Early Childhood Caries: Risk Factors, Oral Health-related Quality of Life and Interprofessional Collaboration

Early Childhood Caries: Risk Factors, Oral Health-related Quality of Life and Interprofessional Collaboration

Early Childhood Caries (ECC) is a significant oral health burden globally. It is defined as ‘the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger’ (under age six).1American Association of Pediatric Dentistry. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. 2016. https://www.aapd.org/media/policies_guidelines/p_eccclassifications.pdf. Severe ECC (S-ECC) is indicated by at least four, five or six decayed, missing or filled teeth at ages three, four and five years, respectively.1American Association of Pediatric Dentistry. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. 2016. https://www.aapd.org/media/policies_guidelines/p_eccclassifications.pdf. (Figure 1) In a child under three years-of-age, any sign of dental caries on smooth surfaces indicates severe early childhood caries (S-ECC) as does one or more cavitated, caries-related missing, or filled smooth surface in the maxillary anterior primary teeth at ages three through five.

The global prevalence of ECC is estimated at 63%, with wide variations by country. In the US, the estimated prevalence of dental caries (treated and untreated) among individuals aged 2–5 years is 21.4%.2Fleming E, Afful J. Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015-2016. NCHS Data Brief 2018;(307):1-8. Among children five years-of-age, high prevalences of 90%, 78.5% and 71.9%, respectively, are reported for Indonesia, Thailand and China.3Chen J, Duangthip D, Gao SS et al. Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions. Front Oral Health 2021;2:670154. doi: 10.3389/froh.2021.670154.^,4Zhang M, Zhang X, Zhang Y et al. Assessment of risk factors for early childhood caries at different ages in Shandong, China and reflections on oral health education: a cross-sectional study. BMC Oral Health 2020;20(1):139. doi: 10.1186/s12903-020-01104-8.^,5Srisilapanan P, Nirunsittirat A, Roseman J. Trends over Time in Dental Caries status in Urban and Rural Thai Children. J Clin Exp Dent 2017;9(10):e1201-06. doi: 10.4317/jced.54054. High prevalences are also reported in Central and South America, such as in a study with more than two thousand participants ages 3 to 5 years in Peru (76.2%).6Castillo JL, Palma C, Cabrera-Matta A. Early Childhood Caries in Peru. Front Public Health. 2019;7:337. https://doi.org/10.3389/fpubh.2019.00337. ECC prevalence has generally been lower for more developed areas, such as Singapore, Europe, Canada, Australia and the USA, while disadvantaged groups disproportionately suffer from ECC.2Fleming E, Afful J. Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015-2016. NCHS Data Brief 2018;(307):1-8.^,7Gao XL, Hsu CY, Loh T et al. Dental caries prevalence and distribution among preschoolers in Singapore. Community Dent Health 2009;26(1):12-7.^,8Pierce A, Singh S, Lee J et al. The Burden of Early Childhood Caries in Canadian Children and Associated Risk Factors. Front Public Health 2019;7:328. doi: 10.3389/fpubh.2019.00328. ^,9Petersen PE, Bourgeois D, Ogawa H et al. The global burden of oral diseases and risks to oral health. Bull World Health Org 2005;83(9):661-9. Some high-income countries do however experience a high prevalence of ECC – within the Gulf Cooperative Council region, in the United Arab Emirates and Qatar, respectively, a prevalence of 83% and 89% is reported (excludes expatriates and refugees).10Alkhtib AO, Mohamed HG. Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010–2021). PLOS Glob Public Health 2023;3(1): e0001228. https://doi.org/10.1371/journal.pgph.0001228.

