IMUNITY ILEY 5 CONCLUSION with disability for 310 diseases and injuries, 1990-2015 nalysis for the Global Burden of Disease Study 2015. Lancet. The aetiology of ECc is complex due to the multilevel web of fac- 2016;388:1545-1602 aum NJ, Smith AGC, Bemabe E, et al. Global, regional, an tors that modify risk. Intervention approaches range from changing ational prevalence incidence, and disability-adjusted life years for ersonal behaviour, working with families and caregivers to public oral conditions for 195 countries, 1990-2015: a systematic analysis health solutions including building health policies, creating supportive for the global burden of diseases, injuries, and risk factors. JDent environments, health promotion and orientation of health services Res.2017;96:380-387 towards disease prevention(Table 3). preventive approaches should 3. Thomson WM. Public health aspects of paediatric dental treatment under general anaesthetic. Dent J. 2016: 4: 20. consider the social characteristics of the family, diet and feeding 4. Otero G. Pechlaner G. Liberman G. Gurcan E. the neoliberal diet vioural risk factors of EcC can be and inequality in the United States. Soc Sci Med. 2015: 142: modified. Population-based prevention of ECC and health promotion 5. Rugg-Gunn A. Getting diet right: dietary advice for health in prac- initiatives should be implemented, targeting pregnant women, new mothers and primary caregivers with the aim of raising awareness 6. Jurgensen N, Petersen PE. Promoting oral health of children througl bout the common risk factors, particularly the addition of free sug schools- Results from a WHo glot ars to drinks and complementary foods. In addition policies promot- Hea|th2013;30:204218 ing the intake of healthier foods and diets and reducing the intake 7. Petersen PE Hunsrisakhun J, Thearmontree A, et al. School-based intervention for improving the oral health of children in southern of sugar-sweetened beverages and foods should be formulated Thailand. Community Dent Health. 2015: 32: 44-50 these may include taxation and recommendations on the marketing 8. World Health Organization. WHo Expert Consultation on Public of less healthy foods and drinks. In view of the many benefits of Health Intervention against early childhood caries, report of a Meet breastfeeding, ECC prevention should align with WHo breastfeed ingThailand26-28January2016.2017.http://www.who.int/oral health/publications/early-childhood-caries-meeting-report-Thailand/ ing recommendations, although further research is required to obtain en/. Accessed June 10. 2017. better quality data on any independent effect of breastfeeding of longer duration on caries risk. Emphasis on dental care should be 10. Drury TF, Horowitz AM, Ismail Al, Maertens MP, Rozier RG, Selwitz arly childhood caries Pediatr Dent. 2003: 25: 328-333. RH. Diagnosing and reporting early childhood caries for research should be dearly defined. Dental personnel and other health profes purposes. A report of a workshop sponsored by the National Insti sionals, as well as mothers and caregivers, should be trained to tute of dental and Craniofacial Research, the health Resources and etect the early signs of ECC and instructed on seeking advice. Oral Services Administration, and the health Care Financing Administra- health should be integrated into the childs health profile at well- tion. J Public Health Dent. 1999: 59: 192-197. child clinics during primary health care, such as visits for vaccination. 11. American Academy of Pediatric Dentistry. Definition of Early Child- hoodCaries(ecc).2008,p.15.http://www.aapd.org/assets/1/7/d For the clinical management of ECC, noncavitated lesions should be ECC.pdf. Accessed April 10, 2017. arrested and remineralized, and the restoration of cavitated lesions 12. The Joint Task Force (TF) eering group for ICD-11 version should follow conservative principles which aim to preserve tooth for Mortality and morbidity Statistics (ICD-11-MMS) ICD-11 Beta structure and avoid unnecessary extraction. Finally, to monitor and Draft(mortalityandMorbidityStatistics).http://apps.whoint/class ations/icd11/browse/f/en#thttp%3a%2f%2fid.whoint%2ficd%2fen ity%2f1112319601 Accessed April 10, 2017. veys of preschool children may be required; such surveys should also 13. Dye BA, Hsu KL, Afful J Prevalence and measurement of dental ca nclude assessment of the factors that modify risk ies in young children. Pediatr Dent. 2015: 37: 200-216. 