Ending childhood dental caries: WHO implementation manual

Overview

Early childhood caries (ECC) affects teeth of children aged under six years. According to the Global Burden of Disease Study in 2017, more than 530 million children globally have dental caries of the primary teeth. However, as primary teeth are exfoliated due to growth of the child, ECC has previously not been considered important.

ECC has significant influence on individuals, families and societies. The disease affects primary teeth and permanent teeth and influences general health and quality of life across the entire life course. ECC links with other frequent diseases of childhood, primarily due to risk factors shared with other noncommunicable diseases (NCDs) such as high sugar intake, and the disease relates to other health conditions such as obesity. Dental caries can lead to abscesses and cause toothache, which may compromise ability to eat and sleep and restrict life activity of children. Severe dental caries is associated with poor growth. Moreover, ECC is an economic burden to the family and society; treatment of ECC under general anaesthesia for extensive dental repair is especially costly.

The manual is based on evidence from systematic reviews and WHO recommendations, especially on nutrition, including breastfeeding, and primary care workers’ programmes.

The current manual focus on tackling ECC in its global context defines the disease and outlines known risk factors and approaches to prevention and treatment. It is intended to inform and support:

• policy-makers on actions and rationales for ECC interventions;
• chief dental officers, ministry of health focal points and public health administrators in the development and implementation of plans for ECC prevention and control, using the primary health-care approach.

The manual may also be used in training activities to help primary care teams:

• understand ECC as a public health problem;
• recognize the essential risk factors for ECC, especially lack of exclusive breastfeeding, consumption of free sugars, and inadequate exposure to fluoride in prevention of dental caries;
• identify opportunities for intervention against ECC and its causes.