Oral Diseases

Early Childhood Caries

Tooth Decay that affects children worldwide.
Introduction
Oral health is one component of general
health and is an important factor in the
normal development of a child. Oral
health problems or illnesses can influence
the general development of a child and
its general health and can adversely
affect quality of life.

Early childhood caries

Early childhood caries (ECC), also called
baby bottle tooth decay or nursing
mouth, can destroy your childs teeth and
become a serious mouth infection that
can be life-threatening if left untreated.
ECC is the most common chronic
infectious
disease
of
childhood
worldwide. Severe ECC can destroy the
primary teeth; cause painful abscesses
and is the major reason for dental
visits for young children. This condition
disproportionately affects severely the
disadvantaged socio-economic groups.
Infants and toddlers are most susceptible
to ECC and proper oral care goes a long
way in ensuring natural dentition for life.
Early childhood caries, or ECC, is a severe

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November 2012

form of cavities. It is another term for

dental decay among infants and children. It is a very common bacterial infection characterised by severe decay in the
teeth. It is a serious and painful dental
disease. It can quickly destroy your child's
teeth. For the last fifty years, dentists
and researchers have struggled to clearly
define ECC. Dental decay on infants
and children is known by other names
as well such as baby bottle tooth decay
(BBTD), baby bottle caries, infant caries
and bottle rot, nursing caries or nursing
bottle syndrome etc. ECC often occurs
when your baby's teeth are exposed to
sugars for long periods throughout the
day. Its prevalence is epidemic. A large
body of scientific evidence indicates that
ECC is an infectious and transmissible
disease. Streptococcus mutans, a group
of bacteria, is the primary microbiological agent in the disease. A major reason
for ECC is the limitless breast feeding at
night as and when desired after the first
primary tooth begins to erupt. ECC is
said to cause dental decay of epidemic
proportions in certain populations. It is
a chronic childhood dental disease. The
disease process begins with the transmission of the bacteria to the child, usually

12

from the primary caretaker, the mother.

Mothers with untreated dental disease
present a very high risk to their children.

How tooth decay

begins
EEC is a chronic and infectious oral disease
of young children, most commonly seen
in poor and minority populations. Factors
such as improper feeding practices,
familial socioeconomic background,
lack of parental education and dental
knowledge, and lack of access to dental
care can contribute to and explain why
the prevalence of ECC is so great in these
select populations.
Tooth decay in children is usually painless
until the decay reaches deep into the
pulp. If the decay is left untreated, an
infection can develop as food from the
mouth enters into the tooth pulp.

Disease process
Biologically, ECC is an infectious process.
Prolonged exposure of sugars, such
as those present in milk, formula, and
fruit juice, causes damage to the teeths
surface. The practice of putting a child

Oral Diseases
to sleep using the bottle at naptime or
bedtime exposes sugary fluids that may
pool around a baby or childs teeth for
hours. The longer that the sugary liquids
come into contact with the tooths
enamel, the more likely it is for these
sugars to combine with bacteria in the
mouth.
Baby bottles with fruit juice or milk both
contain sugars. When these liquids are
in the mouth, bacteria start eating the
sugars and then produce acids. These
acids cause decay if they remain on teeth
long enough. The teeth that get affected
initially are the top front teeth.

But in children with ECC, it makes up

more than half the bacteria.
S. mutans is common. It is passed from
parent to child, usually when a child is
between 6 and 31 months old. Keeping
your own mouth healthy and free of
cavities can help your child's mouth stay
healthier, too.
The top front teeth usually are the first
ones affected by ECC. Often, the cavities
start on the backs of the teeth. The top
teeth farther back in the mouth are
affected next. Finally, the bottom back
teeth get cavities. The lower front teeth
usually
do not

Early childhood caries can occur if

your child:

is put to bed with a bottle

filled with any liquid other
than plain water

drinks from a bottle

filled with sugary
liquids or milk
during the day

receives
a
pacifier dipped
in sugar, honey
or a sweet liquid

Normal breastfeeding
has not been shown
to cause dental cavities.
However, breastfeeding
for long periods of time can
still put your child at higher
risk for dental decay.
Remember, it's not just what your
baby is drinking, but how often. Longer
the time liquids (other than water)
remain in a baby's mouth, the higher the
risk. This is why it is dangerous to let your
baby go to sleep with a bottle or use a
bottle as a pacifier during the day. The
teeth most often affected by ECC are the
upper front teeth. But others can decay,
too.

get
cavities.
These
teeth
are covered by the tongue, which keeps
liquids away. These teeth also are close to
large salivary glands, so they are bathed
in saliva. Saliva helps wash away sugars
and bacteria.

Tooth decay can occur much more easily if

there are large numbers of cavity-causing
bacteria living in your child's mouth.
One of the most dangerous types of
cavity-causing bacteria is Streptococcus
mutans. In the mouths of children with
no or little tooth decay, S. mutans makes
up less than 1% of the mouth's bacteria.

Decayed teeth that are not fixed can

cause pain and infection. Teeth that
are very badly decayed may need to
be removed. Tooth decay is a bacterial
infection, and it can spread if it is not
treated. Also, the permanent teeth under
the gum can be affected if the decay is
not treated.

