Parent’s Guide to Preventing Early Childhood Caries (ECC) with ADA & AAPD Recommendations

Early Childhood Caries (ECC) remains one of the most common chronic childhood diseases in the United States, Canada, the United Kingdom, and Australia.

📌 Recommended Article :

Dental Article 🔽 Fluoride in Pediatric Dentistry: Dosage, Frequency, and Current Controversies ... Key aspects include topical vs. systemic fluoride, caries-preventive effectiveness, and a special update on recent FDA considerations (2025) related to systemic fluoride supplements.

This guide presents prevention strategies supported by the ADA and AAPD, offering parents actionable, evidence-based advice to protect their child’s oral health from infancy through early development.

Advertisement

✅ Introduction
Early Childhood Caries (ECC) is defined as the presence of one or more decayed, missing, or filled tooth surfaces in a child under six years of age. According to the American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA), ECC disproportionately affects children from low-income households and remains a major public health concern in English-speaking countries.
The purpose of this guide is to provide updated, parent-friendly, evidence-based prevention strategies aligned with ADA and AAPD standards.

📌 Recommended Article :

Dental Article 🔽 Latest FDA Guidelines (2025) on Fluoride Use in Children: What Dentists Need to Know ... This article analyzes the 2025 FDA updates on fluoride use in children, focusing on systemic (ingestible) restrictions, safety concerns, and clinical implications.

1. Understanding ECC Risk Factors
▪️ Frequent consumption of sugary drinks, including juice and flavored milk
▪️ Bedtime bottles with anything other than water
▪️ Poor oral hygiene habits
▪️ Low fluoride exposure
▪️ Transmission of cariogenic bacteria from caregivers
▪️ Socioeconomic barriers to dental care

Parents play a critical role in reducing ECC risk early through consistent hygiene, fluoride use, and dietary habits.

📌 Recommended Article :

Dental Article 🔽 Rampant Caries vs Early Childhood Caries (ECC): Clinical and Preventive Insights ... Among its severe forms, ECC and rampant caries demand special attention due to their rapid progression and systemic implications.

2. ADA- & AAPD-Approved Prevention Strategies

A. Establishing the Dental Home by Age 1
The ADA and AAPD recommend scheduling the first dental visit by age 12 months. Early evaluation allows risk assessment, anticipatory guidance, and professional fluoride application.

B. Daily Fluoride Toothpaste Use
Using a smear (rice-sized) amount for children under 3 and a pea-sized amount for children 3–6 is strongly supported by both ADA and AAPD. Fluoride toothpaste is considered safe, effective, and essential for cavity prevention.

C. Evidence-Based Nutrition Recommendations
Parents should:
▪️ Limit juice to ≤4 oz/day for toddlers
▪️ Avoid sticky snacks and frequent grazing
▪️ Offer water between meals instead of sugary drinks
▪️ Prioritize fresh fruits, vegetables, lean proteins, and whole grains

D. Professional Fluoride Varnish
The AAPD and U.S. Preventive Services Task Force (USPSTF) recommend professional fluoride varnish every 3–6 months for children at risk of ECC.

E. Avoiding High-Risk Behaviors
▪️ No bottle-feeding in bed
▪️ No sharing utensils with infants
▪️ Discouraging prolonged breastfeeding on demand at night after tooth eruption

📌 Recommended Article :

Dental Article 🔽 Preventing Dental Emergencies in Primary Dentition: Caries, Abscesses and Early Intervention ... This article examines preventive strategies to reduce dental emergencies in primary dentition, focusing on early childhood caries, dental abscesses, and the role of early intervention in maintaining oral health.

3. Early Warning Signs Parents Should Monitor
Parents should promptly seek care if they notice:

▪️ White spot lesions along the gumline
▪️ Brown discolorations
▪️ Sensitivity or discomfort during eating
▪️ Visible holes or fractures
▪️ Swelling or abscess formation

Early detection prevents progression and reduces invasive treatments.

📊 Comparative Table: Preventive Fluoride Options for Children

Aspect	Advantages	Limitations
Fluoride Toothpaste	Widely available, inexpensive, ADA-approved	Requires parental supervision to avoid swallowing
Fluoride Varnish	Highly effective, applied professionally, safe for infants	Needs regular dental visits; temporary taste/texture dislike

💬 Discussion
ECC prevention requires a multifactorial approach, integrating oral hygiene, fluoride exposure, dietary regulation, and early professional care. Research consistently shows that fluoride toothpaste and varnish significantly reduce caries risk when used correctly.
Because ECC is influenced by behaviors and environment, parents must receive clear, practical guidance, especially regarding high-risk dietary habits and nighttime feeding. Support from public health programs and early establishment of the dental home are essential for long-term success.

📌 Recommended Article :

Dental Article 🔽 Chemical Caries Removal: Drill-Free Technique, Materials, and Clinical Application ... Chemical caries removal is a minimally invasive technique that allows for the selective elimination of decayed dentin without the use of a dental drill.

✍️ Conclusion
Early Childhood Caries is largely preventable when families follow ADA- and AAPD-endorsed strategies, including early dental visits, fluoride use, healthy nutrition, and consistent oral hygiene. Empowering parents with accurate and evidence-based information is key to reducing ECC prevalence and promoting healthier childhood development across English-speaking communities.

🔎 Recommendations
▪️ Schedule the first dental visit by age 1
▪️ Brush twice daily using fluoride toothpaste according to age
▪️ Avoid sugary drinks and snacks between meals
▪️ Do not put the child to bed with a bottle
▪️ Request fluoride varnish applications every 3–6 months
▪️ Replace toothbrushes every 3 months or after illness
▪️ Monitor for early signs of white spot lesions
▪️ Maintain regular dental check-ups through childhood

📚 References

✔ American Academy of Pediatric Dentistry. (2023). Guideline on caries-risk assessment and management for infants, children, and adolescents. AAPD. https://www.aapd.org/
✔ American Dental Association. (2022). Fluoride toothpaste use for young children. ADA. https://www.ada.org/
✔ Centers for Disease Control and Prevention. (2022). Children’s oral health. CDC. https://www.cdc.gov/oralhealth/
✔ Tinanoff, N., Reisine, S., & Lee, J. (2022). Update on early childhood caries. Pediatric Dentistry, 44(5), 341–349.
✔ U.S. Preventive Services Task Force. (2021). Prevention of dental caries in children younger than 5 years: Screening and interventions. JAMA, 326(21), 2172–2179.

📌 More Recommended Items

► How Is Early Childhood Caries Managed in Canada? Evidence-Based Pediatric Approaches
► Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide
► Fluoride Varnish in Pediatric Dentistry: Benefits, Indications, Mechanism, and Application Protocol

Updated Management of Early Childhood Caries: Modern Restorative Materials and Techniques

Early Childhood Caries (ECC) remains one of the most prevalent chronic diseases in children under six years old. Advances in minimally invasive dentistry, bioactive restorative materials, and preventive approaches have transformed the management of this condition.

📌 Recommended Article :

Video 🔽 Use of Silver Diamine Fluoride (SDF) - General Guide on its application ... Silver diamine fluoride (SDF) is a topical medicine that is used to stop the advance of caries and in cases of dentin hypersensitivity. It can be used in both primary and permanent dentition.

This review provides an updated overview of current diagnostic concepts, restorative materials, and modern clinical techniques for ECC management.

