Early Childhood Caries – A Preventable Disease

by Keith Titley, BDS, MScD, FRCD(C)

The title for this editorial could just have appropriately been, ‘The time for a child’s first dental visit’. Although early childhood caries (ECC) has been shown to be more prevalent in low socio-economic groups, it is also found in the general population. As indicated in the title, ECC is a preventable disease that the profession can and must play its part in its prevention. From the moment teeth enter the oral cavity they enter a hostile environment that places them at risk for both caries and periodontal disease. Children who experience caries as infants and toddlers exhibit a greater susceptibility to subsequent caries in both the primary and permanent dentitions. ECC can be a particularly virulent form of caries that can rapidly spread from cervical decalcifications of maxillary primary incisors to total coronal destruction, pulpal necrosis, infection, and abscess formation. Aggressive restorative therapy that includes full coronal coverage of posterior teeth with stainless steel crowns and anterior teeth with fluoride releasing aesthetic materials is indicated. As a result, the disease is expensive to treat requiring complex restorative procedures and, more often than not, treatment under general anaesthesia in a hospital setting. The waiting lists for treatment of infants under general anaesthesia are extensive so that it is often delayed with the risk of progression of the disease and pain in the interim.

Prevention of ECC begins with parents starting in the prenatal period and continues after the birth of the child. Proper nutrition in the prenatal period is of particular importance to both the mother and her baby to optimize maturation of enamel and birth weight. Since frequent bottle-feeding at night and breast-feeding on demand are associated with ECC advice should be given on early infant nutrition and the perils of using the nursing bottle as a comforter. Parents usually, but not always, receive this information during pre-natal classes and post-natal well baby check-ups from physicians and paediatricians. All too often their answer to the question of when the child should first see the dentist is when ‘the child is three years old or when all the baby teeth erupt’. Unfortunately these health professionals are not trained to examine and assess those white objects that are interposed between the lips and the tonsils! As a result it is unlikely that early that evidence of ECC will be detected.

It is almost automatic that parents expect to take their newborns for well baby medical check-ups but the concept of a well baby dental check-up has yet to become a routine part of infant health care. With the exception of paediatric dental specialist groups the dental profession at large has failed to promote this concept. The profession should be promoting the concept that the time for a first dental visit is as soon as the first primary tooth erupts. At this visit, an oral examination can be easily accomplished with the parent sitting in the dental chair with the infants head resting on a pillow in the dentist’s lap. If teeth are present they can be wiped with a damp gauze sponge, dried and visually examined for defects. The most important part of this visit, however, is to question and give advice about feeding practices, nutrition, oral hygiene procedures, discuss the transmission of oral bacteria from caregivers to infants and to stress the need for regular monitoring. With the promotion of well baby dental check-ups the profession is uniquely placed to reduce the prevalence of what is a preventable disease in infants.