A Systematic Review of Clinical Diagnostic Criteria of Early Childhood Caries

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Abstract
Objective: This paper reviews case definitions and clinical diagnostic criteria of early childhood caries (ECC) and severe ECC (S‐ECC) in children aged 1 to 5 years old. The acronym S‐ECC as used in this paper refers to nursing caries, baby bottle tooth decay, rampant caries, labial caries, maxillary anterior caries, and other terms used to refer to severe dental caries in preschool children. Methods: A search was carried out for articles published in peer‐reviewed journals and indexed in MEDLINE using the following terms: nursing caries, baby bottle tooth decay, early childhood caries, rampant caries in preschool children, labial caries, maxillary anterior caries, and nursing bottle caries. MEDLINE's MeSH terms “dental caries” and “deciduous teeth” were used to search for other relevant studies. Reports were selected if they included children 1 to 5 years of age and described diagnostic criteria or case definitions of S‐ECC. Three previous reviews were searched for other relevant reports. One unpublished report was included in this review and data from NHANES III were analyzed to provide information on caries patterns in preschool children in the United States. The first author read all the abstracts from the MEDLINE search and tagged relevant reports for photocopying. He also abstracted all the information from the reports. The first author calibrated the second author, who independently read all included and excluded reports. Disagreements were resolved by consensus. Results: Out of 126 studies, 32 were excluded and 94 (93 published and 1 unpublished) were included in this review. Eighty‐one of the 94 published studies were cross‐sectional surveys or clinical studies, 7 were case‐control clinical studies, 2 studies were controlled clinical trials, and 4 were cohort or field trials. About two‐thirds of the included studies did not report on calibration of examiners. Information on reliability of examiners was reported by 19 of the 94 studies. The included studies varied widely in the name used to identify S‐ECC, case definitions, and diagnostic criteria. “Cavitation” was the most common criterion used to define dental caries. Several studies measured early or noncavitated carious lesions. Twenty‐seven studies used the presence of 1 dmf maxillary incisor to classify a child with S‐ECC. Another 23 and 9 studies defined S‐ECC by the presence of 2+ or 3+ dmf maxillary incisors, respectively. Dental caries in preschool children clusters 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‐ECC. Dental caries in the maxillary incisors is one of several patterns of dental caries that may occur in primary teeth of preschool children. A consensus is needed on case definitions and diagnostic criteria that can assist researchers to test preventive interventions and study the etiology and epidemiology of ECC.