Management Of Early Childhood Caries Research Articles

Application of Golden Nanoparticles against Streptococcus Mutans for Prevention of Caries Lesions

Background: Dental caries also known as baby bottle tooth decay, is a critical public health problem around the world for which Streptococcus mutans (S.mutans) has been introduced as the main infectious etiology. In the past two decades, nanotechnology has permitted the development of new materials with antimicrobial properties. The aim of this study was to compare the bactericidal and bacteriostatic effects of three golden nanoparticles (SP, NR, and CS) on S.mutans. Methods: To determine the minimum inhibitory concentrations (MICs) and the minimum bactericidal concentrations (MBCs), a liquid dilution method was applied. Results: All golden nanoparticles (GNPs) showed antimicrobial activity with no statistically significant differences (> 0.05) in MIC or MBC. Conclusion: Our findings revealed that the size and shape of the nanoparticles did not significantly affect the antimicrobial properties of the GNPs. This finding might be useful for achieving important clinical effects with reduced toxicity in the management of early childhood caries in future in vivo studies.

Minimally Invasive Dentistry: Parent/Carer Perspectives on Atraumatic Restorative Treatments and Dental General Anaesthesia to the Management of Early Childhood Caries.

Introduction: Parents of children treated under dental general anaesthesia (DGA) have reported feelings of concern and anxiety. This study elicited the views of parents/carers (P/C) of children with early childhood caries (ECC) who participated in a randomised trial (core study) which tested the effectiveness of care under DGA or care using alternative minimally invasive Atraumatic Restorative Treatment and the Hall Technique approaches (ART/HT).Methods: P/C of children treated using the ART/HT (test) approach or care under a DGA (control) were interviewed. Focus group semi-structured interviews with P/C were undertaken in community facilities. The transcripts were read and inductively coded into domains to identify emergent themes. The codes were entered into NVivo software to assist data management and were further refined into broad themes.Results: Seven grouped interviews with 14 participants were conducted and one test participant provided a written response. Four groups with eight test participants; two groups with four control participants; and one combined group with one test and one control participant were interviewed. Five broad themes emerged after thematic analysis: (1) Impacts on the child and the family; (2) Child-/family-centred care; (3) Timeliness of care; (4) Affordable care; (5) Accessible care. Impacts were related to that of the effects of the disease, and of the care for the disease. Child-centred/family-centred care (CCC) was a source of appreciation by P/C of both groups when it was experienced. Frustration at the lack of timely care of their child's treatment needs, coupled with the perceived expensiveness of care and difficulties in physically getting to the location for a specialist consultation was expressed by P/Cs in the study.Discussion: The use of the ART/HT enabled the establishment of a relationship between the clinical team and the child and P/C which was central to the delivery of CCC. P/Cs in the DGA arm of the study expressed dissatisfaction more often with the issues of timely care, cost of care and accessibility of care. P/C of both groups were equally satisfied with the treatment, where treatment had been received in a timely, child-centred manner.Conclusion: The findings suggest that minimally invasive approaches which facilitated CCC are acceptable alternative options to the DGA and should be considered for the management of ECC.Australian New Zealand Clinical Trials Registry: ACTRN12616001124426.

Evaluation of the clinical efficacy of 38% silver diamine fluoride in arresting dental caries in primary teeth and its parental acceptance.

