2 - Oral Health Policies Flashcards
How is dental care medically necessary?
- Dental care is medically necessary to prevent and eliminate orofacial disease, infection, and pain, to restore the form and function of the dentition and to correct facial disfiguration or dysfunction.
- The US Surgeon General’s report emphasizes that oral health is integral to general health. Oral diseases can have a direct and devastating impact on overall health, especially for those with certain systemic health problems or conditions.
What percent of children experience caries?
- Approximately 60% of children experience caries in their primary teeth by age five.
- -There is a significant increase in caries prevalence in the two to five year age range. - By 17 years of age, 78% of children in the US have experienced caries.
Where do most of the caries occur in school aged children?
As much as 90% of all caries in school-aged children occurs in pits and fissures.
What developmental problems is early childhood caries associated with?
Children with early childhood caries (ECC) may be severely underweight bc of the associated pain and disinclination to eat. Nutritional deficiencies during childhood can impact cognitive development.
What systemic problems is periodontal disease associated with?
- Cardiovascular disease
2. Adverse pregnancy outcomes
What association is there between oral health and respiratory disease?
- Oral health, oral microflora and bacterial pneumonia, especially in populations at high risk for respiratory disease, have been linked.
- The mouth can harbor respiratory pathogens that may be aspirated, resulting in airway infections.
How do infants and young children have unique caries-risk factors?
- Ongoing establishment of oral flora and host defense systems
- Susceptibility of newly erupted teeth
- Development of dietary habits and childhood food preferences
What can predispose children to have caries?
- Children are most likely to develop caries if mutans streptococci is acquired at an early age.
- High-risk caries-conducive dietary practices appear to be established early, probably by 12 months of age, and are maintained throughout early childhood.
What percent of the US population does not benefit from community water fluoridation?
More than one-third of the US population does not benefit from community water fluoridation.
What children benefit from sealants placed prophylactically?
Children with multiple risk factors and tooth morphology predisposed to plaque retention (i.e., developmental defects, pits and fissures).
What reduction in caries does sealants provide?
A child who receives sealants is 72% less likely to receive restorative services over the next three years than children who do not.
Are sealants on primary molars beneficial?
Sealants placement on primary molars in young children is a cost-effective strategy for children at risk for caries, including those insured by state Medicaid programs.
What is the success rate of sealants with follow-up care?
With follow-up care, the success rate of sealants may be 80 to 90 percent, even after a decade.
What percent of Medicaid programs reimburse dentists for sealants on primary molars?
While all Medicaid programs reimburse dentists for sealants on permanent teeth, only one in three reimburses for primary molar sealants.
What are most of the insurance companies’ basis for refusal to provide reimbursement for sedation/general anesthesia and related facility services?
- Most denials cite the procedure as “not medically necessary.” This determination appears to be based on arbitrary and inconsistent criteria.
- American Dental Association Resolution 1989-546 states that insurance companies should not deny benefits that would otherwise be payable “solely on the basis of the professional degree and licensure of the dentist or physician providing treatment, if that treatment is provided by a legally qualified dentist or physician operating within the scope of his or her training and licensure.”
What is the AAPD’s policy on medically necessary care?
The AAPD encourages:
- Oral health care to be included in the design and provision of individual and community-based health care programs to achieve comprehensive health care.
- Establishment of a dental home for all children by 12 months of age in order to institute an individualized preventive oral health program based upon each pt’s unique caries risk assessment.
- Healthcare providers who diagnose oral diseases to either provide therapy or refer the pt to a primary care dentist or dental/medical specialist as dictated by the nature and complexity of the condition. Immediate intervention is necessary to prevent further dental destruction, as well as more widespread health problems.
- Evaluation and care provided for an infant, child, or adolescent by a cleft lip/palate, orofacial or craniofacial deformities team as the optimal way to coordinate and deliver such complex services.
- The dentist providing oral health care for a pt to determine the medical indication and justification for treatment. The dental care provider must assess the pt’s developmental level and comprehension skills, as well as the extent of the disease process, to determine the need for advanced behavior guidance techniques such as sedation or general anesthesia.
What is the AAPD’s encouragement to third party payers?
The AAPD encourages third party payers to:
- Recognize malformed and missing teeth are resultant anomalies of facial development seen in orofacial anomalies and may be from congenital defects. Just as the congenital absence of other body parts requires care over the lifetime of the pt, so will these.
