Preventing Early Childhood Caries

Overview

Definition of early childhood caries 

Early childhood caries (ECC), often referred to as nursing caries or baby bottle tooth decay is one of the most prevalent diseases of children worldwide, and a significant oral health problem affecting infants and young children globally. ECC is defined as the presence of one or more decayed (cavitated or non-cavitated lesions), missing ( due to caries), or filled tooth surfaces in any primary tooth in a child under six years.¹ It represents a multifactorial disease process influenced by various factors including diet, oral hygiene practices, socioeconomic status, and access to dental care.

Prevalence of early childhood caries

Despite ECC being a preventable condition, the prevalence of early childhood caries remains a concern, particularly in communities with limited access to oral healthcare services and among populations facing socioeconomic challenges. ECC not only affects the dental health of young children but also has a broader impact on their overall well-being, including impacts on nutrition, speech development, and self-esteem. The Public Health England (PHE) National Dental Epidemiology Programme (NDEP) conducted an oral health survey of 5-year-old children in 2019, 23.4% of the children whose parents consented to the survey had experienced dental decay, but there was a wide variation in the prevalence and severity of the experience of dental decay based on geographical location, level of deprivation and ethnic group. The prevalence of experience of dental decay was higher in children from more deprived areas (34.3%) than in children from less deprived areas (13.7%). There was variation in prevalence of experience of dental decay by ethnic group and this was significantly higher in the ‘Other Ethnic Groups’ (44.3%) and the Asian/Asian British ethnic group (36.9%) than other ethnic groups.²

Aetiology of ECC

Dental caries develop when the bacteria that naturally exist in the oral cavity, mainly streptococcus mutans metabolize carbohydrates to produce acids that destroy the hard surface of tooth structure, this can only occur over a long period of time. Dental plaque or biofilm is formed from food debris when dental hygiene is not proper, providing a suitable environment for the bacteria to grow, produce acids, and be able to resist antimicrobials. ECC is an aggressive form of dental caries, a multifactorial disease linked mainly to bad diet and improper oral hygiene habits.³

Risk factors of ECC

There are many factors associated with early childhood caries including the following:

• Poor Oral Hygiene: Inadequate tooth brushing, improper cleaning techniques, and irregular dental care can contribute to the development of caries
• Frequent Bottle or Breastfeeding at Bedtime: Falling asleep with a bottle containing sugary liquids (such as milk, formula, fruit juice, or sweetened drinks) can lead to prolonged exposure of teeth to sugars, promoting the growth of bacteria and subsequent tooth decay
• Lack of Fluoride Exposure: Insufficient exposure to fluoride, whether through water, toothpaste, or fluoride treatments, can weaken tooth enamel and make teeth more susceptible to decay
• Infrequent Dental Visits: Limited access to dental care and irregular dental check-ups can result in untreated dental issues and exacerbate the risk of early childhood caries
• Socioeconomic Factors: Lower socioeconomic status, including limited access to nutritious foods, preventive dental care, and education about oral hygiene practices, can increase the likelihood of early childhood caries
• Maternal Factors: Maternal dental health and oral hygiene practices during pregnancy can influence the transmission of cavity-causing bacteria to infants and increase their susceptibility to early childhood caries
• Genetic Predisposition: Genetic factors may contribute to an individual's susceptibility to tooth decay, including variations in saliva composition and tooth enamel strength
• Environmental Factors: Living in communities with limited access to fluoridated water, healthy food options, and preventive dental services can heighten the risk of early childhood caries
• Cultural Practices: Cultural beliefs and practices related to infant feeding practices, oral hygiene, and dental care can impact the prevalence of early childhood caries within specific communities

Consequences of early childhood caries

ECC can harm the oral health and quality of life of children. Developing ECC can be associated with a higher risk of tooth in permanent teeth, and frequent visits to dental and emergency rooms. Severely decayed teeth due to ECC can cause pain, swelling and infection, difficulties in chewing and eating and reduced appetite can affect the child’s diet, growth and development. ECC is also associated with absent days at school for the child, and from work for the parent, affecting the learning experience of the child and the productivity level of the parent.⁴