Advertisement

✅ Introduction
Early Childhood Caries (ECC) is defined by the American Academy of Pediatric Dentistry (AAPD, 2023) as the presence of one or more decayed, missing, or filled tooth surfaces in any primary tooth of a child under six years of age.
It results from the interaction between cariogenic bacteria (mainly Streptococcus mutans), fermentable carbohydrates, and susceptible tooth surfaces.
ECC has significant implications for the child’s overall health, nutrition, and quality of life. Therefore, modern management emphasizes early detection, risk assessment, and non-invasive or minimally invasive therapies whenever possible.

📌 Recommended Article :

Dental Article 🔽 Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide ... This article explores its characteristics, advantages, disadvantages, clinical applications, and a step-by-step guide for proper use.

1. Definition and Etiology
ECC is a multifactorial disease involving biofilm dysbiosis and frequent sugar exposure. Salivary flow, oral hygiene habits, and socioeconomic factors contribute to disease development.
Modern caries management focuses on biofilm control, fluoride exposure, and remineralization of incipient lesions, instead of purely mechanical removal of decay.

2. Restorative Materials for Early Childhood Caries
Recent advances have introduced bioactive and fluoride-releasing restorative materials that promote remineralization and reduce recurrent caries.

Some of the most commonly used materials include:
▪️ Glass Ionomer Cements (GICs): chemical adhesion, fluoride release, and biocompatibility.
▪️ Resin-Modified Glass Ionomer (RMGI): improved strength and aesthetics.
▪️ Bioactive composites: release calcium, phosphate, and fluoride ions for enamel repair.
▪️ Silver Diamine Fluoride (SDF): effective in arresting caries non-invasively.

These materials align with minimally invasive dentistry (MID) and the Atraumatic Restorative Treatment (ART) philosophy.

📌 Recommended Article :

Dental Article🔽 SMART Technique in Pediatric Dentistry: Caries Management in Children ... It combines the application of 38% silver diamine fluoride (SDF) with atraumatic restorative treatment (ART), offering effective caries control in children without the need for anesthesia or extensive drilling.

3. Modern Techniques for ECC Management
Modern techniques emphasize preservation of sound tooth structure and control of infection rather than aggressive cavity preparation.

Key clinical strategies include:
▪️ Selective caries removal: partial removal of infected dentin to prevent pulp exposure.
▪️ Hall Technique: sealing carious lesions under preformed stainless-steel crowns without caries removal.
▪️ Silver Diamine Fluoride (SDF): applied for arresting active lesions in uncooperative or medically compromised children.
▪️ Resin infiltration: for non-cavitated proximal lesions.
▪️ Fluoride varnish and sealants: essential for preventive care and remineralization support.

📌 Recommended Article :

Dental Article 🔽 Chemical Caries Removal: Drill-Free Technique, Materials, and Clinical Application ... Chemical caries removal is a minimally invasive technique that allows for the selective elimination of decayed dentin without the use of a dental drill.

4. Current Understanding of the Caries Process
Below is an updated summary of the caries formation process, integrating the latest microbiological and pathophysiological concepts relevant to pediatric dentistry.

📊 Comparative Table: Modern Understanding of Dental Caries Formation

Stage	Key Biological Process	Clinical Implications
Initial Stage (Biofilm Dysbiosis)	Shift from symbiotic to cariogenic biofilm due to frequent sugar intake and reduced pH	Encourage dietary modification and plaque control
Demineralization	Acidic by-products from bacterial metabolism dissolve enamel hydroxyapatite	Apply fluoride or bioactive agents to promote remineralization
Progression into Dentin	Demineralization extends into dentin, involving collagen breakdown and bacterial invasion	Implement minimally invasive restorative intervention
Cavitated Lesion Formation	Loss of tooth structure with bacterial colonization and infection risk	Use restorative materials with fluoride release and antibacterial properties
Arrest or Reversal	Remineralization via saliva, fluoride, calcium, and phosphate deposition	Preventive programs to maintain oral pH and enhance remineralization

💬 Discussion
The management of ECC has evolved from a purely surgical approach to a biological and preventive model. Recent studies (e.g., Gao et al., 2023; Pitts et al., 2022) support the use of bioactive materials and non-invasive methods that arrest lesions while preserving pulp vitality.
Fluoride, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and SDF have shown excellent outcomes for controlling initial lesions without the need for local anesthesia or rotary instrumentation.
Early diagnosis, combined with parental education and behavioral interventions, is key to reducing ECC incidence and recurrence.

📌 Recommended Article :

Dental Article 🔽 Webinar: Oral Health in the Perinatal and Early Childhood Periods ... Oral health during the perinatal and early childhood periods is essential for lifelong well-being, as this stage sets the foundation for healthy growth and development.

✍️ Conclusion
Early Childhood Caries remains preventable and manageable when detected promptly and treated using evidence-based, minimally invasive strategies. Pediatric dentists must integrate modern restorative materials, non-invasive techniques, and family education into daily practice to achieve long-term success.
Adopting a biofilm-centered philosophy rather than lesion-based intervention ensures sustainable oral health outcomes.

🔎 Recommendations
▪️ Perform caries risk assessment in all children under six years old.
▪️ Use fluoride varnish, SDF, or resin infiltration for early lesions.
▪️ Choose bioactive and fluoride-releasing materials for restorations.
▪️ Educate parents on dietary habits and daily oral hygiene.
▪️ Promote routine follow-ups to monitor lesion arrest or progression.

📚 References

✔ American Academy of Pediatric Dentistry (AAPD). (2023). Policy on Early Childhood Caries (ECC): Classification, Consequences, and Preventive Strategies. Retrieved from https://www.aapd.org
✔ Gao, S. S., Zhang, S., & Lo, E. C. M. (2023). Non-invasive management of dental caries in children: Current evidence and future perspectives. Frontiers in Oral Health, 4, 112–124. https://doi.org/10.3389/froh.2023.104589
✔ Pitts, N. B., Ekstrand, K. R., & Ismail, A. I. (2022). Modern caries management: Moving beyond the operative approach. Caries Research, 56(1), 1–10. https://doi.org/10.1159/000520895

📌 More Recommended Items

► Early Childhood Caries: Current Concepts and Innovative Treatment Approaches
► Severe early childhood caries: an integral approach
► Atraumatic Restorative Treatment - Indications, Advantages and Disadvantages

Early Childhood Caries: Current Concepts and Innovative Treatment Approaches

✅ Abstract
Early Childhood Caries (ECC) remains one of the most prevalent and challenging oral diseases in children under six years of age. Once referred to as Baby Bottle Tooth Decay (BBTD), ECC is now recognized as a multifactorial, biofilm-mediated disease influenced by biological, behavioral, and environmental factors.

📌 Recommended Article :

Dental Article 🔽 Chemical Caries Removal: Drill-Free Technique, Materials, and Clinical Application ... Chemical caries removal is a minimally invasive technique that allows for the selective elimination of decayed dentin without the use of a dental drill.

Despite preventive efforts, ECC continues to affect global pediatric populations. This review explores the etiology, pathogenesis, diagnosis, prevention, and modern evidence-based treatments, emphasizing emerging approaches such as silver diamine fluoride, bioactive restorative materials, and minimally invasive dentistry.

Advertisement


✅ Introduction
Historically, Baby Bottle Tooth Decay referred to a specific pattern of dental caries in infants associated with prolonged bottle feeding, especially with sweetened liquids during sleep. However, research in recent decades has shown that this terminology is limited, as caries in young children arise from multiple risk factors, not just feeding habits.
To address this, the American Academy of Pediatric Dentistry (AAPD) introduced the term Early Childhood Caries (ECC) — defined as the presence of one or more decayed, missing, or filled tooth surfaces in any primary tooth of a child under six years old (AAPD, 2023). This broader perspective allows for a comprehensive, preventive, and biological approach to pediatric oral health.

