Case definition, aetiology and risk assessment of early childhood caries (ECC): a revisited review

Examining the Efficacy of 38% Silver Diamine Fluoride in Halting Active Dental Caries Lesions Among Children: A Descriptive Study

BACKGROUND/OBJECTIVES

Dental caries, a prevalent issue among children, often leads to discomfort and potential complications. Utilizing caries-arresting treatments to slow down its progression offers a practical alternative. Previous research indicates that topical fluorides can deactivate and remineralize enamel caries. This study aims to evaluate the efficacy of 38% silver diamine fluoride (SDF) in halting active dental caries lesions in children.

MATERIALS AND METHODS

This descriptive case series was conducted at the Operative Dentistry Department of the Nishtar Institute of Dentistry in Multan, Pakistan. We enrolled 753 patients aged three to nine years, of both genders, each with at least one cavitated lesion graded 3-6 according to the International Caries Detection and Assessment System (ICDAS). SDF was directly applied to dried and isolated teeth using a micro brush and left to absorb for up to two minutes (adjusted based on the child's cooperation), and parents were instructed to ensure the child refrained from eating or drinking for an hour post-application. Baseline examinations were performed by consultant restorative dentists, and reexaminations were conducted after two to three weeks by a consultant unaware of the study.

RESULTS

The study included children aged three to nine years, with a mean age of 6.02±1.35 years. The majority of patients (61.75%) were aged between three and six years. Among the 753 patients, 619 (82.20%) were male, and 134 (17.80%) were female, with a male-to-female ratio of 4.6:1. The efficacy of 38% SDF in arresting active dental caries lesions in children was observed in 720 (95.62%) patients.

CONCLUSION

This study demonstrates that 38% SDF is highly effective in halting active dental caries lesions in children.

Association between Serum Iron, Serum Ferritin Levels, and Severe Early Childhood Caries: A Case-Control Study

Aim

The presence of extensive dental caries leads to pain, inflammation, and discomfort and hence interferes with their nutritional intake, which includes iron deficiency anemia. This study was undertaken to determine whether any correlation exists between severe early childhood caries (S-ECC), serum iron, and serum ferritin levels in children.

Materials and methods

A total of 688 children were examined in the age-group of 2-6 years, and 82 children who fulfilled the selection criteria were equally divided into group I, that is, case group (carious group n = 41) and group II, that is, control group (caries-free group n = 41), on the basis of decayed, missing, and filled primary teeth (dmft) scores. All the selected children in both groups underwent blood investigations through phlebotomy for assessment of serum iron and serum ferritin levels.

Results

The mean values of variables, that is, hemoglobin (Hb), serum iron, serum ferritin, total iron-binding capacity (TIBC), and unsaturated iron-binding capacity (UIBC), are lower in the case group when compared to control group. The differences observed were statistically significant in case of dmft and UIBC values at p < 0.05 but not significant in cases of other variables like Hb, serum iron, serum ferritin, and TIBC values.

Conclusion

An inverse relationship was found between S-ECC, serum iron, and serum ferritin levels, but the evidence is still inconclusive.

How to cite this article

Atri Y, Garg N, Pathivada L, et al. Association between Serum Iron, Serum Ferritin Levels, and Severe Early Childhood Caries: A Case-Control Study. Int J Clin Pediatr Dent 2023;16(S-3):S288-S292.

Early Childhood Caries and Oral Health-Related Quality of Life: Evaluation of the Effectiveness of Single-Session Therapy Under General Anesthesia

OBJECTIVE

  The aim of this study is to evaluate whether the treatment of ECC, performed in a single-session dental treatment under general anesthesia, can affect the quality of life of pediatric patients. It was assessed whether risks and discomforts involved in SSGA are outweighed by its effectiveness and reliability in improving oral health-related quality of life.

MATERIALS AND METHODS

 The quality of life that was assessed in this prospective study was oral health-related quality of life (OHRQL). Pediatric patients aged between 3 and 6 years with ECC undergoing dental treatment in SSGA were asked to fill in the Early Childhood Oral Health Impact Scale (ECOHIS) form both before and 1 month after the intervention. The data obtained were then statistically elaborated and analyzed to evaluate the actual significance of the differences found between the values before and after treatment and between the two sexes.

RESULTS

 Mean ECOHIS score before treatment was 30.58, following a large decrease after treatment, with a mean score of 2.94. Most parameters show a significant improvement between pre- and post-SSGA treatments, mainly those related to oral-dental pain, daytime irritability, and impact on family environment. Average ECOHIS scores for males and females are 31.72 and 29.76 before treatment and 3.55 and 2.52 1 month after treatment, respectively, showing no statistically significant differences.

CONCLUSION

 The dental treatment of young children under SSGA is associated with considerable improvement in their OHRQL. It can be considered an effective and reliable way of managing cases that cannot be dealt with by alternative methods.

Nomogram prediction of caries risk among schoolchildren age 7 years based on a cohort study in Shanghai

Objective

Caries risk assessment tools are essential for identifying and providing treatment for individuals at high risk of developing caries. We aimed to develop a nomogram for the assessment and evaluation of caries risk among Chinese children.

Methods

We enrolled schoolchildren age 7 years from a primary school in Shanghai. Baseline information of participants was collected using a questionnaire completed by children’s caregivers. A nomogram of a novel prediction scoring model was established based on predictors detected in univariate and multivariate analyses. Predictive accuracy and discriminative ability of the nomogram were calculated using the concordance index (C index). The bootstrap method (1000 samples) was used to decrease overfitting. The net benefit of the model was validated using decision curve analysis.

Results

Overall, 406 children with complete information and two completed dental examinations were included in the final analysis. The nomogram based on logistic regression model coefficients demonstrated a C index of 0.766 (95% confidence interval: 0.761–0.771) for caries risk. The net benefit of the decision curve analysis was 38.6% at 55% threshold probability.

Conclusion

This nomogram model, derived using dietary habits, oral hygiene status, and caries experience, showed promising predictive ability to assess the caries risk among Chinese children.

