Early Childhood Caries: IAPD Bangkok Declaration

384

wileyonlinelibrary.com/journal/ipd Int J Paediatr Dent. 2019;29:384–386.

Published by John Wiley & Sons Ltd

DOI: 10.1111/ipd.12490

DECLARATION

Early Childhood Caries: IAPD Bangkok Declaration

INTRODUCTION

The purpose of this Declaration is to gain worldwide support for

an evidence‐based definition and a common understanding of

the evidence around the aetiology, risk factors, and interventions

to reduce Early Childhood Caries (ECC), as well as to mobilize

collaborative approaches and policies to diminish this chronic

disease. With this background, 11 experts from across the globe

convened under the auspices of the International Association for

Paediatric Dentistry (IAPD) to create this statement.

THE IAPD BANGKOK

DECLARATION

Early Childhood Caries (ECC) is defined as the presence of

one or more decayed (non‐cavitated or cavitated lesions),

missing or filled (due to caries) surfaces, in any primary tooth

of a child under six years of age. Primary teeth maintain the

space for the permanent teeth and are essential to a child's

well‐being since dental caries on primary teeth may lead to

chronic pain, infections, and other morbidities. ECC is pre-

ventable, but currently affects more than 600 million children

worldwide, and remains largely untreated. This disease has

major impact on the quality of life of children and their fami-

lies and is an unnecessary burden to society.

Early Childhood Caries, like other forms of caries, is con-

sidered to be a biofilm‐mediated, sugar‐driven, multifactorial,

dynamic disease that results in the imbalance of demineraliza-

tion and remineralization of dental hard tissues. Dental caries

is determined by biological, behavioural, and psychosocial

factors linked to an individual's environment. ECC shares

common risk factors with other non‐communicable diseases

(NCDs) associated with excessive sugar consumption, such

as cardiovascular disease, diabetes, and obesity. Excessive in-

take of sugars leads to prolonged acid production from tooth

adherent bacteria and to a shift in the composition of the oral

microbiota and biofilm pH. If sustained, tooth structures are

demineralized. ECC is in some cases associated with devel-

opmental defects of enamel.

Appropriate management of ECC from informed parents,

health professionals, and community health workers, as well as

evidence‐based health policy, is important to reduce this bur-

den of preventable disease. Caries risk assessment aids in this

process by establishing the probability of individual patients, or

groups of children developing carious lesions. For the individ-

ual child, risk assessment is an essential key element to guide

prevention and management. At the community level, the caries

risk assessment can guide the design of public interventions and

allocate time and resources to those with the greatest need.

Prevention and care of ECC can be structured in three

phases. Primary prevention includes improving oral health

literacy of parents/caregivers and healthcare workers, limiting

children's consumption of free sugar in drinks and foods, and

daily exposure to fluorides. Secondary prevention consists

of the effective control of initial lesions prior to cavitation

that may include more frequent fluoride varnish applications

and applying pit and fissure sealants to susceptible molars.

Tertiary prevention includes the arrest of cavitated lesions

and tooth‐preserving operative care.

RECOMMENDATIONS

To reduce the prevalence and burden of ECC worldwide, the

IAPD Bangkok Declaration recommends the following actions:

Four key areas requiring action with multiple stakeholders

are as follows:

1. Raise awareness of ECC with parents/caregivers, dentists,

dental hygienists, physicians, nurses, health professionals,

and other stakeholders.

2. Limit sugar intake in foods and drinks and avoid free sug-

ars for children under 2 years of age.

3. Perform twice daily toothbrushing with fluoridated tooth-

paste (at least 1000 ppm) in all children, using an age‐ap-

propriate amount of paste.

4. Provide preventive guidance within the first year of life by

a health professional or community health worker (build-

ing on existing programs—eg vaccinations—where pos-

sible) and ideally, referral to a dentist for comprehensive

continuing care.

In addition, it is recommended that:

• Stakeholders advocate for reimbursement systems and ed-

ucational reform that emphasizes evidence‐based preven-

tion and comprehensive management of ECC.

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GUIDELINES

• In order to standardize comparisons across countries and

regions, epidemiology studies should record the presence

of non‐cavitated and cavitated caries; ideally record initial,

moderate, and extensive stages of decay; children should

be surveyed at three and five years of age to capture pre-

ventive as well as restorative needs.

• An educational curriculum on ECC should be implemented

in dental schools worldwide to ensure that evidence‐ and

risk‐based preventive care is given equal weight to tradi-

tional surgical management.

