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The Informed Parent

Early Childhood Caries

by Shanna R. Cox, M.D., F.A.A.P.
Published on Oct. 21, 2013
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Frequently, during the four-month well check examination, parents will point out to me that their infant is drooling profusely and sucking on anything that finds its way toward the mouth. These behaviors lead to a discussion of the teething process. Infants may start teething at four months of age. However, the teething process is highly variable and may not begin until many months later. Drooling and sucking are appropriate behaviors that are not necessarily predictive of teething in as much as they are of an infant’s developmental stage.

Usually the middle bottom two teeth are the first to appear. Parents may note the gums swelling and blanching before a pearly first tooth emerges. It is at this point that dental health care should begin. This entails a number of preventive measures parents must take to ensure the long-term health of their child’s teeth. Although this first set of teeth will ultimately be lost, their care sets the stage for good lifetime oral health.

Early Childhood Caries are a large public health problem generally misunderstood. The American Academy of Dentistry defines ECC as one or more decayed teeth in a child less than six years of age. These decayed teeth may be yellowed or brownish in color, cavitated, or lost due to disease. ECC are often mistakenly referred to as ”bottle caries”, which erroneously defines only one cause behind this multifactor illness.

Maternal health in the third trimester of pregnancy starts the foundation for healthy tooth development. Maternal malnutrition or drug abuse may lead to a low birth weight infant whose gums may not have sufficiently developed. This gum hyperplasia combined with insufficient enamel development leaves new teeth more vulnerable to disease. Additionally, close contacts to the baby may be carriers of virulent strains of a particular bacteria called streptococcus mutans that cause tooth decay. These factors, in combination with the more well recognized practice of putting an infant to bed with a bottle or sippy cup, are all underlying factors in the manifestation of ECC. Less well known along these lines is that constant breast-feeding on demand may also contribute to ECC.

Many parents feel that primary teeth are not as important as secondary teeth since they will be lost relatively quickly. This is not the case. Among the dental communities it is well known that infants who develop ECC are more likely to develop caries in the permanent teeth. ECC are also associated with decreased growth rates and increased rates of other systemic diseases. Treatment of ECC may range from extraction to crown placement in order to arrest the spread of the disease. Future therapies may include topical sustained fluoride  released glass implants that may also release antibacterial agents directed particularly against streptococcal mutans.

Primary preventive strategies are multiple. Health care providers must emphasize the importance of maternal nutrition throughout pregnancy. Family members of new infants must have good dental health as well, so as not to pass on cariogenic bacteria inadvertently through their contact with the new baby. Parents should be advised to avoid putting children to bed with a bottle or cup in their mouth. This included the technique known as ”bottle propping”. Breastfeeding mothers must avoid constantly having the infant to breast. Both breast milk and formula will leave residue on a child’s teeth that can feed bacteria in a child’s mouth, leading to tooth decay. Perhaps most importantly is the simple recognition that dental health begins early and is a topic ripe for frequent discussion.




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