Fung et al.

, Oral Hyg Health 2013, 1:1

Oral Hygiene & Health http://dx.doi.org/10.4172/johh.1000107

Research
Review Article
Article Open
OpenAccess
Access

Early Childhood Caries: A Literature Review

Marcus HT Fung, May CM Wong, Edward CM Lo and CH Chu*
Department of Dentistry, The University of Hong Kong, Hong Kong SAR, China

Abstract
Early Childhood Caries (ECC) is defined as the presence of one or more decayed tooth surfaces in any primary
tooth in children 71 months of age or younger. ECC is the most common chronic illness among children and
adolescents. Studies have found caries prevalence among preschool children varies greatly in different countries,
ranging from 17 to 94%. However, in most of the studies; over 90% of decayed teeth were left untreated. Caries
progression can lead to pain and reduced ability to chew and eat, which may also lead to iron deficiency due to
malnutrition. Reduction of quality of life for children with ECC, resulting from disturbed sleeping and concentration
problems, has been reported. Children with severe caries may experience reduced weight and delayed growth. This
paper provides an updated literature review of ECC. The aetiology, clinical features, caries prevalence in recent
literature, consequences of caries infection and management of ECC are discussed.

Keywords: Early childhood caries; Children; Review and anti-microbial treatments can prevent or delay infant inoculation
[11,12].
Introduction
Cariogenic bacteria such as MSis often transmitted from an
Early childhood caries (ECC) is defined as the presence of one expectant mother’s mouth to the infant. Moreover, horizontal
or more decayed tooth surfaces in any primary tooth in children 71 transmission of MS between members of a related group can also occur
months of age or younger [1]. ECC is the most common chronic illness [8]. Recent studies have also shown that MS can colonize the mouth
among children and adolescent. Caries progression can lead to pain and of pre-dentate infants [8,13]. Transmission of MS also occurs between
reduced ability to chew and eat, which may also lead to iron deficiency unrelated children older than 4 years of age. Doméjean et al. [14]
due to malnutrition [2]. Reduction of quality of life for children with reported MS could widely transmit from child to child in kindergarten.
ECC, resulting from disturbed sleeping and concentration problems,
has been reported. This paper performs a literature review for ECC. In addition to the establishment of oral flora, infants and
younger children have other unique risk factors for carries, including
Aetiology development of poor dietary habits and food preferences. High-
risk dietary practices appear to be established early, probably by
The aetiology of ECC involves the interaction between pathogenic
12 months of age, and are maintained throughout early childhood
organisms, fermentable carbohydrate substrate, host susceptibility, and
[15,16]. Frequent consumption of between-meal snacks and beverages
time [3,4]. With sufficient time, the cariogenic microorganisms in the
containing fermentable carbohydrates increases the risk of caries
presence of fermentable carbohydrates, such as sucrose, can induce
demineralization of tooth substance, which can progress to loss of due to prolonged contact between sugars in the consumed food or
tooth structure or cavitation. liquid and cariogenic bacteria on the susceptible teeth [17]. Sucrose
is considered to be a major cariogenic substance in the diet, acting as
The cariogenic microorganisms play an important part in caries a substrate both for the production of extracellular polysaccharides
development. Streptococcus mutan is an important pathogenic and for acid production of the dental plaque. Freshly squeezed or
organism in the development of caries lesions [5]. Vertical transmission commercially prepared fruit juices and fluid supplements that are
of cariogenic microbes from caretakers to children is possible. S. mutan claimed to be “natural health foods” frequently contain high sugar
constitutes about 60% of the cultivable flora of dental plaque obtained content and present caries risk to children. There is some controversy
from preschool children with ECC [5]. In children with few or no as to whether bovine and breast milk imposes risk for caries. Bovine
caries, S. mutans constitutes less than 1% of the flora [5]. A recent and human milk both contain lactose, which in vitro can enhance the
study reported an association between the amount of S. mutans and implantation of cariogenic bacteria and produce caries in laboratory
the prevalence of dental caries in children [6]. Apart from S. mutans, animals [3]. Although it is possible for breast and bovine milk to cause
a similarly high number of veillonella and lactobacilli have been found dental caries, the prevalence is low and is associated with frequent and
in children with ECC [3]. Lactobacilli counts are significantly higher
prolonged breast or bottle feeding, during the day and night, until the
within caries lesions than on adjacent tooth surfaces, suggesting that
child is two or more years old [18].
lactobacilli play a role in caries progression but not in lesion initiation
[7].
The major reservoir from which infants acquire cariogenic bacteria, *Corresponding author: CH Chu, Prince Philip Dental Hospital, Hong Kong SAR,
such as mutans streptococci (MS), is the mother’s saliva [3,8]. The China, Tel: +852 28590287; Fax: +852 2858 2532; E-mail: [email protected]
success of the transmission and resultant colonization of the maternal Received April 13, 2013; Accepted May 28, 2013; Published June 05, 2013
MS may relate to factors including magnitude of the inoculums [9],
Citation: Fung MHT, Wong MCM, Lo ECM, CH Chu (2013) Early Childhood
frequency of small-dose inoculations [10], and receipt of a minimum Caries: A Literature Review. Oral Hyg Health 1: 107. doi:10.4172/johh.1000107
infective dose [5]. Infants whose mothers have high levels of MS,
as a result of untreated caries, are at greater risk of acquiring the Copyright: © 2013 Fung MHT, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
organism earlier than children whose mothers have low levels of MS unrestricted use, distribution, and reproduction in any medium, provided the
[9]. Suppressing maternal reservoirs of MS via dental rehabilitation original author and source are credited.

