What is Early Childhood Caries?
Early childhood caries (ECC) refers to the presence of tooth decay or cavities in the primary or “baby” teeth of young children. This condition is defined by one or more decayed, missing (due to decay) or filled teeth in children aged up to 71 months.
The term early childhood caries also encompasses conditions often referred to as nursing caries and rampant caries. Names like “baby bottle syndrome,” “nursing caries,” or “bottle mouth caries” describe a specific pattern of tooth decay where the baby’s upper front teeth (incisors) and back teeth (molars) are severely affected. One distinguishing factor of this type of tooth decay is that the lower front teeth are typically untouched and can be completely healthy or only slightly affected. The term rampant caries is typically reserved for children aged three to four years old with extensive tooth decay that does not match the pattern of nursing caries.
While it’s unfortunate that early childhood caries, which can easily be prevented, it is one of the most common diseases in children globally. It predominantly affects disadvantaged communities.
What Causes Early Childhood Caries?
All forms of tooth decay, including one called Nursing Caries, all come about from a mix of three things happening over an extended timeframe: bacteria that cause tooth decay, sugars that these bacteria feed on, and teeth that are susceptible to decay.
Two types of bacteria, Streptococcus mutans and Streptococcus sobrinus, are usually found in Early Childhood Caries (tooth decay). Another bacteria, Lactobacilli, while not a cause, can make tooth decay worse. These bacteria use sugars such as sucrose, fructose and glucose to make lactic acid, which reduces the pH level in the mouth leading to enamel on the teeth being gradually worn away. This eventually wears down into the dentin—a hard substance below the enamel—and cavities form.
Children who get certain harmful bacteria, like Streptococcus mutans, earlier in their lives are more likely to experience tooth decay. This is especially true for very young kids even before their first tooth comes out. It’s a critical time to take preventive steps since it can lower the chances of harmful bacteria growing in the mouth.
Streptococcus mutans can be passed straight from mother to child through shared saliva and eating utensils. Bad habits like chewable tobacco or betel-nut also spread these bacteria. Kids born through c-section are at a higher risk of getting cavities, possibly because the bacteria find it easier to settle in their mouths. Research has shown that a mother’s level of Streptococcus mutans in the mouth are usually reflected in their child’s mouth. The transmission of these bacteria is also seen between siblings and caregivers.
Specific feeding practices and dietary habits have been linked to Early Childhood Caries. For example, children who are frequently fed sugary foods or rice pre-chewed by the mother, or fall asleep while breastfeeding are more likely to get cavities. However, breastfeeding beyond twelve months without these habits was found safe. The use of bottles during daytime naps or nighttime sleep times and continuing breastfeeding at night after twelve months are risk factors for early childhood caries.
Kids who consume sweet drinks and foods between meals or fall asleep with a bottle often get cavities more often. This is because there’s less saliva—nature’s own mouthwash—when we’re asleep, and combined with a sugary environment, it heightens the risk for cavities.
Other factors, such as enamel hypoplasia—a condition where the teeth’s protective coating is underdeveloped—is a big risk element for early childhood cavities as it becomes an easier site for these harmful bacteria to grow.
Children with high blood sugar levels such as in juvenile diabetes or those with special needs who may struggle with oral hygiene are more likely to get cavities. Also, cancer patients often eat sugar-containing lozenges to stimulate salivary flow, which increases their risk of tooth decay.
Kids from lower-income families are more commonly found with early childhood cavities. A few contributing reasons could be poor nutrition before and after birth, lower levels of education correlating with poorer oral hygiene and higher sugar intake, difficulty in accessing dental care, and lack of fluoride exposure.
There have also been associations between kids exposed to tobacco smoke at home and tooth decay; this, however, might be linked to the socioeconomic background of the parents.
Risk Factors and Frequency for Early Childhood Caries
Early childhood cavities, also called caries, are most commonly found in people with low income. This health issue is more prevalent in developing countries and underprivileged groups in developed nations, with a prevalence rate as high as 70%. On the other hand, in developed countries, the rate is between 1 and 12%. In the United States, about 3 to 6% of children have early childhood cavities.
- Early childhood caries are more common in children aged 3 to 4 and in boys.
- Having a young mother and belonging to an ethnic groups are also risk factors for developing these cavities.
Signs and Symptoms of Early Childhood Caries
Nursing caries, a type of childhood tooth decay, typically affects the four upper front baby teeth, while the lower front teeth often remain healthy. However, other teeth can be involved, though usually less severely. Kids with this condition often feel pain and have difficulty eating.
At first, parents may fail to notice the initial sign – a white band around the gum line of the upper front teeth. That band gradually progresses into cavities appearing as a dark collar around the tooth. The bottom front teeth, by contrast, typically remain unaffected and are either completely healthy or only mildly decayed. In severe cases, the upper front teeth can be so damaged that only the root remains.
Testing for Early Childhood Caries
Children with Early Childhood Caries (ECC) need detailed check-ups. Poor dental health can have impacts reaching beyond just the mouth. Cavities can impact a child’s ability to eat, drink, and talk. It can even affect their social interactions and overall physical, mental, and emotional development.
A detailed dental check-up is done using special X-rays taken from inside the mouth or using a panoramic x-ray technique. It’s important to evaluate the health status of the pulp (the inner part of the tooth), to plan suitable treatment. Doctors may also need to perform further tests like a complete blood count (CBC).
