Expert consensus on early childhood caries management

Abstract

Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.

References

[1] American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): unique challenges and treatment options. Pediatr. Dent. 30, 44–46, (2008).

[2] Tinanoff N. Introduction to the conference: Innovations in the prevention and management of early childhood caries. Pediatr. Dent., 2015, 37: 198-199.

[3] Dean, J. A., Avery, D. R. & McDonald, R. E. McDonald and Avery’s Dentistry for the Child and Adolescent (10th edition). 156 (Elsevier, 2016).

[4] American Dental Association. Statement on early childhood caries http://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/ (2018).

[5] Vos MB, . Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circulation, 2017, 135: e1017-e1034.

[6] El Tantawi M, . Prevalence and data availability of early childhood caries in 193 United Nations Countries, 2007–2017. Am. J. Public Health, 2018, 108: 1066-1072.

[7] Tinanoff N, . Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int. J. Paediatr. Dent., 2019, 29: 238-248.

[8] Kazeminia M, . Dental caries in primary and permanent teeth in children’s worldwide, 1995 to 2019: a systematic review and meta-analysis. Head. Face Med., 2020, 16: 1-21.

[9] Uribe SE, Innes N, Maldupa I. The global prevalence of early childhood caries: a systematic review with meta‐analysis using the WHO diagnostic criteria. Int. J. Paediatr. Dent., 2021, 31: 817-830.

[10] Phantumvanit P, . WHO global consultation on public health intervention against early childhood caries. Community Dent. Oral Epidemiol., 2018, 46: 280-287.

[11] Min Quan D, . Dental caries status and its associated factors among 3-to 5-year-old children in China: a national survey. Chin. J. Dent. Res., 2018, 21: 167-179.

[12] Markovic, D. et al. How much country economy influences ECC Profile in Serbian children—a macro-level factor analysis. Front. Public Health 7, 285 (2019).

[13] Schwendicke F, . Socioeconomic inequality and caries: a systematic review and meta-analysis. J. Dent. Res., 2015, 94: 10-18.

[14] Haworth S, . Heritability of caries scores, trajectories, and disease subtypes. J. Dent. Res., 2020, 99: 264-270.

[15] Silva, M. J. et al. Genetic and early-life environmental influences on dental caries risk: a twin study. Pediatrics 143, e20183499 (2019).

[16] Zhang S, . Dental caries status of Lisu preschool children in Yunnan Province, China: a cross-sectional study. BMC Oral Health, 2019, 19: 1-8.

[17] Cho H, Lee H, Paik D, Bae K. Association of dental caries with socioeconomic status in relation to different water fluoridation levels. Community Dent. Oral Epidemiol., 2014, 42: 536-542.

[18] Isaksson H, . Parental factors in early childhood are associated with approximal caries experience in young adults—A longitudinal study. Community Dent. Oral. Epidemiol., 2019, 47: 49-57.

[19] Iheozor‐Ejiofor, Z. et al. Water fluoridation for the prevention of dental caries. Cochrane Database Syst. Rev. 2015, CD010856 (2015).

[20] Folayan MO, . An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries. BMC Oral Health, 2021, 21: 1-7.

[21] Heimisdóttir LH, . Metabolomics insights in early childhood caries. J. Dent. Res., 2021, 100: 615-622.

[22] Lipton R, Schwedt T, Friedman B. GBD 2015 disease and injury incidence and prevalence collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016, 388: 1545-1602.

[23] Kassebaum N, . Global burden of untreated caries: a systematic review and metaregression. J. Dent. Res., 2015, 94: 650-658.

[24] Teng F, . Prediction of early childhood caries via spatial-temporal variations of oral microbiota. Cell Host Microbe, 2015, 18: 296-306.

[25] Jiang W, Jiang Y, Li C, Liang J. Investigation of supragingival plaque microbiota in different caries status of Chinese preschool children by denaturing gradient gel electrophoresis. Microb. Ecol., 2011, 61: 342-352.

[26] Chen Y, Li Y, Zou J. Intrageneric and intergeneric interactions developed by oral Streptococci: pivotal role in the pathogenesis of oral diseases. Curr. Issues Mol. Biol., 2019, 32: 377-434.

[27] Kameda M, . Sugar metabolism of Scardovia wiggsiae, a novel caries-associated bacterium. Front. Microbiol., 2020, 11: 479.

[28] Tian, J. et al. Acquisition of the arginine deiminase system benefits epiparasitic Saccharibacteria and their host bacteria in a mammalian niche environment. Proc Natl Acad Sci USA https://doi.org/10.1073/pnas.2114909119 (2022).

[29] Yang XQ, . Genotypic distribution of Candida albicans in dental biofilm of Chinese children associated with severe early childhood caries. Arch. Oral. Biol., 2012, 57: 1048-1053.

[30] Chen J, . EpsR negatively regulates Streptococcus mutans exopolysaccharide synthesis. J. Dent. Res., 2021, 100: 968-976.

[31] Gong T, . Transcriptional profiling reveals the importance of RcrR in the regulation of multiple sugar transportation and biofilm formation in Streptococcus mutans. mSystems, 2021, 6: e0078821.

