Understanding Early Childhood Caries

It is Children's Dental Health Month. Every year at this time, I reflect on years of caring for children's oral health. One child always comes to mind.

Almost 20 years ago, a preschool teacher asked for me to examine one of her three year old pupils. This very well behaved child stood still while I examined him. First, it was obvious that his face was not the same on both sides. His right cheek was larger than his left. When he opened his mouth, the offending tooth was plain to see. An upper molar was crumbling away. Touching his cheek or the tooth made the little boy and the teacher wince. This was not my introduction to the problem of Early Childhood Caries (ECC). However, the picture of the little boy and the concerned teacher stays with me.

"...Dental caries has remained the most prevalent chronic disease of childhood," according the U.S. Department of Health and Human Services.The American Dental Association defines ECC as "the presence of one or more decayed, missing (due to cavities) or filled [teeth] in any primary [baby] tooth in a preschool-age child ..."

Even though caries is a completely preventable disease, many parents accept their children's illness as part of growing up. While tooth decay is decreasing among older children and adults, early childhood caries is increasing.

The National Center for Helath Statistics reports that from 1999 to 2004, over a quarter of children aged two to five and over half of those six to 11 have a history of tooth decay. The rate is higher for poor and non-white children. Additionally, the same research indicates that about a third of American children aged two to 11, have untreated tooth decay. Once again, the numbers are much higher for poor and minority children.

When should parents begin to consider their children's oral health?

Parents, teachers and other care givers can ensure that their young children will not develop tooth decay by brushing their children's teeth as soon as they come in (erupt). Young children are not able to brush their own teeth correctly. They need their parents to brush their teeth 2 to 3 times a day until they are able to tie their own shoes.

When teeth begin to erupt, it is time to reduce the child's use of the bottle and introduce the sippy cup. This is the same time that children need to see a dentist with their parents.

Parents should never allow children to sleep with a bottle of milk or formula. This will lead to an extreme case of ECC called baby bottle caries or baby bottle decay. Baby bottle caries often causes children to lose all of their front teeth to tooth decay by their second or third birthday. These children will not have adult front teeth until they are at least six years old, but maybe not until they are eight.

What else can parents do to prevent early childhood caries?

Children need a healthy diet. It is very important to limit the amount of sugar children eat and drink. Keep sweet treats to mealtimes. Be aware of hidden sugar in healthy appearing snacks such as raisins and crackers.

Children who drink carbonated beverages such as soda and sparkeling water have much more frequent cavities. Carbonation makes the drink very acidic. Acid eats into teeth causing tooth decay.

Fluoride makes teeth more resistant to acid. Fluoride is a mineral that occurs naturally in the water of many communities around the United States. The Massachusetts Water Resources Authority has added fluoride to drinking water since the 1950's. Fluoridation of tap water is the least expensive and most effective technique available to reduce tooth decay.

Parents who avoid tap water and give their children bottled water may not realize that tap water is almost always healthier and better tested than bottled water. Some brands of bottled water have fluoride. Please do not ask a physician or dentist to provide a prescription for a fluoride supplement before asking the bottler how much fluoride is in their water. The ideal concentration of fluoride in water is one part per million or 1 ppm.

Most tooth paste has fluoride. Unfortunately, the concentration of fluoride in tooth paste is too high for children to swallow it. Do not use fluoridated tooth paste with very young children. Wait until they are able to rinse and spit it out.

Sealants are another preventive treatment for children and adults. Dentists, dental hygienists and dental assistants apply thin plastic coatings into the crevices of back teeth. Cavities are much more likely to form in these areas. Sealing teeth prevents more than half of early childhood caries.

Children can grow up without tooth decay. They need their parents and care givers to help them with brushing their teeth and choosing a good diet. Fluoride and sealants reduce the risk of caries further. If you have questions about preventing Early Childhood Caries, please ask your child's dentist, dental hygienist, or physician.