Oral Hyg Health

ISSN: JOHH, an open access journal Volume 1 • Issue 1 • 1000107
Citation: Fung MHT, Wong MCM, Lo ECM, CH Chu (2013) Early Childhood Caries: A Literature Review. Oral Hyg Health 1: 107. doi:10.4172/
johh.1000107

Page 2 of 7

As for the host factors, reduced salivary flow can predispose Clinical Features
children to the risk of caries. Salivation falls to a minimum during night
The development of ECC often follows a special pattern. The
sleep and reduces significantly during any sleep. This affects mechanical
pathogenesis frequently relates to the eruptive pattern of the primary
cleansing and buffering following fermentation of cariogenic substrates
dentition, the cariogenic feeding pattern, and the oral physiology of
[19]. The nursing liquid can stagnate and has cariogenic potential. the infant or child [3,4,23]. The caries attack usually starts on the labial
Therefore, a child put to bed with a nursing bottle filled with cariogenic surface of the upper anterior incisors. The initial lesion appears as a
substrate is at risk of caries. Moreover, demographic factors (e.g. age, whitish area of decalcification along the gingival margin. These lesions
oral hygiene, and socio-economic and cultural characteristics) also soon become pigmented and spread laterally and coronally. Caries on
affect the development of ECC [4]. A literature review found that most molars may start simultaneously in the pit and fissure area and the
studies determined an inverse relationship between oral hygiene status gingival area of the buccal surface. The four upper incisors are usually
and the incidence of ECC [3]. the more severely affected, since they are among the first teeth to erupt
and therefore have the longest exposure to cariogenic substances.
Children’s caries status is also found to be related to their socio-
Moreover, the nursing liquid always pools around these four teeth. The
economic background [20]. Poor parental education, low family mandibular incisors are more resistant to decay, which may be due to
income and single parenting are all associated with a higher caries rate their close proximity to the secretion area of the submandibular glands
of preschool children [3]. In addition, cultural and ethnic variables are as well as the cleansing action of the tongue during sucking [4]. The
also significant factors that predispose infants and children to ECC tongue extends anteriorly during sucking to form an oral seal, which
because diet, feeding habits, and pacifier use differ between cultures prevents the nursing liquid from pooling around the mandibular
[3]. Neglect, if ECC and untreated tooth decay is associated with incisors [24].
avoidance of care [21]; and aversive parental experience and disregard
for primary dentition are serious obstacles to improving the oral health Caries Prevalence
of children [22]. Some researchers suggested a global reduction of dental caries was

Search criteria
(Children AND caries experience OR caries prevalence AND 5 Years-old)
Language: English

Database searched

PubMed (2000-2013)

Publications identified (n =366)

Pubmed (1980-2012)
PubMed: (n=366)

Pubmed (1980-2012)

Publications Screened (n=52)

Title and abstract reviewed

Pubmed (1980-2012)

Full-text publications assessed for eligibility (n= 52)

Publications includedfor review (n=28)

Figure 1: Flowchart of literature search and selection.

Oral Hyg Health

ISSN: JOHH, an open access journal Volume 1 • Issue 1 • 1000107
Citation: Fung MHT, Wong MCM, Lo ECM, CH Chu (2013) Early Childhood Caries: A Literature Review. Oral Hyg Health 1: 107. doi:10.4172/
johh.1000107

Page 3 of 7

observed in recent decades, Bagramian et al. [25] performed a literature from 17 to 94% (Table 1). However, more than half of the surveys found
search of the available epidemiological data of dental caries from many the caries prevalence is more than 50%; and in most of the studies, over
countries. They reported that the results indicate that there was a 90% of decayed teeth were left untreated.
marked increase globally in the prevalence of dental caries. In general,
Consequences of Caries Infection
the increase in dental caries prevalence affects children as well as adults,
primary as well as permanent teeth, and coronal as well as root surfaces. Caries is the most common chronic illness among children and
This increase in dental caries signals a pending public health crisis [25]. adolescents, and it has a significant impact on oral health and general
A PubMed search of the studies published 2000 and after on primary health. Caries can lead to pain, inability to chew, and reduced ability to
dentition of preschool children was performed (Figure 1). We selected chew and eat. This results in limitations in the choice of foods and loss
5-year-old children as recommended by World Health Organisation of appetite. For this reason, children with severe caries may experience
for survey of primary teeth [26]. Studies have found caries prevalence reduced weight and delayed growth. Dental infection can spread
among preschool children varies greatly in different countries, ranging systemically which can be critical. In 2007, a 12-year-old boy living in

