Australasian Dentist Magazine Sept-Oct 2021

Category 104 Australasian Dentist clinical D ental caries is one of the most common and preventable non- communicable diseases affecting all age groups, not least pre-school children. It has a complex aetiology with several risk factors involved and increases the likelihood of poor child growth, development and social outcomes. Since it is a preventable disease, a preventive approach is fundamental for a positive impact on prevalence. Knowledge of the disease needs to be considered a cornerstone in the work of oral disease prevention and oral health promotion 1,2 . Early Childhood Caries Early Childhood Caries (ECC) is defined 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 pre-school age child between birth and 71 months of age 1,3 . The aetiology of ECC is multifactorial and mainly attributed to an interaction of microorganisms with sugars on a tooth surface. Factors such as high sugar intake, lack of oral hygiene, and lack of fluoride exposure are some of the most important parameters responsible for the development of ECC 3,4 . Caries in the primary dentition has a higher progression rate than in permanent teeth, probably due to the relatively thinner enamel. In addition, caries early in life is a predictor for caries incidence later in life 5,6 . Causes and prevention Dental caries is currently the most common chronic disease of children, affecting 60–90% of children worldwide, meaning that around 600 million children suffer from ECC 6,7 . The percentages of five- and six-year-old children with dental caries in 2017–2018 indicate a high level in certain countries of Eastern Europe and the Middle East, Asia, Africa, and Latin America (more than 70%). North America and Western Europe had moderately high levels of children with caries in this age Early childhood caries – a prevalent disease with a considerable impact Anna Nilvéus Olofsson, DDS, Specialist Paediatric Dentistry, Odont lic, Manager Odontology and Scientific Affairs, TePe Susanne Brogårdh-Roth, DDS, Specialist Paediatric Dentistry, Odont dr, Malmö University (35–69%), while northern Europe showed the lowest scores (less than 35%) 2,8 . The World Health Organization (WHO) set a goal for dental health in Europe that by 2020, 80% of six-year- olds should be caries-free, a goal that most likely no country will reach 6,9 . On the contrary, reports indicate that the prevalence of ECC is increasing rapidly in low- and middle-income countries 2 . This increase in dental caries in children signals a pending public health crisis. Caries is not evenly distributed between countries, and neither is the distribution within countries or cities; the problem is concentrated to vulnerable areas 2,8 . The need to reach these communities is obvious, and one approach is based on participatory health promotional activities. Impact on the quality of life Oral health is a fundamental component of overall health and quality of life. Irrespective of the measurement approach of oral health-related quality of life and culture, ECC seems to impact the affected children, their families and the communities in a negative way 10 . If left untreated 11 , it influences the child’s wellbeing and may lead to pain, chronic dental infection and inflammation, disrupted sleep, and reduced chewing ability, which in the long run leads to malnutrition and growth problems 1,10 . On the other hand, treatment of ECC has been shown to have a positive impact on oral health-related quality of life 10 . Improvement in parental and caregiver knowledge, attitude and behaviour towards oral health during early childhood have been reported to give a reduction in caries scores and prevalence of ECC 12 . A preventive approach Primary prevention is fundamental to impact the global prevalence of ECC. Relevant education of caregivers and the use of fluoride toothpaste are cornerstones. Based on family-centered and customised recommendations, an early dental visit during the first year of life is of great importance for the preventive strategy. It should focus on caries risk assessment, toothbrushing instruction, dietary counselling, anticipatory guidance, and