Early childhood caries is a specific type of caries that affects infants and young children. Early childhood caries was historically attributed to inappropriate and prolonged use of sweetened liquid in the bottle. It is the presence of 1 or more decayed (cavitated or non-cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 month of age or younger. It includes 2 variants: Nursing bottle caries and Rampant caries
Those practices of frequent consumption of sugar content food in the presence of streptococci may result in caries formation. Consumption of sweetened liquids from infant and toddler size ‘sippy’ “cups” and frequent snacking.
The caries risk generated by on-demand breast-feeding is unclear, but because lactose is poorly metabolized by mutans streptococci. Irregular oral hygiene habits also contribute to ECC.
Classification of ECC
Type I (Mild to moderate ECC) Isolated carious lesions involving molars and/or incisors in 2-5 years old children due to cariogenic food and poor oral hygiene.
Type II (Moderate to severe ECC) Labiolingual caries lesion affecting maxillary incisors with or without involving molars. The mandibular incisors are not affected. It is due to inappropriate nursing bottle feeding habits and poor oral hygiene. It is found as soon as the teeth erupt in the oral cavity.
Type III (Severe ECC) caries involving almost whole teeth including lower incisors. Found in 3-5 years old children.
Features of ECC
Caries involve maxillary anterior teeth, the maxillary, and mandibular posterior teeth and mandibular canines.
Mandibular incisors are not affected (due to protection by the tongue)
Seen as the white or dark brown collar of caries around the neck of incisors and may also fracture of teeth.
Etiology
If the child is put to bed with a nursing bottle containing milk or sugar-containing beverages. The child falls asleep and the milk or sweetened liquid becomes pooled around the maxillary anterior teeth. Salivary flow is reduced during sleep and clearance of the liquid from the oral cavity is slowed.
Management
Includes parents counseling, provisional restoration, diet assessment, caries activity test, fluoride therapy followed by restoration, and recaType III (Severe ECC) caries involving almost whole teeth including lower incisors. Found in 3-5 years old children.