- Include oral health care services related to these facial and dental anomalies as benefits of health insurance without discrimination between the medical and dental nature of the congenital defect. These services, optimally provided by the craniofacial team, include, but are not limited to, initial appliance construction, periodic examinations, and replacement of appliances.
- End arbitrary and unfair refusal of compensation for oral health care services related to orofacial and dental anomalies.
- Recognize the oral health benefits of dental sealants and not base coverage for sealants on permanent and primary teeth on a pt’s age.
- Ensure that all children have access to the full range of oral health delivery systems. If sedation or general anesthesia and related facility fees are payable benefits of a health care plan, these same benefits shall apply for the delivery of oral health services.
- Regularly consult the AAPD with respect to the development of benefit plans that best serve the oral health interests of infants, children, adolescents and persons with special health care needs, especially those with craniofacial or acquired orofacial anomalies.
What are the major themes in the US Surgeon General’s report on “Oral Health in America”?
- Oral health means much more than healthy teeth.
- Oral health is integral to general health.
- Profound and consequential disparities exist in the oral health of our citizens.
What are the recommendations in the DHHS report “National Call to Action to Promote Oral Health”?
It recommends:
- Changing perceptions of the public, policymakers, and health providers regarding oral health and disease so that oral health becomes an accepted component of general health.
- Removing known barriers between people and oral health services.
- Accelerating the building of the scientific and evidence base, as well as the application of research findings, to improve oral health.
- Ensuring the adequacy of public and private health personnel and resources to meet the oral health needs of all Americans and enable the integration of oral health effectively with general health. The focus is on having a responsive, competent, diverse and flexible workforce.
- Expanding public-private partnerships and building upon common goals to improve the oral health of those who suffer disproportionately from oral diseases.
According to the AAPD, AAP, ADA and Academy of General Dentistry, when should children first see the dentist?
- Referral by the primary care physician or health provider has been recommended, based on risk assessment, as early as six months of age, six months after the first tooth erupts and no later than 12 months of age.
- -This provides time-critical opportunities to provide education on preventive health practices and reduce a child’s risk of preventable dental/oral disease.
What should a dental home provide?
- Comprehensive oral health care including acute care and preventive services in accordance with AAPD periodicity schedules.
- Comprehensive assessment for oral diseases and conditions.
- Individualized preventive dental health program based upon a caries-risk assessment and a periodontal disease risk assessment.
- Anticipatory guidance about growth and development issues (i.e., teething, digit or pacifier habits).
- Plan for acute dental trauma.
- Information about proper care of the child’s teeth and gingivae. This would include the prevention, diagnosis and treatment of disease of the supporting and surrounding tissues and the maintenance of health, function and esthetics of those structures and tissues.
- Dietary counseling.
- Referrals to dental specialists when care cannot directly be provided within the dental home.
- Education regarding future referral to a dentist knowledgeable and comfortable with adult oral health issues for continuing oral health care; referral at an age determined by patient, parent and pediatric dentist.
What concept is the dental home based on?
Derived from the AAP model of a medical home.
What did the US Surgeon General’s report on “Oral Health in America: A Report of the Surgeon General” in 2000, say about the disparities in oral health?
- The report identified profound and consequential disparities in the oral health of our citizens.
- Dental disease restricts activities in schools, work and home and often significantly diminishes the quality of life.
- For certain large groups of disadvantaged children there is a silent epidemic of dental disease.
- -Dental caries is the most common chronic disease of children in the US.
- -80% of tooth decay is found in 20-25% of children, large portions of whom live in poverty or low-income households and lack access to an on-going source of quality dental care.
What factors contributes to access to care?
- Health care professionals often elect not to participate as providers in Medicaid or CHIP programs due to:
- -Low reimbursement rates
- -Administration burdens
- -Frequency of failed appointments by pts whose treatment is publicly funded - Underutilization of services due to:
- -Lack of health literacy
- -Limited English proficiency
- -Cultural and societal barriers - Financial circumstances and geographical/transportational considerations.
In the dental home model who directs the care?
- Central to the dental home model is dentist-directed care.
- -The dentist performs the examination, diagnoses oral conditions and establishes a treatment plan that includes preventive services, and all services are carried out under the dentist’s supervision. - The dental home delivery model implies direct supervision (i.e., physical presence during the provision of care) by the dentist.