📌 Recommended Article :

Dental Article 🔽 SMART Technique in Pediatric Dentistry: Caries Management in Children ... The SMART technique (Silver Modified Atraumatic Restorative Technique) is a minimally invasive and innovative approach in pediatric dentistry.

✅ Etiology and Pathogenesis
ECC is a biofilm-mediated, sugar-driven, dynamic disease resulting from an imbalance between demineralization and remineralization. The key etiologic components include:

▪️ Cariogenic bacteria (Streptococcus mutans, Lactobacillus spp.)
▪️ Frequent exposure to fermentable carbohydrates
▪️ Host factors, such as enamel hypoplasia or reduced saliva flow
▪️ Socio-behavioral determinants, including parental education and socioeconomic status

Recent studies (Berkowitz, 2022; Tinanoff et al., 2023) highlight that the oral microbiome composition plays a critical role, with early colonization of S. mutans strongly associated with rapid lesion development.

📌 Recommended Article :

Dental Article 🔽 Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide ... Glass ionomer cement (GIC) is a widely used dental material in pediatric dentistry due to its strong adhesion, fluoride release, and biocompatibility.

✅ Clinical Presentation
The initial lesions appear as chalky white spots on the smooth surfaces of the maxillary incisors, followed by brown discoloration and cavitation. In advanced cases, caries may involve multiple teeth, leading to:

▪️ Pain and infection
▪️ Difficulty eating or sleeping
▪️ Premature tooth loss and potential malocclusion

Lower incisors are often spared due to protection from the tongue and saliva, a key clinical distinction in diagnosis.

📌 Recommended Article :

PDF 🔽 Step-by-step Procedure Manual on Atraumatic Restorative Treatment ... Atraumatic restorative treatment is a procedure that removes carious tissue from teeth using only hand instruments. This procedure is performed when patients live in areas where basic services are lacking.

✅ Diagnosis
Diagnosis should combine visual-tactile inspection with caries detection technologies such as:

▪️ ICDAS II system for lesion classification
▪️ Laser fluorescence (DIAGNOdent) for early detection
▪️ Bitewing radiographs to assess interproximal involvement

Risk assessment tools such as the AAPD Caries Risk Assessment Tool (CAT) and CAMBRA for children help clinicians develop individualized preventive plans.

📌 Recommended Article :

Dental Article 🔽 How Is Early Childhood Caries Managed in Canada? Evidence-Based Pediatric Approaches ... Early Childhood Caries (ECC) remains one of the most prevalent chronic diseases among Canadian children, particularly in underserved and Indigenous populations.

✅ Modern Preventive Strategies

1. Parental Education and Behavior Modification
Educating caregivers remains essential. Key measures include:
▪️ Avoiding night-time bottle feeding with anything other than water.
▪️ Initiating toothbrushing with fluoride toothpaste (1000 ppm) when the first tooth erupts.
▪️ Weaning from the bottle by 12–14 months.
▪️ Reinforcing fluoride exposure through toothpaste, varnishes, and community programs.

2. Fluoride-Based Approaches
Recent studies confirm the efficacy of 5% sodium fluoride varnish for preventing ECC and remineralizing white spot lesions (Marinho et al., 2021). In cases of active caries, Silver Diamine Fluoride (SDF 38%) has emerged as a non-invasive alternative capable of arresting lesions with minimal discomfort — a valuable tool for uncooperative or medically compromised children.

3. Probiotic and Microbiome Modulation
New evidence suggests that oral probiotics containing Lactobacillus rhamnosus GG and Bifidobacterium lactis may reduce S. mutans levels and modulate the oral microbiome, although results remain preliminary (Aparna et al., 2023).

📌 Recommended Article :

Webinar 🔽 Webinar: Oral Health in the Perinatal and Early Childhood Periods ...Oral health during the perinatal and early childhood periods is essential for lifelong well-being, as this stage sets the foundation for healthy growth and development.

✅ Modern Treatment Modalities

1. Minimally Invasive Dentistry (MID)
The focus has shifted toward preserving healthy tooth structure.
▪️ Atraumatic Restorative Treatment (ART): Uses high-viscosity glass ionomer cements (GICs) that release fluoride and bond chemically to enamel.
▪️ Resin infiltration (Icon system): Effective for non-cavitated lesions to halt progression.

2. Bioactive Restorative Materials
Innovations such as bioactive glass ionomer and calcium silicate-based materials (ACTIVA BioACTIVE, Cention N) provide ion release, enhancing remineralization and promoting enamel repair (Santanoni et al., 2023).

3. Hall Technique
The Hall technique, which seals carious lesions under preformed stainless steel crowns without caries removal, has shown high success rates (Innes et al., 2022) and reduces the need for local anesthesia.

4. Pulp Therapy Advances
In cases of pulpal involvement, bioceramic materials like Mineral Trioxide Aggregate (MTA) and Biodentine offer superior sealing ability, biocompatibility, and dentin bridge formation compared to traditional calcium hydroxide (Stringhini et al., 2023).

5. Behavior Management and Sedation
For extensive cases or young uncooperative patients, conscious sedation (nitrous oxide) or general anesthesia may be required, ensuring complete oral rehabilitation and prevention of future disease progression.

📌 Recommended Article :

Webinar 🔽 Webinar: Minimally Invasive Dentistry - Dra. Aisha Mohamed ... In pediatric dentistry, minimally invasive approaches emphasize a preventive philosophy supported by early risk assessment and tailored care.

💬 Discussion
The paradigm shift from Baby Bottle Tooth Decay to Early Childhood Caries represents more than a change in terminology — it reflects a modern understanding of caries as a chronic, multifactorial disease.
Recent evidence supports the integration of bioactive, fluoride-releasing restorative systems and non-invasive techniques such as SDF and ART. Moreover, addressing behavioral and microbiological factors remains key to long-term control.
Public health programs incorporating fluoride varnish applications, caregiver counseling, and community-level interventions have demonstrated measurable reductions in ECC incidence, especially in low-income populations (WHO, 2022).

✍️ Conclusion
Early Childhood Caries remains a major public health concern despite being largely preventable. Modern approaches emphasize early detection, biofilm control, fluoride use, and minimally invasive management. Pediatric dentists should integrate behavioral guidance, restorative innovation, and interprofessional collaboration to ensure comprehensive care.
The evolution from “Baby Bottle Tooth Decay” to “Early Childhood Caries” reflects the profession’s ongoing commitment to evidence-based, preventive, and patient-centered dentistry.

📌 Recommended Article :

Video 🔽 Use of Silver Diamine Fluoride (SDF) - General Guide on its application ... Silver diamine fluoride (SDF) is a topical medicine that is used to stop the advance of caries and in cases of dentin hypersensitivity. It can be used in both primary and permanent dentition.

🔎 Recommendations
▪️ Apply fluoride varnish and SDF as primary preventive and arresting agents.
▪️ Incorporate bioactive and minimally invasive materials in pediatric restorative care.
▪️ Conduct microbiome-based risk assessment for early intervention.
▪️ Strengthen parental education programs on feeding and hygiene habits.
▪️ Promote community fluoride and probiotic initiatives where applicable.

