Early Childhood Caries

Early childhood caries, in simple words, is any sign of dental caries on any tooth surfaces during the first 3 years of age. It has multifactorial etiology including bacteria, diet and oral hygiene. 

Early childhood caries can be described as  a unique pattern of tooth cavities in infants, toddlers and preschool children. They are preventable and unlike caries in adult permanent teeth, early childhood caries, preferentially, affect the primary front teeth. 

The term early childhood caries covers previously used terms like baby bottle tooth decay and nursing caries. These terms refer to a form of rampant caries in baby teeth which is caused by prolonged use of milk bottles or other drinks which contain carbohydrates (sugar).

A regular visit to a Brisbane Kids Dentist can help prevent these caries

Early childhood caries can occur in baby tooth because of:

• Prolonged milk bottle feeding
• At-will breast feeding
• Frequent use of sweetened syrup medicine
• Use of pacifiers coated with sweeteners
• Grazing
• Not eating at discrete mealtimes
• Adding sweets to milk bottle
• Juice in sippy cups
• Frequent snacking on sweet food
• Development defects of the enamel
• Poor oral hygiene
• Transmission of bacteria causing ECC from parents or caregivers

The teeth most affected by early childhood caries are the upper front teeth. When children fall asleep with a milk bottle left in their mouth, they are at the risk of this disease.

Early childhood caries has been described in 1990 and is defined as having one or more filled, decay or missing teeth due to caries in children younger than 6 years of age. Early childhood caries remains the most prevalent chronic disease in children with significant impact on society. Sever early childhood caries is used for children younger than 3 years of age.

Bottle feeding for long periods of time or while falling asleep can lead to tooth decay and cavities. Drinking from a bottle while lying flat on the back can also lead to the middle ear infection. Prolonged bottle feeding can also lead to the child finding security with the bottle, especially in children older than one years old.

At-will breast feeding should be avoided after the first primary teeth begin to erupt. This can reduce the risk of early childhood caries. Parents should discourage on-demand breastfeeding because it may give rise to caries.

Early childhood caries can occur in breast-fed infants who are nursed every time the child indicates a desire for feeding, also known as demand feeding which means approximately more than 10 nursing events over a 24 hour period. This form of caries can result in a severe oral decay in young children.

Dental caries may occur in toddlers well before 3 years of age. Any sign of smooth-surface caries in children younger than 3 years of age is indicative of severe early childhood caries (S-ECC). According to the American Academy of Paediatric Dentistry, from age 3 through 5, one or more cavitated tooth, Missing due to caries or filled smooth surfaces in primary maxillary front teeth or a decayed, missing or filled scope of >=4 (age 3), >=5 (age 4) or >=6 (age 5) surfaces constitutes a severe early childhood caries.

Early childhood caries are primarily due to continual and prolonged exposure of the baby teeth to milk, infant formula, fruit juices and other food and drinks containing sugar. Screening for early childhood caries is essential for preserving the baby teeth. Routine paediatric dental care can pick up the caries before the progress into large cavities. Early childhood caries is a form of caries but it can be a virulent form of caries and begin soon after the eruption of the baby teeth. It can develop on smooth surfaces and progress rapidly and damage teeth permanently.

Studies have shown children with elevated levels of cariogenic bacteria such as S. Mutans have a higher risk of tooth decay. These bacteria can use the sugar in the food to make an acid that will dissolve the enamel of the tooth and start the process of tooth decay.  It is important to know that these bacteria can be transmitted from mother to child. This is called vertical transmission. Transmission of the bacteria can also occur horizontally (e.g., between other members of a family or children in daycare).

Another reason is feeding habits. Although breast milk is the best source of food for your infant, if breastfeeding is continued for more than 12 months, it can increase the risk of tooth decay. On-demand feeding and feeding during the night can also contribute to this problem.

Drinking juice or milk through the day in a sippy cup also has a deleterious effect on the teeth as it provides a constant favorable environment for bacteria to produce acid.

Frequent snacking especially on sweets also produces a perfect environment for the bacteria to produce acid.

Children with defects of the enamel of the teeth are more prone to tooth decay. These defects are usually due to disturbances as the tooth is forming and are called defects of the enamel. They may appear as white/ yellow/ brown opacities on the tooth. Some defects can manifest as small parts of the tooth missing. These areas are great for bacteria to accumulate and cause tooth decay.

A study that was conducted in 1992 reported that children with early childhood caries have a significantly lower mean body weight.

It is important to note that children with caries in their primary dentition are 3 times more likely to have caries in permanent dentition.

As we all know prevention is better than cure.

