Case definition, aetiology and risk assessment of early childhood caries (ECC): a revisited review.
OBJECTIVE
To provide a review of the existing literature on early childhood caries (ECC) with particular reference on the nomenclature, case definition, epidemiology, etiology and risk assessment.


METHODS
An electronic search was used to identify and critically review papers that have been published and are pertinent to the above issues, evaluate and compile the reported evidence.


RESULTS
The term ECC has been adopted to more accurately describe dental caries that affects primary dentitions, replacing previously used terminology that associated the disease with the nursing habit. Suggested ECC case definition uses caries patterns as defining criteria, however, further refinement to include different clinical expressions of a varying severity is necessary. Significant percentages of preschool child populations are affected by ECC today, with the disease concentrating disproportionately in deprived families. Early colonization by mutans streptococci (MS) is associated with increased ECC development, with bacteria being transmitted in both vertical and horizontal ways. Dietary factors related to sugar consumption predispose to early MS colonization and establishment and increase the risk for ECC development, being part of the causal chain. Inappropriate bottle and breast-feeding behaviors also increase the risk, without showing a direct causal relationship. High risk children belong to ethnic minority groups and to low income families with poor parental behaviors and attitudes.


CONCLUSIONS
Further high-quality studies are needed to explore the role bacteria other than MS may play in caries initiation and progression, elucidate the interaction of the saliva immune defence system with a potentially defective tooth, and investigate the effect distant behavioral factors have on the causal chain that leads to ECC development.
Vadiakas
G
G
Dept. of Paediatric Dentistry, Dental School, University of Athens, Greece. gvadiakas@dent.uoa.gr
D017668:Age of Onset; D002675:Child, Preschool; D004245:DMF Index; D019140:Dental Care for Children; D003731:Dental Caries / Q000145:classification* / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D004037:Diet, Cariogenic; D006801:Humans; D007223:Infant; D018570:Risk Assessment; D012463:Saliva / Q000382:microbiology; D013295:Streptococcus mutans / Q000472:pathogenicity; D014094:Tooth, Deciduous / Q000473:pathology
Int J Paediatr Dent. 1998 Jun;8(2):115-22
9728096
Pediatr Dent. 1987 Sep;9(3):221-5
3507638
Br Dent J. 1992 Mar 7;172(5):191-7
1543634
J Public Health Dent. 1996 Winter;56(1):38-50
8667317
Pediatrics. 1993 Aug;92(2):233-7
8337022
J Dent Child (Chic). 2003 Sep-Dec;70(3):235-42
14998208
Eur J Oral Sci. 1996 Aug;104(4 ( Pt 2)):436-43
8930595
Br Med J. 1979 Jul 7;2(6181):14-6
466249
Int J Paediatr Dent. 1995 Jun;5(2):67-72
7547816
