Review Article

An Overview on Early Childhood Caries: A Literature

Review
Alaa Abdulkarim Sanari1*, Mohammed Abdullah A Khashman2, Raghad Fahad Alharbi3, Ahmed Abdulhakim Alhashim4, Raghad
Fahad Bukhari3, Afnan Abdulrahman Bokhari3, Samar Hamdan Alrayiqi3, Awadh Ali Alazmi2, Weam Othman M Barnawi2, Ghadah
Mustafa Aljohani2, Anwar Hassan Alzahrani1

1
Faculty of Medicine, King Abdulaziz University, Jeddah, KSA. 2Faculty of Medicine, Hail University, Hail, KSA. 3Faculty of Medicine, Batterjy
Medical College, Jeddah, KSA. 4Faculty of Medicine, King Faisal University, Al Ahsa, KSA.

Abstract
Early childhood caries is highly prevalent in preschool children in many countries. This has been attributed to many factors. The awareness
about the disease, dentition, oral health, and preventive measures are generally lacking in communities. Reviewing the current literature on
early childhood dental caries, clinical features, etiological factors, management, and prevention. PubMed database was used for articles
selection, and the following keys used in the mesh (“Early Childhood Caries” [Mesh] AND “Diagnosis” [Mesh] AND “Management”
[Mesh]). In children, there are many risks for teeth decay and most notably of those are infectious causes, poor dietary style and excessive
sugar intake. The diagnosis of early childhood caries is a clinical one where the affected teeth are recognized by their dull white enamel. This
clinical sign is a manifestation of demineralization after repetitive damage by bacteria, sugar and acidity. Management of dental caries are
central to clinical dental practice. It is, therefore, necessary to understand the condition and what could be done to prevent its occurrence or
progression.

Keywords: Dental caries, Gingival lesions, Early childhood caries, Diagnosis, Management

INTRODUCTION MATERIALS AND METHODS

In dental practice, the early childhood caries is identified by PubMed database was used for articles selection, and the
the presence of one or more cavitation lesion, a lost teeth due following keys used in the mesh (“Early Childhood Caries”
to caries, and/or a filling in primary teeth of children aged [Mesh] AND “Diagnosis” [Mesh] AND “Management”
seventy-two months or younger [1]. As children grow, the [Mesh]). In regards to the inclusion criteria, the articles were
definition of early childhood caries differs slightly. In selected based on inclusion of one of the following topics:
children younger than three years of age, the dentist should early childhood dental caries, etiological and predisposing
identify smooth-surface caries as this is a pathognomonic factors, diagnosis, clinical features, and management.
sign of early childhood caries. In older children, single or Exclusion criteria were all other articles which did not have
multiple cavitation, lost teeth due to caries, fillings, and/or one of these topics as their primary endpoint.
tooth decay are all considered signs of severe early childhood
caries. These caries are prevalent across the globe, in China Review
the prevalence of early childhood caries is around 78% and Etiological Factors
the severe form reached up to 41% [2]. In Qatar, there is also
a high prevalence of severe childhood dental caries in pre-
Address for correspondence: Alaa Abdulkarim Sanari,
school children reach as 27% [3]. In India’s Himachal Faculty of Medicine, King Abdulaziz University, Jeddah, KSA.
Pradesh province, the prevalence of severe early childhood Dr.a.sanari@gmail.com
caries is around 20% in pre-school children [4]. This
condition is highly prevalent in preschool children, This is an open-access article distributed under the terms of the Creative Commons
potentially reflecting a poor oral health education in the Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix,
tweak, and build upon the work non commercially, as long as the author is credited
community [5]. This oral health literacy is correlated heavily and the new creations are licensed under the identical terms.
with socio-economic background of the family [6]. In this
paper, we will review the literature for the relevant causes, How to cite this article: Sanari AA, Khashman MAA, Alharbi RF,
clinical features, diagnosis, and management options for this Alhashim AA, Bukhari RF, Bokhari AA, et al. An Overview on Early
disease. Childhood Caries: A Literature Review. Arch Pharm Pract.
2021;12(1):55-8. https://doi.org/10.51847/coBValKcm4