[32] Li Z, Xiang Z, Zeng J, Li Y, Li J. A GntR family transcription factor in Streptococcus mutans regulates biofilm formation and expression of multiple sugar transporter genes. Front. Microbiol., 2018, 9: 3224.

[33] Pan Y, . The Adc regulon mediates zinc homeostasis in Streptococcus mutans. Mol. Oral Microbiol., 2021, 36: 278-290.

[34] Ma Q, . Acetylation of glucosyltransferases regulates Streptococcus mutans biofilm formation and virulence. PLoS Pathog., 2021, 17: e1010134.

[35] Cheng X, . Regulation of oxidative response and extracellular polysaccharide synthesis by a diadenylate cyclase in Streptococcus mutans. Environ. Microbiol, 2016, 18: 904-922.

[36] Zheng T, . Deletion of the yqeK gene leads to the accumulation of Ap4A and reduced biofilm formation in Streptococcus mutans. Mol. Oral Microbiol., 2022, 37: 9-21.

[37] Chen J, . Characterization of the clustered regularly interspaced short palindromic repeats sites in Streptococcus mutans isolated from early childhood caries patients. Arch. Oral Biol., 2017, 83: 174-180.

[38] Zhang, A. et al. Deletion of csn2 gene affects acid tolerance and exopolysaccharide synthesis in Streptococcus mutans. Mol. Oral Microbiol. https://doi.org/10.1111/omi.12308 (2020).

[39] Xiang Z, . EzrA, a cell shape regulator contributing to biofilm formation and competitiveness in Streptococcus mutans. Mol. Oral Microbiol., 2019, 34: 194-208.

[40] Dinis M, . Oral microbiome: Streptococcus mutans/caries concordant-discordant children. Front. Microbiol., 2022, 13: 782825.

[41] Zhou Y, . ERG3 and ERG11 genes are critical for the pathogenesis of Candida albicans during the oral mucosal infection. Int. J. Oral Sci., 2018, 10: 1-8.

[42] Xiao J, . Candida albicans and early childhood caries: a systematic review and meta-analysis. Caries Res., 2018, 52: 102-112.

[43] Yang C, . Antigen I/II mediates interactions between Streptococcus mutans and Candida albicans. Mol. Oral Microbiol., 2018, 33: 283-291.

[44] Du Q, . [Analysis of the oral microbiota in twin children]. Hua Xi Kou Qiang Yi Xue Za Zhi, 2014, 32: 182-185.

[45] Teng F, . Prediction of early childhood caries via spatial-temporal variations of oral microbiota. Cell Host Microbe, 2015, 18: 296-306.

[46] Hemadi AS, Huang R, Zhou Y, Zou J. Salivary proteins and microbiota as biomarkers for early childhood caries risk assessment. Int. J. Oral Sci., 2017, 9: e1.

[47] Niu J, . An electrospun fibrous platform for visualizing the critical pH point inducing tooth demineralization. J. Mater. Chem. B, 2019, 7: 4292-4298.

[48] Lin Y, Chen J, Zhou X, Li Y. Inhibition of Streptococcus mutans biofilm formation by strategies targeting the metabolism of exopolysaccharides. Crit. Rev. Microbiol., 2021, 47: 667-677.

[49] Lin Y, Zhou X, Li Y. Strategies for Streptococcus mutans biofilm dispersal through extracellular polymeric substances disruption. Mol. Oral. Microbiol, 2022, 37: 1-8.

[50] Zhang Q, . Structure-based discovery of small molecule inhibitors of cariogenic virulence. Sci. Rep., 2017, 7

[51] Ren Z, . Molecule targeting glucosyltransferase inhibits Streptococcus mutans biofilm formation and virulence. Antimicrob. Agents Chemother., 2016, 60: 126-135.

[52] Chen L, . Inhibition of Streptococcus mutans biofilm formation, extracellular polysaccharide production, and virulence by an oxazole derivative. Appl. Microbiol. Biotechnol., 2016, 100: 857-867.

[53] Zhang Q, . New small-molecule inhibitors of dihydrofolate reductase inhibit Streptococcus mutans. Int. J. Antimicrob. Agents, 2015, 46: 174-182.

[54] Zhang Q, Ma Q, Wang Y, Wu H, Zou J. Molecular mechanisms of inhibiting glucosyltransferases for biofilm formation in Streptococcus mutans. Int. J. Oral. Sci., 2021, 13: 30.

[55] Zhang G, . Inhibition of Streptococcus mutans biofilm formation and virulence by Lactobacillus plantarum K41 isolated from traditional Sichuan pickles. Front. Microbiol., 2020, 11: 774.

[56] Liang J, . pH-responsive antibacterial resin adhesives for secondary caries inhibition. J. Dent. Res., 2020, 99: 1368-1376.

[57] Zero D, Fontana M, Lennon ÁM. Clinical applications and outcomes of using indicators of risk in caries management. J. Dent. Educ., 2001, 65: 1126-1132.

[58] Nicolau B, Marcenes W, Bartley M, Sheiham A. A life course approach to assessing causes of dental caries experience: the relationship between biological, behavioural, socio-economic and psychological conditions and caries in adolescents. Caries Res., 2003, 37: 319-326.