Interventions Targeting Bottle and Formula Feeding in the Prevention and Treatment of Early Childhood Caries, Overweight and Obesity: An Integrative Review

Overweight, obesity and early childhood caries (ECC) are preventable conditions affecting infants and young children, with increased prevalence in those formula-fed. Previous research has focused on distinct outcomes for oral health and healthy weight gain. However, the aetiology may be linked through overlapping obesogenic and cariogenic feeding behaviours, such as increased sugar exposure through bottle propping and overfeeding. Best-practice bottle feeding and transition to cup use may concurrently reduce overweight, obesity and ECC. This integrative review aimed to identify interventions supporting best-practice formula feeding or bottle cessation and examine the intervention effects on feeding, oral health and weight outcomes. The reviewers searched nine databases and found 27 studies that met the predetermined inclusion criteria. Eighteen studies focused on populations vulnerable to ECC or unhealthy weight gain. All studies focused on carer education; however, only 10 studies utilised behaviour change techniques or theories addressing antecedents to obesogenic or cariogenic behaviours. The outcomes varied: 16 studies reported mixed outcomes, and eight reported worsened post-intervention outcomes. While some studies reported improvements, these were not maintained long-term. Many study designs were at risk of bias. Effective intervention strategies for preventing ECC and child obesity require the holistic use of interdisciplinary approaches, consumer co-design and the use of behavioural change theory.

Replication of GWAS significant loci in a sub-Saharan African Cohort with early childhood caries: a pilot study

BACKGROUND

Early childhood caries (ECC) is a rapidly progressing form of dental infection and a significant public health problem, especially among socially and economically disadvantaged populations. This study aimed to assess the risk factors for ECC among a cohort of Sub-Saharan African children and to determine the role of genetics in the etiology of ECC.

METHODS

A sample of 691 children (338 with ECC, 353 without ECC, age < 6 years) was recruited from schools in Lagos, Nigeria. Socio-demographic, dental services utilization and infant dietary data were obtained with interviewer-administered questionnaire. Oral examination was conducted using the WHO oral health diagnostic criteria. Saliva samples were collected from the children for genetic analysis. Single nucleotide polymorphisms were selected from previous study for genotyping. Genetic association analyses to investigate the role of genetics in the etiology of ECC was done. Bivariate comparisons and Multivariate logistic regression analyses were conducted to assess associations between ECC and predictor variables, p < 0.05.

RESULTS

Of the 338 children with ECC, 64 (18.9%) had Severe-Early Childhood Caries (S-ECC). Children aged 48-59 months comprised the highest proportion of subjects with ECC (165; 48.8%) and S-ECC (24; 37.5%) while female subjects had higher dt (3.13 ± 2.56) and dmft values 3.27 ± 2.64. ECC was significantly more prevalent among children who were breastfed at night ≥ 12 months (OR 3.30; CI 0.39, 4.75), those with no previous dental visit (OR 1.71; CI 0.24, 2.77), those who used sweetened pacifiers (OR 1.85; CI 0.91, 3.79) and those who daily consumed sugar-sweetened drinks/snacks (OR 1.35; CI 0.09, 18.51). A suggestive increased risk for ECC (OR 1.26, p = 0. 0.0397) was observed for the genetic variant rs11239282 on chromosome 10. We also observed a suggestive reduced risk for ECC (OR 0.80, p = 0.03) for the rs131777 on chromosome 22. None of the genetic variants were significant after correction for multiple testing (Bonferroni p value p = 0.004).

CONCLUSIONS

Prolonged night-time breastfeeding, poor utilization of dental services and daily consumption of sugar were risk factors for ECC. Larger sample size is needed to confirm the results of the genetic analysis and to conduct genome wide studies in order to discover new risk loci for ECC.

Identifying risk factors of severe early childhood caries in infants from Bosnia and Herzegovina

OBJECTIVE

The aim of the study was to investigate risk factors for S-ECC among infants under 24 months of age living in Banja Luka, Bosnia and Herzegovina.

METHODS

A cross-sectional population-based study was carried out. Considering inclusion criteria, the total sample consisted of 192 examined infants under 24 months of age. Parents/caregivers were interviewed ahead of each dental examination of children. Following data collection, outcome measures were: the presence/absence of S-ECC (children with at least one active early carious lesion on the smooth surfaces of the maxillary anterior teeth/caries-free children) and the severity of dental caries (no caries, initial caries and cavitated caries lesion).

RESULTS

Overall results of the study indicated that 22.9% of infants had initial caries, while 12.0% (95% CI: 8.1-17.3) of infants had at least one cavitated carious lesion. Multivariate logistic regression analysis showed that the age of infants (p < 0.001) and family monthly income (p = 0.003) variables were statistically significant predictors for the development of caries.

CONCLUSIONS

This research found that the most important risk predictors for the development and severity (intensity) of S-ECC in infants under 24 months of age were low monthly income of parents and the infant's age.

Feasibility of 3-Dimensional Visual Guides for Preparing Pediatric Zirconia Crowns: An In Vitro Study

This study evaluated the feasibility of a tooth preparation guide for prefabricated zirconia crowns (PZCs). Three-dimensional surface data for PZCs of the left maxillary primary first molar and left mandibular primary second molar were obtained using a model scanner. The tooth preparation data were digitally designed to harmonize with the adjacent teeth on the mixed dentition model and visualized using a color-coded map, which presents the required amount of tooth reduction. Twenty participants were recruited for preparing teeth with and without using the tooth preparation guide. The following three parameters were evaluated: tooth preparation time, harmony score, and amount of tooth reduction. The preparation time when using the guide was significantly reduced (p < 0.05), and a significant difference was observed in the harmony scores for the maxillary primary first molar preparation. Furthermore, the amount of tooth reduction was significantly different for both maxillary and mandibular primary molars (p < 0.05) in terms of the occlusal distal surface and buccal line angle in the maxillary primary first molars, and the smooth surfaces, proximal surfaces, and mesial line angles in the mandibular primary second molars. Thus, the results suggest that a tooth preparation guide could facilitate better tooth preparation for PZCs.

Oral Microbiota in Severe Early Childhood Caries in Thai Children and Their Families: A Pilot Study

Thailand has a comparatively high prevalence of severe early childhood caries (S-ECC). S-ECC adversely affects the quality of life for children and their caregivers and represents a considerable economic burden. We have assessed the bacteriological composition of unstimulated saliva, dental plaque, and degraded dentine in a Thai cohort, including children with S-ECC and children without cavities; their siblings, and their primary caregivers. Samples were collected during a dental examination and patients were scored for plaque accumulation and their decayed, missing, and filled teeth (dmft) index. Samples were analyzed using differential bacteriological counting and gel-based eubacterial DNA profiling. Plaque Lactobacillus abundance correlated significantly with S-ECC. Whilst Lactobacillus counts were significantly higher in children with S-ECC than in their siblings and primary caregivers (five families), the opposite trend was apparent for cavity-free children. Counts of Gram-negative anaerobes were significantly lower in children with S-ECC than orally healthy children. S-ECC correlated significantly with plaque index scores, dmft, and with Lactobacillus abundance in a highly predictive manner. DNA profiles showed significant homology between families but not within non-cavity and S-ECC groups. In conclusion, salivary and plaque Lactobacillus counts were significantly associated with S-ECC in the Thai subjects. Lactobacillus counts in the children were not correlated with those of their siblings and primary caregivers. Individuals could be significantly differentiated based on family but not on caries status.

