Alves AC, Nogueira RD, Stipp RN Prospective study of potential sources of Streptococcus mutans transmission in nursery school children. J Med Microbiol.. 2009; 58:(4)476-481

Anil S, Anand PS. Early childhood caries: prevalence, risk factors, and prevention. Front Pediatr.. 2017; 5

American Academy of Pediatric Dentistry. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. 2016. (accessed 13 July 2020)

American Academy of Pediatric Dentistry. Fluoride therapy. 2018. (accessed 6 August 2020)

Balaban R, Aguiar CM, Da Silva Araújo AC, Dias Filho EBR. Knowledge of paediatricians regarding child oral health. Int J Paediatr Dent.. 2012; 22:(4)286-291

Bernstein J, Gebel C, Vargas C Listening to paediatric primary care nurses: a qualitative study of the potential for interprofessional oral health practice in six federally qualified health centres in Massachusetts and Maryland. BMJ Open.. 2017; 7:(3)

Bullappa D, P Puranik M, Sowmya KR, Nagarathnamma T. Association of feeding methods and Streptococcus mutans count with early childhood caries: a cross-sectional study. Int J Clin Pediatr Dent.. 2017; 10:(2)119-125

Congiu G, Campus G, Sale S, Spano G, Cagetti MG, Lugliè PF. Early childhood caries and associated determinants: a cross-sectional study on Italian preschool children. J Public Health Dent.. 2014; 74:(2)147-152

Damle SG, Yadav R, Garg S, Dhindsa A, Beniwal V, Loomba A, Chatterjee S. Transmission of mutans streptococci in mother-child pairs. Indian J Med Res.. 2016; 144:(2)264-270

Douglass JM, Clark MB. Integrating oral health into overall health care to prevent early childhood caries: need, evidence, and solutions. Pediatr Dent.. 2015; 37:(3)266-274

Dye BA, Hsu KL, Afful J. Prevalence and measurement of dental caries in young children. Pediatr Dent.. 2015; 37:(3)200-216

Ehlers V, Callaway A, Azrak B, Zock C, Willershausen B. Survey of midwives' knowledge of caries prevention in perinatal care. MCN Am J Matern Child Nurs.. 2014; 39:(4)253-259

Evans EW, Hayes C, Palmer CA, Bermudez OI, Cohen SA, Must A. Dietary intake and severe early childhood caries in low-income, young children. J Acad Nutr Diet.. 2013; 113:(8)1057-1061

Prévention de la carie dentaire chez les enfants avant 3 ans (in French). 2006. (accessed 2 July 2020)

Fuller LA, Stull SC, Darby ML, Tolle SL. Oral health promotion: knowledge, confidence, and practices in preventing early-severe childhood caries of Virginia WIC program personnel. J Dent Hyg.. 2014; 88:(2)130-140

Haute Autorité de Santé. 2010. (accessed 13 July)

Kagihara LE, Niederhauser VP, Stark M. Assessment, management, and prevention of early childhood caries. J Am Acad Nurse Pract.. 2009; 21:(1)1-10

Kamiya RU, Taiete T, Gonçalves RB. Mutacins of Streptococcus mutans. Braz J Microbiol.. 2011; 42:(4)1248-1258

Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJL, Marcenes W. Global burden of untreated caries: a systematic review and metaregression. J Dent Res.. 2015; 94:(5)650-658

Krisdapong S, Somkotra T, Kueakulpipat W. Disparities in early childhood caries and its impact on oral health-related quality of life of preschool children. Asia Pac J Public Health.. 2014; 26:(3)285-294

Leong PM, Gussy MG, Barrow SYL, de Silva-Sanigorski A, Waters E. A systematic review of risk factors during first year of life for early childhood caries. Int J Paediatr Dent.. 2013; 23:(4)235-250

Lynch DJ, Villhauer AL, Warren JJ Genotypic characterization of initial acquisition of Streptococcus mutans in American Indian children. J Oral Microbiol. 2015; 7

Mika A, Mitus-Kenig M, Zeglen A, Drapella-Gasior D, Rutkowska K, Josko-Ochojska J. The child's first dental visit. Age, reasons, oral health status and dental treatment needs among children in Southern Poland. Eur J Paediatr Dent.. 2018; 19:(4)265-270

Murphy KL, Larsson LS. Interprofessional oral health initiative in a nondental, American Indian setting. J Am Assoc Nurse Pract.. 2017; 29:(12)733-740

Pattanaporn K, Saraithong P, Khongkhunthian S Mode of delivery, mutans streptococci colonization, and early childhood caries in three-to five-year-old Thai children. Community Dent Oral Epidemiol.. 2013; 41:(3)212-223

Perera PJ, Fernando MP, Warnakulasooriya TD, Ranathunga N. Effect of feeding practices on dental caries among preschool children: a hospital based analytical cross sectional study. Asia Pac J Clin Nutr.. 2014; 23:(2)272-277

