Early Childhood Caries: Prevalence, Risk Factors, and Prevention

MANAgeMeNT
Maintaining primary dentition in a healthy condition is impor-
tant for the well-being of the child. Primary dentition is required 
for proper mastication, esthetics, phonetics, space maintenance, 
and for prevention of aberrant habits. Reducing dental plaque 
formation, changing the bacterial composition of plaque, and 
modification of dietary habits are essential for the prevention 
of dental caries. Prevention of the progress of the ECC can be 
achieved with the aid of restorations, diet counseling, educating 
parents regarding decay promoting feeding behaviors, maintain 
good oral hygiene, and the use of preventive agents like topical 
fluorides (
75
). The management of ECC is expensive, often 
requiring extensive restorative treatment and extraction of teeth 
at an early age. General anesthesia or deep sedation may be 
required at times, since young children lack the ability to cope 
with the extensive treatment procedures (
76
). Chemothera-
peutic agents, such as povidone-iodine and chlorhexidine, have 
shown antimicrobial effect against the most cariogenic SM
(
77
, 
78
). Chlorhexidine varnish is applied to protect the tooth 
surface (
79
).
In addition, fluorides are very effective in preventing den-
tal caries, including fluoride toothpaste, water fluoridation, 
fluoride mouth rinse, and professional topical fluoride appli-
cation, primarily by inhibiting mineral loss from the tooth. 
Tooth paste containing fluoride showed a strong preventive 
effect in young permanent teeth (
80
). Professionally applied 
fluoride varnishes and supervised use of fluoride mouth 
rinses also showed reduction in childhood caries (
81
, 
82
).
The application of casein phosphor peptide (CPP) could 
stabilize the calcium and phosphate thereby preserving them 
in an amorphous or soluble form known as amorphous cal-
cium phosphate (ACP). Calcium and phosphate are essential 
components of enamel and dentine and form highly insoluble 
complexes in the presence of CPP. CPP–ACP complexes can 
prevent tooth demineralization and improve enamel reminer-
alization and enhance fluoride activity. Hence, the application 
of CPP–ACP-based compounds helps in the prevention of 
dental caries (
83
, 
84
).