Pediatr Dent. 1999 Nov-Dec;21(7):409-16
10633512
Community Dent Oral Epidemiol. 1998;26(1 Suppl):67-81
9671202
Caries Res. 2000 Mar-Apr;34(2):133-9
10773630
J Dent Res. 1995 Feb;74(2):681-5
7722065
Community Dent Health. 2005 Mar;22(1):46-56
15819117
J Dent Res. 2000 Feb;79(2):770-7
10728979
Chin J Dent Res. 1999 May;2(2):58-62
10863409
Pediatr Dent. 1988 Dec;10(4):268-82
3078603
Eur J Clin Nutr. 1993 Nov;47(11):794-802
8287849
Community Dent Oral Epidemiol. 1976 Mar;4(2):66-9
1062253
J Can Dent Assoc. 1988 Oct;54(10):751-8
3052718
Community Dent Oral Epidemiol. 1994 Oct;22(5 Pt 1):273-6
7813174
J Am Dent Assoc. 1998 Sep;129(9):1229-38
9766104
J Am Dent Assoc. 1975 Feb;90(2):418-25
234140
Community Dent Oral Epidemiol. 2001 Feb;29(1):14-22
11153558
Community Dent Oral Epidemiol. 1997 Feb;25(1):87-96
9088697
Pediatr Dent. 1997 Jan-Feb;19(1):22-7
9048409
Pediatr Dent. 1996 May-Jun;18(3):200-4
8784909
Pediatr Dent. 2002 Nov-Dec;24(6):543-51
12528947
Caries Res. 1975;9(5):333-9
1055636
J Dent Res. 1993 Dec;72(12):1573-6
8254124
Clin Pediatr (Phila). 1989 Mar;28(3):129-31
2920490
Int J Paediatr Dent. 1995 Sep;5(3):149-55
9601235
J Dent Res. 2000 Feb;79(2):778-84
10728980
Caries Res. 2001 May-Jun;35(3):186-92
11385198
Caries Res. 1993;27(6):461-6
8281559
Caries Res. 1996;30(1):65-70
8850585
Community Dent Oral Epidemiol. 1994 Oct;22(5 Pt 1):289-93
7813178
Oral Microbiol Immunol. 1998 Oct;13(5):271-7
9807118
Caries Res. 2001 Nov-Dec;35(6):442-50
11799285
Caries Res. 1990;24(6):381-96
2289223
J Dent Res. 1996 Feb;75 Spec No:631-41
8594087
J Dent Res. 1956 Feb;35(1):109-14
13286394
Pediatr Dent. 1982 Sep;4(3):218-24
6963401
Caries Res. 1998;32(3):181-92
9577983
Acta Odontol Scand. 1996 Apr;54(2):131-7
8739147
Community Dent Health. 2002 Dec;19(4):237-42
12489838
J Dent Res. 1992 Dec;71(12):1926-33
1452896
Caries Res. 1996;30(1):8-15
8850577
J Public Health Dent. 1998 Summer;58(3):248-9
10101702
Public Health Rep. 1989 Jan-Feb;104(1):50-4
2493662
J Public Health Dent. 1999 Summer;59(3):192-7
10649591
J Public Health Dent. 1987 Spring;47(2):94-7
3471967
Pediatr Dent. 1999 Mar-Apr;21(2):86-90
10197331
Scand J Dent Res. 1983 Dec;91(6):453-7
6581521
J Public Health Dent. 1996 Spring;56(2):81-3
8863291
Community Dent Oral Epidemiol. 1993 Oct;21(5):288-91
8222603
J Dent Res. 1995 Jun;74(6):1272-9
7629336
J Public Health Dent. 1999 Summer;59(3):171-91
10649590
Public Health Rep. 1997 Jul-Aug;112(4):319-29; 330-1
9258297
J Dent Res. 1982 Nov;61(11):1225-8
6958716
Scand J Dent Res. 1983 Jun;91(3):163-8
6576457
J Dent Res. 1987 Jan;66(1):23-8
3476538
Eur J Paediatr Dent. 2002 Dec;3(4):195-8
12870992
Caries Res. 1996;30(4):256-66
8773417
Pediatr Dent. 1992 Sep-Oct;14(5):314-21
1303535
Oral Microbiol Immunol. 1988 Mar;3(1):14-7
3268743
Community Dent Oral Epidemiol. 1996 Jun;24(3):164-8
8871013
Community Dent Oral Epidemiol. 2008 Apr;36(2):168-78
18333881
Pediatr Dent. 1994 Nov-Dec;16(6):413-8