- -The allied dental personnel (e.g., dental hygienist, expanded function dental assistant/auxiliary (EFDA), dental assistant) work under direct supervision of the dentist to increase productivity and efficiency while preserving quality of care. - This model also allows for provision of preventive oral health education by EFDAs and preventive oral health services by a dental hygienist under general supervision (i.e., without the presence of the supervising dentist in the treatment facility) following the examination, diagnosis and treatment plan by the licensed, supervising dentist.
- The dental team can be expanded to include auxiliaries who go into the community to provide education and coordination of oral health services.
Why would the mid-level provider model not improve access to care for the underserved?
- Current US proposed models are private practice/non-government employee models, providing no assurances that independent providers will locate in underserved areas.
- -If providers are government employees, assignment to areas of greatest need is possible. - Evidence from several developed countries that have initiated mid-level provider programs suggests that, when afforded an opportunity, those practitioners often gravitate toward private practice settings in less-remote areas, thereby diminishing the impact on care for the underserved.
How is the technical quality of restorative procedures performed by non-dentist providers?
- Studies have found, in general, that within the scope of services and circumstances to which their practices are limited, the technical quality is comparable to that produced by dentists.
- There is, however, no evidence to suggest that they deliver any expertise comparable to a dentist in the fields of diagnosis, pathology, trauma care, pharmacology, behavioral guidance, treatment plan development and care of special needs pts.
- It is essential that policy makers recognize that evaluations which demonstrate comparble levels of technical quality merely indicate that individuals know how to provide certain limited services, not that those providers have the knowledge and experience necessary to determine whether and when various procedures should be performed or to manage individuals’ comprehensive oral health care, especially with concurrent conditions that may complicate treatment or have implications for overall health. Technical competence cannot be equated with long-term outcomes.
What does the New Zealand model show about the use of non-dentist providers?
- New Zealand, known for utilizing dental therapists since the 1920’s and frequently referenced as a workforce model for consideration in the US, recently completed its first nationwide oral health status survey in over 20 years.
- The New Zealand caries rates, which are higher than the US, UK, and Australia, help refute a presumption that utilization of non-dentist providers will overcome the disparities.
Does the AAPD support non-dentist providers?
- AAPD encourages the greater use of expanded function dental assistants/auxiliaries and dental hygienists under direct supervision by a dentist to help increase volume of services provided within a dental home, based upon their proven effectiveness and efficiency in a wide range of settings.
- AAPD also supports provision of preventive oral health services by a dental hygienist under general supervision (i.e., without the presence of the supervising dentist in the treatment facility) following examination, diagnosis and treatment plan by the licensed, supervising dentist.
- Similarly, partnering with other health providers, especially those who most often see children during the first years of life (e.g., pediatricians, family physicians, pediatric nurses), will expand efforts for improving children’s oral health.
- AAPD strongly believes there should not be a two-tiered standard of care, with our nation’s most vulnerable children receiving services by providers with less education and experience, especially when evidence-based research to support the safety, efficiency, effectiveness and sustainability of such delivery models is not available.
What dental records are used for identification purposes?
- Dental radiographs
- Facial photographs
- Study casts
- Dental histories documenting teeth present and distinguishing features of oral structures.
- Restorative history documenting restored surfaces and materials used.
- Bite registrations
What non-dental sources are used for identification purposes?
- Fingerprints
- Photographs
- Physical descriptions
- DNA from blood, saliva and other tissue
What programs have been developed by community groups that use child identification methods?
- Child Identification Program (CHIP) - sponsored by the Masons. this program gathers saliva samples for DNA fingerprinting, videos, toothprints and fingerprints
- The National Child Identification Program - sponsored by the American Football Coaches Association with the Optimist International and Clear Channel Int. They use an identification card which includes fingerprints, a physical description, photographs and the physician’s office address/telephone number.
- New England Kids Identification System (KIDS) - sponsored by the Massachusetts Free Masons and the Massachusetts Dental Society, which incorporated dental bite impression and cheek swabs to gather DNA material into the CHIP events.
What percent of children receive some form of child care on a regular basis from persons other than their parents?
In the US in 2005, 61% of children ages 0 through 6 who were not yet in kindergarten received some form of child care on a regular basis from persons other than their parents.
