Learn about the treatment options for early childhood caries with this comprehensive guide. Discover the causes and symptoms of this common dental problem

Childhood Caries

Humza Khizer

Overview

Dental caries or cavities is a medical condition characterized by the breakdown of tooth enamel. It is also known as baby bottle tooth decay since babies are particularly vulnerable to early childhood caries. 
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Early childhood caries (ECC) is a major public health problem in developing and developed countries. It can develop early in life and progress quickly in high-risk individuals.

The predominance of ECC varies depending on the group studied, with disadvantaged groups having a prevalence of up to 85%<a href="#accordion">[4]</a>. According to a study, 23% of kids aged 2-5 had dental caries in their primary teeth in 2011-2016<a href="#accordian">[5]</a>. 
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ECC is classified based on the severity and its etiology: 
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<ul>
	<li>
	<h5>Type I (Mild To Moderate)</h5>
	</li>
</ul>

Initially, early childhood caries present themselves as dull white or brown spots on maxillary incisors along the gingival margin. It then gradually progresses to the destruction of the crown and root stumps.

The presence of &#39;isolated carious lesion(s)&#39; is associated with developmental defects, i.e., pit and fissure defects as well as hypoplasia. Typically, the most likely reasons are poor oral hygiene and a mix of semi-solid and solid food. 
&nbsp;

<ul>
	<li>
	<h5>Type II (Moderate To Severe)</h5>
	</li>
</ul>

At this stage, smooth surface lesions or &lsquo;labiolingual lesions&rsquo; affect the maxillary incisors. Whether this spread occurs with or without molar caries depends on the child&#39;s age. However, the mandibular incisors are usually unaffected.

The most common cause is an inappropriate use of feeding bottles, at-will breastfeeding, or a combination of both. This may or may not be accompanied by poor oral hygiene. 
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<ul>
	<li>
	<h5>Type III (Severe)</h5>
	</li>
</ul>

Severe early childhood caries (S-ECC) refers to a pattern of dental caries that is &#39;atypical,&#39; &#39;progressive,&#39; &#39;acute,&#39; or &#39;rampant&#39;. 

These are lesions that affect almost all teeth, including the mandibular incisors. Generally, a child will have caries in 14 out of 20 primary teeth, with at least one mandibular incisor. Type III caries are usually caused by a combination of poor oral hygiene and cariogenic foods. 
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Signs and Symptoms

These include:

<ul>
	<li>Dull white spots form on the tooth surface closest to the gum line, indicating enamel breakdown and causing early sensitivity</li>
	<li>Light brown or yellow bands appear on teeth, indicating progression to decay</li>
	<li>Cavities present as dark brown or black stumps, indicating advanced decay</li>
	<li>Pain around the affected teeth</li>
	<li>Sensitivity to certain foods, such as sweet or sour, hot or cold 
	&nbsp;</li>
</ul>

NOTE: Your child can be either symptomatic or asymptomatic (not exhibit any clinical signs of a cavity for months or even years, especially if the decay is in its initial stages). That is why it is critical to visit the dentist regularly because the condition can go from acute to chronic and cause serious complications. 
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Causes

A diet high in carbs (sugar and starch), including food items like cake, milk, bread, and soda, can lead to tooth decay. Bacteria in the mouth is the main culprit of caries. It interacts with these items and produces acid, which weakens the tooth enamel to the point that it disintegrates and cavities appear. As a result, caries penetrate the internal tissues of the teeth and destroy dentin. 
&nbsp;

Other factors include:

<ul>
	<li>Poor dietary habits, including frequent snacking with a predominance of carbs and soft foods </li>
	<li>Deficiency of minerals and vitamins (calcium, phosphorous, fluoride, vitamin C, etc.) that help construct the hard tissues of teeth</li>
	<li>Poor oral hygiene</li>
	<li>Ineffective tooth brushing</li>
	<li>Letting the child fall asleep while drinking from a bottle (especially milk or any sweet substance) multiple times</li>
	<li>Prolonged breastfeeding</li>
	<li>Gastrointestinal tract diseases</li>
	<li>Systemic diseases, like hormonal disorders and <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a></li>
	<li>Weakened immunity</li>
	<li>Genetic factor 
	&nbsp;</li>
</ul>

Diagnosis

Early identification of ECC can prevent or stop the progression of this disease. A specialist can detect signs of pathology at any stage even if it&rsquo;s just the appearance of a spot and no damage has occurred to the enamel. This is why it&rsquo;s important to have regular checkups and cleanings. 
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Generally, the dentist will ask the child about tooth pain and sensitivity. They will examine the mouth and teeth, probing the teeth with dental instruments to look for soft spots. Additionally, they will order dental X-rays to get a better picture of the extent of cavities and decay. 
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Treatment

ECC treatment is costly because it frequently necessitates wide-ranging restorative treatment and tooth extraction at a young age. Sometimes, it also requires general anesthesia since young kids cannot cope with the exhaustive therapeutic approaches. 

