Early childhood caries
Encyclopedia
Early childhood caries, also known as baby bottle caries, baby bottle tooth decay, and bottle rot, is a syndrome
characterized by severe decay in the teeth
of infant
s or young child
ren. Early childhood caries (ECC) is a very common bacterial infection. Its prevalence is epidemic; in the US its rate is highest in minority and rural populations, at times infecting over 70% of the children. A large body of scientific evidence indicates that ECC is an infectious and transmissible disease, with Streptococcus mutans the primary microbiological agent in the disease. The disease process begins with the transmission 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.
able carbohydrates (e.g., juice
, milk
, formula
, soda
) increases the risk of dental caries
due to prolonged contact between sugars
in the liquid and cariogenic bacteria
on the teeth. Poor feeding practices without appropriate preventive measures can lead to a distinctive pattern of caries in susceptible infants and toddlers commonly known as baby bottle
tooth decay (BBTD), a form of severe early childhood caries (ECC). Frequent bottle feeding at night, and extended and repetitive use of a no-spill training cup are associated with ECC. Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in primary
and permanent teeth
.
According to the American Dental Association
, "As soon as a baby's first teeth appear—usually by age six months or so—the child is susceptible to decay. This condition is often referred to as Baby Bottle Tooth Decay or Early Childhood Caries (cavities). In some unfortunate cases, infants and toddlers have experienced severe tooth decay that has resulted in dental restoration
s or extractions
. The good news is that decay is preventable.
"Decay occurs when sweetened liquids are given and are left clinging to an infant's teeth for long periods. Many sweet liquids cause problems, including milk, formula and fruit juice. Bacteria in the mouth use these sugars as food. They then produce acids that attack the teeth. Each time your child drinks these liquids, acids attack for 20 minutes or longer. After many attacks, the teeth can decay."
The ADA adds, "It's not just what you put in your child's bottle that causes decay, but how often — and for how long a time. Giving your child a bottle of sweetened liquid many times a day isn't a good idea. Allowing your child to fall asleep with a bottle during naps or at night can also harm the child's teeth."
The primary culprit for ECC is a group of bacteria called streptococcus mutans
. The American Academy of Pediatric Dentistry, in their Clinical Guideline for Infant Oral Healthcare, advises that "Caries results from an overgrowth of specific organisms that are part of normally occurring human oral flora
. Streptococcus mutans and Lactobacillus
species are considered to be principal indicator organisms of those bacteria responsible for caries. Human oral flora is site specific, and an infant is not colonized with normal oral flora until the eruption of the primary dentition
at approximately 6 to 30 months of age. The vertical colonization of S. mutans from mother to infant is well documented."
Research on preventing or delaying maternal transmission of these bacteria to children suggest that a comprehensive program of counseling, oral hygiene instruction, fluoride treatments, and restorative care are effective. Xylitol products also are promising.
It is a form of childhood disease
recommend that babies’ and toddlers’ teeth and gums be cleaned after every feeding or meal, starting from their teeth's first emergence.Preventive programs with young children should begin at the earliest time possible. Fluoridated water will have a very positive effect on this disease. Other chemotherapeutics found to be effective include topical fluoride (fluoride varnish), fluoridated dentifrice (toothpaste), and PVP-iodine.
Parental tooth cleaning, especially with a very small amount of fluoridated dentifrice, is helpful when accomplished at least once a day. Twice a day is even better. Given that fermentable carbohydrates provide fuel for the harmful bacteria, dietary interventions are appropriate, but very difficult to implement. A counseling approach, providing the parent with choices has been found effective. The sugar substitute xylitol
has been found to be effective at reducing levels of harmful micro-organisms in the mouth, and has recently been promoted as a cavity reducing agent in the form of disposable wipes.
According to an article in the Journal of the Canadian Dental Association, "Primary prevention of ECC has largely been restricted to counselling parents about caries-promoting feeding behaviours. This approach has also had minimal success. Newer strategies addressing the infectious component through use of topical antimicrobial therapy appear promising."