Petersen PE. Global policy for improvement of oral health in the 21st century—implications to oral health research of World Health Assembly 2007, World Health Organization. Community Dent Oral Epidemiol.. 2009; 37:(1)1-8

Prakash P, Subramaniam P, Durgesh BH, Konde S. Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: a cross-sectional study. Eur J Dent.. 2012; 06:(02)141-152

Ramos-Gomez F, Askaryar H, Garell C, Ogren J. Pioneering and interprofessional pediatric dentistry programs aimed at reducing oral health disparities. Front Public Health. 2017; 5

Samnaliev M, Wijeratne R, Kwon EG, Ohiomoba H, Ng MW. Cost-effectiveness of a disease management program for early childhood caries. J Public Health Dent.. 2015; 75:(1)24-33

Sezer RG, Paketci C, Bozaykut A. Paediatricians' awareness of children's oral health: knowledge, training, attitudes and practices among Turkish paediatricians. Paediatr Child Health.. 2013; 18:(4)e15-e19

Sharma P, Goswami M, Singh D, Massod SS, Nganba K. Correlation of Streptococcus mutans count in mother-child pair of working and nonworking mothers: a cross-sectional study. Int J Clin Pediatr Dent.. 2016; 9:(4)342-348

Sheiham A, James WPT. Diet and dental caries. J Dent Res.. 2015; 94:(10)1341-1347

T S, Anandan V, Apathsakayan R. Use of a teledentistry-based program for screening of early childhood caries in a school setting. Cureus.. 2017; 9:(7)

Tungare S, Paranjpe AG. Baby bottle syndrome.Treasure Island (FL): StatPearls Publishing; 2020

Toumba KJ, Twetman S, Splieth C, Parnell C, van Loveren C, Lygidakis NA. Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document. Eur Arch Paediatr Dent.. 2019; 20:(6)507-516

Valaitis R, Hesch R, Passarelli C, Sheehan D, Sinton J. A systematic review of the relationship between breastfeeding and early childhood caries. Can J Public Health.. 2000; 91:(6)411-417

Vozza I, Capasso F, Marrese E, Polimeni A, Ottolenghi L. Infant and child oral health risk status correlated to behavioral habits of parents or caregivers: a survey in central Italy. J Int Soc Prev Community Dent.. 2017; 7:(2)95-99

Wagner Y, Heinrich-Weltzien R. Pediatricians' oral health recommendations for 0- to 3-year-old children: results of a survey in Thuringia, Germany. BMC Oral Health.. 2014; 14:(1)

Early childhood caries prevention: non-dental health professionals' viewpoint

13 August 2020
Volume 29 · Issue 15



Dental caries can develop early in life and have harmful consequences. Objective: To examine non-dental practitioners' knowledge of early childhood caries (ECC).


A questionnaire on oral health and caries knowledge was emailed to five types of health professional who work with young children: paediatricians, GPs, midwives, paediatric nurses and paediatric healthcare assistants. Questions concerned: when a child should first visit a dentist; at what age toothbrushing should start; aetiopathogenic factors; early diagnosis; and the effect of breastfeeding.


494 health professionals (79 paediatricians, 59 physicians, 217 midwives, 92 paediatric nurses and 47 paediatric healthcare assistants) participated. Although most (89.86%) discussed oral health with parents, responses on when a child should first see a dentist and when toothbrushing should start varied. Almost half of respondents said they could diagnose caries but not all were confident in this. Aetiological factors in ECC mentioned included oral hygiene, bottle feeding, sugar intake, genetics and a lack of fluoride.


Non-dental practitioners lack knowledge about ECC, so cannot help prevent it. Initiatives including interprofessional training would improve their knowledge of oral health in early childhood.

In the 21st century, dental caries are the most widespread infectious disease and remain the third commonest disease in the world (Petersen, 2009; Kassebaum et al, 2015). The American Academy of Pediatric Dentistry (AAPD) defined early childhood caries (ECC) as the presence of one or more decayed (non-cavitated or cavitated lesions), lost (because of caries) or filled tooth surfaces in any primary tooth in a child aged under six years (AAPD, 2016).

ECC is a significant public health problem with harmful consequences (Kagihara et al, 2009). These include: pain, bacteraemia, sleeping problems, reduced social activities, reduced growth and development, speech and breathing disorders, premature tooth loss, the need for orthodontic treatment, compromised chewing, ear, nose and throat infection, loss of self-esteem and a poorer quality of life (Anil and Anand, 2017); poorer school performance and disrupted attendance at work for parents (Balaban et al, 2012); and high treatment costs for both those affected and society, and future harm to permanent dentition because of an unbalanced oral ecosystem (Samnaliev et al, 2015). ECC has the characteristics of a long-term condition (Krisdapong et al, 2014).

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