ECC and Quality of Life

ECC significantly affects quality of life, and is an early predictor of future caries risk in the permanent dentition and poor oral health.11Tinanoff N, Baez RJ, Diaz Guillory C et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent 2019;29:238-48. ^,12Meyer F, Enax J. Early Childhood Caries: Epidemiology, Aetiology, and Prevention. Int J Dent 2018:1415873. doi: 10.1155/2018/1415873.^,13Abanto J, Carvalho TS, Mendes FM et al. Impact of oral diseases and disorders on oral health-related quality of life of preschool children. Commun Dent Oral Epidemiol 2011;39(2):105-14.^,14Shokravi M, Khani-Varzgan F, Asghari-Jafarabadi M et al. The Impact of Child Dental Caries and the Associated Factors on Child and Family Quality of Life. Int J Dent 2023;2023:4335796. doi: 10.1155/2023/4335796.^,15Díaz S, Mondol M, Peñate A et al. Parental perceptions of impact of oral disorders on Colombian preschoolers’ oral health-related quality of life. Acta Odontol Latinoam 2018;31(1):23-31.^,16Corrêa-Faria P, Silva KC, Costa LR. Impact of dental caries on oral health-related quality of life in children with dental behavior management problems. Braz Oral Res 2022;36:e041. doi: 10.1590/1807-3107bor-2022.vol36.0041. Assessment tools include the Oral Health-Related Quality of Life (OHRQoL) and the Early Childhood Oral Health Impact Scale (ECOHIS).17Barbosa TDS, Gavião MBD. Evaluation of the family impact scale for use in Brazil. J Appl Oral Sci 2009;17(5):397-403.^,18Pakkhesald M, Riyahi E, Alhosseini AAN, Amdjadi P. Impact of dental caries on oral health related quality of life among preschool children: perceptions of parents. BMC Oral Health 2021;21:68. https://doi.org/10.1186/s12903-021-01396-4.^,19Scarpelli AC, Oliveira BH, Tesch FC et al. Psychometric properties of the Brazilian version of the early childhood oral health impact scale (B-ECOHIS). BMC Oral Health 2011;11(1):19. Data points used in ECOHIS include a determination of whether and how often the child experiences oral/dental pain; has difficulty eating, drinking, pronouncing words or sleeping; becomes irritable/frustrated; avoids smiling, laughing, or talking; and misses pre-school/school days.

ECC can result in abscesses, and the need for sedation or general anesthesia and invasive procedures including extractions.11Tinanoff N, Baez RJ, Diaz Guillory C et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent 2019;29:238-48. ^,12Meyer F, Enax J. Early Childhood Caries: Epidemiology, Aetiology, and Prevention. Int J Dent 2018:1415873. doi: 10.1155/2018/1415873.^,20Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century—the approach of the WHO Global Oral Health Programme. Commun Dent Oral Epidemiol 2003;31:3-24. Children may experience low self-esteem, poor school performance, and when primary teeth are prematurely lost orthodontic problems may ensue in the permanent dentition.12Meyer F, Enax J. Early Childhood Caries: Epidemiology, Aetiology, and Prevention. Int J Dent 2018:1415873. doi: 10.1155/2018/1415873.^,21American Academy of Pediatric Dentistry. Policy. The State of Little Teeth. https://www.aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf. Malnutrition, ear and sinus infections, and life-threatening infections may occur.21American Academy of Pediatric Dentistry. Policy. The State of Little Teeth. https://www.aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf. In one study, 55%, 40% and 27.3% of children, respectively, complained of difficulty eating, sleeping and avoiding smiling.22BaniHani A, Deery C, Toumba J et al. The impact of dental caries and its treatment by conventional or biological approaches on the oral health-related quality of life of children and carers. Int J Paediatr Dent 2018;28(2):266-76. doi: 10.1111/ipd.12350. (Figure 2) Parents may be wakened at night, miss work looking after their child, and treatment of ECC may require hospitalization.23Alkarimi H A, Watt R G, Pikhart H et al. Impact of treating dental caries on schoolchildren’s anthropometric dental, satisfaction and appetite outcomes: a randomized clinical trial. BMC Public Health 2012;12:706-14. ^,24Chrisopoulos S, Harford JE. Oral Health and Dental Care in Australia: Key Facts and Figures 2015, Australian Institute of Health and Welfare and the University of Adelaide, Canberra, ACT, Australia, 2016. ECOHIS includes data points that measure the impact on parents based on whether they are upset, feel guilty, have to take time off, and the financial impact on the family.18Pakkhesald M, Riyahi E, Alhosseini AAN, Amdjadi P. Impact of dental caries on oral health related quality of life among preschool children: perceptions of parents. BMC Oral Health 2021;21:68. https://doi.org/10.1186/s12903-021-01396-4.

