Counseling caregivers regarding feeding practices and daily tooth cleaning for infants should include information on Early Childhood Caries (ECC). ECC is a particularly virulent but multifactorial form of caries that can develop when an infant is provided a bottle of formula, milk, or sugary liquids for at-will feedings and/or at sleep times. Sugary liquids remain in the mouth for hours creating an acid environment that enhances enamel demineralization. Caries progression depends on sufficient levels of Streptococcus mutans and Lactobacillus species, and saliva-sharing habits (such as utensil sharing) are discouraged to decrease the transmission of this bacteria.
ECC 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 under the age of six. Severe ECC is any sign of smooth surface caries in a child under the age of 3, any lesion in a maxillary anterior tooth in a child ages 3 through 6, or any DMFT score higher than the child’s age for children ages 3 through 6.
Because children who experience ECC have a greater probability of subsequent caries development in both the primary and permanent dentitions, aggressive preventive and therapeutic measures often are necessary. Silver diamine fluoride (SDF), interim therapeutic restoration (ITR), and stainless steel crowns (SSC) should be considered as management options. Without early caries detection and therapeutic intervention, extractions may be later indicated. Sedation or general anesthesia are often necessary adjuncts in guiding the behaviors of young children who require dental treatment.