Study (Year) Site (Country) No. of children Age / yr % dmf>0 Mean dmft
Mantonanaki et al. (2013) [74] Attica (Greece) 605 5 17 Nil
64 (2008) 2.96 (2008)
64 (2009) 2.99 (2009)
Li et al. (2012) [75] Shanghai (China) 1850 5
65 (2010) 3.23 (2010)
64 (2011) 2.96 (2008)
Chu et al. (2012) [76] Shan state (Myanmar) 95 5 25 0.90
Wigen et al. (2011) [77] Oslo (Norway) 1348 5 11 Nil
Sufia et al. (1974) [78] Lahore (Pakistan) 700 3–5 75 (5 yr) 1.85
Simratvir et al. (2009) [79] Ludhiana (India) 609 3–6 59 (5 yr) 4.76 (1995)
Saravanan et al. (2008) [80] Tamilnadu (India) 508 5 – 10 72 3.00
Johannesburg (South
Cleaton-Jones et al. (2008) [81] 7185 2–5 59 (5 yr) 3.4 (5 yr)
Africa)
2132 (1995) 72 (1995) 4.76 (1995)
Li et al. (2008) [82] Shanghai (China) 5
789 (2005) 78 (2005) 4.17 (2005)
Li et al. (2008) [83] Sichuan (China) Nil 5 59 2.77
Cheng et al. (2007) [84] Liaoning (China) 792 5 74 4.38
Ferreira et al. (2007) [85] Canoas (Brazil) 1487 0–5 40 1.53
England 216873 38 1.47
Pitts et al. (2007) [86] Wales 10660 5 53 2.38
Scotland (UK) 11161 46 2.16
Ferro et al. (2007) [87] North-Eastern (Italy) 3401 5 31 Nil
Philadelphia
Wanjau et al. (2006) [88] 269 5 53 2.18
(Mpumalanga)
Ferro et al. (2006) [89] Veneto (Italy) 290 5 27 1.34
1.3 (1983)
Pitts et al. (2006) [90] Dundee (UK) 10381 5 43 1.4 (1993)
1.4 (2003)
30 (1997) 1.1 (1997)
Haugejorden et al. (2005) [91] Bergen (Norway) Nil 5 >40 (2001) 1.6 (2001)
36 (2003) 1.4 (2003)
England
239
Pitts et al. (2005) [92] Wales 5–6 39 2.16
389
Scotland (UK)
Skeie et al. (2005) [93] Oslo (Norway) 775 5 48 4.8
Lucas et al. (2005) [94] Minas Gerais (Brazil) Nil 5 67 Nil
Autio-Gold et al. (2005) [95] Alachua County (Florida) 221 5 48 2.5
Mello et al. (2004) [96] Itapetininga (Brazil) 291 5 Nil 2.63
Peressini et al. (2004) [97] Manitoulin (Ontario) 51 5 62 4.8
73
Ueda et al. (2004) [98] Cambira (Brazil) 5 69 3.5
61
Northern Philippines
Cariño et al. (2003) [99] 448 5 94 9.8
(Philippines)
England 170
Pitts et al. (2001) [100] 5 40 1.52
Wales (UK) 731
Mora et al. (2000) [101] Granada (Spain) 173 2-5 37 Nil
Table 1: Caries prevalence among preschool children.

Oral Hyg Health

ISSN: JOHH, an open access journal Volume 1 • Issue 1 • 1000107
Citation: Fung MHT, Wong MCM, Lo ECM, CH Chu (2013) Early Childhood Caries: A Literature Review. Oral Hyg Health 1: 107. doi:10.4172/
johh.1000107

Page 4 of 7

Maryland, USA died of a toothache [27]. The bacteria from the dental provide funding to treat the massive amount of caries in children in
abscess had spread to his brain. developing countries. Atraumatic restorative treatment (ART) is a
relatively new approach to the management of dental caries, originally
In the case of pulpal involvement, the abscess developed can developed to provide restorative dental treatment outside of the
potentially damage permanent teeth and incur enamel opacities, traditional clinical settings [52]. Taifour et al. [53] reported that ART
hypoplasia, or incomplete development. Premature loss of deciduous using glass ionomer yielded better results in treating carious lesions
teeth can lead to reduced dental arch, tooth displacement, tilting, and extending into dentine in primary teeth than the traditional treatment
rotations. Early loss of teeth results in difficulty in phonetics, affecting using amalgam after 3 years. Glass ionomer has the ability of bonding
normal language development. Pain associated with caries leads to chemically to enamel and dentine. Moreover, it releases fluoride and
reduced quality of life for children, which results from disturbed this is believed to prevent secondary caries formation and progression
sleeping and concentration problems [28-30]. Interruption in play [54]. ART treatment approach is recommended by the World Health
and school work from pain and infection due to caries can induce Organization for bringing restorative dental treatment to people who
emotional stress, including anger and instability. As a result of aesthetic would not normally have access to dental care [55]. This treatment
and/or phonetics problems, children may be teased by other children, can also be provided to patients who may have difficulty tolerating
which could negatively affect their self-esteem. Children may develop a conventional dental treatment with drilling and local anaesthesia
silent demeanor or avoid smiling and laughing as a result. injection.
ECC is associated with a higher risk of new carious lesions in Managing caries through minimally-invasive and low-cost
both the primary and permanent dentitions. Early onset of caries is methods is a critical issue. Caries-arresting treatment that aims to halt
associated with future caries development [31-36]. Infants with ECC or slow caries progression provides a practical solution for minimizing
grow at a slower pace than caries-free infants, experiencing with children’s discomfort and problems stemming from caries. Caries
insufficient physical development, especially in height and weight has been demonstrated to be arrested and remineralized with the use
[37,38]. Some young children with ECC may be severely underweight of chemical modalities such as topical fluorides [56] and sugar free
because of associated pain and the disinclination to eat. ECC may also chewing gum [57]. Topical fluorides have been used to prevent and
lead to iron deficiency due to malnutrition [2]. arrest dental caries. Fluoride application can either be self-applied or
Hospitalizations and emergency room visits are required to manage professionally applied. Self-applied fluorides reduce the cost of using
pain and spreading of infections due to caries [39-42]. These visits professional staff but not the cost of the material as it is consumed
increase treatment costs and time [43,44], while also causing children frequently in low concentrations. Self-application of fluorides also
to suffer from loss of school days and increased days with restricted requires close supervision and the procedures may not be suitable for
activity [45-47], as well as from diminished ability to learn [47,48]. young children.