[59] Featherstone JD. The caries balance: contributing factors and early detection. CDA, 2003, 31: 129-134.

[60] Affairs, A. A. O. P. D. C. O. C. Policy on use of a caries-risk assessment tool (CAT) for infants, children, and adolescents. Pediatr. Dent., 2005, 27: 25-27.

[61] Nainar SH, Straffon LH. Predoctoral dental student evaluation of American Academy of Pediatric Dentistry’s caries‐risk assessment tool. J. Dent. Educ., 2006, 70: 292-295.

[62] American Academy of Pediatric Dentistry. Caries-risk assessment and management for infants, children, and adolescents. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 252–257 (2021).

[63] Ramos-Gomez FJ, Crall J, Gansky SA, Slayton RL, Featherstone J. Caries risk assessment appropriate for the age 1 visit (infants and toddlers). J. Calif. Dent. Assoc., 2007, 35: 687-702.

[64] Featherstone JD, Domejean-Orliaguet S, Jenson L, Wolff M, Young DA. Caries risk assessment in practice for age 6 through adult. CDA, 2007, 35: 703.

[65] Featherstone J, Crystal Y, Chaffee B, Zhan L, Ramos-Gomez F. An updated CAMBRA caries risk assessment tool for ages 0 to 5 years. J. Calif. Dent. Assoc., 2019, 47: 37-47.

[66] Ramos-Gomez F, Crystal YO, Ng MW, Tinanoff N, Featherstone JD. Caries risk assessment, prevention, and management in pediatric dental care. Gen. Dent., 2010, 58: 505-517.

[67] Featherstone JD, . Evidence-based caries management for all ages-practical guidelines. Front. Oral Health, 2021, 2: 14.

[68] Bratthall D, Petersson Hänsel. G. Cariogram–a multifactorial risk assessment model for a multifactorial disease. Community Dent. Oral Epidemiol., 2005, 33: 256-264.

[69] Su N, Lagerweij MD, van der Heijden GJ. Assessment of predictive performance of caries risk assessment models based on a systematic review and meta-analysis. J. Dent., 2021, 110: 103664.

[70] Bobetsis YA, Graziani F, Gürsoy M, Madianos PN. Periodontal disease and adverse pregnancy outcomes. Periodontology 2000, 2020, 83: 154-174.

[71] Van Gemert-Schriks M. Post-academic dental specialties. 11. Discomfort during atraumatic restorative treatment (ART) versus conventional restorative treatment. Ned. Tijdschr. Voor Tandheelkd., 2007, 114: 213-217.

[72] Günay H, Dmoch-Bockhorn K, Günay Y, Geurtsen W. Effect on caries experience of a long-term preventive program for mothers and children starting during pregnancy. Clin. Oral Investig., 1998, 2: 137-142.

[73] Nakai Y, . Xylitol gum and maternal transmission of mutans streptococci. J. Dent. Res., 2010, 89: 56-60.

[74] Xiao J, . Prenatal oral health care and early childhood caries prevention: a systematic review and meta-analysis. Caries Res., 2019, 53: 411-421.

[75] Prevention, O. O. D. & Promotion, H. US Department of Health and Human Services: healthy people 2010. http://www/health/gov/healthypeople/ (2000).

[76] American Acandemy of Pediatric Dentistry. Oral health care for the pregnant pediatric dental patient. The Reference Manual of Pediatric Dentistry. American Academy of Pediatric Dentistry 277–286 (2021).

[77] American College of Obstetricians and Gynecologists. Nutrition during pregnancy. https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy (2021).

[78] Correa A, . Diabetes mellitus and birth defects. Am. J. Obstet. Gynecol., 2008, 199: 237. e231-237. e239.

[79] Steinberg BJ, Hilton IV, Iida H, Samelson R. Oral health and dental care during pregnancy. Dent. Clin., 2013, 57: 195-210.

[80] American Dental Association. Pregnant? 9 questions you may have about your dental health: is it safe to have a dental procedure? https://www.mouthhealthy.org/en/pregnancy-slideshow (2021).

[81] Peres RCR, . Cariogenic potential of cows’, human and infant formula milks and effect of fluoride supplementation. Br. J. Nutr., 2008, 101: 376-382.

[82] Nakayama, Y. & Mori, M. Association between nocturnal breastfeeding and snacking habits and the risk of early childhood caries in 18-to 23-month-old Japanese children. J. Epidemiol. 25, 142–147 (2015).

[83] Tham R, . Breastfeeding and the risk of dental caries: a systematic review and meta‐analysis. Acta Paediatrica, 2015, 104: 62-84.

[84] Erickson PR, Mazhari E. Investigation of the role of human breast milk in caries development. Pediatr. Dent., 1999, 21: 86-90.

[85] Peres, K. G. et al. Breastfeeding and oral health: evidence and methodological challenges. J. Dent. Res. 97, 251–25 (2018).

[86] Chaffee BW, Feldens CA, Vítolo MR. Association of long-duration breastfeeding and dental caries estimated with marginal structural models. Ann. Epidemiol., 2014, 24: 448-454.

