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Lesson 3: Early Childhood Caries

Overview: The health care provider will gain an understanding of early childhood caries (ECC), its causes and influencing factors.

Goals: The health care provider will be able to describe:

¬ Early Childhood Caries (ECC) is the development of severe toothdecay in infants and young children

¬ Risk factors for ECC include socio-economic status, feeding habits,genetics, and caregiver oral health

¬ ECC primarily affects the 4 upper front teeth, but lower teeth andmolars and canines are often affected as well

¬ Most cases of ECC can be managed if detected early and properdietary, behavioral, and oral health habits are practiced

Key Terms:

Early Childhood Caries: infectious disease that initially affects (ECC) the teeth of infants and young children;

rapidly developing type of decay thatprimarily affects the 4 upper front teeth,although lower teeth and molars mayalso be affected.

Baby Bottle Tooth Decay: nursing bottle or nursing mouth(BBTD) syndrome-

terms formerly used to describe ECC.The current term, ECC, is moreaccurate as many factors may impactthe decay process

Permanent Teeth: second set of teeth that erupt into a

person’s mouth; also known assecondary or adult teeth

Primary Teeth: first set of teeth that erupt into aperson’s mouth; also known as baby ordeciduous teeth

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Development of Early Childhood Caries

Early Childhood Caries involves the development of caries in infants and youngchildren, often to a severe degree. At first white spots may be noted on theupper incisors. Later, brown areas adjacent to the gum line are frequently seen.Finally the teeth may break off leaving brown or black stumps. Eye-teeth(canines) and molars often become involved as well. This risk for disease canstart as soon as the teeth begin to erupt into the mouth, anywhere from 4 monthsto a year.

If the condition is noted when there is merely a white line at the base of the tooth,the decay process may be halted. The white band indicates that the enamel hasbeen decalcified, leaving the surface less resistant to further breakdown. Iffluoride is applied on a regular basis at this point, this tooth structure can beremineralized and, in some cases, the integrity of the enamel reestablished,provided dietary and oral care changes are made to reduce the bacterial burden.Once the tooth has brown areas, however, it will usually need to be restored by adentist. This can be difficult with a young child or infant who may be unable tocooperate for the needed care.

Decalcification Early decay Lingual decay Advanced decay

Who is at Risk?

Research has shown the percentage of children in the following age groups thathave dental decay:

One year olds: 6%Two year olds: 22%Three year olds: 35%Four year olds: about 50%

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It has also been shown that 20% of the population has 80% of the decay. Incertain populations, including those in the lower socio-economic strata, up to25% of the children may have ECC. As many as 65% of parents and caregiversin these populations use feeding practices that may put their infants at risk forECC.

Eating Habits that Affect Risk

Eating habits are a major contributor to the pattern of ECC. The quality of food,as well as the frequency at which it is consumed, affects the risk of ECC.Children with this problem commonly are allowed to nurse at will, especiallythroughout the night, or are put to bed with a bottle or sippy cup, usuallycontaining formula, milk, juice, or other sweetened drink. This frequent exposureto sweetened liquids creates an ideal environment for mutans streptococci tomultiply and thrive. Sugary liquids tend to pool in the mouth when the child fallsasleep after feeding. While the child slumbers, there is less saliva flow and oralactivity. Thus the damage is prolonged as the acid has time to decalcify theteeth. And, although breast milk provides many protective agents, includingantibodies and antigens that help keep the mouth healthy, repeated exposures tobreast milk, along with other sugars in the diet can also result in ECC.

The habitual use of a sippy cup, or bottle, throughout the day (and/or night) islikely to lead to caries, unless it contains only plain water. Starchy foods andsweet beverages provide substrate for the biofilm’s bacterial components toproduce destructive compounds if the plaque is not removed on a frequent basis.

Poor Home Care Affects Risk

Poor oral hygiene is a common finding in children with ECC. Heavy amounts ofplaque are often seen on the teeth. Ineffective and infrequent brushing iscommonly a factor in the development of this disease. It is essential that twicedaily brushing and daily flossing are routine practices for this disease to becontrolled. The daily physical removal of plaque will help these children reducetheir risk of severe infection.

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Complications from ECC

Healthy primary teeth are important for many reasons. Children who begin theirlife with ECC are at risk of the following conditions:

• Painful infections• Compromised ability to chew a healthy diet• Problems with development of their permanent teeth and dental

arches due to infection and/or early loss of primary teeth• Dental disease in their permanent teeth• Affected speech due to missing dentition• Abnormal development of facial structure

Prevention Reduces Risk

The use of fluoride on a daily basis, via drinking water supplies or oralsupplements, has been shown to reduce the incidence of dental decay bymaking the tooth more resistant to demineralization. Topical applications offluoride are also beneficial, but require the care of a dental health care provider,to which many children have little access.

Regular professional care and oral health education are effective means toimprove the chances for a healthy mouth. The lack of available options for adental home for many children as well as the lack of education on the parent’spart regarding the importance of oral health care or parental anxiety regardingdental care may cause underutilization of preventive oral health services forchildren.

When the caregiver has a high rate of oral disease, the child will benefit if theirdisease is treated. Oral antibiotic mouthwashes can be prescribed for thecaregivers of children at high risk, to help reduce the caregiver’s bacterial load.Ideally the caregivers will have their dental disease treated by an oral healthprofessional.

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Pacifying the infant using alternatives to the bottle or breast is important in thedevelopment of healthy parenting skills and a harmonious parent childrelationship. A difficult challenge for new parents relates to sleep. Parents,when sleep deprived, look for the easiest means to help their child settle downfor a nap or the night. Rather than feeding to calm a child, the followingapproaches may be used:

Holding, patting or rocking the child Reading or singing to the infant Using a pacifier Providing a favorite toy or blanket Talking softly Letting the child cry, when first put to bed

If these methods do not work in a short time, the child’s physician should beconsulted.

If the parents choose to pacify a child with a bottle or sippy cup, plain water canbe used. If the child is used to juice, milk or other sweetened liquids in the bottleor sippy cup, it may be necessary to dilute the liquid over a week or two until theinfant is used to water alone. Water should only be used for the young infant ifapproved by the infant’s physician.

During meals children should have milk or juice. Once they are old enough to sitby themselves, they can use a regular cup, or a valveless sippy cup if that ismore convenient for the parent. They should not be permitted to routinely use asippy cup or bottle throughout the day, unless it contains only water. Children doneed frequent (5-6) meals during the day. If a child is thirsty, water will satisfythat need and impact the teeth in a healthy way.