Elsevier

Academic Pediatrics

Volume 9, Issue 6, November–December 2009, Pages 396-403
Academic Pediatrics

Science and Surveillance
Update on Early Childhood Caries Since the Surgeon General's Report

https://doi.org/10.1016/j.acap.2009.08.006Get rights and content

The 2000 Surgeon General's Report on Oral Health included a limited discussion of the condition known as early childhood caries. Because of its high prevalence, its impact on young children's quality of life and potential for increasing their risk of caries in the permanent dentition, early childhood caries is arguably one of the most serious and costly health conditions among young children.

A necessary first step in preventing dental caries in preschool children is understanding and evaluating the child's caries risk factors. Previous caries experience and white spot lesions should automatically classify a preschool child as high risk for caries. Microbial factors, such as presence of visible plaque and tests that identify a child as having high levels of mutans streptococci, also predict caries in young children. Frequency of sugar consumption, enamel developmental defects, social factors such as socioeconomic status, psychosocial factors, and being an ethnic minority also have shown to be relevant in determining caries risk.

On the basis of this knowledge of specific risk factors for an individual, different preventive strategies and different intensities of preventive therapies can be implemented. Caries preventive strategies in preschool children include fluoride therapy, such as supervised tooth brushing with a fluoridated dentifrice, systemic fluoride supplement to children who live in a nonfluoridated area and who are at risk for caries, and professional topical fluoride with fluoride varnish. There is emerging evidence that intensive patient counseling or motivational interviews with parents to change specific behaviors may reduce caries prevalence in their children. Findings regarding antimicrobial interventions, efforts to modify diets, and traditional dental health education are less consistent.

Section snippets

Epidemiology

Although ECC was known to be a significant problem in preschool populations at the time of the Surgeon General's Report on Oral Health (SGROH) in 2000, comprehensive understanding of its epidemiology has been limited as a result of lack of a case definition, complexity in accessing this age group for data collection, and difficulty in examining these young children. The first reports of caries prevalence in preschool populations in the United States were derived from convenience samples of Head

Previous Caries Experience

One of the best predictors of future caries is previous caries experience.24, 25 Children under the age of 5 with a history of dental caries should automatically be classified as being at high risk for future decay. However, the absence of caries is not a useful caries risk predictor for infants and toddlers because even if these children are at high risk, there may not have been enough time for carious lesion development. Because white spot lesions are precursors to cavitated lesions, they

Interventions to Reduce ECC

As we have seen, there has been an increase in our knowledge regarding the risk factors for ECC, but interventions to reduce the disease have been less successful. Clinical trials on infants and toddlers are challenging and difficult to accomplish for several reasons. Populations of young children at risk for dental caries are difficult to recruit because they are not enrolled in large numbers in institutional settings. Parents of young children, especially those in low socioeconomic settings,

Acknowledgments

Supported in part by NIH/NIDCR 1U54DE019275. Center for Research to Evaluate and Eliminate Dental Disparities. We acknowledge the assistance of Drs William Maas, Alan Douglass, and Joanna Douglass for suggestions and review.

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