[87] Peres, K. G. et al. Impact of prolonged breastfeeding on dental caries: a population-based birth cohort study. Pediatrics 140, e20162943 (2017).

[88] Chiao C, Kaye E, Scott T, Hayes C, Garcia RI. Breastfeeding and early childhood caries: findings from the National Health and Nutrition Examination Survey, 2011 to 2018. Pediatr. Dent., 2021, 43: 276-281.

[89] van Palenstein Helderman W, Soe W, Van’t Hof M. Risk factors of early childhood caries in a Southeast Asian population. J. Dent. Res., 2006, 85: 85-88.

[90] Perinatal and infant oral health care. Pediatr. Dent. 39, 208–212 (2017).

[91] Wright JT, . Fluoride toothpaste efficacy and safety in children younger than 6 years: a systematic review. J. Am. Dent. Assoc., 2014, 145: 182-189.

[92] American Academy on Pediatric Dentistry Council on Clinical Affairs. Policy on the dental home. Pediatr. Dent. 30, 22–23 (2008–2009).

[93] American Academy of Pediatric Dentistry. Caries-risk assessment and management for infants, children, and adolescents. Pediatr Dent. 39, 197–204 (2017).

[94] American Academy of Pediatric Dentistry. Fluoride therapy. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 302–305 (2021).

[95] Buzalaf MAR, Pessan JP, Honório HM, Ten Cate JM. Mechanisms of action of fluoride for caries control. Fluoride Oral Environ., 2011, 22: 97-114.

[96] Feng, X. Preventive Dentistry. The seventh Edition, p 213 (2020).

[97] Affairs, A. D. A. C. o. S. Professionally applied topical fluoride: evidence–based clinical recommendations. J. Am. Dent. Assoc., 2006, 137: 1151-1159.

[98] Weyant RJ, . Topical fluoride for caries prevention. J. Am. Dent. Assoc., 2013, 144: 1279-1291.

[99] Zhao IS, . Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int. Dent. J., 2018, 68: 67-76.

[100] Scottish Intercollegiate Guideline, Dental interventions to prevent caries in children. (2019).

[101] Pienihäkkinen K, Jokela J, Alanen P. Risk-based early prevention in comparison with routine prevention of dental caries: a 7-year follow-up of a controlled clinical trial; clinical and economic aspects. BMC Oral Health, 2005, 5: 1-7.

[102] Beil HA, Rozier RG. Primary health care providers’ advice for a dental checkup and dental use in children. Pediatrics, 2010, 126: e435-e441.

[103] Periodicity of examination, preventive dental services, anticipatory guidance: counseling, and oral treatment for infants, children, and adolescents. Pediatr. Dent. 39, 188–196 (2017).

[104] Imes, E. P., Ginnis, J., Shrestha, P., Simancas-Pallares, M. A. & Divaris, K. Guardian reports of children’s sub-optimal oral health are associated with clinically determined early childhood caries, unrestored caries lesions, and history of toothaches. Front. Public Health 9, 751733 (2021).

[105] Samaddar A, Shrikrishna SB, Moza A, Shenoy R. Association of parental food choice motives, attitudes, and sugar exposure in the diet with early childhood caries: case–control study. J. Indian Soc. Pedod. Prev. Dent., 2021, 39: 171.

[106] Committee, A. A. o. P. D. C. A. & Affairs, A. A. o. P. D. C. o. C. Policy on dietary recommendations for infants, children, and adolescents. Pediatr. Dent. 27, 36–37 (2005).

[107] Krebs NF. American Academy of Pediatrics Committee on Nutrition. Prevention of pediatric overweight and obesity. Pediatrics, 2003, 112: 424-430.

[108] Ahovuo‐Saloranta, A. et al. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst. Rev. 7, CD001830 (2017).

[109] Splieth C, Förster M, Meyer G. Additional caries protection by sealing permanent first molars compared to fluoride varnish applications in children with low caries prevalence: 2-year results. Eur. J. Paediatr. Dent., 2001, 2: 133-137.

[110] Wright JT, . Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: a report of the American Dental Association and the American Academy of Pediatric Dentistry. J. Am. Dent. Assoc., 2016, 147: 672-682. e612.

[111] Sasa I, Donly KJ. Sealants: a review of the materials and utilization. J. Calif. Dent. Assoc., 2010, 38: 730-734.

[112] American Academy of Pediatric Dentistry. Definition of dental home. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 15 (2021).

[113] Nowak AJ, Casamassimo PS. The dental home: a primary care oral health concept. J. Am. Dent. Assoc., 2002, 133: 93-98.

[114] Casamassimo, P. & Hold, K. Bright futures in practice: oral health, pocket guide, 2nd edn. (2014).

[115] U.S. Department of Health and Human Services. Healthy People 2020: Oral health of children and adolescents. http://www.healthypeople.gov/2020/topics-objectives/topic/oral-health/objectives (2020).

[116] Rowan-Legg, A. Canadian Paediatric Society, Community Paediatrics Committee. Oral health care for children—a call for action. Paediatr. Child Health 18, 37–50 (2013).