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...
characterized by severe decay in the teeth
Tooth
Teeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are embedded in the Mandible bone or the Maxillary bone and are...
of infant
Infant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...
s or young child
Child
Biologically, a child is generally a human between the stages of birth and puberty. Some vernacular definitions of a child include the fetus, as being an unborn child. The legal definition of "child" generally refers to a minor, otherwise known as a person younger than the age of majority...
ren. Early childhood caries (ECC) is a very common bacterial infection. Its prevalence is epidemic; in the US its rate is highest in minority and rural populations, at times infecting over 70% of the children. A large body of scientific evidence indicates that ECC is an infectious and transmissible disease, with Streptococcus mutans the primary microbiological agent in the disease. The disease process begins with the transmission 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.
Causes of early childhood caries
The American Society of Pediatric Dentistry says that frequent consumption of liquids containing fermentFermentation (food)
Fermentation in food processing typically is the conversion of carbohydrates to alcohols and carbon dioxide or organic acids using yeasts, bacteria, or a combination thereof, under anaerobic conditions. Fermentation in simple terms is the chemical conversion of sugars into ethanol...
able carbohydrates (e.g., juice
Juice
Juice is the liquid that is naturally contained in fruit or vegetable tissue.Juice is prepared by mechanically squeezing or macerating fruit or vegetable flesh without the application of heat or solvents. For example, orange juice is the liquid extract of the fruit of the orange tree...
, milk
Milk
Milk is a white liquid produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals before they are able to digest other types of food. Early-lactation milk contains colostrum, which carries the mother's antibodies to the baby and can reduce the risk of many...
, formula
Infant formula
Infant formula is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid . The U.S...
, soda
Soft drink
A soft drink is a non-alcoholic beverage that typically contains water , a sweetener, and a flavoring agent...
) increases the risk of dental caries
Dental caries
Dental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the...
due to prolonged contact between sugars
in the liquid and cariogenic bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
on the teeth. Poor feeding practices without appropriate preventive measures can lead to a distinctive pattern of caries in susceptible infants and toddlers commonly known as baby bottle
Baby bottle
A baby bottle is a bottle with a teat to drink directly from. It is typically used by infants and young children when a mother does not breastfeed, or if someone cannot drink from a cup, for feeding oneself or being fed.In particular it is used to feed infant formula, expressed breast milk or...
tooth decay (BBTD), a form of severe early childhood caries (ECC). Frequent bottle feeding at night, and extended and repetitive use of a no-spill training cup are associated with ECC. Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in primary
Deciduous teeth
Deciduous teeth, otherwise known as reborner teeth, baby teeth, temporary teeth and primary teeth, are the first set of teeth in the growth development of humans and many other mammals. In some Asian countries they are referred to as fall teeth as they will eventually fall out, while in almost all...
and permanent teeth
Permanent teeth
Permanent teeth are the second set of teeth formed in humans. There are thirty-two permanent teeth, consisting of six maxillary and six mandibular molars, four maxillary and four mandibular premolars, two maxillary and two mandibular canines, four maxillary and four mandibular incisors.The first...
.
According to the American Dental Association
American Dental Association
The American Dental Association is an American professional association established in 1859 which has more than 155,000 members. Based in Chicago, the ADA is the world's largest and oldest national dental association and promotes good oral health to the public while representing the dental...
, "As soon as a baby's first teeth appear—usually by age six months or so—the child is susceptible to decay. This condition is often referred to as Baby Bottle Tooth Decay or Early Childhood Caries (cavities). In some unfortunate cases, infants and toddlers have experienced severe tooth decay that has resulted in dental restoration
Dental restoration
A dental restoration or dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. It is also lost intentionally during tooth preparation to improve the...
s or extractions
Extraction (dental)
A dental extraction is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to render the tooth non-restorable...
. The good news is that decay is preventable.