• Research on ECC inequalities, oral health‐related quality of

life, interventions, and health economics should be supported

to further understand benefits of effective and timely care.

The Appendix below, prepared by the Expert Panel, pro-

vides a Communication Statement on Early Childhood Caries

designed for a wide range of professional and lay stakeholders. A

detailed paper, entitled ‘Global Perspective of Early Childhood

Caries Epidemiology, Aetiology, Risk Assessment, Societal

Burden, Management, Education and Policy’, provides the up-

dated evidence and references that informed this declaration.

*Global Summit on Early Childhood Caries was held in

Bangkok on November 2–4, 2018. Members of the Expert

Panel who drew up this Declaration with input from the

IAPD Board were: Drs. N.B. Pitts (U.K), R. Baez (USA), C.

Diaz‐Guallory (USA), K. Donly (USA), C. Feldens (Brazil),

C. McGrath (Hong Kong), P. Phantumvanit (Thailand), K.

Seow (Australia), N. Sharkov (Bulgaria), N. Tinanoff (USA),

and S. Twetman (Denmark).

IAPD Board members in alphabetical order: Drs. M.

Bönecker (Brazil), A. O’Connell (Ireland), B. Drummond

(New Zealand), T. Fujiwara (Japan), C. Hughes (USA), N.

Krämer (Germany), A. Kupietzky (Israel), A.M. Vierrou

(Greece), A. Tsai (Taiwan).

REFERENCE

1. Tinanoff, N, Baez, RJ Diaz-Guillory, C, et al. Early childhood car-

ies epidemiology, aetiology, risk assessment, societal burden, man-

agement, education, and policy: Global perspective. Int J Paediatr

Dent. 2019;29:238‐248. https://doi.org/10.1111/ipd.12484

APPENDIX

IAPD Bangkok Declaration: Communication Statement

on Early Childhood Caries

What is Early Childhood Caries (ECC)?

• Dental Caries: Scientific definition—Dental caries is a

biofilm‐mediated, sugar‐driven, multifactorial, dynamic

disease that results in the imbalance of demineralization

and remineralization of dental hard tissues. Dental caries

is determined by biological, behavioural, and psychosocial

factors linked to an individual's environment.

• Early Childhood Caries is: Lay definition—Tooth decay in

pre‐school children which is common, mostly untreated and

can have profound impacts on children's lives. Clinical defi-

nition—the presence of one or more decayed (non‐cavitated

or cavitated lesions), missing (due to caries), or filled sur-

faces, in any primary tooth of a child under age six.

The context for ECC

• Dental caries is the most common preventable disease.

• Untreated dental caries in primary teeth affects more than

600 million children worldwide.

• Dental caries shares common risk factors with other non‐

communicable diseases (NCDs) associated with excessive

sugar consumption, such as cardiovascular disease, diabe-

tes, and obesity.

The unacceptable burden of ECC

• ECC is an unacceptable burden for children, families, and

society.

• The timely and appropriate prevention and management of

ECC is important to reduce this burden and to improve the

quality of life of children globally.

How do we reduce ECC and its burden?

• ECC is multifactorial, and there is no easy or single solu-

tion to the complex ‘Caries Puzzle’. The engagement of

multiple stakeholders to address the multiple aspects of

caries causation is necessary to prevent ECC.

• Primary Prevention of ECC

• Upstream interventions at the community level.

• Prevention of new disease at the individual level.

• Secondary Prevention of ECC

• Effective control of initial lesions prior to cavitation.

• Arrest of more advanced lesions, where possible.

• Tertiary Prevention of ECC

• Non‐invasive caries control procedures.

• Appropriate, tooth‐preserving restorative care.

Action on ECC needed from multiple

stakeholders in four key areas

• Raise awareness of ECC with parents/caregivers, den-

tists, paediatricians, nurses, other health professionals, and

other stakeholders.

• Limit sugar intake in foods and drinks and avoid free

sugars for children under 2 years of age.

The declaration is co-published in Pediatric Dentistry and Journal of Dentistry for Children

386

GUIDELINES

• Perform twice daily toothbrushing with fluoridated

toothpaste (at least 1000 ppm) in all children, using an

age‐appropriate amount of paste.

• Provide preventive guidance within the first year of life

by a health professional or community health worker

(building on existing programs—eg vaccinations—where

possible) and ideally, referral to a dentist for comprehen-

sive continuing care.

How to cite this article: Pitts, N, Baez, R, Diaz-

Guallory, C, et al. Early Childhood Caries: IAPD

Bangkok Declaration. Int J Paediatr Dent. 2019;29:

384‐386.