[117] Nowak AJ, Casamassimo PS, Scott J, Moulton R. Do early dental visits reduce treatment and treatment costs for children?. Pediatr. Dent., 2014, 36: 489-493.

[118] Weninger A, . Risk indicators and treatment needs of children 2–5 years of age receiving dental treatment under general anesthesia in Saskatchewan. Dent. J., 2022, 10: 8.

[119] Kierce EA, Boyd LD, Rainchuso L, Palmer CA, Rothman A. Association between early childhood caries, feeding practices and an established dental home. Am. Dent. Hygienists’ Assoc., 2016, 90: 18-27.

[120] Frencken, J. Report on the execution of the Morogoro rotation in primary oral health care in the academic year 1984-1985. University of Dar es Salaam, Division of Dentistry (1985).

[121] Frencken, J., Van Amerogen, E., Phantumvanit, P., Songpaisan, Y. & Pilot, T. Manual for the Atraumatic Restaurative Treatment Approach to Control Dental Caries. (Dental Health International Nederlant ISBN90-803296-1-4, 1997).

[122] Frencken JE, Holmgren CJ. How effective is ART in the management of dental caries?. Community Dent. Oral Epidemiol., 1999, 27: 423-430.

[123] Mjör IA, Gordan VV. A review of atraumatic restorative treatment (ART). Int. Dent. J., 1999, 49: 127-131.

[124] Kevin H, Smales RJ, Gao W, Peng D. The effects of two cavity preparation methods on the longevity of glass ionomer cement restorations: an evaluation after 12 months. J. Am. Dent. Assoc., 2002, 133: 744-751.

[125] Anusavice KJ. Does ART have a place in preservative dentistry?. Community Dent. Oral Epidemiol., 1999, 27: 442-448.

[126] Frencken J, Makoni F, Sithole W, Hackenitz E. Three-year survival of one-surface ART restorations and glass-ionomer sealants in a school oral health programme in Zimbabwe. Caries Res., 1998, 32: 119-126.

[127] De Amorim R, . Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis. Clin. OralZ Investig., 2018, 22: 2703-2725.

[128] Ladewig NM, Tedesco TK, Gimenez T, Braga MM, Raggio DP. Patient-reported outcomes associated with different restorative techniques in pediatric dentistry: a systematic review and MTC meta-analysis. PLoS ONE, 2018, 13: e0208437.

[129] Simon AK, Bhumika T, Nair NS. Does atraumatic restorative treatment reduce dental anxiety in children? A systematic review and meta-analysis. Eur. J. Dent., 2015, 9: 304-309.

[130] Araujo MP, . Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting. BMC Oral Health, 2020, 20: 1-18.

[131] Deery C. Atraumatic restorative techniques could reduce discomfort in children receiving dental treatment. Evid. Based Dent., 2005, 6: 9-9.

[132] Farag A, Frencken J. Acceptance and discomfort from atraumatic restorative treatment in secondary school students in Egypt. Med. Princ. Pract., 2009, 18: 26-30.

[133] Mallow P, Durward C, Klaipo M. Restoration of permanent teeth in young rural children in Cambodia using the atraumatic restorative treatment (ART) technique and Fuji II glass ionomer cement. Int. J. Paediatr. Dent., 1998, 8: 35-40.

[134] Raggio D, Sônego F, Camargo L, Marquezan M, Imparato J. Efficiency of different polyacrylic acid concentrations on the smear layer, after ART technique, by scanning electron microscopy (SEM). Eur. Arch. Paediatr. Dent., 2010, 11: 232-235.

[135] Nadanovsky P, Carneiro FC, de Mello FS. Removal of caries using only hand instruments: a comparison of mechanical and chemo–mechanical methods. Caries Res., 2001, 35: 384-389.

[136] Abdul Khalek A, Elkateb M, Abdel Aziz W, El Tantawi M. Effect of papacarie and alternative restorative treatment on pain reaction during caries removal among children: a randomized controlled clinical trial. J. Clin. Pediatr. Dent., 2017, 41: 219-224.

[137] American Academy on Pediatric Dentistry Council on Clinical Affairs. Policy on interim therapeutic restorations. Pediatr. Dent. 30, 38–39 (2008–2009).

[138] Smales, R. & Yip, H.-K. The atraumatic restorative treatment (ART) approach for primary teeth: review of literature. Pediatr. Dent. 22, 294–298 (2000).

[139] Gryst ME, Mount GJ. The use of glass ionomer in special needs patients. Aust. Dent. J., 1999, 44: 268-274.

[140] Vij R, Coll JA, Shelton P, Farooq NS. Caries control and other variables associated with success of primary molar vital pulp therapy. Pediatr. Dent., 2004, 26: 214-220.

[141] Antonson SA, . Twenty-four month clinical evaluation of fissure sealants on partially erupted permanent first molars: glass ionomer versus resin-based sealant. J. Am. Dent. Assoc., 2012, 143: 115-122.

[142] Bönecker M, Toi C, Cleaton-Jones P. Mutans streptococci and lactobacilli in carious dentine before and after atraumatic restorative treatment. J. Dent., 2003, 31: 423-428.

