacity to control the milk outflow, i.e. the flow of milk is at-will.

PowerPoint Presentation: The constituents include: Lactose content Lactoalbumin Vit C and vit D Colostrum

PowerPoint Presentation: The facts in favor of bovine milk are: Concentration of calcium and phosphorus : contribute to remineralization of tooth. It’s additional constituents include: - proteins like casein

PowerPoint Presentation: There is a wide range of food items readily found in the child’s diet whose inherent acidity contributes directly to demineralization, whether or not, they contain sugars 100% fruit juices are acid and allow demineralization when drunk over long periods of time ( Mcintosh et al 1991)

: Thus, the initiation of caries is precipitated by the way a child is fed, and particularly by what it is in the bottle and when it’s given.

Feeding habits: Feeding habits This type and nature of feeding behavior during sleep intensifies the risk of caries This is so, because oral clearance and salivary flow rate are decreased during sleep In this regard, it was reported that the nocturnal clearance of glucose is the slowest on the labial surfaces of maxillary incisors and buccal surfaces of mandibular molars. ( Hanaki et al 1993)

Host factors: Host factors Salivary factors: A lot depends on the flow rate of saliva, such as, the oral clearance, buffering action and antimicrobial action. Immunological factors: S- IgA is related to actions against S. mutans and found in high concentration in breast milk Less incidence of ECC is seen in children who suck breast milk containing antibodies to S. mutans ( Michalek et el 1987)

Tooth maturation: Tooth maturation Newly erupted enamel surface undergoes the final stages of post eruptive maturation and hardening with the incorporation of flouride ions. ( Fejerskow & Clarkson 1966) Developmental defects of enamel - May be manifested as partial or total loss of enamel ( hypoplasia )/change in translucency (opacity) - The resultant surface irregularities predispose to plaque retention and decreased clearance of carbohydrates

Risk factors: Risk factors Pacifiers and comforters dipped in honey or other sweeteners Behavioral factors Kiwanuka 2004 Medication sweetened pediatric syrups- iron syrup, cough syrup, mild sedatives

Pacifiers : Pacifiers The United States Consumer Products Safety Commission enumerates the following requirements of a pacifier: Should be of sturdy , one piece construction of material that is non toxic, flexible and firm, but not brittleeasily graspable handles. have inseparable nipples and mouthgaurds . have mouthguards of adequate diameter to prevent aspiration

PowerPoint Presentation: Socioeconomic status Sayegh et al 2005 Al haani , Rugg -Gunn 1998 Race and ethnicity Pollick 2003- Native Americans ethnic minorities immigrant populations Oral hygiene Sayegh et al 2005

PowerPoint Presentation: Dental awareness Szatko 2004 Habibian et al 2001 Febres 1997 Environmental insults Lead poisoning Genetics Slavakin 1997

Diagnosis : Diagnosis Like every other disease, early diagnosis increases the chances of adequate disease control and reverting back to normal condition. The catch lies in the fact that clinically, it is difficult to detect the initial lesion, as it is visible only when the tooth thoroughly dry. A positive diagnosis is established on the basis of questions to parents regarding :

PowerPoint Presentation: maternal history feeding habits, exposure to risk factors and clinical endo -oral examination, completed by radiographs. Differential diagnosis is based on observation of hereditary tooth structure anomalies, such as: - Infantile melanodontia - Amelogenesis imperfecta

Treatment : Treatment Before the onset of any treatment, it is mandatory to individually review every child under the following parameters, to assess a fitting treatment plan: Child factors: - Age - Chief complaint - Behavior type - Physical and mental health Parent factors: Co-operation Socioeconomic status

PowerPoint Presentation: Based on these parameters the following modalities can be selected: Treatment under General Anesthesia Too young to comprehend the instructions Mentally/physically challenged Moderate/high socioeconomic status Multiple quadrant/teeth requiring invasive treatment

Treatment under Quadrant dentistry : Treatment under Quadrant dentistry Age and mental/physical health allow understanding of procedure Parent cooperation for multiple appointment Multiple teeth involved In this situation 2 options can be followed:

PowerPoint Presentation: First, where the chief complaint is dealt with first Severely debilitating condition of child due to that tooth Cooperative age group Previous experience of dental treatment Secondly, where minor treatment is started first First dental visit Cooperative but apprehensive child

Allows development of trust between child and dentist Sequence should be, GIC or Composite fillings followed by endodontic management and finally exodontia .

PowerPoint Presentation: The treatment of ECC is usually restricted to surgical removal or restoration of carious teeth coupled with recommendations regarding feeding habits. Following is a treatment protocol for ECC: -Incipient or white spot lesions - topical flouride and observation - fissure sealant application

PowerPoint Presentation: Carious lesions in enamel and dentin preventive resin restoration glass inomer filling composite restoration stainless steel crown Carious lesion with pulp involvement pulp therapy with full coverage coronal restoration exodontia with space management

Recall of the patient : Recall of the patient When the restorative and all the other measures are completed the patient is recalled in 3 months. During the first recall session a thorough follow up examination and radiographs are made. Salivary specimen testing is done. Topical fluoride therapy is again given. Oral hygiene is evaluated and instructions given. Counseling is given, if necessary, altered and given.

