1. Dr Salome K. Ireri BDS, MSc, MCLinDent, PhD Kenyatta National Hospital

2.  Severe decay in the teeth of infants or young children (preschool-age).. child between birth and 71 months of age.decayteethinfants children  Also known as baby bottle caries, baby bottle tooth decay /nursing bottle tooth decay  "Severe Early Childhood Caries" refers to "rampant" patterns of dental caries.

3.  ECC is a significant public health problem  Afflicts predominantly disadvantaged children in developed countries  In Kenya –both disadvantaged & those not disadvantaged.

5.  frequent consumption of foods containing fermentable carbohydrates (e.g., juice, milk, formula, soda) due to prolonged contact between sugars and cariogenic bacteria on the teeth. fermentablecarbohydratesjuicemilk formulasodasugarsbacteria  Dental caries is preventable

6. Early colonization by Streptococcus mutans is a major risk factor for ECC and future dental caries.

7. Prevention  Comprehensive program of counselling- preventing or delaying maternal transmission  Oral hygiene instructions -as soon as 1 st primary tooth erupts brush X2 by parents, soft brush etc  Early dental consultation-6 months -caries risk assessment, parental education including anticipatory guidance for prevention

8.  Avoiding frequent consumption of foods/drinks containing sugar  Infants should not be put to sleep with a bottle or breast in mouth  Encourage infants to drink from a cup  wean from the bottle between 12 to 18 months of age.  Fluoride treatments  Restorative care.

9.  Costly because the cooperative capacity of babies and preschool children: usually necessitates the use of general anaesthesia.  Restoration (fillings) and/or surgical removal of teeth with cavities  Recommendations regarding feeding habits.

10. Behaviour management Non-Pharmacological - tell show & do, modelling positive and negative reinforcement, voice control, physical retrain etc Pharmacological -Sedation- (conscious) nitrous oxide, oral, iv -GA- costly and other risk factors

12.  Children are becoming more un cooperative,.. parenting styles, failure of parents to set limits on children's behaviour.  Cost of dental care is a barrier to families of lower socio-economic status.  A degree of ignorance among the medium-high social class

13. Primary prevention has largely been restricted to counselling parents about caries; promoting feeding behaviours. Limitation; Relapse rates of approx 40% have been reported within the first year after dental surgery. Topical antimicrobial therapy appears promising- more research needed. Potential for enormous strain on healthcare system and society