Management of Early Childhood Caries When the caries progresses substantially into dentine, the mineral
component is demineralised and the organic component of collagen
Regarding the prevention and management of ECC, the focus has fibres breaks down. Carious lesions can also theoretically become
been on modifying the dental, infectious, and behavioural determinants arrested at any stage in the progression of caries. Arrested dentine
of the disease [49]. The treatment objectives for ECC are commonly to caries is clinically defined by the hardness of the dentine surface and
improve oral hygiene; to eliminate carious teeth; and to improve the a yellow to dark brown coloration [58]. Advanced carious lesions in
functioning and aesthetics of the child [23]. The management of ECC dentine consist of two distinct layers with different microscopic and
often requires education of both the parents and the child to improve chemical structure [59]. Two types of microbiological carious infected
their dental awareness and attitude toward dental health. The current dentine lesions were found: the lactobacilli-rich infected dentine (which
best practice recommended by the American Academy of Pediatric has high numbers of lactobacilli) and the non-lactobacilli-rich infected
Dentistry includes twice-daily use of fluoridated toothpaste for dentine (which as a low number of lactobacilli and a diverse micro-
dentate children. Parents should provide assisted tooth brushing for flora) [60]. Although dental caries causes demineralization of mineral
preschool-age children. Oral hygiene measures for all children should tissue and denaturation of collagen fibres, the inner layer is scarcely
be implemented no later than the time of eruption of the first primary infected by bacteria but is affected by plaque acid [61]. The inner part
molar tooth. of dentine caries still contains a high concentration of mineral salts and
Conventional care usually involves preventive and restorative care. can be remineralized [62].
Preventive care includes dental health education, dietary analysis and It has been shown that the pulp can remain vital in primary teeth
advice, the use of fluoride agents, and the use of anti-bacterial agents with deep dentine caries. Eidelman et al. [63] reported that 69% of
like chlorhexidine varnish and fissure sealant to prevent new caries the carious primary incisors in their study had a normal pulp without
development. Topical anti-microbial therapy using povidone iodine pulpal exposure. When the dentinal tubules in the area between the soft
has been reported effective in the prevention of ECC [50]. Restorative and the hard dentine were obstructed with large mineral crystals, caries
care may involve restoration of carious teeth with dental materials was arrested. Another study found that the lesion in arrested caries had
like silver amalgam, composite resins, or glass ionomer cements. A a higher pH than that of active caries lesions [64]. A histopathological
stainless steel crown can be used to restore large multi-surface carious study of carious primary teeth in children found that arrested caries
lesions. Pulpotomy [51] and pulpectomy are treatments for the pulpally had a significantly more favourable pulpal status than active caries [65].
involved carious teeth. Teeth with a poor prognosis should be extracted It may even be possible to monitor caries lesions with frank cavitation
to prevent pain and the spreading of infection. without placing a restoration on the carious lesion if there is evidence
The Commonwealth Dental Association and the World Health that the caries process has been arrested [66].
Organization held a workshop in 1986 on equity in oral health. Cost-effective caries preventive procedures have been used to tackle
One of the many challenges addressed at the workshop was how to the severe caries problem in children in disadvantaged communities.

Oral Hyg Health

ISSN: JOHH, an open access journal Volume 1 • Issue 1 • 1000107
Citation: Fung MHT, Wong MCM, Lo ECM, CH Chu (2013) Early Childhood Caries: A Literature Review. Oral Hyg Health 1: 107. doi:10.4172/
johh.1000107

Page 5 of 7

A study reported that brushing with fluoride toothpaste was effective 9. Berkowitz RJ, Turner J, Green P (1981) Maternal salivary levels of
Streptococcus mutans and primary oral infection of infants. Arch Oral Biol 26:
in re-hardening dentine caries in preschool children [67]. Fluoride 147-149.
varnishes is becoming popular in recent years. It adheres to tooth
10. Loesche WJ (1986) Role of Streptococcus mutans in human dental decay.
surfaces for longperiods and prevent the immediate loss of fluoride after Microbiol Rev 50: 353-380.
application, thus acting as slow-releasing reservoirs of fluoride.Regular
11. Isokangas P, Söderling E, Pienihäkkinen K, Alanen P (2000) Occurrence of
application of 5% sodium fluoride varnish over five years was reported dental decay in children after maternal consumption of xylitol chewing gum, a
to be able to arrest caries [68]. Another study found that active dentine follow-up from 0 to 5 years of age. J Dent Res 79: 1885-1889.
caries should be arrested by daily oral hygiene procedures and fluoride 12. Köhler B, Bratthall D, Krasse B (1983) Preventive measures in mothers
varnish [69]. The two-year longitudinal study on xylitol chewing gum influence the establishment of the bacterium Streptococcus mutans in their
showed that caries could be arrested in children with the chewing gum infants. Arch Oral Biol 28: 225-231.

