Chapter 24
Early Childhood Caries
179
Table 24.3
Stages of Progression of Early Childhood Caries (ECC)
Stage
Illustration
Description of Lesion
Age of
Occurrence
Symptoms
Initial
(reversible)
stage
Cervical and interproximal
opaque, white, chalky
demineralisation seen
on maxillary anterior
teeth
Molars also display chalky
white discolouration on
occlusal surfaces around
pits and fissures
Usually 10–18
months
No pain
Dentist discovers
lesion by drying the
tooth with an air
syringe
Damaged
(carious)
stage
Discontinuity of enamel
surface
Marked discolouration is
seen and caries extends
into dentin
Dentinal caries
demonstrated on
molars
18–24 months
Parents spot decay
due to penetration
into lesion
Child expresses
difficulty and
toothache while
eating cold food
Stage of deep
lesion
Caries progresses further
to involve deeper layers
of dentin approximating
the pulp
Molars also incur deep
dentinal involvement
approximating the pulp
24–36 months or
sooner
Child complains
of pain during
brushing and taking
hot or cold drinks
Child refrains from
using anterior teeth
for incising food
Traumatic
stage
Caries encircles the cervix of
the anterior tooth
Multiple surfaces are
involved in molars,
namely occlusal,
mesial and distal, and
sometimes cervical too
(multi-surface carious
lesion)
36–48 months or
sooner
Frequent fracture of
carious tooth at the
cervix
Of these, the caries arising due to the first reason, or
pattern A, can be described as
nursing bottle caries
.
Caries caused due to pattern B can be called
tooth
cleaning neglect.
Dental carious involvement with
respect to pattern C refers to
rampant caries
.
NURSING BOTTLE CARIES
Nursing bottle caries is a unique pattern of dental
caries in very young children due to prolonged or
improper feeding habits. The infant may be fed with a
nursing bottle containing a high amount of fermentable
carbohydrates during sleep. The sugary liquid substrate
from the bottle pools around the maxillary incisors
(Figs 24.2 and 24.3). This retentive, sugary environment
Figure 24.1
Early childhood caries is a universal set and nursing
bottle caries, tooth cleaning neglect and rampant caries are
subsets.
Early childhood caries
comprises
A. Inappropriate
nursing pattern
‘Nursing bottle
caries’
B. Inadequate oral
hygiene
‘Tooth cleaning
neglect’
C. Enhanced
caries
susceptibility
‘Rampant caries’
Chapter 24.indd 179
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