Clinical Outcomes for Severe Early Childhood Caries

Jeffrey   M.   Karp; Robert   J.   Berkowitz

Abstract

Severe Early Childhood Caries (S-ECC) is a public health care problem affecting toddlers and preschool children worldwide. S-ECC is an infectious disease most frequently characterized by an overwhelming mutans streptococci infection. The current community standard of care for S-ECC calls for the removal and restoration of carious teeth, application of topical fluoride agents, oral hygiene instruction, and counseling regarding decay-promoting feeding behaviors. Dental surgery alone has minimal impact on oral mutans streptococci reservoirs in the setting of S-ECC and counseling regarding feeding behaviors by dental professionals has largely been unsuccessful. Not surprisingly, clinical outcomes for S-ECC treated under sedation or general anesthesia are poor. Improved clinical outcomes for S-ECC may be realized through treatment strategies that focus on the infectious basis of this disease. Suppression of oral mutans streptococci reservoirs to non-pathogenic levels with a topical anti-microbial agent shows promise as the approach of choice. Preliminary studies using a one time intra-operative application of 10% povidone iodine solution to the dentition in the setting of S-ECC has produced persistent suppression of salivary mutans streptococci reservoirs for 3 months post dental surgery. This paper reviews the relevant literature focusing on this important pediatric health care issue.

Keywords: Mutans streptococci, early childhood caries, povidone iodine, general anesthesia

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