method [70]. In addition, studies have shown that chlorhexidine varnish 13. Milgrom P (2000) Tooth decay in our poorest children: what can we do? J
can inhibit proteolytic activity, arrest dentine caries, and reduce caries Indiana Dent Assoc 79: 24-26.

incidence in preschool children [71,72]. However, a systemic review of 14. Doméjean S, Zhan L, DenBesten PK, Stamper J, Boyce WT, et al. (2010)
Horizontal transmission of mutans streptococci in children. J Dent Res 89: 51-
selected caries prevention and management methods has found that
55.
the strength of evidence for the success of fluoride varnishes is fair, and
15. Tinanoff N, Palmer CA (2000) Dietary determinants of dental caries and dietary
evidence is insufficient for all other methods [73]. In addition, the use recommendations for preschool children. J Public Health Dent 60: 197-206.
of chewing gum may not be indicated for young children.
16. Kranz S, Smiciklas-Wright H, Francis LA (2006) Diet quality, added sugar, and
Conclusion dietary fiber intakes in American preschoolers. Pediatr Dent 28: 164-171.

17. Marino RV, Bomze K, Scholl TO, Anhalt H (1989) Nursing bottle caries:
ECC is a transmissible infectious disease, but these hazardous characteristics of children at risk. Clin Pediatr (Phila) 28: 129-131.
effects can be prevented by early effective interventions. Progression of
18. Hackett AF, Rugg-Gunn AJ, Murray JJ, Roberts GJ (1984) Can breast feeding
ECC can lead to pain and reduced ability to chew and eat, which may cause dental caries? Hum Nutr Appl Nutr 38: 23-28.
also lead to malnutrition and reduction of quality of life of children.
19. Dawes C, Ong BY (1973) Circadian rhythms in the flow rate and proportional
The focus on the prevention and management of ECC has been on contribution of parotid to whole saliva volume in man. Arch Oral Biol 18: 1145-
modifying the dental, infectious, and behavioural determinants of the 1153.
disease. The management of ECC often requires education of both the
20. Chu CH, Fung DS, Lo EC (1999) Dental caries status of preschool children in
parents and the child to improve their dental awareness and attitude Hong Kong. Br Dent J 187: 616-620.
toward dental health. Managing caries has shifted from surgical or
21. Skaret E, Weinstein P, Milgrom P, Kaakko T, Getz T (2004) Factors related
restorative caries treatment to preventive early intervention to arrest to severe untreated tooth decay in rural adolescents: a case-control study for
and even reversal of initial non-cavitated caries lesions. public health planning. Int J Paediatr Dent 14: 17-26.

Disclosure 22. Riedy CA, Weinstein P, Milgrom P, Bruss M (2001) An ethnographic study for
understanding children’s oral health in a multicultural community. Int Dent J
This work is part of Dr Marcus Ho Tak Fung’s Ph.D. study. Drs. C 51: 305-312.
H Chu, Edward C M Lo and May C M Wong served as supervisors for 23. Chu CH (2000) Treatment of early childhood caries: a review and case report.
Dr Fung’s study. The authors would like to thank Ms Rita Suen and Dr Gen Dent 48: 142-148.
Zhang Shinan for their editing and proof reading. The authors report
24. Johnston T, Messer LB (1994) Nursing caries: literature review and report of a
no conflict of interest in this research. case managed under local anaesthesia. Aust Dent J 39: 373-381.
References 25. Bagramian RA, Garcia-Godoy F, Volpe AR (2009) The global increase in dental
caries. A pending public health crisis. Am J Dent 22: 3-8.
1. Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, et al. (1999)
Diagnosing and reporting early childhood caries for research purposes. A report 26. World Health Organization: Oral healty surveys: Basic methods, 4th edn.
of a workshop sponsored by the National Institute of Dental and Craniofacial Geneva.1997.
Research, the Health Resources and Services Administration, and the Health
Care Financing Administration. J Public Health Dent 59: 192-197. 27. Otto M. For Want of a Dentist. Washington Post 2007
2. Clarke M, Locker D, Berall G, Pencharz P, Kenny DJ, et al. (2006) 28. Acs G, Pretzer S, Foley M, Ng MW (2001) Perceived outcomes and parental
Malnourishment in a population of young children with severe early childhood satisfaction following dental rehabilitation under general anesthesia. Pediatr
caries. Pediatr Dent 28: 254-259. Dent 23: 419-423.
3. Ripa LW (1988) Nursing caries: a comprehensive review. Pediatr Dent 10: 268- 29. Low W, Tan S, Schwartz S (1999) The effect of severe caries on the quality of
282. life in young children. Pediatr Dent 21: 325-326.
4. Yiu CK, Wei SH (1992) Management of rampant caries in children. 30. Thomas CW, Primosch RE (2002) Changes in incremental weight and well-
Quintessence Int 23: 159-168. being of children with rampant caries following complete dental rehabilitation.
5. van Houte J (1980) Bacterial specificity in the etiology of dental caries. Int Dent Pediatr Dent 24: 109-113.
J 30: 305-326.
31. al-Shalan TA, Erickson PR, Hardie NA (1997) Primary incisor decay before age
6. Tanner AC, Milgrom PM, Kent R Jr, Mokeem SA, Page RC, et al. (2002) The 4 as a risk factor for future dental caries. Pediatr Dent 19: 37-41.
microbiota of young children from tooth and tongue samples. J Dent Res 81:
53-57. 32. Gray MM, Marchment MD, Anderson RJ (1991) The relationship between
caries experience in the deciduous molars at 5 years and in first permanent
7. Matee MI, Mikx FH, Maselle SY, Van Palenstein Helderman WH (1992) Mutans molars of the same child at 7 years. Community Dent Health 8: 3-7.
streptococci and lactobacilli in breast-fed children with rampant caries. Caries
Res 26: 183-187. 33. Grindefjord M, Dahllöf G, Modéer T (1995) Caries development in children from
2.5 to 3.5 years of age: a longitudinal study. Caries Res 29: 449-454.
8. Berkowitz RJ (2006) Mutans streptococci: acquisition and transmission. Pediatr
Dent 28: 106-109. 34. Heller KE, Eklund SA, Pittman J, Ismail AA (2000) Associations between dental