[143] Roshan N, Shigli AL, Deshpande SD. Microbiological evaluation of salivary Streptococcus mutans from children of age 5-7 years, pre-and post-atraumatic restorative treatment. Contemp. Clin. Dent., 2010, 1: 94.

[144] Arrow P. Restorative outcomes of a minimally invasive restorative approach based on atraumatic restorative treatment to manage early childhood caries: A randomised controlled trial. Caries Res., 2016, 50: 1-8.

[145] Saber AM, El-Housseiny AA, Alamoudi NM. Atraumatic restorative treatment and interim therapeutic restoration: a review of the literature. Dent. J., 2019, 7: 28.

[146] Shukla, M., Panigrahi, A., Mohanty, S., Pradhan, S. & Bhuyan, S. Chemo mechanical caries removal technique: a review article on lost and found approach towards painless dentistry. Indian J. Public Health Res. Dev. 10, 239 (2019).

[147] Goldberg M, Keil B. Action of a bacterial Achromobacter collagenase on the soft carious dentine: an in vitro study with the scanning electron microscope. J. de. biologie Buccal., 1989, 17: 269-274.

[148] Beltz R, Herrmann E, Nordbö H. Pronase digestion of carious dentin. Caries Res., 1999, 33: 468-472.

[149] Hamama H, Yiu C. & Burrow, M. Current update of chemomechanical caries removal methods. Aust. Dent. J., 2014, 59: 446-456.

[150] Yamada Y, . Removal of organic debris from occlusal fissures: advantage of Carisolv system over sodium hypochlorite. J. Clin. Pediatr. Dent., 2010, 35: 75-79.

[151] Kochhar GK, Srivastava N, Pandit I, Gugnani N, Gupta M. An evaluation of different caries removal techniques in primary teeth: a comparitive clinical study. J. Clin. Pediatr. Dent., 2011, 36: 5-10.

[152] Peric T, Markovic D, Petrovic B. Clinical evaluation of a chemomechanical method for caries removal in children and adolescents. Acta Odontol. Scand., 2009, 67: 277-283.

[153] Inglehart MR, Peters MC, Flamenbaum MH, Eboda NN, Feigal RJ. Chemomechanical caries removal in children: an operator’s and pediatric patients’ responses. J. Am. Dent. Assoc., 2007, 138: 47-55.

[154] Peters MC, Flamenbaum MH, Eboda NN, Feigal RJ, Inglehart MR. Chemomechanical caries removal in children: efficacy and efficiency. J. Am. Dent. Assoc., 2006, 137: 1658-1666.

[155] Myers T, Myers W, Stone R. First soft tissue study utilizing a pulsed Nd: YAG dental laser. Northwest Dent., 1989, 68: 14-17.

[156] Martens L. Laser physics and a review of laser applications in dentistry for children. Eur. Arch. Paediatr. Dent., 2011, 12: 61-67.

[157] Olivi G, Genovese M. Laser restorative dentistry in children and adolescents. Eur. Arch. Paediatr. Dent., 2011, 12: 68-78.

[158] Tanboga I, Eren F, Altınok B, Peker S, Ertugral F. The effect of low level laser therapy on pain during dental tooth-cavity preparation in children. Eur. Arch. Paediatr. Dent., 2011, 12: 93-95.

[159] van As G. Erbium lasers in dentistry. Dent. Clin., 2004, 48: 1017-1059.

[160] Matsumoto K, Hossain M, Hossain MI, Kawano H, Kimura Y. Clinical assessment of Er, Cr: YSGG laser application for cavity preparation. J. Clin. Laser Med. Surg., 2002, 20: 17-21.

[161] American Academy of Pediatric Dentistry. Policy on the use of lasers for pediatric dental patients. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 120–122 (2021).

[162] Simonsen R, Stallard R. Sealant-restorations utilizing a diluted filled composite resin: one year results. Quintessence Int., Dent. Dig., 1977, 8: 77-84.

[163] Hicks M. Preventive resin restorations: etching patterns, resin tag morphology and the enamel-resin interface. ASDC J. Dent. Child., 1984, 51: 116-123.

[164] Simonsen RJ. Potential uses of pit-and-fissure sealants in innovative ways: a review. J. Public Health Dent., 1982, 42: 305-311.

[165] Henderson H, Setcos J. The sealed composite resin restoration. ASDC J. Dent. Child., 1985, 52: 300-302.

[166] McConnachie I. The preventive resin restoration: a conservative alternative. J. Can. Dent. Assoc., 1992, 58: 197-200.

[167] Houpt, M., Fuks, A. & Eidelman, E. The preventive resin (composite resin/sealant) restoration: nine-year results. Quintessence Int. 25, 155–159 (1994).

[168] Heintze SD, Rousson V. Clinical effectiveness of direct class II restorations-a meta-analysis. J. Adhes. Dent., 2012, 14: 407-431.

[169] Burgess J, Walker R, Davidson J. Posterior resin-based composite: review of the literature. Pediatr. Dent., 2002, 24: 465-479.

