Early Childhood Caries — ORE Part 1 MCQ

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EasyPaediatric DentistryEarly Childhood CariesORE Part 1

A child aged 18 months presents with multiple carious lesions affecting the upper primary incisors. The lower incisors are unaffected. What is the most likely diagnosis?

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Correct answer: D — Early childhood caries (nursing caries/bottle caries)

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

The selective involvement of upper primary incisors with sparing of lower incisors in an 18-month-old is pathognomonic for early childhood caries (ECC), formerly known as nursing or bottle caries. This pattern occurs because bottle-feeding preferentially bathes the upper anterior teeth in sugary liquid while the tongue shields the lower incisors during feeding. Amelogenesis imperfecta (B) is a hereditary enamel defect affecting all teeth equally and symmetrically, not selectively. Hypomineralisation (C) and MIH (D) are generalized developmental conditions: MIH specifically affects permanent molars and incisors, not primary teeth in infants. Fluorosis (E) causes symmetric white spot lesions from systemic fluoride exposure during development, not selective upper incisor caries. The history, age, and tooth distribution pattern clinch the diagnosis of ECC.

Reference: SDCEP Prevention and Management of Dental Caries in Children (2018), and Childhood Caries Management, Patel et al., Journal of Pediatric Dentistry, 2022. https://www.sdcep.org.uk/media/dtqlbqzg/sdcep-prevention-and-management-of-dental-caries-in-children-guidance-development-methodology.pdf