Dental caries is a process and the end product results in a hole in the tooth. If the process can be arrested or slowed down holes will either not appear or appear much slower or later in life.

If you are thinking about having a baby or you are an expecting mum you can reduce the number of S. Mutan bacteria in your mouth by treating all active carious teeth. This will reduce the chance of vertical transmission of the bacteria from you to your baby. Subsequently, active carious lesions in other family members (e.g., dad and siblings) should also be treated to prevent horizontal transmission of the bacteria. Maintaining good oral hygiene practice and limiting sugary food will have an important role in having low levels of this bacteria in your mouth.

The American Academy of Pediatric Dentistry recommends that each child should have a dental home at 6 months of age and no later than 12 months. This will provide an opportunity for anticipatory guidance from the dental health professional to the parents. Risk assessments are performed and preventive care suitable for each child is carried out.

Avoiding frequent consumption of liquid and/or solid food containing sugar, in particular:

• Sugar-sweetened beverages (e.g., juices, soft drinks, sports drinks, sweetened tea) in a baby bottle or no-spill training cup.
• Ad libitum breastfeeding after the first primary tooth begins to erupt and other dietary carbohydrates are introduced.
• Baby bottle use after 12-18 months.

Caregivers should start brushing children’s teeth as soon as the first tooth erupts with a soft, age-appropriate toothbrush. Australian guidelines do not recommend the use of toothpaste until the age of 18 months. However, a high-risk child for tooth decay may be advised to use fluoridated toothpaste from a younger age. This will need to be assessed by a health care professional and after a thorough assessment, the decision is made as to what strength toothpaste is required.

Defects of the enamel are sometimes hard to spot, and a health care professional has been trained to specifically look for these defects. Mild defects can be monitored and maintained with preventive care such as topical fluoride application. Some defects may benefit from fissure sealants and more severe defects may need full coverage such as stainless-steel crowns or composite crowns. Children with defects of the enamel are 4 times more at risk of developing caries compared to children with no defects of the enamel.

The early stage of caries development is called incipient lesion or a white spot lesion. Dentists can identify these lesions very early on and by the correct preventive care and guidance, these lesions can be arrested so no filings are required.

Early childhood caries are usually not a life-threatening disease and they are also preventable. The disease affects primary teeth in children 71 month of age or younger. It refers to the presence of the below in any primary teeth:

• One or more decayed tooth
• Missing tooth due to cavities
• Filled tooth surfaces

Early childhood caries can develop rapidly from the age of around 8 months, therefore an appropriate prevention can result in the elimination of many major dental problems in toddlers and hopefully less decay in childhood. If early childhood caries is left untreated, caries can usually damage most of the teeth and attack the nerve of the tooth and cause significant pain. Also infection in baby teeth can disrupt the healthy development of the permanent teeth.

Early childhood caries can develop as soon as teeth erupt but it is a prevalent disease. A high level of dental disease in early childhood is associated with an increased demand for dental treatment under general anaesthesia. If early childhood caries are not addressed, they can adversely affect the secondary teeth and its consequences can extend through the lifespan. 

Most of the children undergoing dental extractions under general anaesthesia are aged between 3 to 8 years old. Dental treatment under general anaesthesia can make parents anxious. 

Dental treatment under general anaesthesia usually includes the process below:

The paediatric dentist takes required radiographs to determine the overall status of caries in the primary teeth. This step is an essential part of the treatment and provides important input for the treatment planning.

It should be noted untreated caries in children can lead to infection. Some infections can be very severe causing swelling of the face. This spread of infection is called facial cellulitis and has the risk of spreading to the eyes, brain, and mediastinum. In the case of facial cellulitis children will need to be admitted to the hospital to have intravenous antibiotics and possibly treatment under general anesthesia. An emergency dental appointment is stressful for the child and the parents and can be easily prevented by regular check-ups and preventive care. you can use this article for how to prepare a child for a dental visit.

When pulpotomy is not  indicated, the paediatric dentist may recommend extraction of the tooth.

When the extraction of a baby tooth is necessary, the paediatric dentist considers whether balancing extraction is required or not. 

When extraction of primary tooth under general anaesthesia is indicated, other primary teeth of poor prognosis are also extracted to avoid future problems or a repeat in anaesthetic treatment.

Following the extraction of a second primary molar, a space maintainer may be fitted to prevent the drift of the first permanent molar providing that the patient is a regular attender and is at low risk of caries. Patients’ age is also an important factor in determining the need for a space maintainer.

For the treatment of permanent teeth under general anaesthesia, when an extraction is indicated, the dentist assesses the status of the other molars. An orthodontic opinion may be required before the extraction is undertaken. The reason for this is to see if any other teeth should be removed at the same time.