Oral Hyg Health

ISSN: JOHH, an open access journal Volume 1 • Issue 1 • 1000107
Citation: Fung MHT, Wong MCM, Lo ECM, CH Chu (2013) Early Childhood Caries: A Literature Review. Oral Hyg Health 1: 107. doi:10.4172/
johh.1000107

Page 6 of 7

treatment in the primary and permanent dentitions using insurance claims data. 60. Hahn CL, Falkler WA Jr, Minah GE (1991) Microbiological studies of carious
Pediatr Dent 22: 469-474. dentine from human teeth with irreversible pulpitis. Arch Oral Biol 36: 147-153.

35. Johnsen DC, Gerstenmaier JH, DiSantis TA, Berkowitz RJ (1986) Susceptibility 61. Joyston-Bechal S, Kidd EA (1986) Remineralisation of carious lesions in
of nursing-caries children to future approximal molar decay. Pediatr Dent 8: enamel by exposure to a fluoride-containing toothpaste in vitro. Br Dent J 161:
168-170. 133-136.

36. O’Sullivan DM, Tinanoff N (1996) The association of early dental caries patterns 62. ten Cate JM (2001) Remineralization of caries lesions extending into dentin. J
with caries incidence in preschool children. J Public Health Dent 56: 81-83. Dent Res 80: 1407-1411.

37. Acs G, Lodolini G, Kaminsky S, Cisneros GJ (1992) Effect of nursing caries on 63. Eidelman E, Ulmanksy M, Michaeli Y (1992) Histopathology of the pulp in
body weight in a pediatric population. Pediatr Dent 14: 302-305. primary incisors with deep dentinal caries. Pediatr Dent 14: 372-375.

38. Ayhan H, Suskan E, Yildirim S (1996) The effect of nursing or rampant caries 64. Hojo S, Komatsu M, Okuda R, Takahashi N, Yamada T (1994) Acid profiles and
on height, body weight and head circumference. J Clin Pediatr Dent 20: 209- pH of carious dentin in active and arrested lesions. J Dent Res 73: 1853-1857.
212.
65. Di Nicolo R, Guedes-Pinto AC, Carvalho YR (2000) Histopathology of the pulp
39. Fleming P, Gregg TA, Saunders ID (1991) Analysis of an emergency dental of primary molars with active and arrested dentinal caries. J Clin Pediatr Dent
service provided at a children’s hospital. Int J Paediatr Dent 1: 25-30. 25: 47-49.

40. Majewski RF, Snyder CW, Bernat JE (1988) Dental emergencies presenting to 66. Zero DT (1999) Dental caries process. Dent Clin North Am 43: 635-664.
a children’s hospital. ASDC J Dent Child 55: 339-342.
67. Lo EC, Schwarz E, Wong MC (1998) Arresting dentine caries in Chinese
41. Schwartz S (1994) A one-year statistical analysis of dental emergencies in a preschool children. Int J Paediatr Dent 8: 253-260.
pediatric hospital. J Can Dent Assoc 60: 959-962.
68. Milgrom P, Rothen M, Spadafora A, Skaret E (2001) A case report: arresting
42. Sheller B, Williams BJ, Lombardi SM (1997) Diagnosis and treatment of dental dental caries. J Dent Hyg 75: 241-243.
caries-related emergencies in a children’s hospital. Pediatr Dent 19: 470-475.
69. Nyvad B, Fejerskov O (1997) Assessing the stage of caries lesion activity on
43. Griffin SO, Gooch BF, Beltrán E, Sutherland JN, Barsley R (2000) Dental the basis of clinical and microbiological examination. Community Dent Oral
services, costs, and factors associated with hospitalization for Medicaid-eligible Epidemiol 25: 69-75.
children, Louisiana 1996-97. J Public Health Dent 60: 21-27.
70. Mäkinen KK, Bennett CA, Hujoel PP, Isokangas PJ, Isotupa KP, et al. (1995)
44. Ramos-Gomez FJ, Huang GF, Masouredis CM, Braham RL (1996) Prevalence Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res
and treatment costs of infant caries in Northern California. ASDC J Dent Child 74: 1904-1913.
63: 108-112.
71. Du MQ, Tai BJ, Jiang H, Lo EC, Fan MW, et al. (2006) A two-year randomized
45. Gift HC, Reisine ST, Larach DC (1992) The social impact of dental problems clinical trial of chlorhexidine varnish on dental caries in Chinese preschool
and visits. Am J Public Health 82: 1663-1668. children. J Dent Res 85: 557-559.

