Early childhood caries (ECC)
Early childhood caries (decay) is a severe form of dental decay that affects the baby teeth of infants and young children. Other names given to this condition include nursing bottle caries, infant feeding caries and baby bottle decay. The upper four front teeth (incisors) are most commonly affected whereas the lower front teeth are usually not as they are protected by the tongue and saliva.
Causes of early childhood caries
Early childhood caries is an infective process initiated by the transmission of oral bacteria from mother to infant. This transmission of bacteria by saliva could be caused by the mother using her eating utensils to feed the infant or by washing the dummy in her mouth then giving it to the infant. Once the transmission has occurred, the bacteria can multiply significantly. Early childhood caries can occur if babies are settled to sleep with a bottle of milk.
When an infant is allowed to suckle on a nursing bottle containing milk during the night the saliva flow is reduced. The milk pools around the baby teeth enabling the bacteria to convert the natural sugars in milk to acids which dissolve the enamel of the baby teeth. If toddlers constantly sip on sweet drinks (such as fruit juices and soft drinks), they can also develop decay.
Checking for signs of early childhood caries
Early childhood caries can be difficult to detect. Its appearance will depend on how advanced the condition is. “Lift the lip” to look for signs of:
- A dull white band on the tooth surface closest to the gum line. This is the first sign and usually remains undetected by parents.
- A yellow, brown or black band on the tooth surface closest to the gum line indicates the progression to caries (decay).
- Teeth that look like brownish-black stumps indicate that the infant has advanced caries. The upper four incisors (front teeth) are usually involved, while the lower incisors remain relatively unaffected. The back teeth may also be involved.
Importance of early tooth caries detection
Unfortunately, in most cases, early childhood caries is not picked up until the child is about 20 months of age. By this stage, many children need significant dental treatment and may require hospitalisation to have this treatment completed under general anaesthetic. This is why prevention is so important!
Preventing early childhood caries
Babies under four to six months need only breast milk or formula.
- Remove the baby from the breast after feeding, rather than having your baby fall asleep on the breast
If bottle feeding:
- Take the bottle away when the child has had enough.
- The bottle should only contain breast milk or appropriate infant formula.
- Introduce the child to a feeding cup between six and eight months of age. In most cases, the bottle can be discarded when the child is 12 months old.
- Encourage children to drink water rather than fruit juices or sweet drinks
Avoid dipping dummies in honey, glycerine or other foods or liquids. All natural sugars that are not easily cleared from the mouth can lead to tooth decay.
If your child needs medicine, ask your doctor or pharmacist to prescribe a sugar-free form.
Dental checks can help detect early childhood caries. Children should start to visit the dental practice as young as possible, so bring them along with you to your check-ups. They may be too young for an examination but the visits helps to familiarise them with the surroundings, smells, noise and most importantly, to meet the dentists!
Talk with your oral health professional about your child’s risk level and how frequently they should visit for an oral health check.
- Start as soon as possible. Wipe the gums using a finger wrapped in a clean damp face washer or gauze twice a day, especially before bed.
- Introduce a soft toothbrush, with a small head and large handle at 12 months (earlier if tolerated by the infant).
- Brush along the gum line twice a day with no toothpaste.
- Introduce a pea sized amount of CHILDRENS toothpaste at 18 months of age.
- You should brush your baby’s teeth until he or she is old enough to hold the brush. Continue to supervise the process until your child can rinse and spit without assistance. That usually happens at around age 6.
- Reduce the use of a dummy and thumb sucking as the child grows. These habits can have negative affects on how the teeth bite together and the shape of the face as it grows.
In Adelaide, we have access to fluoride in their water. Using the appropriate strength fluoride, and drinking tap water will help to prevent tooth decay.
- An excessive amount of fluoride at a young age, as your child’s teeth are developing can stain or deform teeth. To prevent this:
- Always use the CORRECT strength of toothpaste (300-500 part per million for 2 – 6 years old; 1000 parts per million from 6 years to adulthood), unless advised otherwise by your dentist.
- Ensure the toothpaste is kept out of reach of children.
- Brush your child’s teeth for them, then continue to supervise them as they age, to ensure they are not swallowing any toothpaste.