Of the children who receive some form of child care from persons other than their parents, on a regular basis, what percent attended center-based programs?
57% of the children who received some form of child care on a regular basis from persons other than their parents attended center-based programs which include day care centers, pre-kindergartens, nursery schools, Head Start programs and other early childhood education programs.
What are the organizations that have recommendations and requirements that address oral health in out-of-home child care?
- The American Academy of Pediatrics
- The American Public Health Association
- The National Association for the Education of Young Children (NAYEC)
- Head Start
By the time children begin kindergarten, what percent have caries?
40%
What is the most common chronic disease of childhood?
ECC is the most common chronic disease of childhood, affecting 28% of children 2 to 5 years of age, or over four million children nationwide.
What does the AAPD encouragement to child care centers?
- Utilize oral health consultation, preferably by a pediatric dentist, at least once a year and as needed. The health consultant should review and observe program practices regarding oral health and make individualized recommendations for each program.
- Promote the concept of the dental home by educating their personnel as well as the parents on the importance of oral health and providing assistance with establishment of a dental home no later than 12 months of age of the child.
- Maintain a dental record, starting at 12 months with yearly updates, as part of the child’s health report. It should address the child’s oral health needs including any special instructions given to the care givers.
- Have written up-to-date, comprehensive procedures to prepare for, report, and respond to medical and dental emergencies. The source of urgent care should be known to caregivers and acceptable to parents.
- Sponsor on-site, age-appropriate oral health education programs for the children that will promote good oral hygiene and dietary practices, injury prevention and the importance of regularly scheduled dental visits.
- Provide in-service training programs for personnel regarding oral hygiene concepts, proper nutrition choices, link between diet and tooth decay and children’s oral health issues including proper initial response to traumatic injuries along with dental consequences. Personnel with an understanding of these concepts are at a greater advantage in caring for children.
- Encourage parents to be active partners in their children’s health care process and provide an individualized education plan, one that is sensitive to cultural values and beliefs, to meet every family’s needs. Written material should be available and, at a minimum, address oral health promotion and disease prevention and the timing of dental visits.
- Familiarize parents with the use of and rationale for oral health procedures administered through the program and obtain advance parental authorization for such procedures.
- Incorporate an oral health assessment as part of the daily health check of each child.
- Promote supervised or assisted oral hygiene practices at least once daily after a meal or a snack.
- Provide well-balanced and nutrient-dense diets of low caries-risk.
- Have clean, optimally-fluoridated drinking water available for consumption throughout the day.
- Not permit infants and toddlers to have bottles/sippy cups in the crib or to carry them while walking or crawling while under the child care center’s supervision.
- Minimize saliva-sharing activities (e.g., sharing utensils, orally cleansing a pacifier) to help decrease an infant’s or toddler’s acquisition of cariogenic microbes.
How many states require a dental screening examination prior to school matriculation?
Only 11 states and the District of Columbia require a dental screening examination prior to school matriculation.
Low-income children account for what percent of ECC?
33% of low-income children experience 75% of the ECC.
What is the average number of school days missed from acute dental problems?
In 1996, students aged 5 to 17 missed an average of 3.1 days/100 students due to acute dental problems.
–When these problems are treated and children no longer are experiencing pain, their learning and school attendance improve.
What does the AAPD recommend for a comprehensive oral health exam prior to matriculation into school?
Documentation of:
- Oral health history
- Soft tissue health/pathologic conditions
- Oral hygiene level
- Variations from a normal eruption/exfoliation pattern
- Dental dysmorphology or discoloration
- Caries (including white-spot lesions)
- Existing restorations
Education on:
1. The child/parent should be made aware of age-related caries-risk and caries-protective factors, as well as the benefits of a dental home.
What does the National Association of State Boards of Education state about health and school?
The National Association of State Boards of Education recognizes that health and success in school are interrelated. Schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally and socially.
What does the US Surgeon General state about the national health plan for oral health?
A national public health plan for oral health does not exist.
- -There is no national national policy on excused absences from school for dental appointments.
- -Some states (e.g., California, Texas) have very specific laws excusing students for dental appointments. Other state laws are more general and recognize absences due to doctor’s appointments or illness.
What is the AAPD’s policy on school absences for dental appointments?
The AAPD:
- Supports state law or school policy that allows the absence for legitimate healthcare delivery, including that of oral health services.
