PHANTUMVANIT ET AL EMIOLOCY-WILEY-285 dental health habits will greatly influence their children s oral health atraumatic restorative treatment (art), which has been included in and consequently their quality of life. There is a need for sound the recent Basic Package of Oral Care by the wHo Regional health education and awareness raising programmes that involve all office for Africa, can be used. It is a cost-effective technique family members and provide parents/ caregivers with adequate guid- which is less invasive to dental tissue and can be undertaken with ance on how to maintain the oral health of their children less discomfort to patients. It was considered a "patient-friendly An oral check-up after the first tooth has erupted in the mouth, procedure. 54.55 In addition to aRT, an interim version of ART called should be integrated into existing health programmes alongside vac- the interim therapeutic restoration (ITR), which is almost identical cinations and general medical check-ups. this could lead to a contin- to art with the exception of proposed subsequent uing programme of interventions that provide reassurance and vention, can be provided prior to the definitive restoration,56 to attend finally health appointments. Policy-makers at local and national levels using the hall technique. this involves seating a stainless steel should be encouraged to integrate an oral health element into exist- crown, filled with glass ionomer cement, over the affected tooth. ing health promotion programmes and policies. This is relatively painless procedure that can be undertaken without The social context and cultural pressures within societies also local anaesthesia. 7 influence families' behaviour. Creating supporting environments in which families live is an important element of oral health promotion. TABLE 3 Specific recommendations for public health intervention Accordingly, all sectors of the community should utilize community against ECC health workers and make use of social media to promote healthy Include the definition of ecc in the icd-11 classification behaviours at local and national levels. Thus, an ECC approach to Recommend inclusion of preschool children in subnational surveys prevention should be multidisciplinary targeting"child level, " family as part of oral health population surveys conducted in the country. level"and"community level. 23 Such surveys should be based on the WHo Basic Oral Health Surveys and include risk factor assessment Detect early caries lesions for early intervention 4.2 Arresting of caries lesions Advocate the importance of primary teeth to parents/ caregivers and Recognition of ECC is crucial for its prevention and control. a fur- the community by raising awareness of ECCs impact on quality ther focus should be on the early detection of carious lesions, in part because these progress faster in the primary dentition than in per Emphasize ECC within oral health education and interprofessional education with other health professions manent teeth. 4.45 The identification of early lesions allows a preven- Integrate ECC prevention within the primary health care( PHc) approach measures and implement at appropriate times, such as cavitation and tooth destruction. health behaviours alone (i.e with- vaccination period, as a public health focus out professional intervention)may suffice in securing caries arrest In Align ECC prevention intervention with other health promotion addition to the health behaviours, professional topical fluoride appli- initiatives such as actions against childhood obesity, avoidance of cation may be effective for arresting caries lesions. For instance, sys- free sugars in complementary foods and drinks, and promotion of breastfeed tematic reviews show that sealants and 38% silver diamine fluorid solution(SDF) can be effective in arresting the progression of non- mplement comprehensive programmes that promote the intake of healthy foods and reduce the intake of sugar-sweetened beverag cavitated caries lesions in enamel and dentine in primary teeth and foods, including introduction of taxation policy, a and that 5% sodium fluoride varnish can remineralize early carious ising campaigns to reach lesions in primary teeth. recommendations on marketing of foods and unhealthy drinks to ECC lesions which have progressed to cavitation require tempo- children rization to preserve the tooth structure avoid unnecessary extrac- Develop a training package for dental and nondental personnel for providing appropriate prevention and management for ECC hospitalization, and prevent social consequences such as interfering Confirm the use of community fluoride administration, such as water, salt or milk as primary prevention of ECc with preschooling activities. Sdf is shown to be a cost-effective Perform toothbrushing for children by a parent twice daily, using a procedure. 8.49 Topical application of fluoride varnish and SDF can oft toothbrush of age-appropriate size arrest the progression of ECC lesions, 0 and effectiveness is greater with biannual application 50.51 Inhibition of lesion progression can children under the age of 6 oothpaste(1000-1500 ppm)in all also be achieved by the application of flowable fluoride-releasing Use fluoride vamish and sealants with glass iono ent as glass ionomer cement Application of SDF is a painless, simple agents to help prevent deterioration of the ECc-at dentition and low-cost therapy which can be widely promoted as an alterna- upport the use of silver diamine fluoride and art, and other tive to conventional invasive caries management procedures. minimally invasive methods, using glass ionomer cement to Arrested cavitated lesions can remain appropriately unrestored pro- stabilize the caries lesion viding they do not present risks for posterior space loss or cultur- Promote evaluation, surveilance and research, including cost- ly unacceptable anterior aesthetics. However, if required effectiveness. for the prevention of ECC in different communitiesdental health habits will greatly influence their children’s oral health and consequently their quality of life. There is a need for sound health education and awareness raising programmes that