Hypoplasia-associated Severe Early Childhood Caries – A Proposed Definition

Abstract

A supplemental appendix to this article is published electronically only at http://jdr.sagepub.com/supplemental. AbstrActWe 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.

Prenatal Vitamin D and Dental Caries in Infants

“…Enamel hypoplasia was a strong predictor of ECC in our cohort (odds ratio .8), providing further credence to the theory of hypoplasiaassociated S-ECC. 3,7 The Poisson regression model for the untreated primary tooth decay score (dt) included the same independent variables incorporated in the expanded logistic regression model for ECC. Enamel hypoplasia, infant age, and 25OHD levels were again identified as independent predictors of caries scores.…”

“…2 One proposed explanation for the burden of S-ECC in some children is hypoplasia-associated S-ECC. 3 Enamel hypoplasia results from defective amelogenesis and is clinically identified by the absence of enamel and by pitting, grooves, or irregularities of enamel. 4,5 These defects increase the risk of early colonization by cariogenic bacteria, resulting in caries.…”

“…4,5 These defects increase the risk of early colonization by cariogenic bacteria, resulting in caries. 3,6,7 Therefore, the period when enamel forms is crucial to understanding the significance of enamel hypoplasia and risk for ECC. The primary maxillary anterior teeth begin to calcify during the second trimester (specifically, 13-17 weeks) and continue until 3 months' postnatal.…”

Observation of white spot lesions using swept source optical coherence tomography (SS-OCT): <i>in vitro</i> and <i>in vivo</i> study

“…Interestingly, when such a surface layer is thick, it could also be observed on the cross-sectional OCT images, which can help in diagnosis and clinical decision making regarding these lesions 18,29) . Differentiating WSL with hypomineralization of developmental origins (localized pre-eruption hypoplasia or hypocalcification) from those enamel lesions associated with plaque accumulation and cariogenic diet can be difficult [30][31][32][33] . A critical distinction should be based on pattern differences and low socioeconomic status.…”

Early Childhood Caries: A Review

“…21,22 Also, the presence of enamel defects might contribute to the formation of lesion, such as hypoplasia, known as hypoplasia-associated severe early childhood caries. 23 This type of decay influences generally young kids at or beneath levels of poverty, teeth which are usually vulnerable to caries have structural damage.…”