- Encourages parents, school administrators dentists to work together to ensure that children receive dental care while minimizing school absences.
What is the ADA and AAPD recommendation for emergency dental care?
- ADA Principles of Ethics and Code of Professional Conduct states that “dentists shall be obliged to make reasonable arrangements for the emergency care of their patients of record.”
- AAPD recommends dentists should provided instructions to the parent for accessing emergency care.
- -When consulted for a dental emergency by patients not of record, the dentist should make reasonable arrangements for emergency dental care.
- -If emergency dental treatment is provided, the dentist should recommend that the patient return to his/her dental home unless the parent expresses a different preference.
Is there a difference between fluoride treatment before and after prophylaxis?
- Over the years, there have been numerous reports showing plaque and pellicle are not a barrier to fluoride uptake in enamel and, consequently,
- There is no evidence of a difference in caries rate or fluoride uptake in subjects who receive rubber cup prophylaxis or a tooth brush prophylaxis before fluoride treatment.
What is selective polishing and why is there increased popularity in selective polishing?
- Selective polishing procedure involve individual evaluation of each pt so that only specific teeth that have indications (e.g., stain) receive a rubber cup pumice prophylaxis
- The potential for abrasives causing tooth wear and loss of the fluoride-rich zone of enamel has been cited as a consideration for decreasing the need for pumice prophylaxis. As a result, the selective polishing procedure and the toothbrush prophylaxis procedure have gained popularity..
What is the benefit of a professional prophylaxis?
Professional prophylaxis is indicated to:
- Instruct the caregiver and child or adolescent in proper oral hygiene techniques.
- Remove microbial plaque, extrinsic stain and calculus.
- Facilitate the examination of hard and soft tissues.
- Introduce dental procedures to the young child and apprehensive pt.
- Assess pt cooperation.
Which prophylaxis option can remove stain?
- Rubber cup
- Hand instruments
- Ultrasonic scalers
Which prophylaxis options can remove calculus?
- Hand instruments
2. Ultrasonic scalers
What is the most beneficial and inexpensive method of reducing the occurrence of caries?
The adjustment of the fluoride level in community water supplies to optimal concentration is the most beneficial and inexpensive method of reducing the occurrence of caries.
How much reduction in fluoride has water fluoridation provided?
- Epidemiologic data from the last half-century indicate reductions in caries of 55 to 60 percent.
- Recent data show caries reduction of approximately 25 percent, without significant enamel fluorosis, when domestic water supplies are fluoridated at an optimal level.
How much reduction in the cost of oral health care for children has water fluoridation provided?
Evidence accumulated from long-term use of fluorides has demonstrated that the cost of oral health care for children can be reduced by as much as 50 percent.
If effective fluoridation of drinking water is impossible, what can you do?
When fluoridation of drinking water is impossible, effective systemic fluoridation can be achieved through the intake of daily fluoride supplements.
–Before supplements are prescribed, it is essential to review dietary sources of fluoride (e.g., all drinking water sources, consumed beverages, prepared food, toothpaste) to determine the pt’s true exposure to fluoride.
What is the concern with infant formula and fluoride?
- Fluoride content of ready to use infant formulas in the US and Canada ranges from 0.1 to 0.3 mg/L, which provides only a modest source of fluoride.
- The more important issue, however, is the fluoride content of concentrated or powdered formula when reconstituted with fluoridated water.
- -Considering the potential for mild fluorosis, caution is advised for infants consuming formula that is reconstituted with optimally-fluoridated water.
- -As the Environmental Protection Agency/Department of Health and Human Services’ recommendation for optimizing community water supplies to 0.7ppm F is instituted, fluorosis due to reconstituting infant formula with fluoridated water will be less of an issue.
Numerous clinical trials have confirmed the anti-caries effect of which professional topical fluoride treatments?
Numerous clinical trials have confirmed the anti-caries effect of professional topical fluoride treatments, including:
- -1.23% acidulated phosphate fluoride
- -5% neutral sodium fluoride varnish
- -0.09% fluoride mouthrinse
- -0.5% fluoride gel/paste
How much fluoride toothpaste should be used for tooth brushing in children?
- No more than a smear or rice-size (0.1mg fluoride) amount for children less than 3 years of age.
- No more than a pea-size (0.25mg fluoride) amount for children aged 3 to 6.
