Review of LiteratureOverviewIn order to understand the concepts associated with the prevention of ECC, it is imperative to examine and analyze published material from experts regarding the area. The purpose of this review is to analyze and examine and obtain knowledge of the creation and archival processing of preventing ECC. The review is based on an assessment of the literature on preventing ECC through a series of different mechanisms while also utilizing fluoride varnish. Studies created a preventive program which has children start with very early dental visits, to supervised tooth brushing, to assessing oral microflora, along with the use of professionally applied fluoride varnish. Early Dental Visits There has been a wide range of initiatives being taken to improve oral health in childhood, though the reduction of caries prevalence in primary dentition is still increasingly typical in groups with low socioeconomic status (Wagner & Heinrich-Weltzien, 2015). The need for a new paradigm for caries management due to dental caries being recognized as a non-communicable disease, the vision is connected to health with the involvement of health and non-health sectors, should be developed (Wagner & Heinrich-Weltzien, 2015). One literature focused on evaluating an interdisciplinary preventive program for ECC in 3-year-old children with a prospective birth cohort study. In 2009, there were about 1000 newborn children between the 1st and 4th week after birth per year that had been accompanied by communal newborn visiting services qualified staff (midwives, social workers, and nurses) to counsel new parents on general and oral health. The purpose was to help anticipate and guide their approaches to their children’s health and oral health. In order to categorize the children, the caries-risk assessment tool (CAT) for infants, children, and adolescents of the American Academy of Pediatric Dentistry was used for the caries-risk of the children (Wagner & Heinrich-Weltzien, 2015). Those who had caries initially were considered the high-caries-risk group. These children received fluoride varnish application biannually. Evidence shows that the 3-year-old children who participated in the preventive program who acquired the anticipatory guidance and continuous dental care since birth had a significantly lower caries prevalence and caries experience than those who did not participate (Wagner & Heinrich-Weltzien, 2015).Supervised Tooth Brushing For most parents, supervised tooth brushing with their children is a part of normal routine. This method was an essential part of a literature to incorporate supervised tooth brushing along with the use of professionally applied fluoride varnish. This double-blind randomized controlled trial consisted of the 2-5 year of age for a two-year program. Every child was given oral health education with hygiene instructions twice yearly and was accompanied by an adult for supervised tooth brushing once daily. As for another literature, the intention was to result in a decrease in caries incidence by applying fluoride varnish twice yearly as well as whether it is safe and well accepted. In the 1970s, fluoride varnish had been introduced into the dental field (Oliveria, Salazar, Carvalho, Falcao, Campos, Nadanovsky, 2013). Endorsement for the use of fluoride varnish 2-4 times a year as a caries prevention in primary and permanent teeth by the European Academy of Pediatric Dentistry and the American Academy of Pediatric Dentistry (Oliveria, Salazar, Carvalho, Falcao, Campos, Nadanovsky, 2013). The evidence presented for the efficacy of fluoride varnish in the primary dentition is rated as fair whereas for caries prevention in permanent dentition is undisputable (Oliveria, Salazar, Carvalho, Falcao, Campos, Nadanovsky, 2013). At best, the finding was that fluoride varnish application due tend to reduce the incidence of caries forming, but there’s no significant difference from supervised brushing alone (Agouropoulos, Twetman, Pandis, Kavvadia, Papagaiannoulis, 2014). These studies both resulted in that the prevalence of caries in children did not decrease by using professionally applying fluoride varnishes. Each provided different explanations as to why their studies were unable to demonstrate successful findings such as not properly supervised tooth brushing and/or not enough children involved in the study.Oral Microflora Another area associated with fluoride-based programs is on the long-term impact with oral bacteria. There is about 5% sodium fluoride in fluoride varnishes and once applied, fluoride slowly releases throughout the oral biofilm over a period of several weeks (Anderson, Grindefjord, Dahllof, Dahlen, Twetman, 2016). The focus of this study was to evaluate preschool children oral microflora with semi-annual fluoride varnish application. As for others, this program consisted of yearly dental examinations with instructions for brushing, dietary counseling, and enforced using fluoridated toothpaste (Anderson, Grindefjord, Dahllof, Dahlen, Twetman, 2016). The findings of this study were the oral microflora did not appear to change with the fluoride varnish supplement semi-annually.