Early Childhood Caries

knee to knee dental exam

Early Childhood Caries

age one dental visit

Dr. Chuck Poland demonstrates the age one dental visit.

Keys to Prevention

“To interrupt the Early Childhood Caries disease process, the dentist and parents have to work cooperatively,” explains Dr. Chuck Poland. “The preventive care provided in the dental office is important, but it is only effective if the parents and other caregivers are also providing proper care at home. Good dental office visits can’t offset the damage if bad habits are practiced at home.”13

While general dentists who encounter infants in need of major restorative care may choose to refer to a pediatric dental specialist, all dentists can be involved in the preventive care of Indiana’s youngest citizens. The initial visit allows the dentist or hygienist to ask the following questions as part of an Infant Caries Risk Assessment (IFRA) and conversation with the parent or primary caregiver:


While generally, the issues that follow below may not dramatically affect the dental health of infants, physical, developmental, mental and emotional impairments may limit the child’s ability to perform daily self-maintenance activities as he or she grows older. It is important to discuss the following concerns with parents as the child matures:

  1. Were there problems during the pregnancy or delivery?
  2. Has your child experienced any unusual illnesses or developmental difficulties?
  3. Have there been any injuries to your child’s teeth or jaws?
  4. Does your child have a specific dental problem that needs attention?
  5. Is this your child’s first visit to the dentist?


Acquisition of Virulent Flora comes from vertical transmission of strep mutans (SM) from mother or other close caregiver with active caries (variable virulent subspecies), and/or virulent SM subspecies selected through aciduric shifts from caries enhancing diets.

Discuss with parents the infectious nature of dental disease. Most young children appear to acquire some cariogenic microbes from their mother or primary caregiver, so it is important for parents to take good care of their own teeth. They should understand that if they have active dental disease, it increases the chance dental disease will be passed on to the child. They should avoid sharing food, drink or eating utensils with their baby until their own oral health is free of dental disease.

The following questions give you the information needed for a Risk Assessment and open the door to the Anticipatory Guidance (educational) message:

  1. Are routine dental visits practiced by your family?
  2. When was the last time you saw a dentist?
  3. When was the last time you had a cavity?


Discuss with parents the importance of good nutrition and how sugary foods, snacks, juices and other sugary drinks feed bacteria that set the stage for dental disease. Discuss the difference between “guzzlers and gobblers” vs. “sippers and grazers.”

Toddlers who drink from bottles or sippy cups throughout the day are regularly disrupting the natural oral microflora, creating an environment that is much more acidogenic and susceptible to dental decay. Explain the importance of at-home care, demonstrate how to brush an infant’s teeth and discuss the need for follow-up care and additional fluoride varnishes, if deemed appropriate. The following questions are an important part of the assessment and educational message:

  1. Does your child sleep with a bottle during naps or bedtime?
  2. Does your child use a bottle or sippy cup other than at mealtime?
  3. What does your child like to drink?
  4. Are you brushing your child’s teeth daily?


knee-to-knee dental exam

During the knee-to-knee exam, examine the teeth for plaque, white demineralized enamel near the gum line or redness and swelling at the gum line.

With the parent or guardian’s assistance, conduct a knee-to-knee exam or perform the examination in a dental chair with a good light. Brief parents on your findings and the child’s risk status for developing ECC. Recommend the establishment of a dental home for the child and parents. Explain how at-home preventive care, combined with the preventive care provided in the dental office, sets the stage for a lifetime of good dental health for the child. Follow these steps:

  1. Are there any signs of congenital deformities or other concerns?
  2. Is there visible plaque (white, sticky buildup)?
  3. Are there signs of decay or demineralization (chalky white spots or lesions)?
  4. Apply a fluoride varnish.


  1. Accentuate the positive. Praise the adult for the positive steps they are taking.
  2. Stress the important role they play in their child’s long-term dental health.
  3. Provide educational materials to assist them with in-home care.
  4. Set a follow-up appointment and stress the importance of establishing a dental home.



Download this Early Childhood Caries Risk Assessment for use in your own practice.

Download the AAPD Caries Risk Assessment.



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