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Early childhood caries — Clinical Guidelines

Overview

Early childhood caries (ECC) is a common and preventable infectious disease characterized by tooth decay in children under six years of age, significantly impacting oral health and potentially general well-being 1 4 11.

Diagnosis

Clinical examination for signs of decay, particularly in primary teeth 1.

Assessment of dietary habits and oral hygiene practices 1.

Periodic dental visits to monitor progression and intervene early 1.

Management

First-line treatments:

- Improved oral hygiene practices, including supervised tooth brushing 1. - Fluoride varnish applications and dietary counseling to reduce sugar intake 1 11.

Adjunctive treatments:

- Minimally invasive dentistry and restorative procedures under conscious sedation or general anesthesia 4 14 20. - Pharmacologic behavior management for children who do not cooperate with traditional care 15.

Special Populations

Pediatrics:

- Community-based interventions like the Children's Oral Health Initiative (COHI) show promise in reducing ECC in underserved populations 4. - Parental involvement and caregiver-targeted interventions are crucial for effective oral health outcomes 1.

Comorbidities:

- Maternal vitamin D deficiency is associated with higher rates of severe early childhood caries (S-ECC) in Alaska Native children 11.

Key Recommendations

Implement caregiver-targeted oral health interventions to improve both child and caregiver tooth brushing behaviors 1 (Evidence: Moderate).

Incorporate supervised tooth brushing and dietary counseling as primary preventive measures 1 11 (Evidence: Strong).

Utilize minimally invasive dental treatments under conscious sedation or general anesthesia for severe cases, considering cost-effectiveness analyses 14 20 (Evidence: Moderate).

Address socioeconomic factors and community-based approaches to enhance access to oral health services in disadvantaged populations 4 (Evidence: Moderate).

Monitor and manage maternal vitamin D levels, particularly in high-risk populations, to potentially reduce ECC incidence 11 (Evidence: Moderate).

References

1 Endrighi R, Henshaw M, Adams WG, Montion E, Park H, Borrelli B. The Longitudinal Reciprocal Relationships of Tooth Brushing Behaviors Between Underserved Children and Their Caregivers. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine 2024. link 2 Butcher MB, Haakenstad MK, Noonan CJ, Fyfe-Johnson AL. Identifying Challenges and Solutions to Early Childhood Education and the Perceived Importance of Outdoor Time: A Mixed Methods Approach in a Socioeconomically Diverse Population. International journal of environmental research and public health 2023. link 3 Zeanah PD, Steier A, Lim I, Korfmacher J, Zeanah CH. Current approaches and future directions for addressing ethics in infant and early childhood mental health. Infant mental health journal 2023. link 4 Schroth RJ, Kyoon-Achan G, McNally M, Edwards J, White P, Tait Neufeld H et al.. Children's Oral Health Initiative: workers' perspectives on its impact in First Nations communities. Health promotion and chronic disease prevention in Canada : research, policy and practice 2023. link 5 Wilson AR, Johnson RL, Albino J, Jiang L, Schmiege SJ, Brega AG. Parental Ethnic Identity and Its Influence on Children's Oral Health in American Indian Families. International journal of environmental research and public health 2021. link 6 Mukherjee SB, Agrawal D, Mishra D, Shastri D, Dalwai SH, Chattopadhyay N et al.. Indian Academy of Pediatrics Position Paper on Nurturing Care for Early Childhood Development. Indian pediatrics 2021. link 7 Gao Y, Zhang L, Kc A, Wang Y, Zou S, Chen C et al.. Housing environment and early childhood development in sub-Saharan Africa: A cross-sectional analysis. PLoS medicine 2021. link 8 Ponguta LA, Aragón CA, Varela LR, Moore K, Hein S, Cerezo A. Sector-wide analysis of early childhood development and education in emergencies in Colombia and considerations to strengthen systems globally. New directions for child and adolescent development 2020. link 9 Davis AE, Perry DF, Rabinovitz L. Expulsion prevention: Framework for the role of infant and early childhood mental health consultation in addressing implicit biases. Infant mental health journal 2020. link 10 Astudillo A D, Leppe Z J. [Program offer for the integral development of early childhood in Chile: Scoping review]. Revista chilena de pediatria 2020. link 11 Singleton R, Day G, Thomas T, Schroth R, Klejka J, Lenaker D et al.. Association of Maternal Vitamin D Deficiency with Early Childhood Caries. Journal of dental research 2019. link 12 Russell D, Gleason MM. Starting Early: Promoting Emotional and Behavioral Well-Being in Infant and Toddler Well-Child Care. Pediatric annals 2018. link 13 Sunyach C, Antonelli B, Tardieu S, Marcot M, Perrin J, Bretelle F. Environmental Health in Perinatal and Early Childhood: Awareness, Representation, Knowledge and Practice of Southern France Perinatal Health Professionals. International journal of environmental research and public health 2018. link 14 Burgette JM, Quiñonez RB. Cost-effectiveness of Treating Severe Childhood Caries under General Anesthesia versus Conscious Sedation. JDR clinical and translational research 2018. link 15 Meyer BD, Lee JY, Thikkurissy S, Casamassimo PS, Vann WF. An Algorithm-Based Approach for Behavior and Disease Management in Children. Pediatric dentistry 2018. link 16 Shroff S, Hughes C, Mobley C. Attitudes and preferences of parents about being present in the dental operatory. Pediatric dentistry 2015. link 17 Carvalho AA, Costa LR. Mothers' perceptions of their child's enrollment in a randomized clinical trial: poor understanding, vulnerability and contradictory feelings. BMC medical ethics 2013. link 18 Fuhrer CT, Weddell JA, Sanders BJ, Jones JE, Dean JA, Tomlin A. Effect on behavior of dental treatment rendered under conscious sedation and general anesthesia in pediatric patients. Pediatric dentistry 2009. link 19 Lin MC, Lai MS. Pediatricians' role in caring for preschool children in Taiwan under the national health insurance program. Journal of the Formosan Medical Association = Taiwan yi zhi 2009. link60416-2) 20 Milnes AR. Intravenous procedural sedation: an alternative to general anesthesia in the treatment of early childhood caries. Journal (Canadian Dental Association) 2003. link 21 Eidelman E, Faibis S, Peretz B. A comparison of restorations for children with early childhood caries treated under general anesthesia or conscious sedation. Pediatric dentistry 2000. link

Early childhood caries