12ORAL HEALTH November 2012

Tooth Decay that affects children worldwide.

Oral Diseases

IntroductionOral health is one component of general

health and is an important factor in the

normal development of a child. Oral

health problems or illnesses can influence

the general development of a child and

its general health and can adversely

affect quality of life.

Early childhood cariesEarly childhood caries (ECC), also called baby bottle tooth decay or nursing mouth, can destroy your child’s teeth and become a serious mouth infection that can be life-threatening if left untreated.

ECC is the most common chronic

infectious disease of childhood

worldwide. Severe ECC can destroy the

primary teeth; cause painful abscesses

and is the major reason for dental

visits for young children. This condition

disproportionately affects severely the

disadvantaged socio-economic groups.

Infants and toddlers are most susceptible

to ECC and proper oral care goes a long

way in ensuring natural dentition for life.

Early childhood caries, or ECC, is a severe

Early Childhood Caries

form of cavities. It is another term for dental decay among infants and chil-dren. It is a very common bacterial infec-tion characterised by severe decay in the teeth. It is a serious and painful dental disease. It can quickly destroy your child's teeth. For the last fifty years, dentists and researchers have struggled to clearly define ECC. Dental decay on infants and children is known by other names as well such as baby bottle tooth decay (BBTD), baby bottle caries, infant caries and bottle rot, nursing caries or nursing bottle syndrome etc. ECC often occurs when your baby's teeth are exposed to sugars for long periods throughout the day. Its prevalence is epidemic. A large body of scientific evidence indicates that ECC is an infectious and transmissible disease. Streptococcus mutans, a group of bacteria, is the primary microbiologi-cal agent in the disease. A major reason for ECC is the limitless breast feeding at night as and when desired after the first primary tooth begins to erupt. ECC is said to cause dental decay of epidemic proportions in certain populations. It is a chronic childhood dental disease. The disease process begins with the transmis-sion of the bacteria to the child, usually

from the primary caretaker, the mother. Mothers with untreated dental disease present a very high risk to their children.

How tooth decay beginsEEC is a chronic and infectious oral disease of young children, most commonly seen in poor and minority populations. Factors such as improper feeding practices, familial socioeconomic background, lack of parental education and dental knowledge, and lack of access to dental care can contribute to and explain why the prevalence of ECC is so great in these select populations.

Tooth decay in children is usually painless until the decay reaches deep into the pulp. If the decay is left untreated, an infection can develop as food from the mouth enters into the tooth pulp.

Disease processBiologically, ECC is an infectious process. Prolonged exposure of sugars, such as those present in milk, formula, and fruit juice, causes damage to the teeth’s surface. The practice of putting a child

13 ORAL HEALTHNovember 2012

to sleep using the bottle at naptime or bedtime exposes sugary fluids that may pool around a baby or child’s teeth for hours. The longer that the sugary liquids come into contact with the tooth’s enamel, the more likely it is for these sugars to combine with bacteria in the mouth.

Baby bottles with fruit juice or milk both contain sugars. When these liquids are in the mouth, bacteria start eating the sugars and then produce acids. These acids cause decay if they remain on teeth long enough. The teeth that get affected initially are the top front teeth.

Early childhood caries can occur if your child:

• is put to bed with a bottle filled with any liquid other than plain water

• drinks from a bottle filled with sugary liquids or milk during the day

• receives a pacifier dipped in sugar, honey or a sweet liquid

Normal breastfeeding has not been shown to cause dental cavities. However, breastfeeding for long periods of time can still put your child at higher risk for dental decay.

Remember, it's not just what your baby is drinking, but how often. Longer the time liquids (other than water) remain in a baby's mouth, the higher the risk. This is why it is dangerous to let your baby go to sleep with a bottle or use a bottle as a pacifier during the day. The teeth most often affected by ECC are the upper front teeth. But others can decay, too.

Tooth decay can occur much more easily if there are large numbers of cavity-causing bacteria living in your child's mouth. One of the most dangerous types of cavity-causing bacteria is Streptococcus mutans. In the mouths of children with no or little tooth decay, S. mutans makes up less than 1% of the mouth's bacteria.

But in children with ECC, it makes up more than half the bacteria.

S. mutans is common. It is passed from parent to child, usually when a child is between 6 and 31 months old. Keeping your own mouth healthy and free of cavities can help your child's mouth stay healthier, too.

The top front teeth usually are the first ones affected by ECC. Often, the cavities start on the backs of the teeth. The top teeth farther back in the mouth are affected next. Finally, the bottom back teeth get cavities. The lower front teeth usually do not

get cavities. These teeth are covered by the tongue, which keeps liquids away. These teeth also are close to large salivary glands, so they are bathed in saliva. Saliva helps wash away sugars and bacteria.

Decayed teeth that are not fixed can

cause pain and infection. Teeth that

are very badly decayed may need to

be removed. Tooth decay is a bacterial

infection, and it can spread if it is not

treated. Also, the permanent teeth under

the gum can be affected if the decay is

not treated.

