title: Case definition, aetiology and risk assessment of early childhood caries (ECC): a revisited review.
abstract: 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.
authors.affiliation: Dept. of Paediatric Dentistry, Dental School, University of Athens, Greece. gvadiakas@dent.uoa.gr
authors.forename: G
authors.initials: G
authors.lastname: Vadiakas
mesh_terms: 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
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