📚 References

✔ American Academy of Pediatric Dentistry (AAPD). (2023). Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. Retrieved from https://www.aapd.org
✔ Aparna, R., et al. (2023). Probiotic modulation of Streptococcus mutans in children with early childhood caries: A randomized clinical trial. Pediatric Dentistry, 45(2), 89–97.
✔ Berkowitz, R. J. (2022). Causes, treatment and prevention of early childhood caries: A microbiologic perspective. Journal of the Canadian Dental Association, 88(2), 12–20.
✔ Innes, N. P. T., et al. (2022). Hall technique crowns for primary molars: Evidence update and clinical outcomes. International Journal of Paediatric Dentistry, 32(4), 544–553.
✔ Marinho, V. C. C., et al. (2021). Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews, (12), CD002279.
✔ Santanoni, C., et al. (2023). Bioactive restorative materials and their role in pediatric caries management. Clinical Oral Investigations, 27(5), 2653–2665.
✔ Stringhini, P. H. M., et al. (2023). Clinical performance of bioceramic materials in pulpotomy of primary molars: A systematic review and meta-analysis. Journal of Dentistry, 132, 104531.
✔ Tinanoff, N., Reisine, S., & Milgrom, P. (2023). Early Childhood Caries: Prevention, Diagnosis, and Management—Updated Review. Pediatric Dentistry, 45(1), 13–25.
✔ World Health Organization (WHO). (2022). Oral Health Fact Sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/oral-health

📌 More Recommended Items

► Severe early childhood caries: an integral approach
► Atraumatic Restorative Treatment (ART) for dental caries : Step by step
► Enamel Hypoplasia vs Dental Fluorosis: Key Differences, Diagnosis, and Treatment

How Is Early Childhood Caries Managed in Canada? Evidence-Based Pediatric Approaches

✅ Summary
Early Childhood Caries (ECC) remains one of the most prevalent chronic diseases among Canadian children, particularly in underserved and Indigenous populations. Canada’s approach stands out for its early prevention, community-based programs, and integration of social determinants of health. This article reviews current strategies, clinical protocols, and public health initiatives designed to manage ECC in Canada.

📌 Recommended Article :

Video 🔽 Use of Silver Diamine Fluoride (SDF) - General Guide on its application ... Silver diamine fluoride (SDF) is a topical medicine that is used to stop the advance of caries and in cases of dentin hypersensitivity. It can be used in both primary and permanent dentition.

✅ Introduction
Early Childhood Caries (ECC) is defined as the presence of one or more decayed, missing, or filled tooth surfaces in any primary tooth in children under six years of age. In Canada, ECC represents a major public health challenge, contributing to pain, infection, and reduced quality of life.

Advertisement


Unlike purely clinical approaches, Canadian strategies combine evidence-based dentistry with social, cultural, and preventive frameworks, aligning with the goals of the Canadian Dental Association (CDA) and Health Canada.

✅ Etiology and Risk Factors
ECC in Canada is strongly associated with:

▪️ Early exposure to sugary liquids or prolonged bottle feeding.
▪️ Lack of access to fluoridated water in rural or northern communities.
▪️ Socioeconomic disparities and limited parental education.
▪️ Cultural and geographic barriers among Indigenous populations (CPS, 2022).

📌 Recommended Article :

Dental Article 🔽 Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide ... Glass ionomer cement (GIC) is a widely used dental material in pediatric dentistry due to its strong adhesion, fluoride release, and biocompatibility.

✅ Preventive Strategies
Canadian dental policies emphasize prevention over intervention:

▪️ Early dental visits: CDA recommends the first dental check-up within six months after the eruption of the first tooth or by 12 months of age.
▪️ Fluoride varnish programs are applied regularly in community and school settings.
▪️ Oral health education for parents and caregivers focuses on nutrition, bottle use, and daily hygiene.
▪️ Integration with other health professionals (nurses, pediatricians) to identify risk factors early.

✅ Clinical Management
When ECC develops, Canadian pediatric dentists follow a minimally invasive, evidence-based approach:

▪️ Interim Therapeutic Restorations (ITR) and stainless steel crowns for extensive lesions.
▪️ Silver Diamine Fluoride (SDF) use to arrest caries progression in young or uncooperative children.
▪️ General anesthesia for severe or multiple lesions, commonly used in hospital-based dental care, especially for northern or Indigenous communities.
▪️ Post-operative preventive reinforcement to reduce recurrence rates (Amin et al., 2016).

📌 Recommended Article :

Dental Article 🔽 Chemical Caries Removal: Drill-Free Technique, Materials, and Clinical Application ... Chemical caries removal is a minimally invasive technique that allows for the selective elimination of decayed dentin without the use of a dental drill.

✅ Community and Public Health Programs

▪️ The Canadian Dental Care Plan (CDCP) includes coverage for preventive pediatric care for families without insurance.
▪️ Indigenous-specific oral health initiatives, like Children’s Oral Health Initiative (COHI), deliver culturally adapted preventive care.
▪️ Collaboration between provincial health authorities and dental schools for outreach and public health campaigns.

📌 Recommended Article :

Dental Article 🔽 Top Benefits of Chemical Caries Removal in Children and Patients with Dental Anxiety ... Modern dentistry increasingly embraces minimally invasive approaches that prioritize preserving healthy tooth structure and enhancing the patient experience.

💬 Discussion
The Canadian model of ECC management is noteworthy for its holistic vision. Unlike systems that focus solely on treatment, Canada integrates social determinants, early intervention, and public health education. However, challenges persist:

▪️ Geographic inequity: northern and Indigenous communities still face limited access to care.
▪️ High costs and hospital dependency for severe ECC under general anesthesia.
▪️ Need for national data standardization to evaluate outcomes and long-term program success.

Despite these limitations, Canada’s multi-level approach has become an international reference in pediatric oral health promotion and equity.

📌 Recommended Article :

Dental Article 🔽 SMART Technique in Pediatric Dentistry: Caries Management in Children ... The SMART technique (Silver Modified Atraumatic Restorative Technique) is a minimally invasive and innovative approach in pediatric dentistry.

✍️ Conclusion
Canada’s strategy to manage Early Childhood Caries demonstrates the power of evidence-based, preventive, and community-oriented dentistry. By combining early detection, fluoride-based prevention, education, and social equity, Canada offers a replicable model for other countries facing similar pediatric dental health challenges.

📊 Comparative Table: Distinctive Aspects of Early Childhood Caries Management in Canada

Aspect	Advantages	Limitations
Dental Home Model	Ensures continuous, family-centered care from infancy, improving prevention and trust.	Requires early parental engagement and system coordination; limited access in remote areas.
Personalized Caries Risk Assessment (CRA)	Allows individualized prevention plans and targeted fluoride application.	Time-consuming for practitioners; variable implementation consistency.
Silver Diamine Fluoride (SDF) Protocols	Non-invasive, cost-effective option for arresting caries in high-risk or uncooperative children.	Causes permanent dark staining; parental acceptance may be low.
Integration with Public Health Programs	School-based fluoride varnish and sealant initiatives increase reach in underserved populations.	Dependent on government funding and local health authority priorities.
Interdisciplinary Collaboration	Involves pediatricians, nurses, and educators in early detection and referral.	Requires training alignment and communication across health disciplines.

🔎 Recommendations

1. Expand national fluoride varnish programs to all provinces.
2. Increase parental education and engagement through digital platforms.
3. Strengthen interprofessional collaboration between dentists and pediatric healthcare providers.
4. Implement mobile dental clinics for rural and Indigenous areas.
5. Ensure standardized monitoring and evaluation of ECC prevention outcomes.