Figure 2. Potential impacts of ECC on children

Risk Factors for ECC and poor OHRQoL

ECC, as with dental caries in other age groups, is a multifactorial disease for which the presence of cariogenic bacteria and fermentable carbohydrates are prerequisites. Familial factors for ECC include a low socioeconomic status and the mother’s (or other primary caregiver’s) education level, as well as low oral health literacy.3Chen J, Duangthip D, Gao SS et al. Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions. Front Oral Health 2021;2:670154. doi: 10.3389/froh.2021.670154.^,8Pierce A, Singh S, Lee J et al. The Burden of Early Childhood Caries in Canadian Children and Associated Risk Factors. Front Public Health 2019;7:328. doi: 10.3389/fpubh.2019.00328. ^,11Tinanoff N, Baez RJ, Diaz Guillory C et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent 2019;29:238-48. ^,14Shokravi M, Khani-Varzgan F, Asghari-Jafarabadi M et al. The Impact of Child Dental Caries and the Associated Factors on Child and Family Quality of Life. Int J Dent 2023;2023:4335796. doi: 10.1155/2023/4335796.^,15Díaz S, Mondol M, Peñate A et al. Parental perceptions of impact of oral disorders on Colombian preschoolers’ oral health-related quality of life. Acta Odontol Latinoam 2018;31(1):23-31.^,25Ramos-Gomez FJ, Weintraub JA, Gansky SA et al. Bacterial, behavioral and environmental factors associated with early childhood caries. J Clin Pediatr Dent 2002;26(2):165-73. doi: 10.17796/jcpd.26.2.t6601j3618675326. At the individual level, colonization and timing of exposure to cariogenic bacteria, fermentable carbohydrates with inappropriate feeding,10Alkhtib AO, Mohamed HG. Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010–2021). PLOS Glob Public Health 2023;3(1): e0001228. https://doi.org/10.1371/journal.pgph.0001228. and enamel hypoplasia (enamel defects) are significantly associated with ECC.3Chen J, Duangthip D, Gao SS et al. Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions. Front Oral Health 2021;2:670154. doi: 10.3389/froh.2021.670154.^,11Tinanoff N, Baez RJ, Diaz Guillory C et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent 2019;29:238-48. ^,21American Academy of Pediatric Dentistry. Policy. The State of Little Teeth. https://www.aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf.^,26Kawashita Y, Kitamura M, Saito T. Early childhood caries. Int J Dent 2011;2011:725320. doi: 10.1155/2011/725320. In mothers with poor oral hygiene and high levels of Mutans streptococci, the risk of vertical transmission to infants at an early age and the risk for ECC are high.26Kawashita Y, Kitamura M, Saito T. Early childhood caries. Int J Dent 2011;2011:725320. doi: 10.1155/2011/725320. Horizontal transmission from siblings may also occur. Furthermore, Mutans streptococci are found on the oral mucosa of infants prior to the eruption of primary teeth.27Martínez AR, Ruiz-Guillén A, Romero-Maroto M et al. Impact of Breastfeeding and Cosleeping on Early Childhood Caries: A Cross-Sectional Study. J Clin Med 2021;10:1561. https://doi.org/10.3390/jcm10081561. Maternal dental caries is also a risk factor, and in a Nigerian study a more than six-fold risk of ECC was found for children whose mothers had dental caries.11Tinanoff N, Baez RJ, Diaz Guillory C et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent 2019;29:238-48. ^,28Alade M, Folayan MO, El Tantawi M et al. Early childhood caries: Are maternal psychosocial factors, decision-making ability, and caries status risk indicators for children in a sub-urban Nigerian population? BMC Oral Health 2021;21:73. https://doi.org/10.1186/s12903-020-01324-y.

Other risk factors include poor oral hygiene, inappropriate feeding/poor dietary habits, prior caries experience, insufficient guidance from dental and other healthcare professionals, parental beliefs, lack of a dental home, lack of dental insurance or access to care, and lack of/inadequate fluoride exposure.3Chen J, Duangthip D, Gao SS et al. Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions. Front Oral Health 2021;2:670154. doi: 10.3389/froh.2021.670154.^,10Alkhtib AO, Mohamed HG. Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010–2021). PLOS Glob Public Health 2023;3(1): e0001228. https://doi.org/10.1371/journal.pgph.0001228.^,11Tinanoff N, Baez RJ, Diaz Guillory C et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent 2019;29:238-48. ^,25Ramos-Gomez FJ, Weintraub JA, Gansky SA et al. Bacterial, behavioral and environmental factors associated with early childhood caries. J Clin Pediatr Dent 2002;26(2):165-73. doi: 10.17796/jcpd.26.2.t6601j3618675326.^,26Kawashita Y, Kitamura M, Saito T. Early childhood caries. Int J Dent 2011;2011:725320. doi: 10.1155/2011/725320. (Figure 3)