PowerPoint Presentation: Patients diet and dietary habits are evaluated, and corrections done if required. Subsequent recall is made at 3 monthly intervals until it is apparent that longer intervals are necessary.

PowerPoint Presentation: Prevention is better than cure or Where there is prevention there is no need for cure

INTEGRATED MODEL FOR PREVENTION OF ECC: INTEGRATED MODEL FOR PREVENTION OF ECC

Infant oral health: Infant oral health It is the professional intervention within 6 months after the eruption of the first primary tooth with history taking directed to pre and post natal factors affecting the oral cavity and counseling about oral diseases risk and providing anticipatory guidance.

Oral Hygiene Measures: Oral Hygiene Measures Prior to tooth eruption, the gum pads should be meticulously cleaned using a gauze piece wrapped around the index figure Care should be taken to clean the dorsal surface of the tongue This should be done 3 times a day

PowerPoint Presentation: After the eruption of the tooth, the parent should be instructed to start the use of a tooth brush Fluoridated dentifrice can be incorporated A position of control is used, where the child can be stabilized between the caregiver’s legs Between the ages of 18-24 the child is encouraged to brush his own teeth under adult supervision

Fluoride therapy: Fluoride therapy Topical - tooth paste - up to 2yrs – rice grain size - up to 5yrs – pea grain size (under parental supervision) - professional application Systemic - water fluoridation - salt fluoridation

PowerPoint Presentation: . WATER F LEVEL Caries-free Active caries Rampant caries Deficient ( < 0.7ppm) Apply topical 2x per year Apply topical 2x per year Apply topical 4x per year Optimal 0 Apply topical 2x per year Apply topical 4x per year

Recommended fluoride supplemental Dosage schedule: Recommended fluoride supplemental Dosage schedule AGE(YEAR) 0.3 0.3-0.7 . 0.7 0-2 0.25 0.00 0.00 2-3 0.50 0.25 0.00 3-16 1.00 0.50 0.00

Feeding recommendations: Feeding recommendations Breast feed the child even on demand during the first six months of life. If the child is bottle fed , it should be in the caregivers arms and then put to bed once he falls asleep without a bottle or a sweetened pacifier. At all other times the child should be given water to drink without added sugar.

PowerPoint Presentation: The use of fruit juices should be limited . Additional fruit juice consumption fosters decalcification by erosion. When the child reaches six months of age he should be encouraged to drink out of a training cup.

PowerPoint Presentation: At the age of one the child should stop using the bottle and drink only out of the training cup. Faster swallowing reduces the contact period with the liquid. Do not give teething biscuits. They provide no real benefit and are a food of choice for bacteria.

Weaning : Weaning It is essentially, the expansion of diet It is integral part of nutritional development in infancy Defined as “ the process of expanding the diet to include food and drinks other than breast milk or infant formula” Forms a part of social development, bringing the young child towards eating practices and meal patterns within the family (Holt 1966)

PowerPoint Presentation: Timing : -no earlier than 4 months and no later than 6 month of age The eruption of primary dentition usually starts during or after the establishment of weaning Thus weaning may directly of indirectly affect the onset of dental caries

PowerPoint Presentation: Stages of Weaning Initial stage (4-6 months) - solid /semi-solid food preparations prepared at home. - food free of added sugars - should be given using a spoon not mixed with milk or other drinks in a bottle

PowerPoint Presentation: Second and Third stages ( 6-9 months 9-12 months) - during the second stage solid foods become important source of energy and nutrition - third stage marks progression to a more mature diet of 3 meals with the addition of snacks and drinks

PowerPoint Presentation: Johnson (1997) proposed the concept of gradual dilution of the liquid in the bottle at the time of weaning 1 st week – 1/3 rd of the bottle containing water 2 nd week – 2/3 rd of the bottle containing water 3 rd week – only water in the bottle This allowed the parents to prevent sleep-time bottle feeding with potentially cariogenic liquids

Foods that do not harm: Foods that do not harm It is important to know that food is composed of proteins and fats cannot be used by bacteria to produce acid, namely, meat , fish and eggs They tend to increase pH levels and neutralize the acid that may have been produced, e.g. nuts and seeds They stimulate saliva and it easily neutralizes the acid produced, e.g. raw or uncooked vegetables. Milk prevents dissolution of enamel by providing calcium and phosphate ions.

Maternal intervention: Maternal intervention Xylitol – Soderling E. et al (2001) conducted a thorough research on the effect of xylitol consumption by 169 young mothers and compared their pre- consumption and post- consumption mutans strept . levels. The child’s mouth was assessed for no. of colonies at 2 and a half years and it was seen to be 9.7% as compared to the 48.5% (fluoride group) and

28.6% ( chlorhexidine group). It was also established that the effect of xylitol was greater than fluoride varnish and chlorhexidine mouth wash.

