Early childhood caries affects many children

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

Early childhood caries, or ECC, is a disease which afflicts many children. This new term includes baby bottle tooth decay and nursing caries.

These are the four factors required for carious lesions: A susceptible tooth; Acid producing bacteria (mutans streptococci); Fermentable carbohydrates (sucrose); Time (repeated exposures to sugar).

Since there is almost no saliva flow during sleep, any food or drink, which is in a baby's mouth at this time stays there many hours and promotes the caries disease process. That is why it is absolutely essential to give the baby ONLY water in its bottle when it is sleeping or taking a nap.

Do NOT put fruit juice, soft drinks, sweet tea, formula, or milk in your baby's bottle or sipper cup during bedtime or nap time. Do NOT dip pacifiers in sweet liquids.

Another insidious cause of early childhood caries is the sugar in the medications that are prescribed for infants and toddlers.

Many oral medications and prescriptions contain up to 50 percent sucrose. Oral antibiotic formulations for children are big offenders. The caries disease can be prevented by cleansing your child's teeth after every administration of oral medication. Using ordinary water on a toothbrush works fine.

Soft drinks are very destructive to children's teeth. Many of them contain not only processed sugar, but also carbonic acid, citric acid, and phosphoric acid. The acid in sodas slowly dissolves the enamel of children's teeth. The sugar provides food for the bacteria which cause early childhood caries.

Mutans Streptococcus is the most important bacterium responsible for early childhood caries. This bacterium thrives on the acids contained in soft drinks. To make matters worse, such an acidic environment actually kills off the "good" oral bacteria. Under the right circumstances, an adolescent's mouth may eventually harbor more than 400 species of microbes.

One important warning sign of the caries disease are "white spot lesions". These are white, chalky areas on the front teeth, close to the gum line.

These decalcifications directly precede irreversible loss of tooth structure (a cavity). Be sure to get these areas examined by a pediatric dentist as soon as possible so that treatment can be initiated, if necessary. When your baby is twelve or eighteen months old, it will be time for its first dental checkup. A pediatric dentist is trained to perform dental exams on infants and to advise parents on preventive measures which are essential for maintaining healthy teeth and gums. Do NOT wait until you child is four years old to have this done.

You can help prevent early childhood caries. Begin by NOT sharing your eating utensils with your infant and vice versa because your mouth contains millions of bacteria, including the infectious mutans streptococci. These bacteria are the initiators of the caries disease process as discussed above.

When a parent puts the baby's feeding spoon into his or her mouth, the mutans streptococci bacteria from the parent's mouth will be transferred back to the baby's mouth and infect the baby's teeth. This process can take place as early as eleven months of age. The danger of infecting an infant's teeth is actually increased when the mother already has the caries disease herself.

As soon as the first baby teeth erupt, which occurs between six and twelve months of age, parents need to clean the new teeth with a new, damp cloth twice a day. It is better to use a baby tooth cleanser, NOT tooth paste, until your baby is about eighteen months old.

Using a baby tooth cleanser will prevent excessive fluoride ingestion during infancy. At eighteen months of age, the first primary molars begin to erupt. Then it will be time to brush all of the teeth with an infant toothbrush and a pea-sized drop of children's toothpaste, twice a day.

The good news is that many oral infections, including caries, are preventable. By minimizing the intake of sweets, cleaning your child's teeth daily, providing early dental examinations, and minimizing the sharing of objects that harbor viruses and bacteria, your baby will have a happy, healthy smile.

Next week we will discuss how to take care of dental injuries.