Figure 3. Risk factors for ECC

Poor dietary habits, breastfeeding and bottle feeding
Excessive frequency and duration of feeding increases risk for ECC due to repeated and prolonged exposure to natural or added sugars in bottles (including pacifying bottles) or sippy cups. In addition, extended feeding enables pooling of the liquid around anterior teeth, especially at night when salivary flow is reduced physiologically.10Alkhtib AO, Mohamed HG. Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010–2021). PLOS Glob Public Health 2023;3(1): e0001228. https://doi.org/10.1371/journal.pgph.0001228.^,11Tinanoff N, Baez RJ, Diaz Guillory C et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent 2019;29:238-48. ^,21American Academy of Pediatric Dentistry. Policy. The State of Little Teeth. https://www.aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf.^,26Kawashita Y, Kitamura M, Saito T. Early childhood caries. Int J Dent 2011;2011:725320. doi: 10.1155/2011/725320. Risk is increased by early exposure to sugars before age 1 year. In a study in children 3–5 years-of-age, risk for ECC was associated with frequency of sugar intake at bedtime with a three-fold risk for ECC in five-year-olds.4Zhang M, Zhang X, Zhang Y et al. Assessment of risk factors for early childhood caries at different ages in Shandong, China and reflections on oral health education: a cross-sectional study. BMC Oral Health 2020;20(1):139. doi: 10.1186/s12903-020-01104-8.

The contributions of breastfeeding and bottle feeding to risk for ECC have been controversial, with studies variously considering duration of feeding, frequency of feeding, prolonged feeding, night-time feeding and co-sleeping by the mother and infant (where on-demand feeding occurs during the night). In a systematic review of 7 studies comparing bottle-feeding and breastfeeding, study results were conflicting.29Avila WM, Pordeus IA, Paiva SM, Martins CC. Breast and Bottle Feeding as Risk Factors for Dental Caries: A Systematic Review and MetaAnalysis. PLoS ONE 2015;10(11): e0142922. doi:10.1371/journal.pone.0142922. In four of seven studies, ECC was lower with breastfeeding – duration of feeding was not considered. In a birth cohort study with approximately 1300 subjects, at 5 years-of-age, 23.9% of subjects experienced S-ECC.30Peres KG, Nascimento GG, Peres MA et al. Impact of prolonged breastfeeding on dental caries: A population-based birth cohort study. Pediatrics 2017;140:e20162943. Among children breastfeeding for at least 24 months, a more than two-fold risk for S-ECC was found compared to infants breastfed for up to 12 months. In a separate study, breastfeeding overnight beyond two years-of-age was again found to be a risk factor for ECC, while in other studies no association was found.31Perera PJ, Fernando MP, Warnakulasooriya TD, Ranathunga N. Effect of feeding practices on dental caries among preschool children: a hospital based analytical cross sectional study. Asia Pac J Clin Nutr 2014;23(2):272-7. doi: 10.6133/apjcn.2014.23.2.13.^,32Iida H, Auinger P, Billings RJ, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics 2007;120: e944-52. In one cross-sectional study, breastfeeding more than twice at night at 18 months-of-age and over was found to increase risk for ECC if the mother and infant co-slept, and in the absence of oral hygiene for the infant after feeding.27Martínez AR, Ruiz-Guillén A, Romero-Maroto M et al. Impact of Breastfeeding and Cosleeping on Early Childhood Caries: A Cross-Sectional Study. J Clin Med 2021;10:1561. https://doi.org/10.3390/jcm10081561. This result has been corroborated by other studies addressing ECC in infants.33Nirunsittirat A, Pitiphat W, McKinney CM et al. Breastfeeding Duration and Childhood Caries: A Cohort Study. Caries Res 2016;50(5):498-507. https://doi.org/10.1159/000448145.^,34Lapps Wert KM, Lindemeyer R, Spatz DL. Breastfeeding, co-sleeping and dental health advice. MCN Am J Matern Child Nurs 2015;40:174-9.

