A systematic review of clinical diagnostic criteria of early childhood caries

Objective: This paper reviews case definitions and clinical diagnostic crit eria of early childhood caries (ECC) and severe ECC (S-ECC) in children age d 1 to 5 years old. The acronym S-ECC as used in this paper refers to nursi ng caries, baby bottle tooth decay, rampant caries, labial caries, maxillar y anterior caries, and other terms used to refer to severe dental caries in preschool children. Methods: A search was carried out for articles publish ed in peer-reviewed journals and indexed in MEDLINE using the following ter ms: nursing caries, baby bottle tooth decay, early childhood caries, rampan t caries in preschool children, labial caries, maxillary anterior caries, a nd nursing bottle caries. MEDLINE's MeSH terms "dental caries" and "deciduo us teeth" were used to search for other relevant studies. Reports were sele cted if they included children 1 to 5 years of age and described diagnostic criteria or case definitions of S-ECC. Three previous reviews were searche d for other relevant reports. One unpublished report was included in this r eview and data from NHANES III were analyzed to provide information on cari es patterns in preschool children in the United States. The first author re ad all the abstracts from the MEDLINE search and tagged relevant reports fo r photocopying. He also abstracted all the information from the reports. Th e first author calibrated the second author, who independently read all inc luded and excluded reports. Disagreements were resolved by consensus. Resul ts: Out of 126 studies, 32 were excluded and 94 (93 published and 1 unpubli shed) were included in this review. Eighty-one of the 94 published studies were cross-sectional surveys or clinical studies, 7 were case-control clini cal studies, 2 studies were controlled clinical trials, and 4 were cohort o r field trials. About two-thirds of the included studies did not report on calibration of examiners. Information on reliability of examiners was repor ted by 19 of the 94 studies. The included studies varied widely in the name used to identify S-ECC, case definitions, and diagnostic criteria. "Cavita tion" was the most common criterion used to define dental caries. Several s tudies measured early or noncavitated carious lesions. Twenty-seven studies used the presence of 1 dmf maxillary incisor to classify a child with S-EC C. Another 23 and 9 studies defined S-ECC by the presence of 2+ or 3+ dmf m axillary incisors, respectively. Dental caries in preschool children cluste rs in pits and fissures and on smooth tooth surfaces of primary molars and maxillary incisors. Conclusions: This review found a wide variation in the case definitions and diagnostic criteria used to diagnose ECC or define S-E CC. Dental caries in the maxillary incisors is one of several patterns of d ental caries that may occur in primary teeth of preschool children. A conse nsus is needed on case definitions and diagnostic criteria that can assist researchers to test preventive interventions and study the etiology and epi demiology of ECC.