Re-Defining Early Childhood Caries: An Overview

Background: Early Childhood Caries ( ECC) has been described by a spectrum of terms such as `rampant caries`, `nursing bottle caries`, `baby bottle tooth decay` etc. which were progressively introduced with an understanding of the aetiology of this condition. The modern definition of ` ECC` given by the CDC in 1994 as the presence of 1 or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child, 71 months of age or younger. But is it the most accepted today and with a dramatic change in the understanding of caries and an increasing focus on management of ECC by preventive non surgical strategies does it still hold true ?

This review attempts to answer the following by analysis of published literature on diagnosis and management of ECC and aims to suggest a newer definition based on the findings

Methods: A Pubmed search was carried out for articles published in peer‐reviewed journals between 1994 to 2018 using the following terms: `baby bottle tooth decay`, `early childhood caries`, `rampant caries` and `nursing bottle caries`. Review papers, randomised controlled trials, observational studies and case reports on children between 0-5 years of age specifying clinical diagnostic criteria and case definitions of ECC were selected and the information from them was abstracted.

Results: Early childhood caries is commonly diagnosed by the presence of decayed, misssing or filled teeth between 0-71 months of age as per the CDC definition. However, there is considerable variation in clinical criteria used by examiners on identifying decayed teeth due to improved caries diagnostic methods as well as better understanding of the process. Non-surgical methods used in recent literature for management of ECC are also not encompassed in this definition.

Conclusion: There is an urgent need for the proposal of a more comprehensive and holistic definition of ECC.