Early childhood caries ecc is a rampant dental disease that affects mostly young children. The american dental association ada defines ecc as the presence of one or more decayed non cavitated or cavitated lesions , missing due to caries or filled tooth surfaces in any primary tooth in a preschool age child between birth and 71 months of age. For the last fifty years, dentists and researchers have struggled to clearly define ecc. It has been referred to as baby bottle tooth decay, nursing bottle syndrome, and rampant caries lesions huntington, kim, amp hughes, 2002. Certainly, defining ecc has proven challenging and for this reason, prevalence rates of ecc have varied by definition.

The prevalence of ecc, however, has been shown to be overwhelmingly high among low income and minority populations such as native americans, hispanics, and african americans in the united states. Hispanics have the highest rate of ecc in both developed and developing countries with an average prevalence of 13% 29%, second only to native americans huntington, et al. Ecc is an alarming problem because the disease is so common and widespread amongst young children.

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In fact, the prevalence of ecc in children, ages three to five years, in us head start programs is as high as 90% tinanoff amp o'sullivan, 1997. In developing countries ecc is a critical problem as well, heightened by extraneous factors such as low income or malnutrition. Overall, defining ecc is problematic because the true nature of the syndrome is not clear. This review describes and models the nature of ecc so that effective and efficacious decisions about its prevention may be recommended. The colloquial term for ecc is baby bottle tooth decay because it is common in young children a baby bottle, filled with liquids containing sugars, is used as a pacifier in aiding sleep or quietness. Though this disease can occur in all children, ecc is most prevalent in minority and poorer populations. In 1993 1994, the california oral health needs assessment of children in the head start program demonstrated that 30% 33% of asian and latino/hispanic children had ecc, with 49% to 54% of who presented with untreated caries shiboski, gansky, ramos gomez, ngo, isman, amp pollick, 2003.

Untreated caries may lead to early loss of the primary dentition and affect the growth and maturation of the secondary, adult dentition. In fact, decay in the primary detention is the best predictor for decay in the secondary dentition poor dental health and disease often persist to adulthood, affecting speech articulation, growth, and dietary practices weintraub, 1998. At the most extreme of cases, ecc can also lead to rampant decay, infection, pain, abscesses, chewing problems, malnutrition, gastrointestinal disorders, and low self esteem ramos gomez, weinstraub, gansky, hoover, amp featherstone, 2002.

Additionally, children with ecc are shown to have an elevated risk for new lesions as they get older, both in the primary and permanent dentitions tinanoff amp o'sullivan, 1997. For this review paper, online searches were performed using pubmed, google, and various college research search engines. Peer review papers from scientific journals including community dentistry and oral epidemiology. Sources of information from various websites including those about fluoride prevention, dental sealants, and general ecc and pediatric dentistry information were also used. Biologically, ecc is an infectious process catalyzed by the frequent and prolonged exposure of sugars, such as those present in milk, formula, and fruit juice, to the teeth's surface.

The early, ongoing practice of putting a child to sleep using the bottle at naptime or bedtime exposes sugary fluids that may pool around a baby or child's teeth for hours. The longer that the sugary liquids come into contact with the tooth's enamel, the more likely it is for these sugars to combine with bacteria. Those like mutans streptococci that become present after the first tooth emerges. Children with ecc typically have extremely high levels of mutans streptococci, bacteria that come from mothers tinanoff amp o'sullivan, 1997. Demineralization of the tooth's enamel and dentin is caused by the acids that bacteria, mutans streptococci and lactobacilli, produce. Specifically, the bacteria, acid, food debris, and saliva combine to form a sticky substance called plaque that adheres to teeth. The bacteria and plaque feed from the sugars, producing waste products like lactic acids that cause demineralization or tooth decay.

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If plaque is not removed thoroughly and regularly, tooth decay will not only present itself, but will continue to flourish. The onset of ecc has four necessary components: susceptible teeth, bacteria, a substrate or food for bacteria, and time for caries to develop. During naptime or bedtime, the substrate sugar and the infectious agent bacteria become present on the teeth for a prolonged time, allowing demineralization and caries progression.

When associated with use of the bottle, ecc has been shown to first affect the primary maxillary anterior teeth, followed by involvement of the primary molars tinanoff amp o'sullivan, 1997. Thus, it is common to observe children with ecc having decay predominantly around the central and lateral incisors, and canines of the maxillary. The tongue protects the bottom teeth by serving as a barrier from sugars and bacteria, and consequently, the bottom teeth are less affected and suffer less decay.

Depending on the progression of caries, there are various disease states of which each requires appropriate treatment. A very early sign of caries development is the beginnings of tooth demineralization, the slight penetration into tooth enamel, which is typically visualized by chalky white spots or lines. In this premature stage, white spots or lines can be reversible and caries progression can be avoided with proper care fluoride application and diet changes are likely to be beneficial to the remineralization and protection of teeth.

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Further decay of the teeth from the enamel to the dentin is, obviously, more critical. Even more significant decay to the teeth may require treatment as serious as steel or veneer crowns, in which the decayed or weakened area is removed and repaired with a cap' or crown that is fitted over the remainder of the tooth. Crowns are applied if decay is extensive and there is limited tooth structure that may cause weakened teeth. Dental caries are generally painless until the decay becomes very large inside the tooth and destroys the nerves and blood vessels in the tooth.

If the decay is left untreated, a tooth abscess can develop and the internal structures of the tooth, the pulp, can be destroyed. Decay to the tooth's inner pulp is extremely critical because the pulp is made up of nerves, connective tissue, and blood vessels that help nourish the tooth. A toothache or tooth pain is equated with damage to the tooth's pulp the pulp is the most sensitive area of the tooth.

Treatment for decay to the tooth's pulp requires either pulp therapy or extraction, which is typically accompanied with general anesthesia or sedation and followed by more complex fillings and crowns to restore the teeth. During a root canal the center of the tooth, the nerve and blood vessel tissue or the pulp, is removed along with decayed portions of the tooth. Restorative care and, if necessary, tooth extraction are methods that certainly work, but the cost for restoring the health of teeth is extremely high. Tinanoff and o'sullivan 1997 estimate the cost of restoring the teeth, alone, to be $1,0 or higher per child. They state an additional $1,0 $6,0 can be included for the cost of general anesthesia or sedation.

Aside from the monetary aspects, the restorative process can be potentially painful and frightening for young children. Because this dental visit is likely to be one of the children's first, any negative impressions from this experience can potentially affect how children interact with and adhere to dental care in the future. Perhaps the most damaging effect, however, is that restorative care reinforces the idea to the parent or caretaker that dental professionals have the ability to quickly alleviate all dental problems. That is, the parent or caretaker's perception becomes that dental professionals have the responsibility of fixing caries caries are a static or isolated problem weinstein, 1998.