46. Hollister MC, Weintraub JA (1993) The association of oral status with systemic 72. Garcia MB, Nör JE, Schneider LG, Bretz WA (2001) A model for clinical
health, quality of life, and economic productivity. J Dent Educ 57: 901-912. evaluation of the effect of antimicrobial agents on carious dentin. Am J Dent
14: 119-122.
47. Reisine ST (1985) Dental health and public policy: the social impact of dental
disease. Am J Public Health 75: 27-30. 73. Bader JD, Shugars DA, Bonito AJ (2001) A systematic review of selected
caries prevention and management methods. Community Dent Oral Epidemiol
48. Peterson J, Niessen L, Nana Lopez GM (1999) Texas public school nurses’ 29: 399-411.
assessment of children’s oral health status. J Sch Health 69: 69-72.
74. Mantonanaki M, Koletsi-Kounari H, Mamai-Homata E, Papaioannou W (2013)
49. Ismail AI (2003) Determinants of health in children and the problem of early Prevalence of dental caries in 5-year-old Greek children and the use of
childhood caries. Pediatr Dent 25: 328-333. dental services: evaluation of socioeconomic, behavioural factors and living
50. Lopez L, Berkowitz R, Spiekerman C, Weinstein P (2002) Topical antimicrobial conditions. Int Dent J 63: 72-79.
therapy in the prevention of early childhood caries: a follow-up report. Pediatr 75. Li CR, Zeng XL, Wang X, Xu W, Chen X (2012) [Analysis of caries status
Dent 24: 204-206. among 5-year-old children in Shanghai from 2008 to 2011]. Shanghai Kou
51. Redig DF (1968) A comparison and evaluation of two formocresol pulpotomy Qiang Yi Xue 21: 451-454.
technics utilizing “Buckley’s” formocresol. J Dent Child 35: 22-30. 76. Chu CH, Chau AM, Wong ZS, Hui BS, Lo EC (2012) Oral health status and
52. Frencken JE, Pilot T, Songpaisan Y, Phantumvanit P (1996) Atraumatic behaviours of children in myanmar - a pilot study in four villages in rural areas.
restorative treatment (ART): rationale, technique, and development. J Public Oral Health Prev Dent 10: 365-371.
Health Dent 56: 135-140. 77. Wigen TI, Espelid I, Skaare AB, Wang NJ (2011) Family characteristics and
53. Taifour D, Frencken JE, Beiruti N, van ‘t Hof MA, Truin GJ (2002) Effectiveness caries experience in preschool children. A longitudinal study from pregnancy to
of glass-ionomer (ART) and amalgam restorations in the deciduous dentition: 5 years of age. Community Dent Oral Epidemiol 39: 311-317.
results after 3 years. Caries Res 36: 437-444. 78. Suzuki T, Nishida M, Sobue S, Moriwaki Y (1974) Effects of diammine silver
54. Randall RC, Wilson NH (1999) Clinical testing of restorative materials: some fluoride on tooth enamel. J Osaka Univ Dent Sch 14: 61-72.
historical landmarks. J Dent 27: 543-550. 79. Simratvir M, Moghe GA, Thomas AM, Singh N, Chopra S (2009) Evaluation of
55. Pakhomov GN (1999) Future trends in oral health and disease. Int Dent J 49: caries experience in 3-6-year-old children, and dental attitudes amongst the
27-32. caregivers in the Ludhiana city. J Indian Soc Pedod Prev Dent 27: 164-169.

56. Autio-Gold JT, Courts F (2001) Assessing the effect of fluoride varnish on early 80. Saravanan S, Kalyani V, Vijayarani MP, Jayakodi P, Felix J, et al. (2008) Caries
enamel carious lesions in the primary dentition. J Am Dent Assoc 132: 1247- prevalence and treatment needs of rural school children in Chidambaram
1253. Taluk, Tamil Nadu, South India. Indian J Dent Res 19: 186-190.

57. Mäkinen KK, Hujoel PP, Bennett CA, Isotupa KP, Mäkinen PL, et al. (1996) 81. Cleaton-Jones P, Williams S, Green C, Fatti P (2008) Dental caries rates in
Polyol chewing gums and caries rates in primary dentition: a 24-month cohort primary teeth in 2002, and caries surveillance trends 1981-2002, in a South
study. Caries Res 30: 408-417. African city. Community Dent Health 25: 79-83.