Recommendations and advice for mothers and caregivers

Mothers-to-be should be educated during pregnancy on maintaining their own oral health, good oral hygiene and on the risk of early transmission of bacteria from mothers/caregivers to infants. Mothers and caregivers should receive advice on nutrition and healthy feeding habits for infants and young children, including avoiding/minimizing sugary foods and drinks. The American Academy of Pediatrics (AAP) and other national bodies (e.g., Public Health England), recommend exclusive breastfeeding (breast milk) for the first 6 months of life.35Clark MB, Slayton RL, AAP Section on Oral Health. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics 2020;146(6):e2020034637.^,36Public Health England. Guidance Breastfeeding and dental health. Updated 30 January 2019. https://www.gov.uk/government/publications/breastfeeding-and-dental-health/breastfeeding-and-dental-health. In addition, it has been recommended that infants being bottle-fed should only receive milk or water in bottles and learn to drink from a free-flow cup starting at 6 months, and that bottle feeding be discouraged once the infant reaches one year-of-age.37Guidance. Delivering better oral health: an evidence-based toolkit for prevention. https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention. Education on oral hygiene for infants is recommended to include advice to mothers and caregivers to wipe away residual milk/food from the oral mucosa prior to tooth eruption,27Martínez AR, Ruiz-Guillén A, Romero-Maroto M et al. Impact of Breastfeeding and Cosleeping on Early Childhood Caries: A Cross-Sectional Study. J Clin Med 2021;10:1561. https://doi.org/10.3390/jcm10081561. and once teeth have erupted to brush them. Mothers should be advised not to share spoons/forks/use the child’s spoon to test food for temperature, and not to clean a pacifier using their saliva, to reduce vertical transmission of bacteria. (Table 1)

Advice should include the need to make a dental appointment for children within 6 months of the first tooth erupting and at the latest by age 1 (unless oral problems require an earlier visit), and to establish a ‘dental home’. Young children should attend regularly for dental visits, and provided with any preventive care needed before dental caries can develop and early treatment should this become necessary. Children who do not receive a dental visit until later at age 2 or 3 have been found to be at greater risk for emergency visits.38Lee JY, Bouwens TJ, Savage MF, Vann WF Jr. Examining the cost effectiveness of early dental visits. Pediatr Dent 2006;28(2):102-5, discussion 192-8.

Recommendations for dental professionals

Recommendations for the prevention and management of ECC in young children are provided by the AAPD and the ADA. General recommendations include dietary counselling for parents/caregivers, and that children drink optimally fluoridated water (0.7 ppm fluoride).39U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Rep 2015;130(4):318-31. Recommendations include that caries risk assessment be performed at the age one visit and at recalls, in-office applications of 5% sodium fluoride varnish occur at least every 3 to 6 months (with the frequency based on risk level), and at home age-appropriate use of fluoride toothpaste with twice-daily brushing is performed once teeth have erupted.40American Association of Pediatric Dentistry. Caries-risk Assessment and Management for Infants, Children, and Adolescents. Latest revision, 2019. https://www.aapd.org/media/Policies_Guidelines/BP_CariesRiskAssessment.pdf.^,41Weyant RJ, Tracy SL, Anselmo T et al. Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc 2013;144(11):1279-91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581720/.^,42American Association of Pediatric Dentistry. Fluoride therapy, revised 2023. https://www.aapd.org/globalassets/media/policies_guidelines/bp_fluoridetherapy.pdf Guidelines are provided on the use of pit-and-fissure sealants for sound and early caries lesions – of note, 44% of dental caries in primary teeth occurs in pits and fissures.43American Association of Pediatric Dentistry. Oral Health Policies & Recommendations (The Reference Manual of Pediatric Dentistry). Use of Pit-and-Fissure Sealants (2016). https://www.aapd.org/research/oral-health-policies–recommendations/pit_and_fissure_sealants/.^,44Ferreira Zandona AG, Ritter AV, Eidson RS. Dental caries: Etiology, caries risk assessment, and management. Ch2, p43. In: Ritter AV, Boushell LW, Walter R. Sturdevant’s art & science of operative dentistry-e-book. 7th Ed. Elsevier Health Sciences, 2017. In addition, recommendations on the non-invasive/minimally invasive treatment of existing caries lesions in young children are available, encompassing 5% sodium fluoride varnish, silver diamine fluoride, pit-and-fissure sealants, and resin infiltration (and 1.1% sodium fluoride in high-risk children under age 6 only if clinical judgement suggests the benefits outweigh the risk of dental fluorosis).45Slayton RL, Urquhart O, Araujo MWB et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. J Am Dent Assoc 2018;149(10):837-49. e19. doi: 10.1016/j.adaj.2018.07.002. https://www.aapd.org/media/Policies_Guidelines/R_ChairsideGuide.pdf.^,46American Academy of Pediatric Dentistry. Policy on the use of silver diamine fluoride for pediatric dental patients. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2022:72-5. https://www.aapd.org/media/Policies_Guidelines/P_SilverDiamine.pdf.^,47American Association of Pediatric Dentistry. Guideline on Restorative Dentistry, 2016. https://www.aapd.org/assets/1/7/G_Restorative1.PDF.