📚 References

✔ Amin, M., Elyasi, M., & Schroth, R. J. (2016). Early Childhood Caries: A Review of Etiology, Clinical, and Public Health Perspectives. Frontiers in Public Health, 4(204). https://doi.org/10.3389/fpubh.2016.00204
✔ Canadian Dental Association (CDA). (2023). Position Statement on Early Childhood Caries (ECC). Retrieved from https://www.cda-adc.ca/_files/position_statements/earlyChildhoodCaries.pdf
✔ Canadian Paediatric Society (CPS). (2022). Early Childhood Caries in Canada: Position Statement. Retrieved from https://cps.ca/documents/position/early-childhood-caries
✔ Health Canada. (2024). Children’s Oral Health Initiative (COHI) Annual Report. Government of Canada. https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/reports-publications.html
✔ Tinanoff, N., & Reisine, S. (2021). Update on Early Childhood Caries. Journal of the Canadian Dental Association, 87(g20). https://jcda.ca/g20

📌 More Recommended Items

► Webinar: Minimally Invasive Dentistry - Dra. Aisha Mohamed
► Fluoride Recommendations for Children in the US: What Parents Should Know
► Fluoride Varnish for Preventing and Treating White Spot Lesions: Clinical Evidence and Best Practices

Webinar: Vital Pulp Therapy: A Conservative Alternative in the Treatment of Deep Carious Lesions

The webinar “Vital Pulp Therapy: A Conservative Alternative in the Treatment of Deep Carious Lesions” highlights the importance of preserving pulp vitality in young permanent teeth.

📌 Recommended Article :

Dental Article 🔽 Medications for Pulp Capping in Primary Teeth: Indications, Composition, and Clinical Management ... Pulp capping in primary teeth is a conservative procedure aimed at preserving pulp vitality following an accidental or intentional pulp exposure during caries removal.

It reviews current evidence on pulpotomy indications, direct and indirect pulp capping, and other biologically driven strategies that aim to maintain pulp function when lesions are in close proximity to the pulp chamber.

Advertisement

Emphasis is placed on case selection, material choice, and clinical protocols that reduce the need for more invasive procedures, while ensuring long-term success and continued root development.

📌 Recommended Article :

Video 🔽 Pulpotomy and pulpectomy procedures. Indications and Differences ... Pulpectomy is recommended when it is necessary to completely remove the affected dental pulp, and pulpotomy partially removes the dental pulp.

This session provides clinicians with practical, evidence-based approaches to managing deep caries conservatively, promoting both tooth preservation and patient-centered outcomes.

📌 Watch webinar: "Vital Pulp Therapy: A Conservative Alternative in the Treatment of Deep Carious Lesions"

Youtube/ Dentistree Academy

📌 More Recommended Article

► Webinar: Clinically applicable Pulpotomy for the Primary Tooth - Dr. Joby Peter
► Pulp Polyps in Children: Causes, Diagnosis, and Treatment Options in Pediatric Dentistry
► Clinical Pulpectomy Protocol: Updated Step-by-Step Guide

Webinar: Oral Health in the Perinatal and Early Childhood Periods

Oral health during the perinatal and early childhood periods is essential for lifelong well-being, as this stage sets the foundation for healthy growth and development.

📌 Recommended Article :

Video 🔽 What are the causes of white spots on teeth? ... It can occur in both primary and permanent dentition, and a professional evaluation is necessary to determine what is the cause of the white spots and perform an appropriate treatment.

This webinar addresses the most relevant oral diseases affecting infants and young children, with a focus on understanding the causes and risk factors of dental caries, including early childhood caries (ECC), which remains a global public health concern.

Advertisement

Attention is also given to conditions such as tongue-tie, its impact on feeding and speech, and the importance of timely diagnosis and management.

📌 Recommended Article :

PDF 🔽 Fluoride Varnish in the Prevention of Dental Caries in Children and Adolescents: A Systematic Review ... Fluoride varnish is easy to apply, offers greater absorption of minerals on the teeth, and is very safe, unlike other topical fluoride treatments (gels and rinses).

Through a combination of prevention, education, and evidence-based treatment, pediatric dentists and healthcare providers can work together to reduce disease burden, empower families, and promote sustainable oral health habits from the very beginning of life.

📌 Watch webinar: "Webinar: Oral Health in the Perinatal and Early Childhood Periods"

Youtube/ labestbabies

📌 More Recommended Article

► How to Apply: Clinpro Sealant - Step by step
► Webinar: Silver Diamine Fluoride – A Silver Renaissance in Dentistry - Dr. Anas Al Salami
► ORAL HYGIENE : How to care for your baby's gums

Webinar: The SMART pediatric dentistry: Minimally Invasive Restorative Techniques - Dra. Jeanette MacLean

Minimally invasive restorative techniques, particularly the use of glass ionomer cement (GIC) and the atraumatic restorative treatment (ART) protocol, represent a paradigm shift in how pediatric dentistry addresses caries management.

📌 Recommended Article :

Dental Article 🔽 Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide ... This article explores its characteristics, advantages, disadvantages, clinical applications, and a step-by-step guide for proper use.

By prioritizing early detection, conservative intervention, and restorations that mimic natural tooth properties, SMART dentistry creates functional and aesthetic outcomes while maintaining patient comfort.

Advertisement

Case selection and careful treatment planning are essential, ensuring that each intervention respects the principles of modern cariology and supports long-term oral health.

📌 Recommended Article :

PDF 🔽 Severe early childhood caries: an integral approach ... Treatment will depend on the extent of the injuries and requires interdisciplinary management to achieve successful rehabilitation. In these cases the cooperation of the parents is necessary.

This approach not only provides predictable clinical results but also enhances cooperation, reduces treatment anxiety, and establishes a foundation for sustainable pediatric dental care.

📌 Watch webinar: "The SMART pediatric dentistry: Minimally Invasive Restorative Techniques - Dra. Jeanette MacLean"

Youtube/ Elevate Oral Care

📌 More Recommended Article

► Use of Silver Diamine Fluoride (SDF) - General Guide on its application
► Chemical Caries Removal: Drill-Free Technique, Materials, and Clinical Application
► Webinar: Minimally Invasive Dentistry - Dra. Aisha Mohamed

SMART Technique in Pediatric Dentistry: Caries Management in Children

The SMART technique (Silver Modified Atraumatic Restorative Technique) is a minimally invasive and innovative approach in pediatric dentistry.

📌 Recommended Article :

Video 🔽 Use of Silver Diamine Fluoride (SDF) - General Guide on its application ... It offers several advantages such as its easy application, low cost, it avoids the use of dental anesthetics, and it can be applied in places that do not have dental equipment.

It combines the application of 38% silver diamine fluoride (SDF) with atraumatic restorative treatment (ART), offering effective caries control in children without the need for anesthesia or extensive drilling.

Advertisement

✅ Introduction
Dental caries remain one of the most common chronic diseases in childhood, especially in underserved populations. In this context, the SMART technique has emerged as an accessible and effective option for managing carious lesions, particularly in pediatric patients.

✅ What is the SMART technique?
The SMART technique integrates two approaches:

1. Application of 38% silver diamine fluoride (SDF): halts caries progression and provides an antimicrobial effect.
2. Atraumatic Restorative Treatment (ART): sealing the lesion with glass ionomer cement, which releases fluoride and reinforces tooth structure.

This approach does not require anesthesia or rotary instruments, making it a cost-effective and well-accepted technique in community pediatric dentistry.

📌 Recommended Article :

Dental Article 🔽 Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide ... This article explores its characteristics, advantages, disadvantages, clinical applications, and a step-by-step guide for proper use.

✅ Benefits of the SMART technique

° Effective caries arrest in primary teeth.
° Reduces pain and anxiety in pediatric patients.
° Low-cost and suitable for underserved populations.
° Preserves tooth structure and prolongs tooth survival.
° Minimally invasive and conservative.