"Decay occurs when sweetened liquids are given and are left clinging to an infant's teeth for long periods. Many sweet liquids cause problems, including milk, formula and fruit juice. Bacteria in the mouth use these sugars as food. They then produce acids that attack the teeth. Each time your child drinks these liquids, acids attack for 20 minutes or longer. After many attacks, the teeth can decay."
The ADA adds, "It's not just what you put in your child's bottle that causes decay, but how often — and for how long a time. Giving your child a bottle of sweetened liquid many times a day isn't a good idea. Allowing your child to fall asleep with a bottle during naps or at night can also harm the child's teeth."
The primary culprit for ECC is a group of bacteria called streptococcus mutans
Streptococcus mutans
Streptococcus mutans is a facultatively aerobic, Gram-positive coccus-shaped bacterium commonly found in the human oral cavity and is a significant contributor to tooth decay.The microbe was first described by J Kilian Clarke in 1924.-Introduction:...
. The American Academy of Pediatric Dentistry, in their Clinical Guideline for Infant Oral Healthcare, advises that "Caries results from an overgrowth of specific organisms that are part of normally occurring human oral flora
Flora (microbiology)
In microbiology, flora refers to the collective bacteria and other microorganisms in an ecosystem . While the term microflora is widely used, it is technically a misnomer since the word root flora pertains to the kingdom plantae...
. Streptococcus mutans and Lactobacillus
Lactobacillus
Lactobacillus is a genus of Gram-positive facultative anaerobic or microaerophilic rod-shaped bacteria. They are a major part of the lactic acid bacteria group, named as such because most of its members convert lactose and other sugars to lactic acid. They are common and usually benign...
species are considered to be principal indicator organisms of those bacteria responsible for caries. Human oral flora is site specific, and an infant is not colonized with normal oral flora until the eruption of the primary dentition
Dentition
Dentition pertains to the development of teeth and their arrangement in the mouth. In particular, the characteristic arrangement, kind, and number of teeth in a given species at a given age...
at approximately 6 to 30 months of age. The vertical colonization of S. mutans from mother to infant is well documented."
Research on preventing or delaying maternal transmission of these bacteria to children suggest that a comprehensive program of counseling, oral hygiene instruction, fluoride treatments, and restorative care are effective. Xylitol products also are promising.
It is a form of childhood disease
How and why tooth decay begins
Physicians and dentistsDentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
recommend that babies’ and toddlers’ teeth and gums be cleaned after every feeding or meal, starting from their teeth's first emergence.Preventive programs with young children should begin at the earliest time possible. Fluoridated water will have a very positive effect on this disease. Other chemotherapeutics found to be effective include topical fluoride (fluoride varnish), fluoridated dentifrice (toothpaste), and PVP-iodine.
Parental tooth cleaning, especially with a very small amount of fluoridated dentifrice, is helpful when accomplished at least once a day. Twice a day is even better. Given that fermentable carbohydrates provide fuel for the harmful bacteria, dietary interventions are appropriate, but very difficult to implement. A counseling approach, providing the parent with choices has been found effective. The sugar substitute xylitol
Xylitol
Xylitol is a sugar alcohol sweetener used as a naturally occurring sugar substitute. It is found in the fibers of many fruits and vegetables, and can be extracted from various berries, oats, and mushrooms, as well as fibrous material such as corn husks and sugar cane bagasse, and birch...
has been found to be effective at reducing levels of harmful micro-organisms in the mouth, and has recently been promoted as a cavity reducing agent in the form of disposable wipes.
According to an article in the Journal of the Canadian Dental Association, "Primary prevention of ECC has largely been restricted to counselling parents about caries-promoting feeding behaviours. This approach has also had minimal success. Newer strategies addressing the infectious component through use of topical antimicrobial therapy appear promising."
External links
- American Academy of Pediatric Dentistry
- American Dental Association ADA page on early childhood tooth decay
- Columbia Center Comparison of Dental Surgery versus Caries Suppression with other treatments
- Children's Dental Health Project
- Prevent and Heal Early Childhood Caries With Whole Foods