Hypoplasia-associated Severe Early Childhood Caries – A Proposed Definition

• Published in: Journal of dental research Vol. 91; no. 6; pp. 544 - 550
• Main Authors: Caufield, P.W., Li, Y., Bromage, T.G.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.06.2012; SAGE PUBLICATIONS, INC
• Subjects: Amelogenesis; Anesthesia; Bacteria; Bottle Feeding - adverse effects; Carbohydrates; Child, Preschool; Children; Defects; Dental caries; Dental Caries - classification; Dental Caries - etiology; Dental Caries - microbiology; Dental Caries Susceptibility; Dental enamel; Dental Enamel Hypoplasia - complications; Dental Enamel Hypoplasia - embryology; Diet; Diet, Cariogenic; DMF Index; Enamel; Etiology; Female; Humans; Hypoplasia; Malnutrition; Minority & ethnic groups; Minority Groups; Native North Americans; Nursing; Nutrition research; Obesity; Oral cavity; Poverty; Pregnancy; Prenatal Exposure Delayed Effects; Reviews; Risk Factors; Streptococcus infections; Streptococcus mutans - physiology; Teeth; Terminology as Topic; Tooth, Deciduous; United States > US; tooth development; odontogenesis; access to care; pediatric dentistry; caries; Streptococcus mutans
• ISSN: 0022-0345; 1544-0591
• DOI: 10.1177/0022034512444929

We propose a new classification of severe early childhood caries (S-ECC): hypoplasia-associated severe early childhood caries (HAS-ECC). This form of caries affects mostly young children living at or below poverty, characterized by structurally damaged primary teeth that are particularly vulnerable to dental caries. These predisposing developmental dental defects are mainly permutations of enamel hypoplasia (EHP). Anthropologists and dental researchers consider EHP an indicator for infant and maternal stresses including malnutrition, a variety of illnesses, and adverse birthing conditions. Differentiation of HAS-ECC from other forms of early childhood caries is warranted because of its distinct etiology, clinical presentation, and eventual management. Defining HAS-ECC has important clinical implications: Therapies that control or prevent other types of caries are likely to be less effective with HAS-ECC because the structural integrity of the teeth is compromised prior to their emergence into the oral cavity. By the time these children present to the dentist, the treatment options often become limited to surgical management under general anesthesia. To prevent HAS-ECC, dentists must partner with other health providers to develop interventions that begin with pregnant mothers, with the aim of eliminating or ameliorating the covariates accompanying poverty, including better pre- and post-natal care and nutrition.