14. WHO Collaborating Centre Malmo University Sweden. The WHO OralHealthCountry/areaProfileProgrammehttp://www.mah. se/capp/. accessed May 12, 2016. ACKNOWLEDGEMENT 15. World Health Organization. Oral Health Surveys-Basic Methods Fifth Participants travel expenses were supported by The borrow Foun- Edition.2013.http://apps.whoint/iris/bitstream/10665/97035/1 9789241548649 eng- pdf?ual. Accessed February 15, dation a UK-based chari 6. World Bank. World Bank Country and Lending Groups: historical classificationbyincomehttps://datahelpdesk.worldbank.org/knowl edgebase/articles/906519. Accessed July 20, 2016. ORCID 17. Mishu MP, Hobdell M. Khan MH, Hubbard RM, Sabbah W. Relation ntreated dental caries and weight and height of 6-to YukaMakino(dhttp://orcid.org/0000-0002-0002-0808 12-year-old primary school children in Bangladesh. Int J Dent. PaulaMoynihan(dhttp://orcid.org/0000-0002-5015-5620 2013;2013:629675. WendellEvans(dhttp://orcid.org/0000-0002-2271-7155 18. Fung MHT, Wong MCM, Lo ECM, Chu CH. Early childhood caries: a literature review. J Oral Hyg Health. 2013 1: 107. 19. Chaffee BW, Rodrigues PH, Kramer PF, Vitolo MR, Feldens CA Or REFERENCES caries experience. Community Dent Oral Epidemiol. 2017: 45: 216-224. 20. Peerbhay F. Barrie RB. the burden of early childhood caries in the 1. GBD 2015 Disease and Injury Incidence and Prevalent Collaborator Western Cape Public Service in relation to dental general anaesthe- Global, regional, and national incidence, prevalence, and years lived sia: implications for prevention. SADJ. 2012: 67: 14-16, 18-195 | CONCLUSION The aetiology of ECC is complex due to the multilevel web of fac￾tors that modify risk.3 Intervention approaches range from changing personal behaviour, working with families and caregivers, to public health solutions including building health policies, creating supportive environments, health promotion and orientation of health services towards disease prevention (Table 3). Preventive approaches should consider the social characteristics of the family, diet and feeding practices, and how the sociobehavioural risk factors of ECC can be modified. Population-based prevention of ECC and health promotion initiatives should be implemented, targeting pregnant women, new mothers and primary caregivers with the aim of raising awareness about the common risk factors, particularly the addition of free sug￾ars to drinks and complementary foods. In addition, policies promot￾ing the intake of healthier foods and diets and reducing the intake of sugar-sweetened beverages and foods should be formulated; these may include taxation and recommendations on the marketing of less healthy foods and drinks. In view of the many benefits of breastfeeding,26 ECC prevention should align with WHO breastfeed￾ing recommendations, although further research is required to obtain better quality data on any independent effect of breastfeeding of longer duration on caries risk. Emphasis on dental care should be given to the early detection of caries lesions. To facilitate this, ECC should be clearly defined. Dental personnel and other health profes￾sionals, as well as mothers and caregivers, should be trained to detect the early signs of ECC and instructed on seeking advice. Oral health should be integrated into the child’s health profile at well￾child clinics during primary health care, such as visits for vaccination. For the clinical management of ECC, noncavitated lesions should be arrested and remineralized, and the restoration of cavitated lesions should follow conservative principles which aim to