International Journal of Dentistry of developing ECC, assist in providing information for parents about how to promote oral health, and prevent the development of tooth decay. High-risk infants include those with early signs of ECC, poor oral hygiene (of both infant and mother), limited exposure to ﬂuoride, and frequent exposure to sweet beverages. These infants should be targeted with a professional preventive program that includes oral hygiene instructions for the mother and child, ﬂuoride use, and diet counseling. These professional approaches are important but not suﬃcient to prevent dental caries in high- risk children. Addressing the social and economic factors that many families face where ECC is endemic is also necessary [55]. 6.4. Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP). CPP-ACP nanocomplexes are casein-derived peptides in which ACP is stabilized by CPP. These nanocom- plexes act as a calcium and phosphate reservoir when incorporated into the dental plaque and on the tooth surface [56]. CPP-ACP has been shown to reduce demineralization and promote remineralization of carious lesions both in vitro [57] and in situ [58] and to reduce erosive tooth wear in vitro [59]. CPP-ACP cream, which is eﬀective in remineralizing early enamel lesions of primary teeth, was a little more eﬀective than 500 ppm NaF [60]. Moreover, CPP-stabilized amorphous calcium ﬂuoride phosphate had a greater remineralizing eﬀect on carious lesions compared to ﬂuoride or CPP-ACP individually. Since additive eﬀects were obtained when CPP-ACP was used in conjunction with ﬂuoride, CPP-ACP is better used as a self-applied topical coating after the teeth have been brushed with a ﬂuoridated toothpaste by children who have a high risk of dental caries [61]. 6.5. Pediatricians’ Role. Prevention and control of dental caries can be promoted by clinicians other than dentists if such clinicians are appropriately trained [37, 46, 62]. Pedia- tricians can provide recommendations for the prevention of ECC to mothers and caregivers. Children can be examined by their primary care provider or pediatrician for signs of early carious demineralization, as indicated by white areas around the gingival margin or brown-stained pits and ﬁssures. The detection of dental caries and referral to an appropriate dental care professional for treatment should be thought of as a secondary prevention measure. 6.6. Dental Fluorosis. Two studies have been published sup- porting the eﬀectiveness of ﬂuoride varnish to prevent dental caries in the primary dentition [63, 64]. However, ﬂuoride varnish can also introduce the risk of the development of enamel ﬂuorosis in the permanent teeth [65–67]. Evidence of a major beneﬁt from ﬂuoride consumption during infancy is lacking, and thus, it seems reasonable to limit the intake of ﬂuoride to less than 70 µg/kg BW per day, considering the possible risk of enamel ﬂuorosis [68]. To avoid greater intake, water with relatively low ﬂuoride content (e.g., 0–0.3 mg/L) is recommended to be used as a diluent for infant formula, and no ﬂuoride supplement should be given to infants. 5 For children 1–7 years of age, the repeated addition of small amounts of ﬂuoride to oral ﬂuids is important [68]. Consumption of ﬂuoridated water is highly recommended, and the regular use of ﬂuoridated dentifrices is also an eﬀective means of decreasing the prevalence of dental caries. However, with the knowledge that small children swallow much of the applied dentifrice, education regarding appro- priate tooth brushing in small children is needed for mothers or caregivers. The recommended limit in the amount of dentifrice should be no more than 0.25 g per brushing [68]. Fluoride supplements have been recommended for pre- venting caries. A systematic review [69] found that the evidence supporting the eﬀectiveness of supplements in caries prevention in primary teeth was weak. In permanent teeth, the daily use of supplements prevented dental caries. The use of supplements during the ﬁrst 6 years of life, and especially during the ﬁrst 3 years, was associated with a signiﬁcant increase in ﬂuorosis. 7. Future Approaches to Prevent ECC Considering the integrated roles of dental, medical, and other health care providers, assessing the eﬀects of public health interventions, and introducing oral health promotion as part of general health promotion are all necessary [46]. The mouth can be both a nidus of infection and the location of the ﬁrst sign of systemic disease, and pediatricians have frequent access to young children and have opportunities to address issues relating to oral health. Thus, primary care clinicians should be familiar with eﬀective interventions for the youngest children before they require dental services. A study demonstrated that oral health training during residency can increase pediatrician conﬁdence in partici- pating in important oral health-promoting tasks, including anticipatory guidance, oral screenings, and oral health-risk assessments [62]. Additionally, dentists need to establish the best ways to provide preventive and clinically eﬀective care. Scientiﬁc advances must blur the demarcation between dental and medical practices; dental caries is a health problem that can be managed by a team of health care providers including dentists and physicians [70]. Physicians must concentrate on using existing methods to detect signs of early and advanced caries and provide advice on how to prevent and control caries in their patients. References [1] O. Fejerskov and Kidd E. A. M., Dental Caries: The Disease and Its Clinical Management, Blackwell Munksgaard, Oxford, UK, 2nd edition, 2008. [2] A. Narvey and L. Shwart, “Early childhood dental disease— what’s in a name?” Journal of the Canadian Dental Association, vol. 73, no. 10, pp. 929–930, 2007. [3] R. Harris, A. D. Nicoll, P. M. Adair, and C. M. Pine, “Risk factors for dental caries in young children: a systematic review of the literature,” Community Dental Health, vol. 21, no. 1, pp. 71–85, 2004.