Early Childhood Caries (Tooth Decay)

What is Caries (Tooth Decay)?

Dental caries, commonly termed “cavities” or tooth decay, is the breakdown of teeth as a re- sult of bacterial biochemical reactions that generate acids. Dental caries is caused by bacte- ria and considered to be the most common chronic infectious disease in childhood. Specifical- ly, it is caused by the metabolic activities of bacteria on sugary foods, thereby generating acids that adversely affect the tooth enamel. Although enamel is the hardest substance in the human body, the acidic end products of the bacterial decomposition of sugars cause de- mineralization of the enamel, leading to dental caries. Newly erupted teeth with immature enamel are highly susceptible to developing caries. A baby is not born with the oral bacteria that cause cavities, but may acquire the bacteria from its mother or caregiver through sali- vary contact (e.g., by sharing utensils) or from other children in daycare (e.g., by sharing things that have made oral contact with others).

Effects of Caries

Infants or toddlers with caries have a much greater probability of subsequent caries in both the primary teeth and the permanent teeth. The ramifications of untreated cavities are many and are varied. If the child’s condition remains untreated, dental health deteriorates and is more difficult and costly to treat. Severe cavities may lead to extreme pain, discomfort, acute and chronic infections, and altered eating and sleeping habits. Because of the associat- ed pain with cavities, and lack of desire to eat, young children may be underweight. A young child with rampant early childhood cavities may weigh less than 80% of their ideal weight and grow at a slower rate than dental caries-free infants. Cavities leading to tooth loss have psy- chological, social and physical effects, including impaired speech development, absence from school, and lowered self-esteem.

Childhood Caries

As compared to permanent teeth, newly erupted baby teeth are particularly susceptible to cavities. The enamel and underlying dentin of baby teeth are thinner than permanent teeth and the progression of a cavity to the inner pulp occurs more rapidly in baby teeth. Cavities, missing teeth, and tooth restorations on toddlers and preschool age children are a particularly challenging situation.

Early childhood caries (“ECC”) is defined as one or more cavities or missing teeth, due to cav- ities in a child under age six. ECC is a multifactorial disease with a multitude of causes. Diet is an important factor, principally, the consumption of fermentable carbohydrates and the length of time of exposure of teeth to sugar. Bottle feeding and sleeping with a bottle of sweetened drink has been correlated with ECC. Although breast milk is considered the per- fect nutrient for an infant, prolonged and nocturnal breastfeeding has also been associated with ECC.

What Can Parents Do?

Parents may need to refine their feeding behaviors, such as shunning ad libitum (on demand) breastfeeding after the eruption of the first primary tooth, avoid putting a child to sleep with a bottle containing fermentable carbohydrates, (i.e., milk or juice), weaning the child from the bottle at 12 to 14 months of age, encouraging the child to drink from a training (sippy) cup, and avoiding between meal snacks. Plain water before bedtime or naps is the most ideal drink.

Fluoride, either in a tooth paste or in water, has a positive effect on reversing the process of ECC, as it promotes re-mineralization of the tooth surface, as opposed to bacterial acids which promote de-mineralization of the tooth surface.