preserve tooth structure and avoid unnecessary extraction. Finally, to monitor and evaluate ECC intervention programmes, subnational oral health sur￾veys of preschool children may be required; such surveys should also include assessment of the factors that modify risk. ACKNOWLEDGEMENT Participants’ travel expenses were supported by The Borrow Foun￾dation, a UK-based charity. ORCID Yuka Makino http://orcid.org/0000-0002-0002-0808 Paula Moynihan http://orcid.org/0000-0002-5015-5620 Wendell Evans http://orcid.org/0000-0002-2271-7155 REFERENCES 1. GBD 2015 Disease and Injury Incidence and Prevalent Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545-1602. 2. Kassebaum NJ, Smith AGC, Bernabe E, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990-2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res. 2017;96:380-387. 3. Thomson WM. Public health aspects of paediatric dental treatment under general anaesthetic. Dent J. 2016;4:20. 4. Otero G, Pechlaner G, Liberman G, Gurcan E. The neoliberal diet and inequality in the United States. Soc Sci Med. 2015;142: 47-55. 5. Rugg-Gunn AJ. Getting diet right: dietary advice for health in prac￾tice. Dent Nurs. 2015;11:381-384. 6. Jurgensen N, Petersen PE. Promoting oral health of children through € schools – Results from a WHO global survey 2012. Community Dent Health. 2013;30:204-218. 7. Petersen PE, Hunsrisakhun J, Thearmontree A, et al. School-based intervention for improving the oral health of children in southern Thailand. Community Dent Health. 2015;32:44-50. 8. World Health Organization. WHO Expert Consultation on Public Health Intervention against early childhood caries, report of a Meet￾ing, Thailand, 26-28 January 2016. 2017. http://www.who.int/oral_ health/publications/early-childhood-caries-meeting-report-Thailand/ en/. Accessed June 10, 2017. 9. Ismail AI. Determinants of health in children and the problem of early childhood caries. Pediatr Dent. 2003;25:328-333. 10. Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Insti￾tute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administra￾tion. J Public Health Dent. 1999;59:192-197. 11. American Academy of Pediatric Dentistry. Definition of Early Child￾hood Caries (ECC). 2008, p. 15. http://www.aapd.org/assets/1/7/D_ ECC.pdf. Accessed April 10, 2017. 12. The Joint Task Force (JTF) (The steering group for ICD-11 version for Mortality and Morbidity Statistics (ICD-11-MMS)). ICD-11 Beta Draft (Mortality and Morbidity Statistics). http://apps.who.int/classifi cations/icd11/browse/f/en#http%3a%2f%2fid.who.int%2ficd%2fen tity%2f1112319601. Accessed April 10, 2017. 13. Dye BA, Hsu KL, Afful J. Prevalence and measurement of dental car￾ies in young children. Pediatr Dent. 2015;37:200-216. 14. WHO Collaborating Centre Malmo University Sweden. The WHO € Oral Health Country/Area Profile Programme. http://www.mah. se/capp/. Accessed May 12, 2016. 15. World Health Organization. Oral Health Surveys – Basic Methods Fifth Edition. 2013. http://apps.who.int/iris/bitstream/10665/97035/1/ 9789241548649_eng.pdf?ua=1. Accessed February 15, 2017. 16. World Bank. World Bank Country and Lending Groups; historical classification by income. https://datahelpdesk.worldbank.org/knowl edgebase/articles/906519. Accessed July 20, 2016. 17. Mishu MP, Hobdell M, Khan MH, Hubbard RM, Sabbah W. Relation￾ship between untreated dental caries and weight and height of 6- to 12-year-old primary school children in Bangladesh. Int J Dent. 2013;2013:629675. 18. Fung MHT, Wong MCM, Lo ECM, Chu CH. Early childhood caries: a literature review. J Oral Hyg Health. 2013;1:107. 19. Chaffee BW, Rodrigues PH, Kramer PF, Vitolo MR, Feldens CA. Oral health-related quality-of-life scores differ by socioeconomic status and caries experience. Community Dent Oral Epidemiol. 2017;45:216-224. 20. Peerbhay F, Barrie RB. The burden of early childhood caries in the Western Cape Public Service in relation to dental general anaesthe￾sia: implications for prevention. SADJ. 2012;67:14-16, 18-19. 286 | PHANTUMVANIT ET AL