Early childhood caries (ECC) has been regarded as one of the most prevalent chronic diseases in children. Conventional restorative management of ECC is difficult to perform in very young and apprehensive children. Silver diamine fluoride (SDF) can be a useful tool in the management of dental caries by arresting the carious lesion in primary teeth. After SDF treatment, the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children. This study aimed to evaluate the clinical effectiveness of biannual application of 38% SDF followed by 5% sodium fluoride (NaF) varnish for arresting dental caries in children and its parental acceptance. Twenty-six children aged 2-5 years with 107 active caries lesions in primary teeth were enrolled. At the baseline examination, status of carious lesions was recorded and scored according to the International Caries Detection and Assessment System II. Lesion activity was assessed by visual inspection and tactile detection. Carious lesions with score 3, 4, 5, and 6 were treated with 38%SDF application, followed by 5% NaF varnish. Children were re-evaluated at 3 weeks, 3 months, 6 months, and 12 months. Parental acceptance of SDF treatment was evaluated. This study demonstrated that 38% SDF was 92.31% effective in arresting dental caries in primary teeth and was well accepted by parents. Chi-square test was used to assess the significant difference among the arrested lesions which was statistically significant (P < 0.05). Thirty-eight percent SDF can be effectively used in arresting caries in primary teeth in young and uncooperative children.

Oral Microbiota Composition Predicts Early Childhood Caries Onset

As the most common chronic disease in preschool children in the United States, early childhood caries (ECC) has a profound impact on a child’s quality of life, represents a tremendous human and economic burden to society, and disproportionately affects those living in poverty. Caries risk assessment (CRA) is a critical component of ECC management, yet the accuracy, consistency, reproducibility, and longitudinal validation of the available risk assessment techniques are lacking. Molecular and microbial biomarkers represent a potential source for accurate and reliable dental caries risk and onset. Next-generation nucleotide-sequencing technology has made it feasible to profile the composition of the oral microbiota. In the present study, 16S ribosomal RNA (rRNA) gene sequencing was applied to saliva samples that were collected at 6-mo intervals for 24 mo from a subset of 56 initially caries-free children from an ongoing cohort of 189 children, aged 1 to 3 y, over the 2-y study period; 36 children developed ECC and 20 remained caries free. Analyses from machine learning models of microbiota composition, across the study period, distinguished between affected and nonaffected groups at the time of their initial study visits with an area under the receiver operating characteristic curve (AUC) of 0.71 and discriminated ECC-converted from healthy controls at the visit immediately preceding ECC diagnosis with an AUC of 0.89, as assessed by nested cross-validation. Rothia mucilaginosa, Streptococcus sp., and Veillonella parvula were selected as important discriminatory features in all models and represent biomarkers of risk for ECC onset. These findings indicate that oral microbiota as profiled by high-throughput 16S rRNA gene sequencing is predictive of ECC onset.

ETIOLOGI, DAMPAK DAN MANAJEMEN EARLY CHILDHOOD CARIES (ECC)

Early childhood caries (ECC) is one of the most prevalent diseases in children worldwide. Streptococcus Mutans is the main bacteria that have a strong association with ECC, and these bacteria can be transmitted from mother to child. ECC does not only affect children’s oral health but also the general health of the children and the end affects their quality of life. The impacts of ECC such as problems with sleeping, speaking eating, premature loss of primary dentition, and this condition often leads to orthodontic problems in adult life. Management of ECC has begun preventive strategies, curative and rehabilitative treatment also. As we know the etiology and management of ECC, the impact can be avoided, and the children still have a good quality of life.

A Kindergarten-Based Oral Health Preventive Approach for Hong Kong Preschool Children.

Early childhood caries (ECC) remains the single most common chronic childhood disease. Untreated caries can cause tooth loss and compromised dentition. Severe ECC can also influence nutrition intake, cognitive development, general health and quality of life. In Hong Kong, approximately half of 5-year-old children suffer from ECC, and more than 90% of these caries remain untreated. Thus, the development of effective strategies for promoting the oral health of preschool children is warranted. The Faculty of Dentistry of the University of Hong Kong has provided kindergarten-based dental outreach services to selected kindergartens since 2008. In 2020, the project expanded to serve all kindergarten children in Hong Kong. The aim of the service is to improve oral health through the prevention and control of ECC among preschool children. The service provides dental screening and silver diamine fluoride treatment for ECC management. In addition, the parents receive oral health talks, and teachers receive training in delivering regular oral health education at kindergarten. The objectives of this service are to improve oral and general health of preschool children, develop the children’s good oral health-related behaviours, maintain the children’s psychological well-being and reduce the burden on their family. This paper describes this kindergarten-based dental outreach service.

Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial.

The management of early childhood caries (ECC) is challenging. A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia. Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities. A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group. A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health. This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.

Model for Taking Care of Patients with Early Childhood Caries during the SARS-Cov-2 Pandemic.

Pending the availability of vaccines to contain the SARS-CoV-2 pandemic, the current solution is “social distancing” with a reduction of dental treatments to those assessed as urgent and emergency cases. These treatments also involve Early Childhood Caries (ECC) due to the fact that this disease affects preschool children (a vulnerable population) and, in addition, shows a propensity to evolve into more serious complications (dental pain, infections). A narrative review was carried out to support a protocol for treating ECC with efficacious and safe (in terms of SARS-CoV-2 transmission) procedures. Protocol involves criteria for patients’ selection remotely (telemedicine), and well-detailed criteria/equipment and hygiene procedures to combat against SARS-CoV-2 transmission. Moreover, the protocol proposes innovative caries treatments, named Minimally Invasive Treatments (MITs), well known in pedodontics for their high level of children’s acceptance during dental care. MITs allow for caries removal (particularly in primary teeth) without any high-speed rotating instrument cooled with nebulized air-water spray (with high risk of virus environmental diffusion), usually adopted during traditional treatments. For evaluating MITs effectiveness in caries management, only Systematic Review and Randomized Controlled Trials (RCTs) were included in our study, without any risk of bias assessment. The indications proposed in this protocol could support clinicians for the temporary management of ECC until the SARS-CoV-2 pandemic ends.

Risk Factors for Early Childhood Caries in Toddlers: An Institution-based Study.

BackgroundTooth decay experience among toddlers and preschoolers is of epidemic proportions worldwide and dental caries still remains an important childhood disease affecting a considerable part of this population. Though the prevalence of Early Childhood Caries (ECC) is associated with several risk factors such as feeding and oral hygiene practices, Streptococcus mutans levels, socioeconomic status (SES), etc., it is suggested that these factors should be studied adequately to aid in the early prevention and management of ECC.ObjectiveThe objectives of the study were to: a) evaluate the distribution of ECC, b) study the role of SES in the occurrence of ECC, c) record the variations in feeding and dietary practices along with oral hygiene practices and d) Correlate the sweet score with ECC.Materials and MethodsThis cross-sectional observational study was conducted over a period of 6 months among 100 toddlers (12-36 months) attending the Pediatric outpatient department of a single medical institution in Chennai, India. The study consisted of an intra-oral examination followed by a face to face interview of the mothers of the children using a validated structured oral health questionnaire.ResultsSES and ECC were negatively correlated with statistically significant association. Majority of the subjects did not follow any oral hygiene practices before teeth erupted; few subjects used tooth brush and tooth paste after teeth erupted and followed oral hygiene practices once a day. Statistically significant positive correlation with ICDAS scores was noted in relation to the sweet score and the frequency of intake of sweet foods, candy, etc. Cavitated lesions were more common than non-cavitated lesions and majority of the posterior teeth had ICDAS score 4.ConclusionHealthcare providers for children must be well informed on the etiology and risk factors of ECC and guide children for their first dental visit within one year of age.