[170] Pallav P, De Gee A, Davidson C, Erickson R, Glasspoole E. The influence of admixing microfiller to small-particle composite resin on wear, tensile strength, hardness, and surface roughness. J. Dent. Res., 1989, 68: 489-490.

[171] Oldenburg TR, Vann W, Dilley DC. Composite restorations for primary molars: results after four years. Pediatr. Dent., 1987, 9: 136-143.

[172] Tonn EM, Ryge G. Clinical evaluations of composite resin restorations in primary molars: a 4-year follow-up study. J. Am. Dent. Assoc., 1988, 117: 603-606.

[173] Georgas D, Richardson A, Derkson G, Hann J. Posterior composite resin restorations: four and six-year results. J. Dent. Res, 1989, 68: 185.

[174] Busato A, Loguercio AD, Reis A, Carrilho M. Clinical evaluation of posterior composite restorations: 6-year results. Am. J. Dent., 2001, 14: 304-308.

[175] Opdam N, . Longevity of posterior composite restorations: a systematic review and meta-analysis. J. Dent. Res., 2014, 93: 943-949.

[176] van Dijken JW. A 6-year evaluation of a direct composite resin inlay/onlay system and glass ionomer cement-composite resin sandwich restorations. Acta Odontol. Scand., 1994, 52: 368-376.

[177] Donly, K. J., Jensen, M. E., Triolo, P. & Chan, D. A clinical comparison of resin composite inlay and onlay posterior restorations and cast-gold restorations at 7 years. Quintessence Int. 30, 163–168 (1999).

[178] Antony, K., Genser, D., Hiebinger, C. & Windisch, F. Longevity of dental amalgam in comparison to composite materials. GMS Health Technol. Assess. 4, Doc12 (2008).

[179] Donly KJ, García-Godoy F. The use of resin-based composite in children: an update. Pediatr. Dent., 2015, 37: 136-143.

[180] Wilson AD. A new translucent cement for dentistry: the glass-ionomer cement. Br. Dent. J., 1972, 132: 133-135.

[181] Takeshita, E. M. & Leal, S. C. (eds) Pediatric Restorative Dentistry. (Springer, 2018)

[182] Khoroushi M, Keshani F. A review of glass-ionomers: from conventional glass-ionomer to bioactive glass-ionomer. Dent. Res. J., 2013, 10: 411.

[183] Tyas MJ. Cariostatic effect of glass ionomer cement: a five‐year clinical study. Aust. Dent. J., 1991, 36: 236-239.

[184] Chadwick B, Evans D. Restoration of class II cavities in primary molar teeth with conventional and resin modified glass ionomer cements: a systematic review of the literature. Eur. Arch. Paediatr. Dent., 2007, 8: 14-21.

[185] Qvist V, Laurberg L, Poulsen A, Teglers PT. Eight‐year study on conventional glass ionomer and amalgam restorations in primary teeth. Acta Odontol. Scand., 2004, 62: 37-45.

[186] Mickenautsch S, Yengopal V. Absence of carious lesions at margins of glass-ionomer cement and amalgam restorations: an update of systematic review evidence. BMC Res. Notes, 2011, 4: 1-15.

[187] Wilson, A. D. Resin-modified glass-ionomer cements. Int. J. Prosthodont. 3, 425–429 (1990).

[188] Xie D, Brantley W, Culbertson B, Wang G. Mechanical properties and microstructures of glass-ionomer cements. Dent. Mater., 2000, 16: 129-138.

[189] Robertello FJ, Coffey JP, Lynde TA, King P. Fluoride release of glass ionomer–based luting cements in vitro. J. Prosthet. Dent., 1999, 82: 172-176.

[190] Colceriu Burtea L, . New pre-reacted glass containing dental composites (giomers) with improved fluoride release and biocompatibility. Materials, 2019, 12: 4021.

[191] Tay F, . The glass-ionomer phase in resin-based restorative materials. J. Dent. Res., 2001, 80: 1808-1812.

[192] Gordan VV, Mondragon E, Watson RE, Garvan C, Mjör IA. A clinical evaluation of a self-etching primer and a giomer restorative material: results at eight years. J. Am. Dent. Assoc., 2007, 138: 621-627.

[193] Abdel-Karim U, El-Eraky M, Etman W. Three-year clinical evaluation of two nano-hybrid giomer restorative composites. Tanta Dent. J., 2014, 11: 213-222.

[194] Jyothi K, Annapurna S, Kumar AS, Venugopal P, Jayashankara C. Clinical evaluation of giomer-and resin-modified glass ionomer cement in class V noncarious cervical lesions: an in vivo study. J. conservative Dent.: JCD, 2011, 14: 409.

[195] Gordan VV, . A clinical evaluation of a giomer restorative system containing surface prereacted glass ionomer filler: results from a 13-year recall examination. J. Am. Dent. Assoc., 2014, 145: 1036-1043.

[196] Innes, N. P., Ricketts, D. & Evans, D. J. Preformed metal crowns for decayed primary molar teeth. Cochrane Database Syst. Rev. 2015, CD005512 (2007).

[197] Atieh M. Stainless steel crown versus modified open‐sandwich restorations for primary molars: a 2‐year randomized clinical trial. Int. J. Paediatr. Dent., 2008, 18: 325-332.