Treatment of ECC

The first step to treat childhood caries is to remove the decay and fill the lost tooth structure with a convenient filling material. In certain cases, endodontic treatment or root canal treatment is necessary. When the decay is extensive, a crown is placed over the restored tooth. In severe cases of ECC, extraction of the decayed tooth is an option, however, this may cause loss of space and consequent crowding in permanent teeth.⁵

Prevention of early childhood caries

Dental professionals, parents and caregivers should follow some preventative measures to reduce the risk of developing ECC such as:

• Educate parents and caregivers about the causes and prevention of early childhood caries
• Providing dental treatment and oral hygiene measures during pregnancy can reduce the risk of transmitting infections from the mother to the child
• Encourage dental visits after 6 months of the first primary tooth erupts but no later than 12 months
• Avoidance of diets containing liquid and food containing sugars
• Implementing early oral hygiene measures for children as soon as the first primary tooth erupts. Tooth brushing should be done twice daily by the parent using a soft brush. A smear amount of fluoridated toothpaste should be used for children under the age of three, and a pea-sized amount for children three to six years
• Provide fluoride treatments as a preventative measure for preschool children
• Educate policy-makers about the consequences and the importance of preventing early childhood caries

Challenges and barriers to prevent ECC

1. Early Onset of Tooth Decay: Children can develop dental caries at a very young age, sometimes even before the eruption of their first teeth, making prevention efforts challenging
2. Limited Dental Access: Access to dental care is limited for many children, particularly those from low-income families or rural areas. This limitation affects their ability to receive preventive treatments and regular check-ups
3. Lack of Oral Health Education: Many parents and caregivers lack adequate knowledge about proper oral hygiene practices, including tooth brushing techniques and dietary habits that contribute to dental caries. Without proper education, preventive measures may not be effectively implemented
4. Socioeconomic Factors: Families facing financial constraints may struggle to afford preventive dental care, nutritious foods, and oral hygiene products. Socioeconomic disparities can significantly impact a child's risk of developing dental caries
5. Dietary Habits: Consumption of sugary foods and beverages, especially in between meals and before bedtime, contributes to the development of dental caries. Encouraging healthy dietary habits and limiting sugar intake can be challenging in environments where unhealthy foods are readily available and affordable
6. Prolonged Bottle-Feeding: Allowing infants and young children to fall asleep with a bottle containing sugary liquids can increase the risk of dental caries due to prolonged exposure to sugars
7. Cultural Practices: Cultural beliefs and practices related to infant feeding, oral hygiene, and dental care may vary widely among different communities. Understanding and addressing cultural considerations are essential for developing effective prevention strategies
8. Fluoride Exposure: In areas where water fluoridation is not widespread, children may not receive adequate fluoride exposure, which plays a crucial role in strengthening tooth enamel and preventing dental caries
9. Behavioural Challenges: Encouraging children to adopt healthy oral hygiene habits, such as regular tooth brushing and flossing, can be challenging due to behavioural factors and resistance from children

Addressing these challenges requires a coordinated effort involving healthcare providers, policymakers, educators, community leaders, and families. By implementing comprehensive strategies that address access to care, education, socioeconomic disparities, and cultural considerations, it is possible to reduce the prevalence of childhood caries and promote better oral health outcomes for children.

Summary

Preventing early childhood caries is crucial for safeguarding oral health and the well-being of young children. ECC is a prevalent and preventive chronic condition, and it can have a huge impact on the quality of life of children if left untreated. Understanding the causes, risk factors, and consequences of early childhood caries is important for developing effective prevention and intervention strategies. By addressing ECC early through targeted education, improved oral hygiene practices, and community-based initiatives, it is possible to mitigate its impact and promote better oral health outcomes for young children. By promoting good oral hygiene practices, limiting sugary foods and beverages, encouraging early dental visits, and advocating for fluoride use, we can empower parents, caregivers, and communities to prioritize oral health from infancy. Additionally, addressing socioeconomic disparities and cultural sensitivities ensures that preventive efforts are inclusive and accessible to all children.