58. Wilding RJ, Solomon CS (1996) Arrested caries: a review of the repair potential 82. Li CR, Shen QP (2008) [The dental caries prevalence of primary teeth in 789
of the pulp-dentine. J Dent Assoc S Afr 51: 828-833. five-year-old children in Shanghai]. Hua Xi Kou Qiang Yi Xue Za Zhi 26: 299-
300.
59. Daculsi G, LeGeros RZ, Jean A, Kerebel B (1987) Possible physico-chemical
processes in human dentin caries. J Dent Res 66: 1356-1359. 83. Li KZ, Li X, Hu DY, Fan X, Nie L (2008) [Prevalence of deciduous tooth caries in
780 children aged 5 years]. Hua Xi Kou Qiang Yi Xue Za Zhi 26: 70-72.

Oral Hyg Health

ISSN: JOHH, an open access journal Volume 1 • Issue 1 • 1000107
Citation: Fung MHT, Wong MCM, Lo ECM, CH Chu (2013) Early Childhood Caries: A Literature Review. Oral Hyg Health 1: 107. doi:10.4172/
johh.1000107

Page 7 of 7

84. Cheng RB, Zhang Y, Liu L, Tao W (2007) [The epidemiological investigation of co-ordinated by the British Association for the Study of Community Dentistry.
dental caries among 5-year old children in Liaoning province]. Shanghai Kou Community Dent Health 22(1):46-56.
Qiang Yi Xue 16: 343-346.
93. Skeie MS, Espelid I, Skaare AB, Gimmestad A (2005) Caries patterns in an
85. Ferreira SH, Béria JU, Kramer PF, Feldens EG, Feldens CA (2007) Dental urban preschool population in Norway. Eur J Paediatr Dent 6: 16-22.
caries in 0- to 5-year-old Brazilian children: prevalence, severity, and associated
94. Lucas SD, Portela MC, Mendonça LL (2005) [Variations in tooth decay rates
factors. Int J Paediatr Dent 17: 289-296. among children 5 and 12 years old in Minas Gerais, Brazil]. Cad Saude Publica
86. Pitts NB, Boyles J, Nugent ZJ, Thomas N, Pine CM (2007) The dental 21: 55-63.
caries experience of 5-year-old children in Great Britain (2005/6). Surveys 95. Autio-Gold JT, Tomar SL (2005) Prevalence of noncavitated and cavitated
co-ordinated by the British Association for the study of community dentistry. carious lesions in 5-year-old head start schoolchildren in Alachua County,
Community Dent Health 24: 59-63. Florida. Pediatr Dent 27: 54-60.
87. Ferro R, Besostri A, Meneghetti B, Olivieri A, Benacchio L, et al. (2007) Oral 96. Mello TR, Antunes JL (2004) [Prevalence of dental caries in schoolchildren in
health inequalities in preschool children in North-Eastern Italy as reflected by the rural area of Itapetininga, São Paulo State, Brazil]. Cad Saude Publica 20:
caries prevalence. Eur J Paediatr Dent 8: 13-18. 829-835.

88. Wanjau J, du Plessis JB (2006) Prevalence of early childhood caries in 3- to 97. Peressini S, Leake JL, Mayhall JT, Maar M, Trudeau R (2004) Prevalence
5-year-old children in Philadelphia district, Mpumalanga Province. SADJ 61: of early childhood caries among First Nations children, District of Manitoulin,
390-392, 394. Ontario. Int J Paediatr Dent 14: 101-110.

89. Ferro R, Besostri A, Meneghetti B (2006) Dental caries experience in preschool 98. Ueda EM, Dezan CC, Frossard WT, Salomão F, Morita MC (2004) Prevalence
children in Veneto region (Italy). Community Dent Health 23: 91-94. of dental caries in 3- and 5-year-old children living in a small Brazilian City. J
Appl Oral Sci 12: 34-38.
90. Pitts NB, Chestnutt IG, Evans D, White D, Chadwick B, et al. (2006) The
99. Cariño KM, Shinada K, Kawaguchi Y (2003) Early childhood caries in northern
dentinal caries experience of children in the United Kingdom, 2003. Br Dent
Philippines. Community Dent Oral Epidemiol 31: 81-89.
J 200: 313-320.
100. Pitts NB, Evans DJ, Nugent ZJ (2001) The dental caries experience of 5-year-
91. Haugejorden O, Birkeland JM (2005) Analysis of the ups and downs of caries
old children in Great Britain. Surveys coordinated by the British Association
experience among Norwegian children aged five years between 1997 and for the Study of Community Dentistry in 1999/2000. Community Dent Health
2003. Acta Odontol Scand 63: 115-122. 18: 49-55.
92. Pitts NB, Boyles J, Nugent ZJ, Thomas N, Pine CM (2005) British Association 101. Mora León L, Martínez Olmos J (2000) [The prevalence of caries and
for the Study of Community Dentistry. The dental caries experience of 5-year- associated factors in children 2-5 years old from the Almanjáyar and Cartuja
old children in England and Wales (2003/4) and in Scotland (2002/3). Surveys Health Centers of the capital Granada]. Aten Primaria 26: 398-404.

Oral Hyg Health

ISSN: JOHH, an open access journal Volume 1 • Issue 1 • 1000107