Early Childhood Caries - The "Do"s &"Don't"s

In contract to common belief – deciduous teeth (or “baby teeth”) require proper dental attention, despite their temporary use in the human dental cycle. While baby teeth do fall out by age 12, proper dental care from a young age can prevent future oral infection, dental complications, and can assure the proper development of a happy and healthy smile

(19/1/2014)


עששת בילדיםAs pediatric dentists – we encounter parents puzzled about their children’s dental health: “How does my child have so many cavities at such a young age?” or “Those teeth came through decayed.” In many cases these are issues attributed to Early Childhood Caries (ECC). 

 

Presentation

 

ECC is a very common bacterial infection commonly caused by prolonged contact between sugars and bacteria on the teeth.  ECC is unique in that it is prevalent in children under the age of 6, and can appear in children ages 3 and younger (known as “Severe ECC”).  ECC usually develops near the location of teeth eruption.  In Israel, ECC infects between 40%-50% of all children, with Severe ECC striking between 12%-15%.

 

A specific form of ECC is known as “Baby Bottle Tooth Decay” (BBTD) since it is commonly attributed to frequent evening bottle feeds or prolonged breast feeding after the child’s teeth have erupted.

 

ECC tends to first develop on the upper incisors, followed by the maxillary (upper) and mandibular (lower) molars.  The lower incisors are generally last to get infected, as they are protected by the tongue during feeding, and are located near the sublingual gland.

 

Complications

 

ECC first appears as brown-black spots on the teeth, and can quickly spread to the internal parts of the teeth (dentin and pulp).  This can result in severe sensitivity to hot, cold, and sweet sensations in the mouth.  Infection of the pulp can lead to excruciating tooth pain.  Neglect of these issues can lead to inflammation in the root canal, and can lead to infection to other areas in the skull, including the upper jaw and eye-socket inflammation. 

 

ECC causes chronic tooth sensitivity, interferes with eating and development, sleep deprivation, and general quality of life.  ECC develops and spreads quickly to neighboring teeth.  Root infection can ultimately interfere with odontoblast development.  Aesthetically, ECC-infected teeth can be unsightly, and can hurt the child’s self-confidence.   

 

Prevention

 

The primary goal of parents, dentists, and all others involved in a child’s well-being is to be aware of ECC, and take the necessary preventative measures:

  • Avoid feeding your child a sweet/sugary nighttime bottle
  • Avoid prolonged nursing after teeth-eruption has begun
  • If a child falls asleep while drinking – remove the bottle and wipe the teeth with a soft cloth
  • Brush twice a day already from the first tooth
  • Use a soft toothbrush, and add usage of fluoride toothpaste from ages 2+
  • Minimize eating of carbohydrates (sweets, snacks, sugary drinks, etc)
  • Minimize sharing of pacifiers, spoons, or toothbrushes
  • Routine checkups at a pediatric dentist from age 1 or from first tooth
  • If parent/doctor/nurse/family suspect an ECC infection – see a pediatric dentist ASAP
  • Special attention towards children who take medication regularly as they can be more prone to develop ECC

 

Treatment

 

Dentists who diagnose ECC should instruct parents with the necessary changes needed, including brushing with fluoride as needed.  Since children’s dental health can be complex – it is crucial that the child be seen by a pediatric dental specialist.  Treatment of ECC can include fillings, crowns, root canals, or tooth extraction.  At times, local or general anesthetics are used for the procedure needed.   

 

In contract to common belief – deciduous teeth (or “baby teeth”) require proper dental attention, despite their temporary use in the human dental cycle.  While baby teeth do fall out by age 12, proper dental care from a young age can prevent future oral infection, dental complications, and can assure the proper development of a happy and healthy smile

 

Written by: Dr. Elinor Halperson, Pediatric Dentist at Hadassah Ein Kerem