Identifying predictors of early childhood caries among Australian children using sequential modelling: Findings from the VicGen birth cohort study

ObjectivesThe aim of this birth cohort study was to identify concurrent associations between early childhood caries and putative risk and protective factors. MethodsData were collected in seven waves over five years. The study outcome measure, d3-6mfs, was modelled in a set of sequential negative binomial regressions that introduced the variables in steps starting from health determinants most distal to the child and ending with the more proximal ones. The goodness of fit of each model at each step was tested using the quasi-likelihood under independence model criterion (QIC). A final model included all significant factors identified in the sequential modelling. Bacterial composition of the child’s saliva was determined by 16S RNA gene sequencing. ResultsOverall, 467 children (48.6 % female) participated, of whom 419 (89.7 %) had at least one follow-up visit after baseline. Of the 419 children included in the analyses, 133 (31.7 %) had their saliva samples sequenced for microbiomic determination. Independent protectors of surface cavitation included water fluoridation, and older age of mothers. Risk for d3-6mfs was significantly higher among children whose mothers were current smokers (IRR 3.29, 95 % CI 1.09–9.88, p = 0.034), children who went to bed with a bottle (IRR 2.67, 95–6.88, p = 0.041) and whose saliva sample sequencing over time showed higher percentages of Streptococcus mutans (IRR 1.39, 95 % CI 1.11–1.74, p = 0.005). Model fit was mostly improved by child’s proximal variables. Household and mother covariates did not substantially improve model fit. ConclusionThis analysis highlights the relevance and importance of child-proximal risk factors in childhood dental cavitation. Clinical significanceThe study findings inform clinical decision making for the management of early childhood caries at both the individual and population level. At an individual and family level these risk factors should be incorporated into caries risk assessment tools for more precise identification of risk and evidence-informed interventions by health professionals.

Oral rehabilitation of cerebral palsy patients under general anesthesia in a Zonal Hospital: A novel technique

Introduction: Cerebral Palsy is a group of disorders causing damage to the motor control centres of the brain, which in turn cause defects in psychomotor activity manifested as mental and motor disabilities, sensory defects in vision, hearing, abnormal contraction of joints and behavioural problems. These children have an increased risk of developing ECC (Early Childhood Caries) due to various factors leading to poor oral hygiene. Case Report: This case report presents clinical cases of two children aged 4 & 5 yrs respectively diagnosed with Cerebral Palsy who were managed with therapeutic and preventive intervention under General Anaesthesia. Uniqueness of the Case: Management of Early Childhood Caries in such children is a challenge. Improvement of quality of life is of paramount importance. Conclusion: Behavioural problems are common amongst these children and single visit complete oral rehabilitation under General Anaesthesia leads to improvement of oral health related quality of life, overall wellbeing and attitude of parents.

Epidemiology and Clinical Management of Early Childhood Caries in Israel.

Aim: The aim of the present review is to describe the current status of early childhood caries (ECC) in Israel in aspects of epidemiology, prevention, and management.Methods: PubMed search was performed using the words caries, children, Israel. Demographic data was collected from the Israeli Central Bureau of Statistics.Results: The decayed, missing, and filled teeth index was 2.72 in 1992 and 2.56 in 2016. The proportion of restored teeth has increased. A number of preventive programs are ongoing but a general preventive program is lacking at the national level. From 2010, every child in Israel is eligible to receive free dental treatment.Conclusion: The gaps in understanding of the epidemiological profile of ECC in Israel is a call for more research conduct on ECC in the country.

Syria Profile of the Epidemiology and Management of Early Childhood Caries Before and During the Time of Crisis.

