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

Plaque: As previously discussed (see Factors in Caries Development), this biofilm contains cariogenic bacteria.
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: At this stage, demineralization has continued and there is now a visible defect in the enamel surface.
Dentine caries: ECC has extended through the entire layer of enamel and into the dentine layer, where the nerve and pain fibers are located. At this stage, the child develops tooth heat/cold sensitivity and pain.
Pulpitis: The infection has spread so that it now involves the
Pulp: The highly vascular sensitive tissue occupying the central cavity of a tooth.
pulp. Pulpitis is very painful and requires a root canal for repair.
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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