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Diagnosis and Stages
The stages of Early Childhood Caries (ECC) are as follows:

Plaque: This biofilm contains cariogenic bacteria (see Factors in Caries Development).
Incipient lesions or white spots: These usually begin along the gum line, which is the most important place to examine for ECC. Early lesions are painless and the most difficult to recognize. With intervention at this stage, the caries process is entirely reversible.
Enamel caries: A defect in the enamel surface is visible.
Dentine caries: ECC has extended through the entire layer of enamel and into the dentine layer, where the nerve and pain fibers are located.
Pulpitis: The caries lesion has progressed so that it now affects the
Pulp: The highly vascular sensitive tissue occupying the central cavity of a tooth.
Early Childhood Caries (ECC) develop in 5 stages—plaque, incipient lesions (white spots), enamel caries, dentine caries, and pulpitis.
If intervention occurs during the white spot stage (second stage), ECC is entirely reversible.
Dentine caries affect the nerve and pain fibers, at which stage sensitivity to heat and cold, as well as pain, develop.
If ECC involves the pulp, pulpitis occurs and a root canal is required for repair.
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