[198] Innes N, . The Hall technique 10 years on: questions and answers. Br. Dent. J., 2017, 222: 478-483.

[199] Foley J. A pan-European comparison of the management of carious primary molar teeth by postgraduates in paediatric dentistry. Eur. Arch. Paediatr. Dent., 2012, 13: 41-46.

[200] Ricketts, D., Lamont, T., Innes, N. P., Kidd, E. & Clarkson, J. E. Operative caries management in adults and children. Cochrane Database Syst. Rev. CD003808 (2013).

[201] Innes NP, Evans DJ, Stirrups DR. The Hall technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months. BMC Oral Health, 2007, 7: 1-21.

[202] Schwendicke F, . Managing carious lesions: consensus recommendations on carious tissue removal. Adv. Dent. Res., 2016, 28: 58-67.

[203] Ludwig KH, Fontana M, Vinson LA, Platt JA, Dean JA. The success of stainless steel crowns placed with the Hall technique: a retrospective study. J. Am. Dent. Assoc., 2014, 145: 1248-1253.

[204] Schwendicke F, Stolpe M, Innes N. Conventional treatment, Hall technique or immediate pulpotomy for carious primary molars: a cost‐effectiveness analysis. Int. Endod. J., 2016, 49: 817-826.

[205] Lin, G. S. S. et al. Acceptability of atraumatic restorative treatment and Hall Technique among children, parents, and general dental practitioners: a systematic review and meta-analysis. Quintessence Int. 53,156–169 (2021).

[206] Waggoner W, Drummond B. Anterior crowns for primary anterior teeth: an evidence based assessment of the literature. Eur. Arch. Paediatr. Dent., 2006, 1: 53-57.

[207] Waggoner WF. Restoring primary anterior teeth. Pediatr. Dent., 2002, 24: 511-516.

[208] Kupietzky A, Waggoner WF, Galea J. Long-term photographic and radiographic assessment of bonded resin composite strip crowns for primary incisors: results after 3 years. Pediatr. Dent., 2005, 27: 221-225.

[209] Ram D, Fuks A. Clinical performance of resin‐bonded composite strip crowns in primary incisors: a retrospective study. Int. J. Paediatr. Dent., 2006, 16: 49-54.

[210] Dhar V, . Use of vital pulp therapies in primary teeth with deep caries lesions. Pediatr. Dent., 2017, 39: 146E-159E.

[211] Coll JA, . Primary tooth vital pulp therapy: a systematic review and meta-analysis. Pediatr. Dent., 2017, 39: 16-123.

[212] Kratunova, E. & Silva, D. Pulp therapy for primary and immature permanent teeth: an overview. Gen. Dent. 66, 30–38 (2018).

[213] Fontana M. The clinical, environmental, and behavioral factors that foster early childhood caries: evidence for caries risk assessment. Pediatr. Dent., 2015, 37: 217-225.

[214] Mjör, I. A. & Toffentti, F. Secondary caries: a literature review with case reports. Quintessence Int. 31, 165–179 (2000).

[215] Cox, C. Microleakage related to restorative procedures. Proc. Finn. Dent. Soc. 88, 83–93 (1992).

[216] Irie M, Suzuki K, Watts D. Marginal gap formation of light-activated restorative materials: effects of immediate setting shrinkage and bond strength. Dent. Mater., 2002, 18: 203-210.

[217] Mousavinenasab, S. & Jafary, M. Microleakage of composite restorations following chemo-mechanical and conventional caries removal. Front. Dent. 1, 12–17 (2004).

[218] Fitzgerald R, Adams B, Davis M. A microbiological study of recurrent dentinal caries. Caries Res., 1994, 28: 409-415.

[219] Jokstad A, Mjör IA. Replacement reasons and service time of class-II amalgam restorations in relation to cavity design. Acta Odontol. Scand., 1991, 49: 109-127.

[220] Lloyd-Price J, Abu-Ali G, Huttenhower C. The healthy human microbiome. Genome Med., 2016, 8: 1-11.

[221] Tanner A, Kressirer C, Rothmiller S, Johansson I, Chalmers N. The caries microbiome: implications for reversing dysbiosis. Adv. Dent. Res., 2018, 29: 78-85.

[222] Fakhruddin KS, Ngo HC, Samaranayake LP. Cariogenic microbiome and microbiota of the early primary dentition: a contemporary overview. Oral. Dis., 2019, 25: 982-995.

[223] Sharma G, Puranik MP. Approaches to arresting dental caries: an update. J. Clin. Diagn. Res., 2015, 9: ZE08.

[224] Zhan L. Rebalancing the caries microbiome dysbiosis: targeted treatment and sugar alcohols. Adv. Dent. Res., 2018, 29: 110-116.

Funding

International Science and Technology Innovation Cooperation Projects of Science and Technology Office of Sichuan Province (2019YFH0025)

National Natural Science Foundation of China (National Science Foundation of China)(82170947, 82170947, 82170947, 82170947, 82170947, 82170947, 82170947, 82170947, 82170947, 82170947, 82170947, 82170947)