✅ Drawbacks of the SMART technique

° Permanent black staining of carious lesions due to SDF.
° Potential parental concerns about esthetics.
° Limited effectiveness in deep caries with pulpal involvement.
° Requires regular clinical follow-up.

📌 Recommended Article :

Dental Article 🔽 Top Benefits of Chemical Caries Removal in Children and Patients with Dental Anxiety ... Modern dentistry increasingly embraces minimally invasive approaches that prioritize preserving healthy tooth structure and enhancing the patient experience.

✅ Comparative table: SMART vs. ART

Aspect	SMART	ART
Caries control	High, due to SDF antimicrobial effect	Moderate, depends on seal quality
Esthetics	Limited, black staining occurs	Better, no dark discoloration
Application	Simple, no anesthesia or drill	Simple, no anesthesia or drill
Cost	Low	Low

💬 Discussion
The SMART technique has shown high effectiveness in controlling caries in pediatric patients, especially in underserved communities with limited access to dental services. Its main limitation is esthetics due to black staining, which can cause parental concerns. However, its efficacy, affordability, and minimally invasive nature make it a valuable tool in modern pediatric dentistry.

📌 Recommended Article :

Video 🔽 Atraumatic Restorative Treatment - Indications, Advantages and Disadvantages ... This technique is very useful when it is necessary to attend to oral health needs in hard-to-reach areas. The pediatric patient also generates less anxiety and stress.

✍️ Conclusions
The SMART technique is a safe, effective, and accessible clinical option for managing caries in children. It offers significant benefits in public health dentistry, particularly in resource-limited settings, though its esthetic limitations and follow-up requirements must be considered.

📚 References

✔ Crystal, Y. O., & Niederman, R. (2019). Evidence-Based Dentistry Update on Silver Diamine Fluoride. Dental Clinics of North America, 63(1), 45–68. https://doi.org/10.1016/j.cden.2018.08.011
✔ Horst, J. A., Ellenikiotis, H., & Milgrom, P. L. (2016). UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications, and Consent. Journal of the California Dental Association, 44(1), 16–28. PMID: 26897901
✔ Seifo, N., Robertson, M., MacLean, J., Blain, K., Grosse, S., Milne, R., Seeballuck, C., & Innes, N. P. T. (2020). The use of silver diamine fluoride (SDF) in dental practice. British Dental Journal, 228, 75–81. https://doi.org/10.1038/s41415-020-1203-9

📌 More Recommended Items

► Webinar: Minimally Invasive Dentistry - Dra. Aisha Mohamed
► Chemical Caries Removal: Drill-Free Technique, Materials, and Clinical Application
► Severe early childhood caries: an integral approach

Webinar: Minimally Invasive Dentistry - Dra. Aisha Mohamed

In pediatric dentistry, minimally invasive approaches emphasize a preventive philosophy supported by early risk assessment and tailored care. Advances in diagnostics allow clinicians to identify caries lesions at their earliest stages, enabling interventions that stop or slow progression without the need for extensive drilling or removal of tooth structure.

📌 Recommended Article :

Dental Article 🔽 White Spot Lesions in Orthodontics: Causes, Prevention, and Treatment Options ... This article explores the definition, characteristics, etiology, prevention, and treatment options for WSLs based on the most recent scientific literature.

Non-invasive options such as fluoride therapies, sealants, and behaviorally guided oral hygiene strategies form the foundation of this model, while minimally invasive techniques, including selective caries removal or atraumatic restorative treatments, provide solutions when intervention is required.

Advertisement

By reducing patient anxiety, improving cooperation, and safeguarding dental development, minimally invasive dentistry not only addresses disease but also empowers families with knowledge and practices that promote long-term oral health.

📌 Recommended Article :

Dental Article 🔽 Silver Diamine Fluoride in Pediatric Dentistry: Clinical Guide 2025 ... Its topical application allows the arrest of carious lesions without the need for invasive procedures, making it especially useful in children with high caries risk, behavioral challenges, or limited access to dental care.

This patient-centered perspective ensures that treatment in pediatric dentistry is both scientifically sound and aligned with the unique needs of growing children.

📌 Watch webinar: "Minimally invasive dentistry in pediatric dentistry - Dra. Aisha Mohamed"

Youtube/ The Kenya Association of Paediatric Dentists

📌 More Recommended Webinars

► Webinar: Dental Treatment: Vital Pulp Therapy for Primary Teeth
► Space Maintainers: Benefits and Types - Webinar
► Webinar: Pediatric dentistry and home based oral care - Dr. Silvia Sabatini and Dr. Luis Karakowsky

Top Benefits of Chemical Caries Removal in Children and Patients with Dental Anxiety

Modern dentistry increasingly embraces minimally invasive approaches that prioritize preserving healthy tooth structure and enhancing the patient experience.

📌 Recommended Article :

Video🔽 Use of Silver Diamine Fluoride (SDF) - General Guide on its application ... It offers several advantages such as its easy application, low cost, it avoids the use of dental anesthetics, and it can be applied in places that do not have dental equipment

In this context, chemical caries removal (CCR) has emerged as a safe, effective alternative to traditional drilling—especially valuable in pediatric dentistry and for patients with dental anxiety or phobia. This technique allows clinicians to eliminate decayed dentin without rotary tools, reducing discomfort, fear, and the need for local anesthesia.

Advertisement

✅ What Is Chemical Caries Removal?
CCR is a conservative, non-invasive technique that uses enzymatic or oxidizing agents to soften infected dentin, allowing its manual removal without mechanical drilling. Common products include Carisolv®, Papacárie Duo®, Brix3000®, and Carie-Care™, which have proven effective in clinical studies.

✅ Why Is CCR Ideal for Children and Anxious Patients?

1. Avoids the dental drill
The sound and vibration of a dental drill often trigger anxiety in children and phobic adults. CCR eliminates the need for rotary instruments.
2. Often requires no local anesthesia
Recent studies show that chemical agents can remove caries painlessly, making injections unnecessary in many cases (Elgalaid et al., 2022).
3. Increases treatment acceptance
Minimally invasive techniques result in a more relaxed experience, improving cooperation in young children and anxious patients (Ghasempour et al., 2020).
4. Preserves healthy tooth structure
Most CCR products act selectively on infected dentin, aligning with the principles of minimally invasive dentistry.
5. Creates a calm clinical environment
Less noise and vibration help maintain a soothing atmosphere, reducing stress for both patient and provider.

📌 Recommended Article :

PDF 🔽 Molar incisor hypomineralisation: Definition, diagnosis and clinical management ... In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient

✅ Latest Scientific Evidence
Recent clinical research highlights CCR’s effectiveness and patient acceptance:

° Elgalaid et al. (2022) found that Carisolv® significantly lowered anxiety and pain perception in children compared to conventional methods.
° Ghasempour et al. (2020) reported high satisfaction rates using Brix3000® among children aged 4–7 years.
° Santos et al. (2021) confirmed the safety and effectiveness of Papacárie Duo® in patients with mild to moderate dental anxiety.

📌 Recommended Article :

PDF 🔽 Alternative for the rehabilitation of pediatric patients with early childhood caries ... We share the oral rehabilitation of a pediatric patient affected by early childhood caries, using a functional appliance aesthetically appropriate for the patient

✅ Clinical Guidelines

° Indications: Ideal for shallow to moderate dentin caries without pulpal involvement.
° Contraindications: Avoid in deep lesions near the pulp or sclerotic dentin.
° Chair time: Slightly longer than conventional drilling, but often compensated by improved cooperation.
° Restoration options: Compatible with adhesive and bioactive restorative materials.

