PHANTUMVANIT ET AL NDA-WILEY KEYWORDS Early Childhood Caries, health promotion, prevention, public health 1 INTRODUCTION WHO International Classification of Diseases, 11th edition(ICD-11 The modified definition of ECC which was proposed in 1999, and The findings of the 2015 Global Burden of Diseases study 2 adopted by the american academy of pediatric dentistry(AAPD)in revealed that dental caries of the primary dentition was the 12th 2003-1-ECC experience is the presence of one or more decayed most prevalent disease (560 million children) in all ages combined. (noncavitated or cavitated lesions ) missing(due to caries) or filled The significance of the dental, medical, social and economic costs of tooth surfaces in any primary tooth in a child under the age of Early Childhood Caries(ECC)has increased in all regions of th sixO--was accepted during the meeting world. The aetiology of ECC is complex, and the disease progresses ted ICD-11 cl on of eccl reads as follows more rapidly than caries in the permanent dentition ecc is due to "early childhood caries(Ecc) is characterized by the presence of one the strong influence of health behaviours and practices of children or more teeth affected by severe carious lesions or with white spot and families, mostly mothers and/or caregivers. In addition, structural lesions in anterior and posterior primary teeth, extraordinary loss of factors and poor socioeconomic conditions have an important impact teeth due to caries or filled tooth surfaces in affected teeth. ECc is on the development of ECc and lead to inequalities which are mostly found in young children under the age of 6. those children increasing in low- and middle- income countries. 4 Moreover, ECC is with eCC have been shown to have a high number of teeth affected an economic burden to society. treatment of Ecc under general by progressive disease. Consequences of ECc include a anaesthesia(GA)for extensive dental repair is especially costly. In of pain or discomfort, abscesses, carious lesions in both the primary England, over 60 000 children had decayed teeth extracted under and permanent dentitions, risk for delayed physical growth and Ga between 2012 and 2013; a conservative estimate of the cost of development, increased days with restricted activity, and diminished these admissions for the extraction of decayed teeth was f27.6 mi oral health-related quality of life. the aetiology is frequently linked lion, which is equivalent to the cost of running 3 secondary schools. with a high-frequent consumption of sugared drinks or food, lack of Many countries have introduced effective school-based pro. breastfeeding, and/or poor oral hygiene. Additionally the disease grammes to improve oral health, but it is realized that, in many often manifests in children living in poor families and in poor envi- countries, the disease occurs before the child attends school and can ronmental settings. benefit from these programmes A WHO Global Consultation on ECC was held in Bangkok(Thailand) on 26-28 January 2016 to explore possible public health solutions to 3 THE GLOBAL STATUS OF ECC the worldwide problem of ECC. the 3-day meeting was organized by the WHO Collaborating Centre for Oral Health Education and To assess the impact of the classification of ECC proposed in 1999 Research, Mahidol University, in collaboration with the WHO Oral Dye et al conducted a systematic literature review of the preva Health Programme; nineteen experts from 13 countries, including aca- lence and measurement of dental caries in young children from demic experts from the wHo Collaborating Centres and the WHo 1999 to 2014. The criterion for lesion detection as reported in 71% Expert Panel on Oral Health, attended from all 6 WHO regions. Reviews of the 87 papers reviewed, used cavitation in enamel as a minimal were presented on the definition of ECC, global epidemiology of ECC, threshold. Only 15% of papers reported noncavitated and/or cavi- pattern and development of ECC, aetiology of ECC, infant feeding and tated as the caries detection level, which is aligned with AAPD'S diets of the young child, strategies for prevention considering modifi- ECC definition. The current variation in detection level limits able risk factors, and sociobehavioural factors and effective public ability to obtain valid estimates of disease prevalence rates around health initiatives. Group discussions on each of these topics were held the globe. 13 to reach an agreement on conclusions and recommendations. The WHO Oral Health Programme has maintained its"WHO Oral The purpose of this report is to provide a summary of the meet- lealth Country/Area Profile Programme( CAPP)" for oral diseases ing"A WHO Global Consultation on ECCaB to provide an overview surveillance since 1995. Essentially, the data presented in the CAPP follow the who manual Oral Health action this important public health problem Since the introduction of AAPD's ECC definition, data on the percent- age of children under the age of 6 with one or more treated/ untreated caries lesions(prevalence)have been reported for 44 of the 194 w 2 DEFINITION OF ECC Member States. It was noted that the prevalence ranged from 0.0% in Nigeria to 98% in Cambodia, and bosnia and herzegovina. It should be It is considered to be a high priority to disseminate globally the defi- noted that while some of the surveys included in the database nition and diagnostic criteria for ECC and to include ECC in the included noncavitated carious lesions, most surveys did notKEYWORDS Early Childhood Caries, health