Syria has witnessed the greatest humanitarian crisis of forcibly displaced population since World War II. The present review aimed to outline Syria's profile of the epidemiology and management of early childhood caries (ECC). Before the crisis, the burden of ECC amongst Syrian pre-schoolers had been growing in prevalence and severity. Comparable data showed an increase in the burden of ECC amongst Syrian children aged five years, rising from 74% in 1991 to 81% in 2011, with a dmft value of 8.6. A similar increase was observed in the burden of ECC amongst Syrian children aged three years, rising from 50% in 1991 to 56% in 2011, with a dmft value of 6.1. Whilst there are no data on the burden of ECC during the current crisis, estimates could be extrapolated from data on the current burden of dental caries amongst Syrian primary school children living inside Syria or in informal settlements outside Syria. Such data suggested that the burden of ECC might have further increased amongst Syrian pre-schoolers during the crisis time. This is due to the crisis exacerbating effect on ECC risk factors, in terms of increasing the existing high sugar intake amongst Syrian pre-schoolers as well as increasing different barriers Syrian families face to fresh foods, sugar-free medicines, oral hygiene and fluoride products and accessing essential preventative dental care. Tackling the growing burden of ECC amongst Syrian pre-schoolers should not be postponed till post-crisis time. The seed work for relevant public health interventions could start and be embedded in different health and social initiatives taking place during the time of crisis. A number of public health interventions informed by relevant international and local (Syrian) studies conducted during the time of crisis have been suggested to tackle the burden of ECC amongst Syrian young children. They include a mix of upstream, midstream, and downstream interventions that aim to reduce sugar intake, improve feeding and oral hygiene practices, increase access to an appropriate source of fluoride and build the capacity of the Syrian dental and wider workforce to tackle the growing burden of ECC in Syrian pre-schoolers.

Silver diamine fluoride as a proactive anti-caries tool: A review

The management of ECC by the regular stereotyped restorative methods alone is incapable, particularly in a vast community or developing countries like India, where we lack free availability of dental equipment and manpower. The announcement of silver diamine fluoride (SDF) as another fluoride delivery system is a breakthrough therapy with evidences of caries lesion arrest rates of about 70 percent. SDF presents as an advantageous modality and is favoured as a satisfactory interim treatment option for its less invasive nature and its inexpensiveness. Most of the researchers have reported SDF to be undeniably more potent cariostatic agent than the fluoride varnishes in arresting caries. Its anti -caries effectiveness was found to be alike on incipient dental caries, non-cavitated and cavitated lesions and no severe pulpal damage after SDF application has been reported. Hence it is justified to state that SDF is a competent, efficient, secure and a reasonable caries preventive tool which is time saving and also patient oriented. Keywords: Silver diamine fluoride (SDF), Cariostatic agents, Fluoride delivery systems, Early childhood caries (ECC), Caries prevention, Fluoride varnishes.

Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective

This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018. The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy. This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC. Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care. This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.

Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries.

A systematic review of evidence on the impact of modifiable risk factors on early childhood caries (ECC) was conducted to inform recommendations in a World Health Organization manual on ECC prevention. To systematically review published evidence pertaining to the effect of modifiable risk factors on ECC. Twelve questions relating to infant feeding, diet, oral hygiene, and fluoride were addressed, as prioritized by a World Health Organization expert panel. Questions pertaining to the use of fluoride toothpaste were excluded due to its proven efficacy. The target population was children aged <72 mo. Data sources included Medline, Embase, CINAHL, and PubMed, and all human epidemiologic studies were included. The highest level of evidence was used for evidence synthesis and, where possible, meta-analysis. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement, with evidence assessed via the GRADE method. Of the 13,831 papers identified, 627 were screened in duplicate; of these, 139 were included. The highest-level evidence indicated that breastfeeding ≤24 mo does not increase ECC risk but suggested that longer-duration breastfeeding increases risk (low-quality evidence). Low-quality evidence indicated increased risk associated with consumption of sugars in bottles. Only 1 study had data on the impact of sugars in complementary foods, which increased risk. Moderate-quality evidence showed a benefit of oral health education for caregivers (odds ratio, 0.39; 95% CI, 0.19 to 0.80, P = 0.009). Meta-analysis of data on the impact on ECC from living in a fluoridated area showed a significant effect (mean difference, -1.25; 95% CI, -1.24 to -0.36; P = 0.006). Limited moderate- and low-quality data indicated a benefit of fluoride exposure from salt and milk, respectively. The best available evidence indicates that breastfeeding up to 2 y of age does not increase ECC risk. Providing access to fluoridated water and educating caregivers are justified approaches to ECC prevention. Limiting sugars in bottles and complementary foods should be part of this education. This research is being used by the World Health Organization in developing a toolkit on the prevention and management of early childhood caries. The information will guide 1) governments in developing national oral health plans and 2) clinicians when providing preventive advice, including that regarding infant feeding practices. It will help ensure that advice is in line with current World Health Organization guidelines and the best available evidence.