📌 Recommended Article :

PDF 🔽 Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation ... In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient

💬 Discussion
Chemical caries removal represents a paradigm shift in managing caries in vulnerable populations. Its patient-friendly and drill-free nature allows for a less traumatic and more empathetic experience. The ability to reduce fear and discomfort during treatment makes CCR especially valuable in pediatric and behavioral dentistry. It also fosters better long-term dental relationships by building trust from an early age.

💡 Conclusion
Chemical caries removal is a powerful tool for modern dentistry, particularly when treating children and patients with dental phobia. Backed by recent evidence, its use promotes a more comfortable, conservative, and effective dental care experience. CCR should be considered a standard part of the clinical toolkit when aiming for anxiety-free dental visits.

📚 References

✔ Elgalaid, M. A., Alshoraim, M. A., Alhazmi, Y. F., & Alahmari, R. A. (2022). A randomized clinical trial comparing Carisolv and rotary instruments in caries removal: anxiety and pain perception in pediatric patients. BMC Oral Health, 22, 333. https://doi.org/10.1186/s12903-022-02458-4

✔ Ghasempour, M., Yeganeh, P., & Golkari, A. (2020). Comparison of the effectiveness of Brix3000 and conventional methods in caries removal in children. Journal of Dentistry for Children, 87(3), 151–156.

✔ Santos, A. P., Freire, M. C. M., Oliveira, B. H., & Paiva, S. M. (2021). Effectiveness of Papacárie Duo in minimally invasive treatment of dental caries in anxious children: a randomized clinical trial. Pediatric Dentistry, 43(4), 259–265.

✔ Lussi, A., & Schaffner, M. (2019). Advances in minimally invasive caries removal: Chemo-mechanical agents. In Mount, G. J. & Hume, W. R. (Eds.), Preservation and Restoration of Tooth Structure (3rd ed., pp. 97–104). Wiley-Blackwell.

📌 More Recommended Items

► Chemical Caries Removal: Drill-Free Technique, Materials, and Clinical Application
► Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide
► How well do fluoride treatments work at preventing tooth decay?

Chemical Caries Removal: Drill-Free Technique, Materials, and Clinical Application

Chemical caries removal is a minimally invasive technique that allows for the selective elimination of decayed dentin without the use of a dental drill.

📌 Recommended Article :

Video 🔽 Atraumatic Restorative Treatment - Indications, Advantages and Disadvantages ... This technique is very useful when it is necessary to attend to oral health needs in hard-to-reach areas. The pediatric patient also generates less anxiety and stress

The procedure involves softening infected dentin using a chemical agent, which is then gently removed with manual instruments. This approach reduces pain, anxiety, and the need for local anesthesia, making it ideal for pediatric, geriatric, and anxious patients.

Advertisement

✅ How Does This Technique Work?
The chemical agents dissolve denatured collagen fibers found in infected dentin, leaving healthy dentin intact. The gel is applied directly to the carious lesion, allowed to act for a few minutes, and then the softened tissue is scraped away with hand excavators.

✅ Leading Commercial Products
Here are the most widely used products for chemical caries removal:

1. Carisolv®
➤ Composition: Amino acids (lysine, leucine, glutamate), sodium hypochlorite (0.5%), and a gel carrier.
➤ Mechanism of Action: Sodium hypochlorite breaks down denatured collagen, while amino acids buffer the solution for selective tissue removal.
➤ Advantages: Tissue-selective action, reduced need for anesthesia, well-tolerated by patients.
➤ Disadvantages: Unpleasant odor, longer procedure time compared to traditional methods.

2. Papacárie Duo®
➤ Composition: Papain, chloramine, toluidine blue, and thickening agents.
➤ Mechanism of Action: Papain, an enzyme from papaya, breaks down the protein matrix in decayed dentin. Chloramine enhances the antimicrobial effect.
➤ Advantages: Biocompatible, anti-inflammatory, gentle enzymatic action.
➤ Disadvantages: Less effective in dry or deep lesions, moderately priced.

3. Brix3000®
➤ Composition: Highly purified papain (3,000 U/mg) with EBE (Encapsulated Buffered Emulsion) technology.
➤ Mechanism of Action: Targets and hydrolyzes denatured collagen with high specificity and enhanced stability.
➤ Advantages: Fast-acting, high enzymatic activity, easy-to-use syringe.
➤ Disadvantages: Higher cost, supervision recommended in extensive lesions.

4. Carie-Care™
➤ Composition: Papain, chloramine, clove oil (eugenol), and natural extracts.
➤ Mechanism of Action: Similar to Papacárie, with an added calming effect from clove oil.
➤ Advantages: Affordable, mild analgesic and antiseptic properties.
➤ Disadvantages: Variable effectiveness depending on lesion texture.

📌 Recommended Article :

PDF 🔽 Severe early childhood caries: an integral approach ... Treatment will depend on the extent of the injuries and requires interdisciplinary management to achieve successful rehabilitation. In these cases the cooperation of the parents is necessary

✅ Clinical Guidelines for Use

° Ensure relative isolation to prevent contamination.
° Apply only to infected dentin.
° Use hand excavators to remove softened tissue.
° Visually and tactilely assess the remaining dentin to avoid overexcavation.
° Rinse with saline after the procedure.

✅ Clinical Advantages

° Minimally invasive and conservative.
° Reduces or eliminates the need for dental drills and anesthesia.
° Excellent for children, elderly, and anxious patients.
° Preserves healthy tooth structure.
° Compatible with bioactive restorative approaches.

📌 Recommended Article :

Video 🔽 Use of Silver Diamine Fluoride (SDF) - General Guide on its application ... It offers several advantages such as its easy application, low cost, it avoids the use of dental anesthetics, and it can be applied in places that do not have dental equipment

✅ Potential Disadvantages

° Longer chair time compared to rotary methods.
° Higher cost for certain products.
° May be less effective on hard or sclerotic lesions.
° Requires careful visual and tactile evaluation.

💬 Discussion

Multiple studies support chemical caries removal as a conservative alternative in restorative dentistry. Enzymatic agents such as papain and oxidizers like sodium hypochlorite have demonstrated effectiveness in dissolving infected dentin without compromising healthy tissue. Despite limitations such as longer procedure times and availability, this technique aligns with modern principles of minimally invasive dentistry and is gaining wider acceptance.

📌 Recommended Article :

Dental Article 🔽 Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide ... This article explores its characteristics, advantages, disadvantages, clinical applications, and a step-by-step guide for proper use

💡 Conclusion

Chemical caries removal is a significant advancement in conservative dentistry, offering a drill-free, painless option for removing decayed tissue. While it does not fully replace mechanical methods, its integration into clinical practice provides a more comfortable and tissue-preserving approach for managing dental caries.

📚 References

✔ Abdelaziz, K. M., & Hassan, M. I. (2018). Efficacy of papain gel (Papacárie®) and Carisolv® in caries removal in primary teeth: A randomized clinical trial. Journal of Clinical Pediatric Dentistry, 42(5), 353–359. https://doi.org/10.17796/1053-4625-42.5.10

✔ Bussadori, S. K., Castro, L. C., & Galvão, A. C. (2005). Papain gel: A new chemo-mechanical caries removal agent. Journal of Clinical Pediatric Dentistry, 30(2), 115–119. https://doi.org/10.17796/jcpd.30.2.u025q822j424u5g6

✔ Koch, G., Poulsen, S., Espelid, I., & Haubek, D. (2017). Pediatric dentistry: A clinical approach (3rd ed.). Wiley Blackwell.