Dental caries and their association with socioeconomic characteristics, oral hygiene practices and eating habits among preschool children in Abu Dhabi, United Arab Emirates - the NOPLAS project

Background

Dental caries are a global public health problem and influence the overall health of children. The risk factors for caries include biological, socio-behavioral and environmental factors. This cross-sectional study assessed dental caries and their associations with socioeconomic factors, oral hygiene practices and eating habits among Emirati and non-Emirati children in Abu Dhabi, United Arab Emirates (UAE).

Methods

The stratified sample comprised children aged 18 months to 4 years recruited from 7 nurseries. The World Health Organization (WHO) decayed, missing and filled teeth index (dmft) was used to analyze the dental status of the children. Parents completed a questionnaire regarding demographics, food consumption and oral habits. The study was approved by the Research Ethics Committee at Zayed University, UAE (ZU15_029_F).

Results

A total of 186 children with a mean age of 2.46 years, of which 46.2% were Emirati, participated. Overall, 41% of the children had dental caries. The mean dmft±SD was 1.70 ± 2.81 with a mean ± SD decayed component (dt) of 1.68 ± 2.80 and mean ± SD filled component (ft) of 0.02 ± 0.19. Emirati children showed higher mean dmft, Plaque Index and Significant Carries Index values than non-Emirati children (P < 0.000). Low maternal education, rural nursery location, infrequent tooth-brushing, frequent consumption of high-sugar food items and Emirati nationality were factors significantly associated with dental caries.

Conclusions

In this study, 4 out of 10 nursery children were found to have dental caries. Sociodemographic factors, dietary and oral health habits were associated with dental caries. Effective oral health interventions tailored to improve eating habits and the dental screening of children in this age group are imperative to mitigate these concerns.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0557-8) contains supplementary material, which is available to authorized users.

Genotypic characterization and comparison of Streptococcus mutans in American Indian and Southeast Iowa children

Early childhood caries is a complex health care issue that has a multifactorial etiology. One aspect of this etiology is the colonization and propagation of acidogenic bacteria at an early age. There have been several bacterial species associated with caries but 1 common species is Streptococcus mutans. Here, we describe genotypic diversity and commonality of Streptococcus mutans recovered from children representing 2 groups with similar socioeconomic demographics: a Northern Plains American Indian Tribe and a Southeast Iowa population. Forty 36‐month‐old American Indian children were selected from a cohort of 239 mothers and children, and forty 2‐ to 5‐year‐old children from Southeast Iowa were selected to compare the genotypic profiles of Streptococcus mutans recovered from each child's plaque. S. mutans isolates were selected from whole mouth plaque samples; DNA was extracted and amplified via AP‐PCR to show specific genotype patterns. These patterns were compared with GelComparIIv6.5 gel analysis software. We found 18 distinct genotypes from 524 isolates; 13 of which were common between the 2 communities. Five genotypes were unique to only the American Indian children while the Southeast Iowa children harbored no unique genotypes. Although the American Indian children had some genotypes that were not present in the Southeast Iowa children, these were not widely distributed among the community. Furthermore, the levels of genotypic diversity and commonality were similar between the 2 populations. This study sets the groundwork for a comprehensive comparison of genotypes and caries among larger subsections of both populations.

YouTube as a source for parents' education on early childhood caries

BACKGROUND

Patients can and do search the Internet for information on various health-related topics. YouTube™ is one popular website they may consult.

AIM

To examine the quality of information offered by YouTube™ for patients seeking information on early childhood caries (ECC).

DESIGN

YouTube™ was searched for videos on ECC. The usefulness of selected videos in providing adequate information about ECC was evaluated using a 13-point usefulness score. The guidelines of the American Academy of Pediatric Dentistry were used for benchmarking.

RESULTS

Most videos were uploaded by healthcare professionals (60%, n = 18). Videos had generally low usefulness scores (mean: 5.1 ± 2.9; range: 1-11). An average YouTube™ video on ECC was viewed two times/day (range: 0.07-34.4 views/day). Less useful videos ranked early on the viewing list, and viewer's interactions with videos were not affected significantly by their usefulness.

CONCLUSION

YouTube™ should not be used as a trusted site for educating patients on ECC.

Can oral health education be delivered to high-caries-risk children and their parents using a computer game? - A randomised controlled trial

BACKGROUND

Families of children undergoing general anaesthesia (GA) for caries management requested that oral health advice is delivered using audio-visual media.

OBJECTIVE

To compare an oral health education computer game to one-to-one education.

DESIGN

A blind randomised controlled trial of 4- to 10-year-old children scheduled for GA due to caries. Primary outcome measures were (1) parent and child satisfaction with education method; (2) improvements in child's dietary knowledge; and (3) changes in child's diet and toothbrushing habits. Measures were taken at baseline, post-intervention, and three months later.

RESULTS

One hundred and nine families took part. Both methods of education were highly satisfactory to children and parents. Children in both groups showed significant improvement in recognition of unhealthy foods immediately post-education (P < 0.001). Fifty-five per cent of all participants completed telephone follow-up after 3 months and reported improvements in diet, including reducing sweetened drinks (P = 0.019) and non-core foods (P = 0.046) intake, with no significant differences between the groups. Children reported twice-daily toothbrushing but no changes in snack selection. Attendance for a 3-month dental review was poor (11%).

CONCLUSION

Oral health education using a computer game can be as satisfactory and as effective in improving high-risk-children's knowledge as one-to-one education. The education received can lead to the positive dietary changes in some families.