Interprofessional Collaboration

Interprofessional collaboration is encouraged by the AAPD and the AAP, as well as other dental and medical professional organizations and public health bodies, in order to meet the oral health needs of infants and children.21American Academy of Pediatric Dentistry. Policy. The State of Little Teeth. https://www.aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf.^,48Krol DM, Whelan K, AAP Section on Oral Health. Maintaining and Improving the Oral Health of Young Children. Pediatrics 2023;151(1):e2022060417. Almost 89% of infants and children age one year have visits to pediatricians and nurses each year, including well baby visits.35Clark MB, Slayton RL, AAP Section on Oral Health. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics 2020;146(6):e2020034637. As such, visits to medical offices are often the first opportunity to educate mothers/caregivers on vertical and horizontal transmission, oral hygiene needs, appropriate feeding habits and to provide anticipatory guidance. In addition, during pre-natal visits, mothers can be encouraged to visit a dentist and to perform good oral hygiene and maintain oral health.3Chen J, Duangthip D, Gao SS et al. Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions. Front Oral Health 2021;2:670154. doi: 10.3389/froh.2021.670154.^,10Alkhtib AO, Mohamed HG. Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010–2021). PLOS Glob Public Health 2023;3(1): e0001228. https://doi.org/10.1371/journal.pgph.0001228.^,27Martínez AR, Ruiz-Guillén A, Romero-Maroto M et al. Impact of Breastfeeding and Cosleeping on Early Childhood Caries: A Cross-Sectional Study. J Clin Med 2021;10:1561. https://doi.org/10.3390/jcm10081561. The importance of a dental home by age one is recognized by the American Association of Pediatricians, with recent data suggesting that dental referrals may increase the number of infants and young children receiving dental visits earlier.48Krol DM, Whelan K, AAP Section on Oral Health. Maintaining and Improving the Oral Health of Young Children. Pediatrics 2023;151(1):e2022060417.

Recommendations for medical professionals include risk assessment of oral health beginning at 6 months and at each routine visit. Anticipatory guidance to parents with advice on the role of diet in ECC and good feeding habits, oral hygiene advice for parents for their own and their child’s dentition, and the application of 5% sodium fluoride varnish (within scope of practice) are recommended.35Clark MB, Slayton RL, AAP Section on Oral Health. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics 2020;146(6):e2020034637.^,48Krol DM, Whelan K, AAP Section on Oral Health. Maintaining and Improving the Oral Health of Young Children. Pediatrics 2023;151(1):e2022060417.^,49American Academy of Pediatrics. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. www.aap.org/en-us/Documents/ oralhealth_RiskAssessmentTool.pdf. The US Prevention Services Task Force recommendation is that fluoride varnish be applied to the primary dentition of all infants and children from the time of tooth eruption, by clinicians in primary care.50Moyer VA, US Prevention Services Task Force. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. Pediatrics 2014;133(6):1102-11.
Interprofessional collaboration also occurs for dental and other healthcare professionals, educators, nursery school personnel, and community oral health programs aimed at integrating oral health into general health, and achieving active involvement.10Alkhtib AO, Mohamed HG. Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010–2021). PLOS Glob Public Health 2023;3(1): e0001228. https://doi.org/10.1371/journal.pgph.0001228.^,12Meyer F, Enax J. Early Childhood Caries: Epidemiology, Aetiology, and Prevention. Int J Dent 2018:1415873. doi: 10.1155/2018/1415873.^,51Macpherson LM, Rodgers J, Conway DI. Childsmile after 10 years part 2: programme development, implementation and evaluation. Dental Update 2019; 46(3):238-46.

Conclusions

ECC significantly impacts oral health and quality of life, and disadvantaged groups disproportionally experience ECC. Among the risk factors, there is an opportunity to reduce inappropriate care and feeding of infants, lack of dental visits by age 1, insufficient guidance, and a lack of knowledge on the part of mothers and caregivers through education, action and collaboration. Interprofessional collaboration is recommended by the AAPD and the AAP, as well as other dental and medical professional organizations and public health bodies, in order to meet the oral health needs of infants and children. Furthermore, the medical office is often the first opportunity to educate mothers/caregivers. In addition, community programs can be encouraged with collaboration among healthcare and other professionals. The ultimate goal is to improve the oral health of infants and young children.

References

• 1.American Association of Pediatric Dentistry. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. 2016. https://www.aapd.org/media/policies_guidelines/p_eccclassifications.pdf.
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