7854947
Ann N Y Acad Sci. 1993 Sep 20;694:302-4
8215073
Caries Res. 2000 Nov-Dec;34(6):481-5
11093022
Caries Res. 1996;30(4):237-55
8773416
J Public Health Dent. 1990 Fall;50(5):299-305
2231523
J Dent Res. 2003 Jul;82(7):504-8
12821708
ASDC J Dent Child. 1992 Sep-Oct;59(5):376-83
1401413
Arch Oral Biol. 1984;29(11):949-51
6596042
J Public Health Dent. 2003 Winter;63(1):38-46
12597584
Caries Res. 2005 Mar-Apr;39(2):85-91
15741719
J Public Health Dent. 2006 Winter;66(1):23-9
16570747
Public Health Rep. 1995 Sep-Oct;110(5):607-17
7480616
Community Dent Oral Epidemiol. 1998;26(1 Suppl):8-27
9671196
Community Dent Health. 1992 Sep;9(3):273-81
1451000
Public Health Rep. 1992 Mar-Apr;107(2):167-73
1561298
J Public Health Dent. 2000 Summer;60(3):197-206; discussion 207-9
11109219
Pediatr Dent. 2006 Mar-Apr;28(2):151-3; discussion 192-8
16708790
Infect Immun. 1986 Jan;51(1):348-51
3941001
J Dent Res. 1993 Jan;72(1):37-45
8418105
J Clin Microbiol. 2001 Jun;39(6):2313-6
11376080
Int J Paediatr Dent. 2000 Mar;10(1):47-55
11310126
J Public Health Dent. 1994 Summer;54(3):139-44
7932349
Arch Pediatr Adolesc Med. 1995 Jul;149(7):786-91
7795770
J Dent Res. 2001 Dec;80(12):2060-5
11808762
Caries Res. 1993;27(2):154-60
8319260
Infect Immun. 1998 Jun;66(6):2595-600
9596721
J Can Dent Assoc. 1982 Jun;48(6):389-93
7049333
Caries Res. 1992;26(3):183-7
1628292
Community Dent Oral Epidemiol. 2001 Apr;29(2):136-42
11300173
ASDC J Dent Child. 1993 Jan-Feb;60(1):22-5
8432941
J Dent Res. 1993 Dec;72(12):1577-80
8254125
ASDC J Dent Child. 1995 Nov-Dec;62(6):401-8
8636475
Community Dent Oral Epidemiol. 1994 Apr;22(2):86-9
8205785
Public Health Rep. 1986 Mar-Apr;101(2):147-56
3083469
Community Dent Oral Epidemiol. 1992 Apr;20(2):64-75
1555390
J Dent Res. 1996 Apr;75(4):1008-14
8708129
J Dent Res. 2002 Jan;81(1):53-7
11824414
J Clin Microbiol. 1979 Oct;10(4):497-502
528682
J Clin Microbiol. 2004 Oct;42(10):4620-6
15472319
Pediatr Dent. 1997 Jan-Feb;19(1):42-9
9048413
J Dent Child (Chic). 2006 May-Aug;73(2):105-11
16948372
Community Dent Oral Epidemiol. 2000 Aug;28(4):295-306
10901409
Pediatr Dent. 1998 Nov-Dec;20(7):395-403
9866143
J Dent Res. 1966 Sep-Oct;45(5):1551-61
5225331
Eur J Oral Sci. 2003 Oct;111(5):383-9
12974680
Arch Oral Biol. 1994 Dec;39(12):1057-62
7717887
Community Dent Oral Epidemiol. 1998;26(1 Suppl):106-16
9671208
J Clin Microbiol. 2002 Mar;40(3):1001-9
11880430
Int J Paediatr Dent. 2002 Sep;12(5):306-15
12199889
J Am Dent Assoc. 2004 Jan;135(1):55-66
14959875
J Am Dent Assoc. 2001 Aug;132(8):1153-61
11575024
J Dent Res. 1982 Feb;61(2):382-5
6948854
Caries Res. 1993;27(6):505-10
8281567
Eur Arch Paediatr Dent. 2008 Mar;9(1):12-8
18328233
Arch Oral Biol. 1980;25(7):495-502
6935999
Community Dent Oral Epidemiol. 1998;26(1 Suppl):32-44
9671198
Arch Oral Biol. 1981;26(2):147-9
6944027
Aust Dent J. 2003 Mar;48(1):27-33
14640154
Oral Microbiol Immunol. 1994 Aug;9(4):193-201
7478758