Quantitative assessment of salivary oral bacteria according to the severity of dental caries in childhood

This study aimed to assess differences in selected oral bacteria in children according to the severity of dental caries. One hundred and thirty-six children, 36-60 months old were divided into three groups according to caries status: caries-free (CF) (n=47), early childhood caries (ECC) (n=40) and severe-early childhood caries (S-ECC) (n=49). Saliva was collected for detection and quantification of selected oral streptococci, Actinomyces naeslundii, Lactobacillus spp., Bifidobacterium spp., and Scardovia wiggsiae by quantitative-polymerase chain reaction. The results showed that the detection and quantitative levels of S. mutans, S. sobrinus, Bifidobacterium spp. and S. wiggsiae were significantly higher in S-ECC children compared to CF and ECC children, while for S. salivarius were significantly higher in CF compared to ECC and S-ECC children. There was no statistical difference among the clinical groups for S. mitis, S. oralis, A. naeslundii and Lactobacillus spp. levels and detection. S-ECC children had a lower monthly family income, started tooth brushing later and were breastfeed for a longer duration compared to CF children. S. mutans levels were positively correlated with S. wiggsiae and Bifidobacterium spp. levels, lower mother's education and child bottle-feeding before sleeping and negatively correlated with S. salivarius. It was concluded that in addition to S. mutans, other bacterial species, including bifidobacteria, Scardovia wiggsiae and S. sobrinus, are associated with severity of early childhood caries, although their role in the progress of dental caries remains unclear.

Association of Feeding Methods and Streptococcus mutans Count with Early Childhood Caries: A Cross-sectional Study

Introduction

Early childhood caries (ECC) is a virulent form of dental caries that can destroy the primary dentition of toddlers and preschool children. The aim was to determine the relationship of feeding methods and oral Streptococcus mutans count in 3- to 5-year-old children with ECC.

Materials and methods

A cross-sectional study was conducted in children aged 3 to 5 years. Participating mothers were interviewed regarding child’s demographic profile, educational level and socioeconomic status of parents, past medical and dental history of the mother and child, child’s feeding habits, and dietary habits and oral hygiene practices of mother and child. Clinical examination for dental caries was done using the World Health Organization criteria (1997). Salivary samples of mother-child pair were collected to determine the pH, flow rate, and S. mutans count. Statistical tests, such as Student’s t-test, analysis of variance, and Pearson’s correlation were applied.

Results

Out of 150 mother-child pair, statistically significant difference in the caries experience was found between mothers and children with high and low S. mutans count. Moderate but statistically significant negative correlation was found between mean decayed, missing, and filled teeth of mothers and mean decayed, extracted and filled teeth (deft) of children with high S. mutans count. Regarding deft, there was no statistically significant difference between children who were exclusively breast fed (7.85 ± 2.94), exclusively bottle-fed (8.67 ± 3.98), and both breast and bottle-fed (7.77 ± 2.91).

Conclusion

The mean caries experience of mothers and children was 2.66 ± 2.01 and 7.82 ± 2.94 respectively, with decayed component being maximum. Moderate and significant correlation (r = 0.5) was found between S. mutans of mothers and children in saliva. Significant negative correlation was found between mothers and children with high S. mutans count (r = -0.0284; p = 0.046).

How to cite this article

Bullappa D, Puranik MP, Sowmya KR, Nagarathnamma T. Association of Feeding Methods and Streptococcus mutans Count with Early Childhood Caries: A Cross-sectional Study. Int J Clin Pediatr Dent 2017;10(2):119-125.

The influence of general health on the need for dental general anaesthesia in children

AIM

To analyse the occurrence and causes of dental general anaesthesia (DGA) in healthy and medically compromised children, and to investigate if there are differences between those groups considering factors associated with DGA and DGA procedures.

METHODS

The data was collected from medical records of children under 7 years of age treated under DGA in the years 2009 and 2010 at the Oulu University Hospital, Finland. The children were divided into two groups: 0-35-month-olds and ≥36-month olds. Background information (year, age, gender, dental diagnosis, health) and the procedures performed were registered. The procedures were analysed considering the child's age and tooth types.

RESULTS

The number of children treated under DGA increased between 2009 (58) and 2010 (82), particularly in the group of healthy children. The two main diagnoses leading to DGA were dental caries and dental fear. Dental caries as the first dental diagnosis leading to DGA was more common among the medically compromised children (61.5%) compared to the healthy children (38.6%). The procedures performed were similar among the two groups. However, they varied between the age groups and tooth types and even between upper and lower teeth. The medically compromised children had been treated more frequently under DGA in the past.

CONCLUSIONS

The threshold for treating medically compromised children under DGA seems to be lower than for healthy children. However, the occurrence of DGA among healthy children has increased recently. To avoid unnecessary DGA, the control of caries should be carried out according to individual needs and independent of whether the child is healthy or has a chronic disease.

Biological activities of Rosmarinus officinalis L. (rosemary) extract as analyzed in microorganisms and cells

R. officinalis L. is an aromatic plant commonly used as condiment and for medicinal purposes. Biological activities of its extract were evaluated in this study, as antimicrobial effect on mono- and polymicrobial biofilms, cytotoxicity, anti-inflammatory capacity, and genotoxicity. Monomicrobial biofilms of Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Streptococcus mutans and Pseudomonas aeruginosa and polymicrobial biofilms composed of C. albicans with each bacterium were formed in microplates during 48 h and exposed for 5 min to R. officinalis L. extract (200 mg/mL). Its cytotoxic effect was examined on murine macrophages (RAW 264.7), human gingival fibroblasts (FMM-1), human breast carcinoma cells (MCF-7), and cervical carcinoma cells (HeLa) after exposure to different concentrations of the extract, analyzed by MTT, neutral red (NR), and crystal violet (CV) assays. The anti-inflammatory activity was evaluated on RAW 264.7 non-stimulated or stimulated by lipopolysaccharide (LPS) from Escherichia coli and treated with different concentrations of the extract for 24 h. Interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) were quantified by ELISA. Genotoxicity was verified by the frequency of micronuclei (MN) at 1000 cells after exposure to concentrations of the extract for 24 h. Data were analyzed by T-Test or ANOVA and Tukey Test ( P ≤ 0.05). Thus, significant reductions in colony forming units per milliliter (CFU/mL) were observed in all biofilms. Regarding the cells, it was observed that concentrations ≤ 50 mg/mL provided cell viability of above 50%. Production of proinflammatory cytokines in the treated groups was similar or lower compared to the control group. The MN frequency in the groups exposed to extract was similar or less than the untreated group. It was shown that R. officinalis L. extract was effective on mono- and polymicrobial biofilms; it also provided cell viability of above 50% (at ≤ 50 mg/mL), showed anti-inflammatory effect, and was not genotoxic. Impact statement Rosmarinus officinalis L. extract effectively contributed to in vitro control of important species of microorganisms such as Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Streptococcus mutans, and Pseudomonas aeruginosa in mono- and polymicrobial biofilms that are responsible for several infections in oral cavity as in other regions of the body. Furthermore, this extract promoted also cell viability above 50% at concentrations ≤ 50 mg/mL, excellent anti-inflammatory effect, showing inhibition or reduction of the synthesis of proinflammatory cytokines, being also non-genotoxic to cell lines studied. Thus, this extract may be a promising therapeutic agent that can be added in some medical and dental formulations such as toothpastes, mouthwashes, irrigating root canals, ointments, soaps, in order to control pathogenic microorganisms and biofilms, with anti-inflammatory effect and absence of cytotoxic and genotoxic.