General anesthesia in the management of early childhood caries: an overview.

Early childhood caries is a global healthcare concern in developing and industrialized countries. If left untreated, it leads to immediate and long-term complications that affect the well-being and quality of life of concerned families. Therefore, many preventive and treatment approaches are available to the healthcare provider to curb this virulent form of caries. After behavioral interventions, general anesthesia is used in specific settings when a young patient presents with extensive teeth damage and exhibits a lack of cooperation that is incompatible with conventional dental office care. However, without proper follow-up, any positive results might be lost over time.

Hybrid child-friendly biological primary molar restorative alternatives to general anaesthesia

Abstract: Management of early childhood caries, especially in high caries prevalence regions, is challenging, with multiple extractions under general anaesthesia (GA) becoming frequently unavoidable. This paper describes a combination of child-friendly biological methods of caries management that could be utilized by general dental practitioners. The use of interim therapeutic restorations to aid in diagnosis of pulpal status in deeply carious primary molars followed by using multiple Hall technique preformed metal crowns is described through a series of case reports. By the hybrid utilization of these methods with complete avoidance of local anaesthesia, an alternative treatment to dental GA is demonstrated. CPD/Clinical Relevance: To provide a guide for the use of combined biological methods to treat early childhood caries.

Therapeutic education in pediatric dentistry: analysis of obstacles and levers to the development of programmes in France in 2016

Over recent years, therapeutic patient education has become part of dental medicine. Management of early childhood caries, known to be a very common chronic disease, has evolved to include an educational dimension. The objective of this study was to identify the levers and barriers to the development of formalized therapeutic education programmes and alternatives. A comprehensive exploratory qualitative study was conducted between November 2015 and June 2016 on a targeted sample of 15 people aware of the problem of TPE in dentistry. The study showed that TPE training in dentistry is underdeveloped, despite its numerous benefits: change of the healthcare professional's approach, implementation of structured educational programmes, development of research, etc. There are many obstacles to the development of TPE programmes: insufficient resources, rigid legislation or lack of knowledge of TPE practices. The dental profession is an obstacle itself because of its lack of understanding and variable degrees of integration the medical community. There are multiple levers, but the main ones are changing attitudes of the profession and the provision of resources to develop TPE. Although alternatives to TPE programmes exist (accompanying measures, short educational strategies, connected health), they cannot replace TPE. More educational strategies must be developed in the field of dentistry. However, the framework of TPE must be adapted to the profession to ensure good uptake.

Managing Early Childhood Caries for Young Children in China.

The latest national survey found that 70% of 5-year-old children in China had dental caries. The prevalence of early childhood caries (ECC) may not only be attributed to poor oral hygiene and unhealthy diet, but also to limited access to and availability of dental care. The prevailing preventive measures adopted by industrialised countries for ECC management are neither practical nor affordable in China. Hence, an alternative approach to ECC management is necessary. Atraumatic restorative treatment (ART) has been advocated because the simple and short operative time renders ART affordable. However, the success rate of ART in restoring anterior primary teeth is unfavourable. Although there is no water fluoridation in China, topical fluorides may be used to manage ECC. Tooth brushing with fluoride toothpaste is effective for caries control, but not all toothpastes in China are fluoridated. Professionally applied fluorides such as sodium fluoride varnish can be a cost-effective treatment for managing the high prevalence of ECC in China. Silver diamine fluoride (SDF) at 38% is suggested to be effective in arresting ECC in China. It can be a simple, non-invasive and low-cost treatment. However, it stains caries black. Children and their parents must be well informed before SDF treatment.