involve all family members and provide parents/caregivers with adequate guid￾ance on how to maintain the oral health of their children. An oral check-up, after the first tooth has erupted in the mouth, should be integrated into existing health programmes alongside vac￾cinations and general medical check-ups. This could lead to a contin￾uing programme of interventions that provide reassurance and reinforce in mothers and parents/caregivers the need to attend health appointments. Policy-makers at local and national levels should be encouraged to integrate an oral health element into exist￾ing health promotion programmes and policies. The social context and cultural pressures within societies also influence families’ behaviour. Creating supporting environments in which families live is an important element of oral health promotion. Accordingly, all sectors of the community should utilize community health workers and make use of social media to promote healthy behaviours at local and national levels. Thus, an ECC approach to prevention should be multidisciplinary targeting “child level,” “family level” and “community level.” 23 4.2 | Arresting of caries lesions Recognition of ECC is crucial for its prevention and control. A fur￾ther focus should be on the early detection of carious lesions, in part because these progress faster in the primary dentition than in per￾manent teeth.44,45 The identification of early lesions allows a preven￾tive approach aimed at avoiding the progression of the disease to cavitation and tooth destruction. Health behaviours alone (i.e with￾out professional intervention) may suffice in securing caries arrest. In addition to the health behaviours, professional topical fluoride appli￾cation may be effective for arresting caries lesions. For instance, sys￾tematic reviews show that sealants and 38% silver diamine fluoride solution (SDF) can be effective in arresting the progression of non￾cavitated caries lesions in enamel and dentine in primary teeth46,47 and that 5% sodium fluoride varnish can remineralize early carious lesions in primary teeth.47 ECC lesions which have progressed to cavitation require tempo￾rization to preserve the tooth structure, avoid unnecessary extrac￾tion and negative consequences, including pain, infection and hospitalization, and prevent social consequences such as interfering with preschooling activities. SDF is shown to be a cost-effective procedure.48,49 Topical application of fluoride varnish and SDF can arrest the progression of ECC lesions,50 and effectiveness is greater with biannual application.50,51 Inhibition of lesion progression can also be achieved by the application of flowable fluoride-releasing glass ionomer cement.50 Application of SDF is a painless, simple and low-cost therapy which can be widely promoted as an alterna￾tive to conventional invasive caries management procedures.52 Arrested cavitated lesions can remain appropriately unrestored, pro￾viding they do not present risks for posterior space loss or cultur￾ally unacceptable anterior aesthetics. However, if required, atraumatic restorative treatment (ART), which has been included in the recent Basic Package of Oral Care by the WHO Regional Office for Africa,53 can be used. It is a cost-effective technique which is less invasive to dental tissue and can be undertaken with less discomfort to patients. It was considered a “patient-friendly” procedure.54,55 In addition to ART, an interim version of ART called the interim therapeutic restoration (ITR), which is almost identical to ART with the exception of proposed subsequent clinical inter￾vention, can be provided prior to the definitive restoration.56 Finally, where resources allow, cavities in molars may be treated using the Hall technique. This involves seating a stainless steel crown, filled with glass ionomer cement, over the affected tooth. This is relatively painless procedure that can be undertaken without local anaesthesia.57 TABLE 3 Specific recommendations for public health intervention against ECC Include the definition of ECC in the ICD-11 classification Recommend inclusion of preschool children in subnational surveys as part of oral health population surveys conducted in the country. Such surveys should be based on the WHO Basic Oral Health Surveys and include risk factor assessment Detect early caries lesions for early intervention Advocate the importance of primary teeth to parents/caregivers and the community by raising awareness of ECC’s impact on quality of life of young children Emphasize ECC within oral health education and interprofessional education with other health professions Integrate ECC prevention within the primary health care (PHC) approach measures and implement at appropriate times, such as vaccination period, as a public health focus Align ECC prevention intervention with other health promotion initiatives such as actions against childhood obesity, avoidance of free sugars in complementary foods and drinks, and promotion of breastfeeding Implement comprehensive programmes that promote the intake of healthy foods and reduce the intake of sugar-sweetened beverages and foods, including introduction of taxation policy, awareness raising campaigns to reach all groups in society, implementation of recommendations on marketing of foods and unhealthy drinks to children Develop a training package for dental and nondental personnel for providing appropriate prevention and management for ECC Confirm the use of community fluoride administration, such as water, salt or milk as primary prevention of ECC Perform toothbrushing for children by a parent twice daily, using a soft toothbrush of age-appropriate size Use standard fluoride-containing toothpaste (1000-1500 ppm) in all children under the age of 6 Use fluoride varnish and sealants with glass ionomer cement as agents to help prevent deterioration of the ECC-affected dentition Support the use of silver diamine fluoride and ART, and other minimally invasive methods, using glass ionomer cement to stabilize the caries lesion Promote evaluation, surveillance and research, including cost￾effectiveness, for the prevention of ECC in different communities PHANTUMVANIT ET AL. | 285