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Early Childhood Caries (ECC)

• ECC is a common, bacterial, infectious disease.
• It involves several factors: primary and secondary factors.
• Primary factors include teeth (the host).
• Secondary factors include carbohydrates (substrates), saliva, bacteria, time, and oral hygiene practices.

S-ECC (Severe Early Childhood Caries)

• S-ECC is a severe form of ECC, affecting children under 3 years old.
• Indicators include one or more carious lesions before the age of 3 years
• Four or more lesions between the ages of 3 and 4 years.
• Five or more lesions between the ages of 4 and 5 years.
• Six or more lesions between ages 5 and 6 years.

Dental Caries

• Dental caries is a pathological condition characterized by a microbial infection that damages tooth enamel.
• Key factors contributing to caries formation include the presence of bacteria, carbohydrates (like sugar), and saliva.
• The duration and frequency of sugary intake considerably affect caries development.
• Saliva plays a crucial role in preventing caries by its buffering capacity and fluoride content
• Reduced salivary flow during sleep increases caries risk.

Dental Caries Risk Factors

• Malocclusion (the way teeth fit together)
• Developmental or structural defects in teeth
• Dietary habits
• Genetics
• Orthodontic appliances
• Personal susceptibility

Dental Plaque

• Plaque is a crucial factor in the development of caries.
• It's composed of millions of microorganisms, some of which produce acids.
• Plaque can thrive in acidic environments.
• Specific bacteria, such as mutans streptococci and lactobacilli, play significant roles in caries initiation and progression.
• Saliva's acidity drops below 5.5, triggering mineral loss in teeth (white spots).

Substrates (Sugars)

• Bacteria in the oral cavity use sugars for energy.
• Sucrose is a primary target for bacteria.
• Other sugars, including starch, also contribute to the process.

The Host (Tooth)

• Teeth serve as the host for oral bacteria.
• Caries typically initiates in the enamel but can also begin in the cementum or dentin.
• The enamel surface layer is more susceptible to caries at first.
• The deep layer progresses in a triangular shape towards the pulp.

Time

• While sugar is a necessary for caries initiation, the frequency of sugar consumption is more critical.
• The consumption of sugars leads to a decrease in saliva pH for approximately 20 minutes after meals.
• Repeated exposure to acidic saliva promotes enamel demineralization.

Clinical Examination of Children

• Explain to parents the importance of checking children's teeth early.
• Proper lighting is essential.
• Use appropriate tools (tongue depressors, probes).
• Check teeth positioning, shape, color, and any crowding.
• Exam the gums and tongue for any signs or irregularities

Early Childhood Caries Stages

• Initial Stage (reversible): White, chalky spots on tooth necks form (10-18 months)
• Carious Stage: The spots progress to brown/yellow, and reach the dentin (18-24 months).
• Deep Lesion Stage: The lesions extend to the pulp, causing pain/sensitivity, and possible tooth damage (24-36+ months)
• Pulp Involvement Stage: Lesion advancement towards the tooth pulp can cause decay and tooth damage.

Prevention Strategies for ECC

• Limit/regulate frequent/prolonged breastfeeding/bottle feeding at night.
• Encourage timely dental visits.
• Establish proper oral hygiene routines.
• Help parents with adequate information about the importance of oral health.
• Offer fluoride applications.

Additional Factors Affecting Caries

• Saliva characteristics (acidity, buffering capacity, fluoride, flow rate)
• Socioeconomic status
• Tooth characteristics in relation to caries (positioning, structure, enamel thickness)
• The presence of fillings/dental appliances
• Special needs children
• Psychological factors in children

Management of ECC

• Prevention of recurrence is better than cure.
• Preventing the risk factors which cause ECC is very important.
• Routine checkups/treatments are essential.
• Using fluoride applications.
• Restoring damaged teeth, and use of suitable dental materials (e.g., composite resin, crowns, etc.).
• Extraction where necessary.