Factors causing ECC

Factors such as improper feeding practices, familial socioeconomic background,
lack of parental education and dental
knowledge, and lack of access to dental
care can contribute to ECC. The prevalence of ECC in children, ages three to
five years, in US is reported to be as high
as 90%. In developing countries ECC is
a critical problem as well, heightened by
extraneous factors such as low income
or malnutrition. The prevalence of ECC
in these countries is reported to be as
high as 70-80%. Untreated caries may
lead to early loss of the primary dentition and affect the growth and maturation of the secondary, adult dentition. In
fact, decay in the primary detention
is the best predictor for decay in
the secondary dentition; poor
dental health and disease
often persist to adulthood,
affecting speech articulation, growth, and dietary
practices. At the most
extreme of cases, ECC
can also lead to rampant decay, infection,
pain, abscesses, chewing problems, malnutrition, gastrointestinal
disorders, and low selfesteem. Children with
ECC are shown to have
an elevated risk for new lesions as they get older, both
in the primary and permanent
dentitions.
Here are some tips on preventing
early childhood caries:

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Don't put your baby to bed with a

bottle unless it is filled with plain
water. Even watered-down fruit
juice or milk can increase the risk
of decay.

Talk with your doctor about

weaning your infant from the
bottle when he or she is 12 to 14
months old.

During the day, don't use a bottle

to comfort your baby unless it's
filled with plain water.

Don't dip your baby's pacifier in

sugar or sugary liquids.

November 2012

ORAL HEALTH

Oral Diseases

Don't add sugar to your child's

food.

Clean your baby's teeth and

gums with a damp cloth or a soft
toothbrush after each feeding.

Clean your baby's teeth and

gums with a damp cloth or a soft
toothbrush after each feeding.

Take your baby to the dentist as

soon as the first tooth comes in.

Teach your baby to drink from a

cup by his or her first birthday.

Make sure your baby is getting the

right amount of fluoride. If your
drinking water does not contain
fluoride, ask your doctor or
dentist about fluoride
supplements.

because the pulp is made up of nerves,

connective tissue, and blood vessels that
help nourish the tooth.
Once tooth decay sets in, a restoration or
filling is usually required. Even more significant decay to the teeth may require
treatment as serious as steel or veneer
crowns, in which the decayed or weakened area is removed and repaired with
a cap or crown that is fitted over the
remainder of the tooth. Crowns are applied if decay is extensive and there is
limited tooth structure that may cause
weakened teeth.

Treatment
Dental caries are generally painless until
the decay becomes very large inside the
tooth and destroys the nerves and blood
vessels in the tooth. If the decay is left
untreated, a tooth abscess can develop
and the internal structures of the tooth,
the pulp, can be destroyed. Decay to the
tooths inner pulp is extremely critical

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November 2012

Proper nutrition and feeding your baby in

an appropriate manner, along with regular dental visits, is the best way to protect
your babys oral health.
Dental sealants
The chewing surfaces are where
decay often occurs. A dental
sealant or a pit and fissure
sealant is a material that
is placed on the chewing surfaces of back
teeth, the molars,
to prevent caries.
Sealants smoothen
the chewing surfaces
of teeth by filling the
grooves of back teeth
susceptible to carries
because of trapped
food and bacteria.

Stages of
disease
Depending on the
progression of caries, there are various disease stages
which each require
appropriate
treatment. A very early
sign of caries development is the beginnings of tooth demineralization, the slight
penetration into tooth
enamel, which is typically
visualized by chalky white
spots or lines. In this premature stage, white spots or lines
can be reversible and caries progression can be prevented with proper care;
fluoride application and diet changes are
likely to be beneficial to the re-mineralization and protection of teeth. Further
decay of the teeth from the enamel to
the dentin is, obviously, more critical.

the health of teeth, predominantly in

young children. It is an effective, safe,
and low-cost way to prevent and protect
against the occurrence of tooth decay.
Water fluoridation done in developed
countries is particularly important in dental prevention because it helps the babys
teeth develop strong, hard enamel that
better resists decay. As your child grows
older, using dental products that contain fluoride to provide additional daily
protection to the tooth surface is also
recommended.

Dietary practices

Preventative
measures
Fluoride
It is important to implement prevention
methods when dealing with caries, particularly at an early age. Caries do not
completely form at one time; rather it
takes months or even years before they
appear. Perhaps the most proven and effective method in the prevention of caries is the regular use of fluoride. Fluoride
is essential when it comes to maintaining

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Sugar plays a huge role in

the development and progression of ECC. Feeding children
with sweetened beverages coupled
with poor hygiene habits are detrimental
to the childrens teeth; sucrose, fructose,
and glucose found in fruit juices and vitamin C beverages are the main sugars associated with infant caries. These sugars
cause demineralization. Breast milk and
cow milk do not cause childhood tooth
decay.

Conclusion
ECC is a chronic and infectious, but preventable, disease. Ensuring proper diet,
establishing good oral hygiene and giving necessary fluoride treatments are
helpful in preventing ECC

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