Early Childhood Caries: A growing public health concern

Dr Rajkumari Sarada Devi
Early Childhood Caries (ECC) is a significant public health concern affecting preschool children globally, including Manipur. ECC in infants and young children, is a growing concern for parents due to its rapid progression and potential long-term impact on a child's oral and overall health. ECC refers to tooth decay in children when they are under six years old. ECC was previously known under such terminologies  as “bottle caries”, “baby bottle syndrome”, “baby bottle tooth decay”, “nursing bottle caries”, “nursing caries”, or “prolonged nursing habit caries”. ECC has several unique characteristics in clinical appearance such as rapid development of caries, which affects a number of teeth soon after they emerge in oral cavity. ECC is initially clinically diagnosed as the first presence of a small chalky area within a smooth surface.
It can start where the first ever tooth eruption is and develops fast and powerfully if allowed over time, destroying a large area of the teeth. The primary probable source of decay is the appearance of white spots on the enamel, which may lead to cavities that result in toothache and infection, followed by early loss.
If left untreated, complications from uncontrolled initial caries may gradually worsen and its presence becomes larger, cavitated, and symptomatic. Symptoms include discomfort, sensitivity and pain; later complications include inflammation of the pulp tissue or tissue surrounding the specific tooth, acute and chronic infection, abscess formation, cellulitis and tooth loss leading to difficulty in chewing, malnutrition, gastrointestinal disorders, and difficulty in sleeping. “Rampant caries” is another pattern of tooth decay, signifying advanced or severe decay amongst multiple surfaces of numerous teeth.


Several factors contribute to early childhood caries, including poor oral hygiene, dietary habits, and bacterial infections. Understanding these causes can help in preventing the condition.
The etiology of ECC is multifactorial and is mainly attributed to a time-specific interaction of microorganisms with sugars on a tooth surface. Diet and feeding practices also play an important role in acquisition of the infection and development of caries. Factors such as high sugar intake, lack of oral hygiene, lack of fluoride exposure, and enamel defects are some of the major factors responsible for the development of ECC. Children often have a habit of ingesting excessive sugary foods and juice and hence are at more risk of a cavity. The sugary subject offers the perfect conditions for the survival of bacteria which causes acid erosion of the teeth enamel. Poor oral hygiene such as inadequate brushing and flossing allow plaque and bacteria to accumulate on the teeth, leading to cavities. Many parents assume that baby teeth do not require much care, but neglecting oral hygiene can result in severe dental issues. Microorganisms responsible for ECC are Streptococcus mutans (SM) and Streptococcus sobrinus. SM metabolizes sugars to produce acids, which contribute to the demineralization of tooth structure.
The bacteria causing caries can be transmitted from the care givers to the infants by sharing utensils. Streptococcus mutans, the bacteria primarily responsible for cavities, easily spreads from parents to children. Preschool children with high levels of SM in the oral cavity had higher caries prevalence and a greater risk for development of new lesions. The major source of acquiring the SM is from the mother during first 12–24 months. Poor maternal oral hygiene maintenance and frequent snacking and sugar exposure increase the chances of transmission of the infection to child. SM isolates from infants indicated that the source of the SM in children is mainly from their mothers via vertical transmission through saliva. It has also been recognized that cariogenic bacteria can be transmitted from mother to child through certain practices, for example, tasting the baby’s food with the same spoon. Infants delivered by cesarean section acquire SM earlier than vaginally delivered infants since these deliveries are more aseptic and the atypical microbial environment increases the chances of SM colonization. Children often have a habit of ingesting excessive sugary foods and juice, they are at more risk of a cavity.
Dietary practices also play a significant role in the development of ECC especially if it contains high levels of fermentable carbohydrates; the child is at higher risk for dental caries. Inappropriate feeding practice can prolong the exposure of teeth to fermentable carbohydrates which in turn may aggravate the chances of ECC. Bottle feeding during bedtime or sleeping has been associated with the initiation and development of caries in children.
Breast feeding for more than a year and at night might be associated with an increased prevalence of dental caries. Infant feeding practices such as frequent exposure to sugar, frequent snacking, taking sweetened drinks to bed, sharing foods with adults, as well as maternal caries status, oral hygiene and dietary habits predispose to early SM colonization and establishment of high SM counts.  Saliva has a protective role against dental caries development by providing the main defense system. Saliva flow rate, antimicrobial properties, the buffering capacity, and clearance of foods from the oral cavity are factors that are important in reducing the development of caries. Feeding of high sugar containing food at night may increase the caries risk for infants and toddlers due to the low salivary flow rate.
(To be contd)