Assessment, management, and prevention of early childhood caries

Purpose: To discuss the role of primary care health providers in identifying infants and young children at risk for dental caries during well‐child visits, in providing anticipatory guidance to parents and primary care givers of at‐risk children, and in providing appropriate referrals for the timely establishment of a dental home. Data sources: The search included the following: Ovid MEDLINE, PubMed, American Academy of Pediatrics Web site, American Academy of Pediatric Dentistry Web site, and the American Dental Association Web site. The following search terms were used: dental caries prevention, caries process, caries balance, dental home, early childhood caries, oral health disparities, dental caries risk assessment, fluoride varnish, oral health anticipatory guidance. Search was limited to English language sources from 1990 through 2007. Conclusions: Dental caries is a preventable and reversible infectious disease process, yet it continues to be the single most common chronic disease of childhood. Despite a decrease in caries prevalence and a decrease in untreated tooth decay in 6–19‐year‐olds in the United States, a 15.2% increase in disease was noted among the nation’s youngest children aged 2–5 years. Primary care health providers are uniquely positioned to play a significant role in the prevention of dental caries and are encouraged to complete certification courses in caries risk assessment, intervention, education, and referral. Implications for practice: Clinicians need to understand the dental caries process, including the process of enamel demineralization and remineralization, and the factors contributing to caries balance. The importance of early identification and intervention for infants and toddlers at high risk for dental caries and primary care health provider‐delivered anticipatory guidance during well‐child care visits cannot be overestimated.