Early Childhood Caries: Prevalence, Risk Factors, and Prevention

Early childhood caries (ECC) is major oral health problem, mainly in socially disadvantaged populations. ECC affects infants and preschool children worldwide. The prevalence of ECC differs according to the group examined, and a prevalence of up to 85% has been reported for disadvantaged groups. ECC is the presence of one or more decayed, missing, or filled primary teeth in children aged 71 months (5 years) or younger. It begins with white-spot lesions in the upper primary incisors along the margin of the gingiva. If the disease continues, caries can progress, leading to complete destruction of the crown. The main risk factors in the development of ECC can be categorized as microbiological, dietary, and environmental risk factors. Even though it is largely a preventable condition, ECC remains one of the most common childhood diseases. The major contributing factors for the for the high prevalence of ECC are improper feeding practices, familial socioeconomic background, lack of parental education, and lack of access to dental care. Oral health plays an important role in children to maintain the oral functions and is required for eating, speech development, and a positive self-image. The review will focus on the prevalence, risk factors, and preventive strategies and the management of ECC.

Are distinctive risk indicators associated with different stages of caries in children? A cross-sectional study

Background

Actual caries figures emphasize the need to identify the risk indicators involved in the disease’s development. The hypothesis that certain risk indicators might affect the dynamic evolution of the caries process was assessed; to clarify this premise, a cross-sectional survey was performed in school children.

Methods

A total of 390 subjects aged 6–8 years old were randomly selected. Caries was assessed, and the subjects were stratified as follows: i) highest caries score; ii) most prevalent caries score; and iii) number of affected teeth. Parents/guardians completed a questionnaire regarding vital statistics, socio-economic indicators, dietary habits, oral hygiene habits and oral health behaviours.

Results

Caries was detected in 42.31% of the subjects. Maternal nationality, parental education level, use of a sweetened pacifier at night, intake of lactose-free milk and toothbrushing frequency were statistically significant associated (p < 0.05) with subjects stratified according to the highest caries score. Parental educational level, maternal occupational status and use of a sweetened pacifier at night were associated (p < 0.05) with affected children stratified according to the most prevalent caries score. Maternal educational level and intake of lactose-free milk were associated with subjects with moderate caries stages compared to being caries-free (p = 0.01 and p = 0.02, respectively). Maternal nationality (p < 0.01) and toothbrushing frequency (p = 0.01) were associated with subjects affected by extensive lesions compared to caries-free children. In subjects affected by initial lesions as the most prevalent figure, gender (male) and paternal occupation status (unemployed) were statistically significant associated (p = 0.03 and p = 0.04, respectively) compared to those affected by highest prevalence of extensive caries lesions. In children with the highest prevalence of moderate caries lesions, maternal education level (p < 0.01), paternal occupational status (p = 0.03) and use of a sweetened pacifier at night (p < 0.01) were statistically significantly associated.

Conclusions

Maternal nationality, maternal low level of education, intake of lactose-free milk and low toothbrushing frequency were involved in the change from caries-free status to different caries stages. Gender, paternal unemployment, maternal low educational level and use of a sweetened pacifier were correlated with caries progression, showing how distinctive risk indicators were associated with different caries stages.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3865-4) contains supplementary material, which is available to authorized users.

Natural history of dental caries in very young Australian children

BACKGROUND

Whilst the global burden of caries is increasing, the trajectory of decay in young children and the point at which prevention should occur has not been well established.

AIM

To identify the 'natural history' of dental caries in early childhood.

DESIGN

A birth cohort study was established with 467 mother/child dyads followed at 1, 6, 12, 18, and 36 months of age. Parent-completed surveys captured demographic, social, and behavioural data, and oral examinations provided clinical and data.

RESULTS

Eight per cent of children (95% confidence interval (CI): 5-12%) at 18 months and 23% (95% CI: 18-28%) at 36 months experienced decay. Interesting lesion behaviour was found between 18 and 36 months, with rapid development of new lesions on sound teeth (70% of teeth, 95% CI: 63-76%) and regression of many lesions from non-cavitated lesions to sound (23% of teeth, 95% CI: 17-30%). Significant associations were found between soft drink consumption and lesion progression.

CONCLUSIONS

Findings suggest optimal time periods for screening and prevention of a disease which significantly impacts multiple health and well-being outcomes across the life course.

Prevalence of dental caries and toothbrushing habits among preschool children in Khartoum State, Sudan

BACKGROUND

Dental caries in preschool children remains a major dental public health problem and affects significant numbers of children in developed and developing countries. The incidence is increasing in developing countries, such as Sudan, because of lifestyle changes, absence of oral health-preventive services and inadequate access to oral health care.

OBJECTIVES

This study assessed the prevalence of dental caries and toothbrushing habits among 3- to 5-year-old preschool children in Khartoum State, Sudan, and described the correlation between the mean decayed, missing and filled tooth (dmft) score for primary teeth with toothbrushing and sugar consumption.

MATERIALS AND METHODS

The subjects were 553 preschool children with their mothers/guardians, selected by random sampling from the kindergartens of the seven localities of Khartoum State, Sudan. Data were obtained through clinical examination using a modified World Health Organization (WHO) examination data-capture sheet and through structured administered interviews with mothers/guardians.

RESULTS

The prevalence of dental caries was 52.4%, with a mean dmft score of 2.3. There was an increase in the dmft scores with increasing age. The frequency of children who brushed their teeth regularly at least once a day was high (83.4%), lower dmft scores were associated with starting toothbrushing earlier in life and with increased frequency of brushing per day. Eating sugar-containing food was significantly associated with dmft score.

CONCLUSIONS

The prevalence of dental caries was found to be high among 3- to 5-year-old preschool children, and caries experience increased with age. This was mostly associated with sugar consumption and therefore calls for educational interventions to control sugar intake. The toothbrushing habit is well established in Khartoum State, Sudan, as a large number of children were found to be brushing their teeth regularly. No significant association was found between feeding habits and dmft score.

