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1. Prepared by: Dr. Weam Banjar

1.1. Further reading, Click HERE

2. Definition:

2.1. the presence of 1 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

3. Risk Factors

3.1. Microbiological factors

3.1.1. S. mutans and Streptococcus sobrinus are the main cariogenic micro-organisms

3.1.2. In children with ECC, S. mutans has regularly exceeded 30% of the cultivable plaque flora

3.1.3. Initial acquisition of mutans streptococci (MS) by infants occurs during a well-delineated age range that is being designated as the window of infectivity.

3.1.4. Vertical transmission, also known as mother-to-child transmission, is the transmission of an infection or other disease from caregiver to child. The major reservoir from which infants acquire MS is their mothers.

3.2. Feeding Practices

3.2.1. Inappropriate use of baby bottle has a central role in the etiology and severity of ECC.

3.2.2. Frequent and prolonged contact of enamel with human milk has been shown to result in acidiogenic conditions and softening of enamel.

3.2.3. prolonged and nocturnal breastfeeding is associated with an increased risk of ECC, especially after the age of 12 months.

3.3. Sugar

3.3.1. Dietary features play a crucial and a secondary role

3.3.2. Fermentable carbohydrates are a factor in the development of caries.

3.4. Socioeconomic level

3.4.1. Association between ECC and the socioeconomic status (SES) has been well documented. Studies suggested that ECC is more commonly found in children who live in poverty or in poor economic conditions, who belong to ethnic and racial minorities, who are born to single mothers, whose parents have low educational level, especially those of illiterate mothers.

4. Diagnosis

4.1. The expression S-ECC was adopted in lieu of rampant caries in the presence of at least one of the following criteria:

4.1.1. Any sign of caries on a smooth surface in children younger than 3 years.

4.1.2. Any smooth surface of an antero-posterior deciduous tooth that is decayed, missing (due to caries), or filled in children between 3 and 5 years old.

4.1.3. The dmft index equal to or greater than 4 at the age of 3 years, 5 at the age of 4 years, and 6 at the age of 5 years.

4.2. ECC is initially recognized as a dull, white hand of de-mineralized enamel that quickly advances to obvious decay along the gingival margin.

4.3. The decay is generally first seen on the primary maxillary incisors, and the four maxillary anterior teeth are often involved concurrently.

4.4. Carious lesions may be found on either the labial or lingual surfaces of the teeth and, in some cases, on both.

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