Treatment Options for Early Childhood Caries
Treating early childhood cavities (ECC) is a complicated process. It depends on many things like the child’s age, how bad the dental damage is, and any other complications.
In minor cases, where there are just white spots or small areas of weakened enamel, a complete restoration might not be necessary. In such instances, the dentist can help prevent more decay from happening by educating the parents, giving nutritional advice, and using topical fluoride.
A particular kind of fluoride called resin-based fluoride varnish is highly advised. Other forms of fluoride, like that found in toothpaste, gels, mouthwashes, and drops, have a short-lived effect. On the other hand, fluoride varnish hardens onto the tooth’s surface after application, providing a protective coat for about a week, or even longer on demineralized (weakened) areas of the tooth. This type of protection is excellent to prevent further tooth weakening.
Chlorhexidine varnish can also be applied to shield the tooth surface. Some experts also advise using 10% povidone-iodine every two months for its bacteria-killing property, specifically against Streptococcus mutans, a type of bacteria that often causes decay.
Using casein phosphopeptide (CPP) can help form a special combination of calcium and phosphate called amorphous calcium phosphate (ACP). This combination can greatly enhance fluoride action and improve the repair process of the enamel, protecting the tooth even further.
In moderate to severe cases, the child might need pulp treatment, intensive restoration, or tooth extraction. In these situations, the child might need to be deeply sedated or put under general anesthesia because of their young age hindering compliance.
The preferred method of restoration is by using pre-made stainless steel crowns designed for baby teeth or permanent teeth with cavities.
A newer approach to treatment focuses on prevention rather than just repairing the damage. Traditional restorative and surgical methods require costly general anesthesia, and it only treats the damage caused by the disease, not preventing further decay. That explains why up to 79% of patients treated with conventional therapy relapse. The new approach to ECC management includes parental involvement, preventive programs with constant monitoring of the condition, temporary restorations, and postponing advanced restorations.
What else can Early Childhood Caries be?
Tooth decay in early childhood is quite noticeable, but sometimes it can be confused with other conditions that affect tooth development. These include fluorosis (where high levels of fluoride affect the teeth), and two genetic conditions: amelogenesis imperfecta (which causes poor enamel formation) and dentinogenesis imperfecta (which affects the dentin, the layer of the tooth beneath the enamel).
To confirm whether a child’s symptoms are caused by tooth decay or any of these other conditions, the dentist would look at factors such as the child’s medical history, where they live (as fluoride levels can sometimes be high in certain areas), and their diet.
It’s also important to remember that it’s possible for a child to have tooth decay and one of these developmental conditions at the same time. This could even make the tooth decay worse.
What to expect with Early Childhood Caries
The outlook for ECC, or early childhood caries, hinges on the stage at which it’s detected, the parents’ involvement, and the ability to maintain good hygiene and eating habits over time. If caught early, tooth decay can be halted through preventive actions and education. This stops decay and even reverses the damage, while also safeguarding healthy teeth.
However, severe ECC cases that go untreated can have serious consequences. These can include poor nutrition, long-term anemia, and slowed growth that can harm the child’s overall health and wellbeing.
Possible Complications When Diagnosed with Early Childhood Caries
Early Childhood Caries (ECC) can lead to significant discomfort in children, making it hard for them to eat or even speak sometimes. This can result in poor nutrition, which can further delay their physical development. Research has found that children suffering from ECC are generally shorter and weigh less compared to those who don’t have this condition.
Children with ECC often have visibly damaged teeth, which can impact their social and psychological well-being. This can eventually lead to a decrease in their performance at school.
These challenges frequently impact children from low-income families who do not have proper access to healthcare. This means that their caries isn’t treated and gets worse over time. Caries can lead to inflammations in the tooth pulp and severe dental abscesses. This can disrupt normal blood formation due to its impact on inflammatory processes, leading to chronic anemia and slowing down their growth.
Children with special needs face additional health problems from ECC. In severe cases, it can become a hotspot for streptococcal infections. This type of infection can turn lethal if it reaches a faulty heart valve, causing endocarditis. It can also spread to other organs and cause fever, pneumonia, or a urinary tract infection.
Preventing Early Childhood Caries
Early childhood tooth decay is a major global health concern, as the most common infectious disease in children. To help prevent this, health professionals should take several steps:
Firstly, we should realize that mothers can pass on Streptococcus mutans, the bacteria causing tooth decay, to their children. So, by keeping expecting mothers’ oral health in check and offering them advice about dental care could reduce the risk of their children getting tooth decay. It’s also advised that pregnant women avoid sharing eating utensils, toothbrushes, and food with kids, and should avoid licking their pacifiers.
Secondly, it’s crucial to teach parents and caregivers about maintaining their child’s dental hygiene. It’s found that kids who brush their teeth with fluoride toothpaste have fewer decay-causing bacteria. Thus, parents should start brushing their child’s teeth with a soft brush and fluoride toothpaste as soon as the first tooth appears.
Moreover, sugary foods and drinks play a big role in causing tooth decay. Fruit juice should be avoided for children under a year old, and older children should have it in limited amounts. It’s also important to avoid letting children sip on sweet drinks regularly, fall asleep with a bottle, or keep the breast nipple in their mouth while sleeping.
Lastly, for children with chronic health conditions, doctors should think about the potential of tooth decay when prescribing medicines that contain sugar. Parents are recommended to brush their child’s teeth immediately after giving them these medications.