Role of Pediatrician & other health personnel: Role of Pediatrician & other health personnel Once the pediatrician has been adequately equipped with relevant information and clinical knowledge about early childhood caries, he can prove to be vital tool in the early diagnosis. As the child’s first visit to the professional caregiver would, by default, be in order to get vaccinations. Providing golden opportunity to examine the child and appropriately refer for necessary dental care

References : References Souad Msefer , Importance of early diagnosis of ECC, JODQ, 2006. Brodeur JM, Galarneau C. The High Incidence of Early Childhood Caries in Kindergarten age Children. Available from URL: http:// www.odq.qc.ca /portals/5/ fichiers_public / supplement_carie.pdf (accessed on 21 August 2012 ) 3.Berkowitz, Turner and Green; Maternal salivary levels of S.mutans and primary oral infection of infants; Arch Oral Biol;26;147;1981 4. Julien ; Dietary recommendations for healthy teeth in children, JODQ- suppl , 2006 5. Berkowitz RJ . Causes, treatment and prevention of early childhood caries: a microbiologic perspective. J Can Dent Assoc 2003; 69: 304–07.

PowerPoint Presentation: 6. Tanner AC , Mathney JM , Kent RL , Chalmers NI , Hughes CV , Loo CY , Pradhan N , Kanasi E , Hwang J , Dahlan MA , Papadopolou E , Dewhirst FE . Cultivable anaerobic microbiota of severe early childhood caries. J Clin Microbiol . 2011; 49: 1464-74. 7. Becker MR , Paster BJ , Leys EJ , Moeschberger ML , Kenyon SG , Galvin JL , Boches SK , Dewhirst FE , Griffen AL . Molecular Analysis of Bacterial Species Associated with Childhood Caries. J Clin Microbiol . 2002; 40: 1001-09. 8. Marwah N. Textbook of pediatric dentistry. 2 nd edn . New Delhi: Jaypee brothers medical publishers(p) ltd; 2009. p.10,39 . 9. Pinkham; Pediatric dentistry infancy through adolescence; 4th ed.2005 10. Kandelman , Outaik ; Prevention of early childhood caries; JODQ- suppl 2006

PowerPoint Presentation: 11.Soben Peter; Essentials of Preventive and Community Dentistry; 2nd ed. 12.Soderling. Influence of maternal xylitol consumption on acquisition of mutans strep by infants; J Dent Res 2001.

THANK YOU: THANK YOU

Classification of Early Childhood caries: Classification of Early Childhood caries A clinical interpretation: 1 st type – 1 or 2 carious lesions involving maxillary incisors and/or molars 2 nd type – lesions involving maxillary incisors, with or without molar caries and unaffected mandibular incisors 3 rd type – lesions involving almost all teeth

PowerPoint Presentation: Defined as a unique form of rampant decay of primary teeth which may appear as early as 9 months of age. ( Kotlow 1977)

(Davies 1998) : (Davies 1998) Defined as a complex disease involving maxillary primary incisors within a month after eruption and spreading rapidly to other primary teeth. Coined the term Childhood caries.

PowerPoint Presentation: Defined as the presence of one or more decayed (non-cavitated or cavitated) lesions that can develop extremely quickly and lead to widespread and sometimes, painful deterioration of primary dentition. (AAPD 2004, Drury 1999, Kaste 1999)

PowerPoint Presentation: Defined as the presence of any decayed, missing or filled teeth in the dentition of children under 6 years of age. ( Schroth 2005, Drury 1999) and Severe-ECC is defined as any smooth surface caries in children under 3 years of age. ( Hardison 2003)

Dental home: Dental home Prevention of dental diseases is possible if recognized at an early stage. Thus, it is necessary to have a place which provides early intervention and appropriate health care facilities. Such an establishment is known as a Dental home

PowerPoint Presentation: It should provide the following services Schedule early dental visits at 12 -18 months of age. Assess the risk of the infant for future dental diseases. Evaluate the fluoride status of the infant and make appropriate recommendations. Demonstrate appropriate method of cleaning teeth.

PowerPoint Presentation: Discuss advantages / disadvantages of non nutritive sucking. Be prepared to treat ECC if diagnosed or make appropriate referral. Be available 24 hours a day -7 days a week to deal with acute conditions. Be able to recognize the need for specialty consultation and referrals.

Anticipatory guidance: Anticipatory guidance It is the proactive counseling of parents and patients about developmental changes that will occur in the interval between health supervision visits that include information about daily caretaking specific to upcoming interval. Nowak (1995) defined it as a proactive developmentally based counseling technique that focuses on the needs of a child at each stage of life.

Conclusion : Conclusion The magnitude of effect of Early childhood caries is overwhelming It’s effect extends beyond the realms of the oral cavity It adversely affects the orthodontic and esthetic development of the child , thereby stunting his psychological growth Physically the child’s growth is equally curtailed, where an ECC affected child is shorter and malnutrition