© 2021 Archives of Pharmacy Practice 55

 Sanari et al.: An Overview on Early Childhood Caries: A Literature Review

In children, there are many risks for teeth decay and the most other hand, heavy intake of non-healthy or junk food that is
notable ones are: infectious causes, poor dietary style, and filled with sugar is a known factor in dentition decay [15].
excessive sugar intake. The body is resilient to infections, and Furthermore, eating heavy amounts of sweets combined with
therefore, another factor is often present before caries arise. incorrect or sparingly brushing of teeth renders the child
This is usually because children are often exposed to higher susceptible to developing dentition caries [16]. While other
rate of sugary food and soft drinks, in addition to existing causes of poor oral hygiene may play an important role in the
bacterial infestation. There are a number of important development of caries, such as parental incarceration [17].
organisms, but the most encountered in childhood dental Moreover, other factors related to mothers of these children
caries is Streptococcus mutans [7]. Additionally, have been implicated in the development of disease in the
Streptococcus lactobacilli is implicated as a risk factor for the children. These factors range from illiteracy, poor maternal
development of early childhood caries, especially in obese dental health, to prolonged night-time breastfeeding [18].
children [7]. Other less commonly implicated bacteria
include Rothia mucilaginosa and Veillonella parvula [8]. Clinical Diagnosis
The diagnosis of early childhood caries is a clinical one where
Hence, the pathophysiology is that of bacterial interaction the affected teeth are recognized by their dull white enamel.
with carbohydrates, combined with the ensuing increased This clinical sign is a manifestation of demineralization after
salivary acidity, eventually breaching the protective teeth repetitive damage by bacteria, sugar and acidity. In patients
enamel. This demineralization of teeth enamel inevitably who are left untreated, severe early childhood caries takes
manifests as dental caries. Moreover, children with blood place. To diagnose this former condition, there should be at
disorders such as beta-thalassemia major are at higher risk of least signs of caries on smooth surfaces of teeth of children
developing both dental caries and gingival inflammation [9, younger than three years. There are other criteria that if
10]. Children with iron deficiency are also susceptible to present indicate severity of the condition. These include
severe early childhood caries [11, 12]. These children are presence of decay, missing or filling tooth in deciduous teeth
often susceptible to bacterial infection of the oral cavity. of children aged three–five years. Dentists could utilize the
Furthermore, with the advent of fast-food restaurants and decay-missing-filled index to diagnose the condition
increased sugar placement in many products, children are at according to the age of the affected child (Table 1). However,
increased risk of dental caries. even with clinical defining early childhood caries they are not
distinctively different from dental caries, as these definitions
Malnutrition is a strong risk of dental caries development in are related more to age rather than specific pathology features
permanent teeth, fortunately, this is not the case in early [19].
childhood as primary teeth are predominant [13, 14]. On the

Table 1. Definitions of Severe Early Childhood Caries at Different Ages

Age in Months Severe Manifestation of Early Childhood Caries

<12

12–23 One or More Decay-missing-filled Surfaces

24–35

36–47 Decay-missing-filled surfaces index of >4

One or More Cavities, Filled, or Missing Smooth Surfaces

48–59 Decay-missing-filled surfaces index of >5
in Primary Maxillary Teeth

60–71 Decay-missing-filled surfaces index of >6

The clinical progression of early childhood caries is is important, thereafter, to examine the gingival areas for
important, as detecting and treating the condition early could spread of the disease, which will be manifested as yellowish
prevent unnecessary complications. The demineralization of brown lesions. The problem becomes more complicated as
the teeth enamel would appear as white patch that is children age without proper dental follow-up. Children who
progressing over time to blow-out decay. This decay seeps are not seen until four years of age are at higher risk of dental
further towards the gingivae, if not fastidiously treated. The caries [20].
occurrence of this condition is not insidious, as many children
would present with damage to the anterior maxillary teeth. It Management Approach

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 Sanari et al.: An Overview on Early Childhood Caries: A Literature Review

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