Midwives' oral health recommendations for pregnant women, infants and young children: results of a nationwide survey in Germany

BACKGROUND

Studies suggest that poor oral health during pregnancy can lead to perinatal complications, such as low birth weight and preterm delivery as well as poor oral health in children. Aim of this study was to assess the German midwives knowledge about oral health and preventive recommendations for pregnant women, infants and young children.

METHODS

The nationwide online-survey was conducted with use of a self-developed, pretested and validated standardized questionnaire. The German association of midwives (Deutscher Hebammenverband e.V.) informed their members about the survey through email, newsletter, website and association journal (Hebammenforum) (n = 7.500). Data were analyzed using descriptive statistics.

RESULTS

Response rate was 12.6 % (mean age 42.9 ± 9.3 years). The majority of midwives advised pregnant women about periodontal diseases (78.6 %). Of the midwives, 8.4 % mentioned the possible associations between periodontal diseases and perinatal complications. In general, half of the midwives (53.5 %) recommended a dental visit during pregnancy. A total of 65.5 % of midwives advised parents about early childhood caries. The majority of midwives recommended that oral hygiene starts with eruption of the first tooth (60.4 %) and the first dental visit of the child should be at age 2 or 3 years (51.6 %). Midwives recommendations regarding the implementation of oral hygiene and the referral to a dentist during pregnancy and childhood were highly variable.

CONCLUSIONS

To increase oral awareness and to improve the oral health knowledge among midwives and all other health-care professionals, uniform guidelines should be developed in Germany.

TRIAL REGISTRATION

German Clinical Trial Register DRKS00008021.

Dental caries status of students from migrant primary schools in Shanghai Pudong New Area

BACKGROUND

In China, there is a large migrant population. A significant proportion of children of the migrant population in China are not able to attend public schools due to the lack of local household registration (HuKou). They turn to privately-operated migrant schools, which are usually under-funded, have bad environmental facilities and are inadequately staffed compared to public schools. This study aims to describe the dental caries status of students from migrant primary schools in Shanghai Pudong New Area and factors that influence their caries status.

METHODS

Children (7-12 years old) from migrant primary schools in Shanghai Pudong New Area were randomly selected through a multi-stage cluster sampling method. Following the recommendation of the World Health Organization, caries experiences were recorded using the dmft index. A questionnaire to survey the children's socio-demographic characteristics and oral health-related behaviours was completed by the children's parents or guardians.

RESULTS

A total of 1385 children in migrant primary schools were invited, of which 1323 joined the survey (95.5 %). Among all the surveyed subjects, the prevalence rate of dental caries was 74.7 % (65.7 % for primary teeth and 28.1 % for permanent teeth). The mean (SD) dmft scores were 3.17 (3.12), 2.74 (3.02) for the primary teeth and 0.44 (0.84) for the permanent teeth, and 99.5 % of the carious teeth received no treatment.

CONCLUSIONS

Students from migrant primary schools in Shanghai Pudong New Area had bad conditions of dental caries and most of the carious teeth were left untreated. The caries experience was associated with tooth brushing habits, snacking habits, dental visit and gender.

Monitoring of caries disease by risk assessments and activity

ABSTRACT Dental caries is a non-communicable disease and is considered a public health problem. For diagnosis and correct treatment, the study of risk assessment and caries activity is necessary. The caries risk assessment is a way to formalize the balance and imbalance of predictably disease to diagnose dental caries. Therefore, the caries risk assessment is performed through different evaluation systems. Another parameter of great importance to be studied is the activity of caries, because through it is done the correct treatment decision for the patient. The objective of this article is to inform the reader about: the concepts and caries risk factors; the different caries risk assessment systems described in the literature; and which systems are validated. In addition, this literature review provides for identification and evaluation of risk factors and activity of caries lesions in order to enable greater objectivity in the diagnosis and facilitate the decisions of a successful treatment.

Role of saliva proteinase 3 in dental caries

Salivary analysis can be used to assess the severity of caries. Of the known salivary proteins, a paucity of information exists concerning the role of proteinase 3 (PR3), a serine protease of the chymotrypsin family, in dental caries. Whole, unstimulated saliva was collected from children with varying degrees of active caries and tested using a Human Protease Array Kit and an enzyme-linked immunosorbent assay. A significantly decreased concentration of salivary PR3 was noted with increasing severity of dental caries (P<0.01); a positive correlation (r=0.87; P<0.01; Pearson's correlation analysis) was also observed between salivary pH and PR3 concentration. In an antibacterial test, a PR3 concentration of 250 ng·mL⁻¹ or higher significantly inhibited Streptococcus mutans UA159 growth after 12 h of incubation (P<0.05). These studies indicate that PR3 is a salivary factor associated with the severity of dental caries, as suggested by the negative relationship between salivary PR3 concentration and the severity of caries as well as the susceptibility of S. mutans to PR3.

Evaluation of an interdisciplinary preventive programme for early childhood caries: findings of a regional German birth cohort study

OBJECTIVES

The aim of this prospective birth cohort study was to evaluate the effect of the interdisciplinary preventive programme (PP) for early childhood caries in 3-year-old children in Germany.

MATERIAL AND METHODS

From July 2009 to October 2010, all parents of newborns (n = 1162) were visited after birth by the communal newborn visiting service of Jena, Thuringia, and advised on general and dental health. In the first year of life, children were invited to a dental examination in Jena University Hospital. Participating children were included in a risk-related recall system with continuous oral care over 3 years. Caries-risk assessment tool of the AAPD was used for risk categorizing. High-risk children received fluoride varnish biannual. In 2013, the total birth cohort (participants and non-participants) was invited to evaluate the PP. Dental caries was scored using WHO diagnostic criteria expanded to d1-level without radiography. Data were analysed statistically (multivariate logistic regression).

RESULTS

Seven hundred fifty-five children (mean age 3.26 ± 0.51 years) were examined. Children in the PP (n = 377) showed significantly lower caries prevalence and experience than non-participants (15.6 vs. 37.8 %, 0.9 ± 3.3 d_1-4mfs vs. 2.6 ± 5.2 d_1-4mfs). Lack of vitamin D supplements (OR = 1.9, CI 0.99-3.51), familial caries experience (OR = 2.2, CI 1.27-3.73) and visible plaque on teeth (OR = 6.5, CI 4.41-9.43) were significant risk factors for caries development, whereas regular dental care (OR = 0.5, CI 0.38-0.79) had a protective effect.

