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DrMawloodKowash BDS,MSc,DDSc, FRCD©,FDSRCPS (Glasg),Associate ProfessorinPaediatric Dentistry,Hamdan BinMohammedCol- legeofDentalMedi- cine,MohammedBinRashidUniversity ofMedicineandHealthSciences,Dubai, UnitedArabEmirates. Dental Tribune Middle East & Africa Edition | 5/2016 26 paediatric education program through regu- lar home visits to mothers with in- fants, commencing at or soon after the time of the eruption of the first deciduous teeth, was shown to be ef- fective in preventing the occurrence of caries, improving oral hygiene and dental attendance of young chil- dren. An added benefit was that the mothers of the children also signifi- cantly improved their oral hygiene in terms of debris, gingivitis and calculus scores [9]. Young children are dependent on their parents or caregivers for their daily dietary and oral hygiene practices. Therefore, it is important that the dental health messages should focus on educat- ing and changing the behaviour of parents or caregivers. Moreover, the dental health messages should be practical by giving alternatives, for example substituting milk with wa- ter in baby bottles at night for those who find it difficult to stop night- time bottle feeding. They should also consider the socioeconomic status of the parents and be cultur- ally sensitive [9]. The benefit-cost (B/C) and cost-effectiveness (C/E) of a long-term dental health education program to mothers with young children through repeated home visits were evaluated [43]. Compari- sonsweremadeforB/CandC/Ewith results from a clinical trial of a slow releasing fluoride device, commu- nity water fluoridation and a school based fissure sealant program. The results showed that dental health education programs for mothers of young children starting at 8 months of age gave better B/C and C/E ratios thanotherpreventiveprograms. Restorativetreatment ofECC In recent years there has been a shift from the traditional (drill & fill) to a more conservative treatment mo- dality (seal to heal) with better un- derstanding of the caries process biology. Managing caries through minimally-invasive and low-cost treatment modality such as atrau- matic restorative technique (ART) is important especially in developing countries. It helps in slowing caries progression and hence minimizing the child’s discomfort and prevent- ing other decay complications. Stud- ies have shown that, although caries causes demineralization of dental hard tissues and denaturation of col- lagen, the inner layer is minimally or even not infected by bacteria [44]. The inner part of decayed dentine contains a high concentration of minerals and can be rematerialized [45]. Management of ECC should take into consideration the biol- ogy of dental tissues, remineralisa- tion process and other protective mechanisms. The goal should be to minimize lifelong caries experience while performing the least possible intervention consistent with level of risk(Table1). The type of restoration chosen de- pends on: the tooth to be restored, present and past caries history, child cooperation and medical his- tory. For example a decayed pri- mary molar in a special need child is best restored with a durable res- toration like stainless steel crowns (SSC). A multi-surface decayed pri- mary molar also should preferably be restored with SSC [46]. Grossly decayed maxillary incisors are best restored with either composite strip or zirconia crowns with or without pulp therapy (Figure 3). Depending on patient cooperation, the severity and number of decayed teeth and medical history, dental treatment of paediatric patient can be performed under behaviour management and local analgesia, which is considered tobethebestoptionintermsofcost, safetyandacceptabilitytoparentsor caregivers. Other alternative options include oral or intravenous sedation and general anaesthesia (GA). Full dental rehabilitation under GA (Fig- ure2)ispreferredbymanyclinicians in uncooperative preschool children requiring comprehensive dental careorthosewithspecialneeds. All restorative techniques exhibit strengths and weaknesses for exam- ple: • Glass Ionomer Cement (GIC) is fa- vourable for class I Cavities and in uncooperativechildren • Compomers shows best long-term performance.Thecooperationhasto be sufficient, at least during bonding andlayering. • Resin composites after rubber dam application and correct technique – sensitive adhesion can reach the levelofcompomers. • In severely decayed teeth and after pulp therapy, preformed SSC should betherestorationofchoice. Conclusion Early Childhood Caries (ECC) is a chronic, transmissible infectious disease affecting the primary teeth. The etiology of the condition is a combination of frequent consump- tion of fermentable carbohydrates as drinks, especially when a baby is sleeping, with on-demand breast- or bottle-feeding, oral colonization by cariogenic bacteria (especially mu- tans streptococci), poor oral hygiene and poor parenting. It is the most common chronic disease among childrenandisstillconsideredacon- tinuing oral health problem in de- veloping countries and also in most developed countries. It can result in considerable suffering, pain, disfig- urement, reduction of quality of life of affected children and frequently compromises their future denti- tions. The treatment of ECC is very costly, time consuming and in most cases, requires full dental rehabilita- tion under general anaesthesia by a paediatric dentist. ECC, however, is a preventable disease and the solu- tion for this continuing problem can be achieved by educating parents of young children and pregnant moth- ers. It is important that the dental health messages should focus on ed- ucating and changing the behaviour of parents or caregivers. Moreover, the dental health messages should be practical, consider the socioeco- nomic status of the parents and be culturally sensitive. The manage- ment of ECC should take in to con- sideration the biology of the caries process and protective mechanisms and to be effective, the restoration of active lesions should be monitored through regular follow up and long- ternpreventivestrategy. References [1]. O'Sullivan EA,Williams SA, Cape JE, Wakefield RC, Curzon MEJ. Preva- lence and site characteristics of den- tal caries in primary molar teeth from prehistoric times to the 18th century in England. Caries Res 1993; 27:147–153. [2]. Kaste LM, Drury TF, Horowitz AM, Beltran E. An evaluation of NHANES III estimates of early child- hood caries. J Public Health Dent 1999;59(3):198-200. [3].DruryTF,HorowitzAM,IsmailAI. Diagnosingandreportingearlychild- hood caries for research purposes. J PublicHealthDent1999;59(3):192-7. The full list of references is available fromthepublisher. ◊Page25