ECC

Question 1

Define Early Childhood Caries

Answer 1

“ECC is 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 child under the age of six”

Question 2

Define Severe Early Childhood Caries

Answer 2

In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC).

Question 3

Define population health

Answer 3

It measures the health of individuals within a population by using their social, physical and economic conditions as indicators.

Therefore, it acknowledges that to treat a common health condition within a population, common risk factors that exist between individuals need to identified and addressed.

Question 4

Demonstrate an understanding of Early Childhood Caries with a:
Population Health perspective
Maternal/ Paternal health perspective

Answer 4

Population Health perspective
1. Of children:
• Developmental defects like hypoplasia
• Inter-generational bacteria transmission of MS and LB
• Night feeding with sweetened drinks
• OHI status: disruption of biofilm and fluoride exposure

2. Of environments:
   • Physical environment: presence of fluoride, lead contamination
   • Commercial environment: employment, product availability
   • Political environment: govt legislations, programs that affect dental access
   • Economic environment: parental education, employment and stress

Maternal/ paternal health
• Difficult temperament of child
• Access to prenatal care
• Family stress
• Economic stress
• Low education levels
• Poor oral hygiene, frequent sweet snacks and inappropriate feeding
• Infant difficulty in sleeping
• Mother's poor health/ smoking

Question 5

Predict the possible oral health implications for the child diagnosed with ECC and S-ECC.

Answer 5

• Chronic pain
• Changed eating habits
• Sleep deprivation ( 25-50% of cases )

Question 6

Outline the role of the Oral Health Therapist, in the prevention of ECC and S-ECC

Answer 6

• Our role is largely prevention: keep the sound teeth sound

We need major health promotion projects targeting:
• Extension of fluoridation
• Collaborating with our allied health colleagues to enhance patient oral health

Question 7

Outline clinical considerations the Oral Health therapist will consider when managing early childhood caries

Answer 7

Consider that restoring does not treat the disease. Therefore, creating an oral health care plan is essential.

The Oral Health Care Plan involves:

• Identifying risk factors
• Encouraging behaviour change
• Providing professional (non-invasive) treatment
• Monitoring through recalls and reviews

Question 8

Define secondary and tertiary prevention

Answer 8

Secondary:

• Early disease detection in asymptomatic patients
• E.g treating a white spot lesion

Tertiary:

• Focus is to reduce the negative impact of an already-established disease by restoring function
• Drilling and filling

Question 9

Explain secondary prevention modes

Answer 9

1. Early Detection: When the tooth first erupts or at 6 months of age, the child should be screened in a post natal health care program. Consider siblings of the younger children
2. Diet Counseling: Make this specific to the risk factors that may be known about the patient
3. Fluoride Use: Recommendations to use supervised brushing with a smear layer of toothpaste, containing 1000ppm Fluoride. For cavitated lesions, there may recommendations for the placement of Fluoride varnish every 3-6 months until it arrests.
4. Behavior modification: Parents and caregivers need to be actively involved in the dietary and oral hygiene practices of their children
5. Sealants: Especially for the child at risk sealants should be placed with an evidence-based patient appropriate approach to material of choice and placement on teeth

Question 10

Explain tertiary prevention modes

Answer 10

1. Use screening tools ( ICDAS, blunt probe, good lighting, BW’ ) to detect the cavity: recognize lesions, chart and provide adequate site specific treatments
2. If restoring, consider: preserving structure, shelf life
3. If not restoring, consider: pain, cellulitis, abscess, possible extractions
4. Consider “new” evidence for alternative procedures: fluoride varnish, silver diamine fluoride, ART techniques and Hall technique
5. Establish referral systems and increase the access to care e.g. referral via a early childhood nurse; public/private partnerships to offer ‘universal’ dental coverage e.g. cdbs