CONCLUSIONS

The PP was an effective interdisciplinary approach for preventing early childhood caries in small children.

CLINICAL RELEVANCE

Early dental visits with caries-risk-related preventive dental care are necessary to prevent early childhood caries (ECC).

TRIAL REGISTRATION

German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438.

Breastfeeding and the risk of dental caries: a systematic review and meta-analysis

AIM

To synthesise the current evidence for the associations between breastfeeding and dental caries, with respect to specific windows of early childhood caries risk.

METHODS

Systematic review, meta-analyses and narrative synthesis following searches of PubMed, CINAHL and EMBASE databases.

RESULTS

Sixty-three papers included. Children exposed to longer versus shorter duration of breastfeeding up to age 12 months (more versus less breastfeeding), had a reduced risk of caries (OR 0.50; 95%CI 0.25, 0.99, I(2) 86.8%). Children breastfed >12 months had an increased risk of caries when compared with children breastfed <12 months (seven studies (OR 1.99; 1.35, 2.95, I(2) 69.3%). Amongst children breastfed >12 months, those fed nocturnally or more frequently had a further increased caries risk (five studies, OR 7.14; 3.14, 16.23, I(2) 77.1%). There was a lack of studies on children aged >12 months simultaneously assessing caries risk in breastfed, bottle-fed and children not bottle or breastfed, alongside specific breastfeeding practices, consuming sweet drinks and foods, and oral hygiene practices limiting our ability to tease out the risks attributable to each.

CONCLUSION

Breastfeeding in infancy may protect against dental caries. Further research needed to understand the increased risk of caries in children breastfed after 12 months.

Effectiveness of a preventive program based on caries risk assessment and recall intervals on the incidence and regression of initial caries lesions in children

BACKGROUND

Evidence on caries risk assessment (CRA) and recall intervals are limited in terms of caries prevention.

AIM

To assess the effectiveness of a program on the incidence and regression of initial caries lesions.

DESIGN

A total of 296 children aged 1-12 years old were assessed by calibrated examiners for Gingival Bleeding Index, Dental Plaque Index, dmf-t/DMF-T Index, initial caries lesions, and caries lesion activity. Children were classified as low, moderate, and high caries risk with different recall interval visits. Statistical analysis included Cox regression and Kaplan-Meier curves.

RESULTS

The mean (SD) time of total follow-up for the sample was 11.5(5.5). Higher dmft index at baseline showed a higher risk of new initial lesions (HR = 1.93; P < 0.0001). Higher number of active initial lesions, at baseline and during follow-up visits, is a higher risk predictor for new initial lesions (HR = 9.49; P < 0.0001), as well as for no arrestment of active lesions during follow-up (HR = 1.32; P < 0.0001). Each follow-up visit attended presented a 77% lower risk of initial lesions. The majority (94.8%) of patients did not show new initial lesions.

CONCLUSIONS

The Program is effective on reducing the incidence and promoting regression of initial caries lesions in children.

Comparative evaluation and correlation of salivary total antioxidant capacity and salivary pH in caries-free and severe early childhood caries children

BACKGROUND

Dental caries is a major problem in preschool children. The contribution of saliva in providing defense during caries process is of primary importance. pH buffer capacity through bicarbonate, phosphate and protein buffer systems have universal acceptance as a caries defense mechanism. Antioxidant capacity of saliva can constitute a first line of defense against chronic degenerative diseases including dental caries. Till date, no study is presented with salivary antioxidant capacity of younger children affected with severe early childhood caries with its salivary pH correlation. Hence, this study was carried out to compare, evaluate and correlate the salivary total antioxidant capacity (TAC) and salivary pH of children with caries-free and severe early childhood caries.

MATERIALS AND METHODS

Fifty children from ages 3 to 5 years divided into two study groups had undergone screening. Group I (n = 25) with severe early childhood caries (S-ECC) and group II (n = 25) who were caries free. Unstimulated whole saliva of subjects were in the collection during the study by draining method. Salivary pH determination of saliva samples was done using pH indicator paper strips. The TAC was done using an antioxidant assay with the help of a spectrophotometer at wavelength 532 nm. The means of salivary pH and TAC were subjected to analysis using unpaired student 't' test and correlation was determined using Pearsons correlation coefficient analysis.

RESULTS

Mean salivary pH was higher in group II (7.46 ± 0.37). Mean TAC was greater in group I (1.82 ± 0.19). A statistically significant negative correlation as seen between TAC and salivary pH in S-ECC patients.

CONCLUSION

The study concludes that salivary TAC increases in patients with S-ECC are by that showing a high indirect relationship with salivary pH.

Pediatricians' oral health recommendations for 0- to 3-year-old children: results of a survey in Thuringia, Germany

Background

German societies of pediatricians and dentists disagree about oral health-related preventive recommendations (use of fluoride supplements, fluoride-containing toothpaste) for children aged 0–3 years. After failure to reach a consensus, there is no study that has evaluated the guidelines that pediatricians use in daily practice.

Methods

A standardized questionnaire was sent to all 167 practicing pediatricians in the state of Thuringia, Germany, to assess the current oral health-related preventive recommendations. Data were analyzed using descriptive statistics.

Results

The response rate was 52.0%. More than 9.0% of the pediatricians advise parents with regard to diet, use of baby bottles, oral hygiene and dental visits. The majority of pediatricians recommend to start tooth-brushing after the 1st birthday and recommend the use of toothpaste and a 1st dental visit after the 2nd birthday (78.0%). Additionally, 23.3% (n = 20) of pediatricians prescribe solely vitamin D, and 20.9% (n = 18) prescribe vitamin D combined with fluoride. Fluoride supplements are given as required by 37.2% (n = 32) of pediatricians, primarily between the 1st and 6th birthdays. The guidelines of the Pediatric Society were used by 1.2% of the pediatricians, the guidelines of the dentists were used by 5.8%, and a mix of both was used by 93.0%. The simultaneous use of fluoride supplements and fluoride toothpaste in the first three years was recommended by 45.9% of the pediatricians.

Conclusions

Pediatricians’ oral health recommendations are based on a mix of the guidelines from the German societies of pediatricians and dentists and led to no use or possible overdose of fluoride. Against the background of early childhood caries and dental fluorosis, there is a need for uniform guidelines.