Factors causing ECCFactors such as improper feeding practic-es, familial socioeconomic background, lack of parental education and dental knowledge, and lack of access to dental care can contribute to ECC. The preva-lence of ECC in children, ages three to five years, in US is reported to be as high as 90%. In developing countries ECC is a critical problem as well, heightened by extraneous factors such as low income or malnutrition. The prevalence of ECC in these countries is reported to be as high as 70-80%. Untreated caries may lead to early loss of the primary denti-tion and affect the growth and matura-tion of the secondary, adult dentition. In

fact, decay in the primary detention is the best predictor for decay in

the secondary dentition; poor dental health and disease

often persist to adulthood, affecting speech articula-tion, growth, and dietary practices. At the most extreme of cases, ECC can also lead to ram-pant decay, infection, pain, abscesses, chew-ing problems, malnu-trition, gastrointestinal disorders, and low self-

esteem. Children with ECC are shown to have

an elevated risk for new le-sions as they get older, both

in the primary and permanent dentitions.

Here are some tips on preventing early childhood caries:

• Don't put your baby to bed with a bottle unless it is filled with plain water. Even watered-down fruit juice or milk can increase the risk of decay.

• Talk with your doctor about weaning your infant from the bottle when he or she is 12 to 14 months old.

• During the day, don't use a bottle to comfort your baby unless it's filled with plain water.

• Don't dip your baby's pacifier in sugar or sugary liquids.

Oral Diseases

14ORAL HEALTH November 2012

• Don't add sugar to your child'sfood.

• Clean your baby's teeth andgumswithadampclothorasofttoothbrushaftereachfeeding.

• Clean your baby's teeth andgumswithadampclothorasofttoothbrushaftereachfeeding.

• Take your baby to the dentist assoonasthefirsttoothcomesin.

• Teach your baby to drink from acupbyhisorherfirstbirthday.

• Makesureyourbabyisgettingtheright amount of fluoride. If yourdrinking water does not containfluoride, ask your doctor ordentist about fluoridesupplements.

Stages of diseaseDepending on theprogression of car-ies, there are vari-ous disease stageswhich each requireappropriate treat-ment. A very earlysign of caries devel-opmentisthebegin-ningsoftoothdemin-eralization, the slightpenetration into toothenamel,which is typicallyvisualized by chalky whitespots or lines. In this prema-ture stage, white spots or linescanbereversibleandcariesprogres-sioncanbepreventedwithpropercare;fluorideapplicationanddietchangesarelikely tobebeneficial to the re-mineral-ization and protection of teeth. Furtherdecay of the teeth from the enamel tothedentinis,obviously,morecritical.

TreatmentDentalcariesaregenerallypainlessuntilthedecaybecomesverylargeinsidethetoothanddestroysthenervesandbloodvessels in the tooth. If the decay is leftuntreated, a tooth abscess can developandtheinternalstructuresofthetooth,thepulp,canbedestroyed.Decaytothetooth’s inner pulp is extremely critical

because thepulp ismadeupofnerves,connectivetissue,andbloodvesselsthathelpnourishthetooth.

Oncetoothdecaysetsin,arestorationorfillingisusuallyrequired.Evenmoresig-nificant decay to the teethmay requiretreatment as serious as steel or veneercrowns, inwhich thedecayedorweak-enedarea isremovedandrepairedwitha ‘cap’ or crown that is fitted over theremainderofthetooth.Crownsareap-plied if decay is extensive and there islimited tooth structure that may causeweakenedteeth.

the health of teeth, predominantly inyoung children. It is an effective, safe,andlow-costwaytopreventandprotectagainst the occurrence of tooth decay.Water fluoridation done in developedcountriesisparticularlyimportantinden-talpreventionbecauseithelpsthebaby’steeth develop strong, hard enamel thatbetterresistsdecay.Asyourchildgrowsolder, using dental products that con-tain fluoride to provide additional dailyprotection to the tooth surface is alsorecommended.

Propernutritionandfeedingyourbabyin

anappropriatemanner,alongwithregu-

lardentalvisits,isthebestwaytoprotect

yourbaby’soralhealth.

Dental sealants

Thechewingsurfacesarewhere

decayoftenoccurs.Adental

sealantorapitandfissure

sealant isamaterial that

is placed on the chew-

ing surfaces of back

teeth, the molars,

to prevent caries.

Sealants smoothen

thechewingsurfaces

ofteethbyfillingthe

groovesofbackteeth

susceptible to carries

because of trapped

foodandbacteria.

Dietary practices

Sugar plays a huge role in

thedevelopmentandprogres-

sion of ECC. Feeding children

with sweetened beverages coupled

withpoorhygienehabitsaredetrimental

tothechildren’steeth;sucrose,fructose,

andglucosefoundinfruitjuicesandvita-

minCbeveragesarethemainsugarsas-

sociatedwithinfantcaries.Thesesugars

cause demineralization. Breastmilk and

cowmilkdonotcausechildhood tooth

decay.

ConclusionECCisachronicandinfectious,butpre-

ventable,disease.Ensuringproperdiet,

establishinggoodoral hygiene andgiv-

ing necessary fluoride treatments are

helpfulinpreventingECC

Oral Diseases

Preventative measures Fluoride

It is important to implementpreventionmethodswhendealingwithcaries,par-ticularly at an early age. Caries do notcompletely form at one time; rather ittakesmonthsorevenyearsbeforetheyappear.Perhapsthemostprovenandef-fectivemethodinthepreventionofcar-iesistheregularuseoffluoride.Fluorideisessentialwhenitcomestomaintaining

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