promotion, prevention, public health 1 | INTRODUCTION The findings of the 2015 Global Burden of Diseases study1,2 revealed that dental caries of the primary dentition was the 12th most prevalent disease (560 million children) in all ages combined. The significance of the dental, medical, social and economic costs of Early Childhood Caries (ECC) has increased in all regions of the world. The aetiology of ECC is complex, and the disease progresses more rapidly than caries in the permanent dentition. ECC is due to the strong influence of health behaviours and practices of children and families, mostly mothers and/or caregivers. In addition, structural factors and poor socioeconomic conditions have an important impact on the development of ECC and lead to inequalities which are increasing in low- and middle-income countries.3,4 Moreover, ECC is an economic burden to society. Treatment of ECC under general anaesthesia (GA) for extensive dental repair is especially costly.3 In England, over 60 000 children had decayed teeth extracted under GA between 2012 and 2013; a conservative estimate of the cost of these admissions for the extraction of decayed teeth was £27.6 mil￾lion, which is equivalent to the cost of running 3 secondary schools.5 Many countries have introduced effective school-based pro￾grammes to improve oral health,6,7 but it is realized that, in many countries, the disease occurs before the child attends school and can benefit from these programmes. A WHO Global Consultation on ECC was held in Bangkok (Thailand) on 26-28 January 2016 to explore possible public health solutions to the worldwide problem of ECC. The 3-day meeting was organized by the WHO Collaborating Centre for Oral Health Education and Research, Mahidol University, in collaboration with the WHO Oral Health Programme; nineteen experts from 13 countries, including aca￾demic experts from the WHO Collaborating Centres and the WHO Expert Panel on Oral Health, attended from all 6 WHO regions. Reviews were presented on the definition of ECC, global epidemiology of ECC, pattern and development of ECC, aetiology of ECC, infant feeding and diets of the young child, strategies for prevention considering modifi￾able risk factors, and sociobehavioural factors and effective public health initiatives. Group discussions on each of these topics were held to reach an agreement on conclusions and recommendations. The purpose of this report is to provide a summary of the meet￾ing “A WHO Global Consultation on ECC” 8 to provide an overview of ECC prevention strategies, and to emphasize the urgent need for action this important public health problem. 2 | DEFINITION OF ECC It is considered to be a high priority to disseminate globally the defi￾nition and diagnostic criteria for ECC and to include ECC in the WHO International Classification of Diseases, 11th edition (ICD-11). The modified definition of ECC which was proposed in 1999, and adopted by the American Academy of Pediatric Dentistry (AAPD) in 20039-11—“ECC experience is the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child under the age of six10”—was accepted during the meeting. The suggested ICD-11 classification of ECC12 reads as follows: “Early childhood caries (ECC) is characterized by the presence of one or more teeth affected by severe carious lesions or with white spot lesions in anterior and posterior primary teeth, extraordinary loss of teeth due to caries, or filled tooth surfaces in affected teeth. ECC is mostly found in young children under the age of 6. Those children with ECC have been shown to have a high number of teeth affected by progressive disease. Consequences of ECC include a higher risk of pain or discomfort, abscesses, carious lesions in both the primary and permanent dentitions, risk for delayed physical growth and development, increased days with restricted activity, and diminished oral health-related quality of life. The aetiology is frequently linked with a high-frequent consumption of sugared drinks or food, lack of breastfeeding, and/or poor oral hygiene. Additionally, the disease often manifests in children living in poor families and in poor envi￾ronmental settings.” 3 | THE GLOBAL STATUS OF ECC To assess the impact of the classification of ECC proposed in 1999, Dye et al13 conducted a systematic literature review of the preva￾lence and measurement of dental caries in young children from 1999 to 2014. The criterion for lesion detection, as reported in 71% of the 87 papers reviewed, used cavitation in enamel as a minimal threshold. Only 15% of papers reported noncavitated and/or cavi￾tated as the caries detection level, which is aligned with AAPD’s ECC definition. The current variation in detection level limits our ability to obtain valid estimates of disease prevalence rates around the globe.13 The WHO Oral Health Programme has maintained its “WHO Oral Health Country/Area Profile Programme (CAPP)” for oral diseases surveillance since 1995.14 Essentially, the data presented in the CAPP follow the WHO manual—“Oral Health Survey Basic Methods.” 15 Since the introduction of AAPD’s ECC definition, data on the percent￾age of children under the age of 6 with one or more treated/untreated caries lesions (prevalence) have been reported for 44 of the 194 WHO Member States. It was noted that the prevalence ranged from 0.0% in Nigeria to 98% in Cambodia, and Bosnia and Herzegovina. It should be noted that while some of the surveys included in the database included noncavitated carious lesions, most surveys did not. PHANTUMVANIT ET AL. | 281