Early Childhood Caries: Prevalence, Risk Factors, and Prevention

CLiNiCAL PReSeNTATiON
ECC is a form of early, moderate and late dental decay that affects 
the primary teeth of infants and toddlers. It develops on tooth 
surfaces that are usually at low risk for caries, such as the labial 
surfaces of maxillary incisors and lingual and buccal surfaces of 
maxillary and mandibular molars. ECC initially presents as dull 
white or brown spots on maxillary incisors along the gingival 
margin, which progresses to a complete destruction of the crown, 
leading to root stumps (
1
). In moderate stage, the caries begins 
to spread to the maxillary molars. In the severe stage, the caries 
process destroys the maxillary teeth and spreads to the mandibu-
lar molars. Based on the clinical appearance, attempts were made 
to classify the ECC (
27
). Severe early childhood caries (S-ECC) 
refers to children with ‘atypical,’ ‘progressive,’ ‘acute,’ or ‘rampant’ 
pattern of dental caries (
25
, 
69
). A child with ECC may suffer 
from considerable pain, which may lead to difficulty in eating and 
talking (
70
). If the extent of the damage results in extraction of 
the anterior teeth by age 2 or 3 years, the child may suffer further 
developmental delays involving speech articulation and patterns 
(
71
). The consequences are delay in physical development due 
to poor nutrition and the pain and discomfort may compromise 

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Anil and Anand
Early Childhood Caries
Frontiers in Pediatrics | www.frontiersin.org
July 2017 | Volume 5 | Article 157
their desire to eat. The pain and suffering associated with the 
caries affect the child’s oral health quality of life (
72
).
CLASSiFiCATiON
Several research groups have attempted to develop classification 
systems for early childhood caries (Tables 1–3).
Another classification based on the stage of development of 
the dentition and severity of dental caries (initial and cavitated) 
was proposed by Veerkamp and Weerheijm (
74
). This system 
assumes that dental caries occurs in successive stages starting late 
in the first year (10 months) and ending in the fourth year of life 
(48 months). The four stages were referred to as: initial, damaged, 
deep lesions, and traumatic. During each stage, a different group 
of teeth are involved, and dental caries can range from enamel 
demineralization (opaque white demineralization) to cavitation 
involving enamel and dentine.