✔ Maragakis, G. M., Hahn, P., & Hellwig, E. (2001). Clinical evaluation of Carisolv® for removing carious dentin and effect on restorative materials and bonding. American Journal of Dentistry, 14(1), 58–60.

✔ Lussi, A., & Hellwig, E. (2019). Alternatives to drilling: Chemomechanical caries removal. In Mount, G. J., & Hume, W. R. (Eds.). Preservation and Restoration of Tooth Structure (3rd ed., pp. 95–104). Wiley-Blackwell.

📌 More Recommended Items

► Atraumatic Restorative Treatment - Step-by-step procedure manual
► Anterior dental esthetics in primary teeth - Oral Rehabilitation
► Medications for Pulp Capping in Primary Teeth: Indications, Composition, and Clinical Management

Medications for Pulp Capping in Primary Teeth: Indications, Composition, and Clinical Management

Pulp capping in primary teeth is a conservative procedure aimed at preserving pulp vitality following an accidental or intentional pulp exposure during caries removal.

📌 Recommended Article :

Video 🔽 Atraumatic Restorative Treatment - Indications, Advantages and Disadvantages ... This technique is very useful when it is necessary to attend to oral health needs in hard-to-reach areas. The pediatric patient also generates less anxiety and stress

Its success largely depends on the material or medication used, which must be biocompatible, promote tissue repair, and provide an adequate marginal seal. With advances in biomaterials, the range of available products has expanded, making it essential to understand their properties, advantages, and limitations for proper clinical application.

Advertisement

✅ Main Medications Used

1. Calcium Hydroxide (Ca(OH)₂)

➤ Composition: Pure calcium hydroxide or formulated with hardening agents (e.g., Dycal®).
➤ Indications: Small pulp exposures without prolonged bleeding, in vital primary teeth.
➤ Advantages:
° Stimulates reparative dentin formation.
° Antibacterial properties.
° Easy to handle.
➤ Disadvantages:
° Soluble in oral fluids.
° Poor sealing ability.
° Fragile under mechanical stress.
➤ Handling: Apply a thin layer over the exposure, followed by a protective material such as resin-modified glass ionomer (RMGI).

📌 Recommended Article :

Video 🔽 Dental Treatment: Pediatric Vital Pulp Therapy - Webinar ... Good biocompatible materials are currently available to help us preserve dental pulp

2. Mineral Trioxide Aggregate (MTA)

➤ Composition: Calcium, silicate, and aluminum oxides. Commercial examples: ProRoot® MTA, MTA Angelus®.
➤ Indications: Direct pulp capping in vital pulps, small pulp perforations.
➤ Advantages:
° High biocompatibility.
° Excellent sealing ability.
° Stimulates dentin bridge formation.
➤ Disadvantages:
° High cost.
° Long setting time (~2–4 hours).
° Difficult to manipulate.
➤ Handling: Mix with sterile distilled water and apply over the pulp; allow complete setting before final restoration.

📌 Recommended Article :

Video 🔽 Pulp Cap and Pulpotomy in Pediatric Trauma Cases ... We share an interesting video that shows us how to perform a pulpotomy step by step, indicating the materials and the steps that we must follow

3. Biodentine®

➤ Composition: Calcium oxide, tricalcium silicate, zirconium oxide (radiopacifier).
➤ Indications: Modern alternative to MTA for direct pulp capping.
➤ Advantages:
° Faster setting time (~12 minutes).
° Biocompatible.
° Better mechanical properties than MTA.
➤ Disadvantages:
° High cost.
° May require training for proper handling.
➤ Handling: Applied directly to the exposure with a spatula, no intermediate layer needed.

📌 Recommended Article :

PDF 🔽 Pulp Therapy Procedures Manual for Primary and Immature Permanent Teeth ... The treatment will depend on the vitality of the pulp, in case it is a vital tooth, pulp capping and pulpotomy can be performed. In non-vital teeth, pulpectomies are performed

4. Zinc Oxide Eugenol (ZOE)

➤ Composition: Zinc oxide mixed with eugenol.
➤ Indications: Indirect pulp capping only (not for direct use) due to cytotoxicity risks.
➤ Advantages:
° Sedative effect on pulp tissue.
° Easy handling.
Disadvantages:
° Cytotoxic if in direct contact with the pulp.
° Inhibits polymerization of resin composites.
➤ Handling: Used as a base in deep cavities with no pulp exposure.

📌 Recommended Article :

Video 🔽 Use of Silver Diamine Fluoride (SDF) - General Guide on its application ... It offers several advantages such as its easy application, low cost, it avoids the use of dental anesthetics, and it can be applied in places that do not have dental equipment

5. Resin-Modified Glass Ionomer (RMGI)

➤ Composition: Polyalkenoic acid, fluoroaluminosilicate glass, hydrophilic resin (HEMA).
➤ Indications: Intermediate layer over medications like Ca(OH)₂ or MTA.
➤ Advantages:
° Excellent adhesion to dentin.
° Fluoride release.
° Good mechanical resistance.
➤ Disadvantages:
° Should not be used alone in direct contact with pulp.
➤ Handling: Apply with microbrush or spatula, light-cure, and proceed with final restoration.

📌 Recommended Article :

Dental Article 🔽 Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide ... This article explores its characteristics, advantages, disadvantages, clinical applications, and a step-by-step guide for proper use

💡 Conclusion
Choosing the appropriate medication for pulp capping in primary teeth should consider factors such as exposure size, pulp vitality, the material's ability to stimulate dentinogenesis, handling properties, and cost. While calcium hydroxide remains widely used, materials like MTA and Biodentine offer significant advantages in sealing ability and biocompatibility. Using an additional protective layer, such as RMGI, improves treatment longevity and reduces microleakage risk. Continuous education in modern biomaterials is essential for achieving predictable and successful outcomes in pediatric dentistry.

📚 References

✔ Aguilar, P., & Linsuwanont, P. (2011). Vital pulp therapy in vital permanent teeth with cariously exposed pulp: A systematic review. Journal of Endodontics, 37(5), 581–587. https://doi.org/10.1016/j.joen.2010.12.004

✔ Fuks, A. B. (2008). Vital pulp therapy with new materials for primary teeth: New directions and treatment perspectives. Journal of Endodontics, 34(7 Suppl), S18–S24. https://doi.org/10.1016/j.joen.2008.02.028

✔ Murray, P. E., García-Godoy, F., & Hargreaves, K. M. (2007). Regenerative endodontics: A review of current status and a call for action. Journal of Endodontics, 33(4), 377–390. https://doi.org/10.1016/j.joen.2006.09.013

✔ Nowicka, A., Lipski, M., Parafiniuk, M., Sporniak-Tutak, K., Lichota, D., Kosierkiewicz, A., … & Buczkowska-Radlińska, J. (2013). Response of human dental pulp capped with biodentine and mineral trioxide aggregate. Journal of Endodontics, 39(6), 743–747. https://doi.org/10.1016/j.joen.2013.01.005

✔ Rodd, H. D., Waterhouse, P. J., Fuks, A. B., Fayle, S. A., & Moffat, M. A. (2006). Pulp therapy for primary molars. International Journal of Paediatric Dentistry, 16(s1), 15–23. https://doi.org/10.1111/j.1365-263X.2006.00774.x

📌 More Recommended Items

► Atraumatic Restorative Treatment - Step-by-step procedure manual
► Severe early childhood caries: an integral approach
► Pulpotomy and pulpectomy procedures. ndications and Differences