What is the most effective method for reducing dental caries prevalence in children?
Drinking fluoridated water and brushing with fluoridated toothpaste at least daily are perhaps the most effective method in reducing dental caries prevalence in children.
What is the chemical structure of xylitol?
- Xylitol is a five-carbon sugar alcohol derived primarily from forest and agricultural materials.
- It is found naturally in various trees, fruits and vegetables and is an intermediate product of the glucose metabolic pathway in man and animal.
What has xylitol been historically used for?
It has been used since the early 1960s in:
- Infusion therapy for post-operative burn and shock patients.
- Diet of diabetic patients.
- Sweetener in products aimed at improved oral health.
What is the optimal amount of xylitol intake for anticariogenic results?
- Studies suggest xylitol intake that consistently produces positive results ranged from 4-10g/day, divided into 3-7 consumption periods.
- -Higher amounts did not result in greater reduction in incidence of caries and may lead to diminishing anticariogenic results.
- -Consumption frequency of less than 3 times per day at optimal xylitol amount showed no effect.
What are the side effects of xylitol?
Abdominal distress, gas and osmotic diarrhea have been reported following the ingestion of xylitol.
- -Diarrhea has been reported in pts who have consumed 3-60g of xylitol per day.
- These symptoms usually occur at higher dosages and will subside once xylitol consumption is stopped.
- To minimize gas and diarrhea, xylitol should be introduced slowly, over a week or more, to acclimate the body to the polyol, especially in young children.
How does xylitol have an anticariogenic effect?
- Reduces plaque formation and bacterial adherence (i.e., is antimicrobial)
- Inhibits enamel demineralization (i.e., reduces acid production)
- Has a direct inhibitory effect on MS - disrupts the energy production processes of MS leading to a futile energy consumption cycle and cell death.
What happens with prolonged use of xylitol?
Prolonged use of xylitol appears to select for a “xylitol resistant” mutant of the MS cells.
- -These mutants appear to shed more easily into saliva than the parent strains, resulting in a reduction of MS in plaque and possibly hampering their transmission/colonization from mother to child.
- -Long lasting effects have been demonstrated up to five years after two years of using xylitol chewing gum.
What delivery vehicles is xylitol available in?
- Gums
- Mints
- Chewable tablets
- Lozenges
- Toothpastes
- Mouthwashes
- Cough mixtures
- Nutraceutical products
Xylitol chewing gum has been shown to be effective as a preventive agent. The effectiveness of other xylitol products is being studied at this time.
What is the difference between ART and ITR?
- Atraumatic/alternative restorative technique (ART) is a means of restoring and preventing caries in populations with little access to traditional dental care.
- -In many countries, practitioners provide treatment in non-traditional settings that restrict restorative care to placement of provisional restorations.
- -Bc circumstances do not allow for follow-up care, ART mistakenly has been interpreted as a definitive restoration. - Interim therapeutic restoration (ITR) utilizes similar techniques but has different therapeutic goals.
- -ITR more accurately describes the procedures used in contemporary dental practice in the US>
When is ITR used?
ITR may be used to restore and prevent carious lesions in:
- Young patients
- Uncooperative patients
- Patients with special health care needs
- When traditional cavity preparation and/or placement of traditional dental restorations are not feasible and need to be postponed
- May be used for step-wise excavation in children with multiple open carious lesions prior to definitive restoration of the teeth, in erupting molars when isolation conditions are not optimal for a definitive restoration, or in patients with active lesions prior to treatment performed under general anesthesia.
How much reduction in cariogenic oral bacteria does ITR provide?
ITR has been shown to reduce the levels of cariogenic oral bacteria (e.g., Mutans Streptococci, lactobacilli) in the oral cavity immediately following its placement.
–However, this level may return to pretreatment counts over a period of six months after ITR placement if no other treatment is provided.
ITR is most successful with what kind of caries?
ITR has the greatest success when applied to single surface or small two surface restorations.
How can ITR restorations fail?
Inadequate cavity preparation with subsequent lack of retention and insufficient bulk can lead to failure.
Why was the term “Nursing Bottle Caries” renamed to ECC?
The distinctive clinical presentation was not consistently associated with poor feeding practices and that caries was an infectious disease. The AAPD adopted the term ECC to reflect better its multifactorial etiology.
What is ECC?
The presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child under the age of six.