Feeding and smoking habits as cumulative risk factors for early childhood caries in toddlers, after adjustment for several behavioral determinants: a retrospective study

BACKGROUND

Several maternal health determinants during the first period of life of the child, as feeding practice, smoking habit and socio-economic level, are involved in early childhood health problems, as caries development. The potential associations among early childhood caries, feeding practices, maternal and environmental smoking exposure, Socio-Economic Status (SES) and several behavioral determinants were investigated.

METHODS

Italian toddlers (n = 2395) aged 24-30 months were recruited and information on feeding practices, sweet dietary habit, maternal smoking habit, SES, and fluoride supplementation in the first year of life was obtained throughout a questionnaire administered to mothers. Caries lesions in toddlers were identified in visual/tactile examinations and classified using the International Caries Detection and Assessment System (ICDAS). Associations between toddlers' caries data and mothers' questionnaire data were assessed using chi-squared test. Ordinal logistic regression was used to analyze associations among caries severity level (ICDAS score), behavioral factors and SES (using mean housing price per square meter as a proxy).

RESULTS

Caries prevalence and severity levels were significantly lower in toddlers who were exclusively breastfed and those who received mixed feeding with a moderate-high breast milk component, compared with toddlers who received low mixed feeding and those exclusively fed with formula (p < 0.01). No moderate and high caries severity levels were observed in an exclusively breastfed children. High caries severity levels were significantly associated with sweet beverages (p < 0.04) and SES (p < 0.01). Toddlers whose mothers smoked five or more cigarettes/day during pregnancy showed a higher caries severity level (p < 0.01) respect to those whose mothers did not smoke. Environmental exposure to smoke during the first year of life was also significantly associated with caries severity (odds ratio =7.14, 95% confidence interval = 6.07-7.28). No association was observed between caries severity level and fluoride supplementation. More than 50% of toddlers belonging to families with a low SES, showed moderate or high severity caries levels (p < 0.01).

CONCLUSIONS

Higher caries severity levels were observed in toddlers fed with infant formula and exposed to smoke during pregnancy living in area with a low mean housing price per square meter.

Prevalence of early childhood caries among preschool children of low socioeconomic status in Bangalore city, India

Aim:

To assess the prevalence of Early Childhood Caries (ECC) among preschool children of low socio- economic status in Bangalore city, India.

Materials and Methods:

A cross-sectional study was carried out among 566, 24–59 months old children attending various Anganwadi centers in Bangalore city, India, selected via cluster sampling. Caries experience was recorded using deft index (Greubbell, 1944). t Test, ANOVA, and Chi-square tests were used to find significant differences. P < 0.05 was considered as statistically significant.

Results:

Prevalence of Early Childhood Caries (ECC) was 37.3% with a mean deft of 1.90 ± 3.38 ranging from 0 to 17 teeth. Out of 211 children with ECC, 94.3% had severe Early Childhood Caries (s-ECC) with a mean deft score of 5.35 ± 3.77. All of the deft was due to untreated caries. Mean caries experience of 36–47 months age group was significantly higher than other groups (P = 0.024).

Conclusions:

The present study showed a 37.3% prevalence of ECC. There is a need for preventive and curative oral health programs in this section of the society.

Association between maternal - child levels of salivary Mutans Streptococci and early childhood caries

Background:

To find out if there is an association between levels of salivary Mutans Streptococci (MS) of mothers and salivary MS and Caries experience of their Children.

Materials and Methods:

A cross sectional study was designed among 180 mother-child pair attending Vanivilasa Children Hospital, Bangalore, India. Caries was diagnosed using WHO criteria. Ninety children with Early Childhood Caries (ECC) with their mothers were included in case group and 90 caries free children with their mothers were included in the control group. Whole non-stimulated saliva was collected from mothers and children and cultured for MS. Colonies were counted and compared. Data was analyzed using SPSS version 10. Chi-square test and t-test were used to find differences between groups. P value of <0.05 was considered as significant.

Results:

Among 180 children, 80 of them had a high MS count. Among them, 60 (75%) had ECC and only 20 (25%) were caries free. This difference was significant with P < 0.001. Among 180 mothers, 100 had a high MS count. Among them, 60 (60%) belonged to case group and 40 (40%) to the control group (P = 0.003). Forty nine of the Children in case group with a high count also had mothers with high count as against only 14 in the control group (P < 0.001).

Conclusion:

Present study showed a strong association between maternal and child salivary MS levels indicating that mother's MS count could be an important risk indicator for ECC development.

Evaluation of the strain identity between isolates from caries lesions and root canals in early childhood caries cases

Early childhood caries (ECC) has become a serious medical problem worldwide in the last decade. Bacterial microflora of the dental plaque and oral cavity is considered an important factor in the formation and progression of dental caries. The aim of this study was strain typing and comparison of bacterial isolates retrieved from caries lesions and root canal contents of the same teeth. In total, 18 pairs of presumptive streptococci and lactobacilli retrieved from dental caries and root canals isolated from ECC-affected children, were selected on the basis of biotyping results and rep-PCR fingerprinting with (GTG)5 primer. Strain typing was further done using the RiboPrinter microbial characterization system (DuPont Qualicon). The automated ribotyping determined 14 pairs of the strains (77.8 %) to be identical. The results obtained confirmed that identical bacterial strains colonized both the decayed dental surface and the necrotic content of the dental pulp cavity during the cariogenesis. Our finding supports the assumption that bacteria could penetrate through the damaged dental surface to the inner parts of the teeth.

Early childhood caries update: A review of causes, diagnoses, and treatments

Dental caries (decay) is an international public health challenge, especially amongst young children. Early childhood caries (ECC) is a serious public health problem in both developing and industrialized countries. ECC can begin early in life, progresses rapidly in those who are at high risk, and often goes untreated. Its consequences can affect the immediate and long-term quality of life of the child's family and can have significant social and economic consequences beyond the immediate family as well. ECC can be a particularly virulent form of caries, beginning soon after dental eruption, developing on smooth surfaces, progressing rapidly, and having a lasting detrimental impact on the dentition. Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in both the primary and permanent dentitions. The relationship between breastfeeding and ECC is likely to be complex and confounded by many biological variables, such as mutans streptococci, enamel hypoplasia, intake of sugars, as well as social variables, such as parental education and socioeconomic status, which may affect oral health. Unlike other infectious diseases, tooth decay is not self-limiting. Decayed teeth require professional treatment to remove infection and restore tooth function. In this review, we give detailed information about ECC, from its diagnosis to management.