Treatment usually depends on the child&rsquo;s age, general health, and the severity of the condition. In the majority of cases, it involves removing and replacing the decayed part with a filling. Some of the options to repair the tooth include: 
&nbsp;

<ul>
	<li>Fillings &ndash; Restorations or fillings are the primary treatment if decay has gone beyond the early stage. These fillings are made of various safe materials, including porcelain and composite resins. Mercury-based fillings known as amalgams have also been approved by health agencies. These fillings rarely cause allergies. 
	&nbsp;</li>
	<li>Crowns &ndash; Dentists recommend crowns if the suspect weakened teeth or if decay has progressed so much that there&rsquo;s hardly any healthy enamel left. They will drill out the decayed part and then fit a crown made of porcelain or porcelain fused to metals or other materials over the tooth. 
	&nbsp;</li>
	<li>Root Canal &ndash; This is suggested in case the tooth is infected or badly damaged to the extent that it affects the pulp as well. The pulp is then removed along with the dead tissue and medication is used to treat the infection. After that, the roots are filled with a sealing material, and a crown is set over the filled tooth. 
	&nbsp;</li>
	<li>Tooth Extractions &ndash; Extensive decay, i.e., when the tooth can&rsquo;t be restored or saved in any way, makes it necessary to remove it. However, when a tooth is pulled, it leaves a gap and causes other teeth to shift. Therefore, it&rsquo;s often followed by a bridge or dental implant.&nbsp; 
	&nbsp;</li>
	<li>Fluoride Treatment &ndash; In case the condition is diagnosed at an early stage, fluoride treatment is all that&rsquo;s required to restore the tooth&rsquo;s enamel. This therapy involves more fluoride than is generally found in toothpaste or mouthwash. It&rsquo;s available in the form of gel, liquid, varnish, or placed in a small tray that is fitted over the affected tooth. 
	&nbsp;</li>
</ul>

Cavities and tooth decay can have significant and long-term consequences, even in young kids who do not yet have permanent teeth.

The complications resulting from cavities typically include the following: 

<ul>
	<li>Chronic pain</li>
	<li>Pulpitis</li>
	<li>Crooked adult teeth</li>
	<li><a href="https://merisehat.pk/disease/periodontitis">Periodontitis</a></li>
	<li>Periostitis </li>
	<li>Speech impediments</li>
	<li>Digestive tract disorders</li>
	<li>Chewing difficulty and tooth loss that impairs the child&rsquo;s ability to consume food, which affects their physical, mental, and psychosocial development 
	&nbsp;</li>
</ul>

<ul>
	<li>Dry mouth due to specific medicines (e.g., chemotherapy drugs), health conditions, radiation to the neck or head</li>
	<li>Tooth fillings can deteriorate, disintegrate, or build rough edges over time</li>
	<li>Eating disorders, like anorexia and bulimia</li>
	<li>Poor oral hygiene in general or due to medical conditions or disabilities that makes it difficult for some caretakers to clean the child&rsquo;s teeth</li>
	<li>Use of orthodontic appliances like braces or retainers </li>
	<li>Poverty and low education can be barriers to access to dental care 
	&nbsp;</li>
</ul>

Effective oral and dental cleanliness helps prevent cavities and tooth decay. 
&nbsp;

<h5>Cleaning Teeth</h5>

<ul>
	<li>Start cleaning the baby&rsquo;s teeth as soon as the first tooth appears. For an infant, wipe their gums after feeding. </li>
	<li>Use only a pea-sized amount of children&rsquo;s low-fluoride toothpaste to brush the teeth of children aged 1.5-6 years.</li>
	<li>After 6 years or as their dentist recommends, children can be introduced to standard fluoride toothpaste.</li>
	<li>Floss the child&rsquo;s teeth daily after the child turns 2. 
	&nbsp;</li>
</ul>

NOTE: Help your child brush their teeth properly until about 8 years or when they can do it well by themselves. Fluoride is dangerous if swallowed, which is another reason you should monitor your child while they brush their teeth. Lastly, make sure that they brush their teeth at least twice a day. 
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<h5>Feeding Habits</h5>

<ul>
	<li>Do NOT give a bottle while putting the baby to bed, especially with milk or juice as the sugar will remain on the infant&rsquo;s teeth for many hours. If necessary, only put water in it.</li>
	<li>Do NOT dip a pacifier in sweetened syrup or honey. Also, avoid prolonged use of the pacifier. </li>
	<li>Ask for sugar-free medicines if possible.</li>
	<li>Start teaching the child to drink from a feeding cup when they are 6 months old. They should only drink from a cup by the time they turn 1.</li>
	<li>For children older than 1 year, water and plain full-fat milk are good choices. After a year, they can start low-fat milk. </li>
	<li>Juice is not recommended at all for babies under 6 months because of acidity and high sugar content.</li>
	<li>Children can be introduced to solid foods as early as 6 months of age. It should be a well-balanced diet. Certain foods like those rich in vitamin C and protein are especially good for teeth. Limit snacks like cookies, chips, and cake.</li>
	<li>Do NOT share eating utensils to prevent the transfer of bacteria.</li>
	<li>Visit the dentist for routine exams and dental cleanings every 6 months. 
	&nbsp;</li>
</ul>

<h5>Other Tips</h5>

<ul>
	<li>Chewing xylitol-based gum, along with prescription fluoride and an antibacterial mouthwash, can lower the chance of cavities.</li>
	<li>Take your child to a dentist regularly. 
	&nbsp;</li>
</ul>
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Salivary proteins are crucial for the preservation of oral health and the mechanisms that restore damaged tissues. The amounts of salivary proteins in caries-free (CF) and caries-active (CA) patients are, however, poorly described in the literature. So, this systematic review was done to assess the potential for salivary proteins to be used as caries indicators. 
&nbsp;

High variability was seen between different articles when using DMFT as the caries index. Alpha-amylase, histatin-5, acidic proline-rich protein-1, lactoperoxidase, and mucin-1 were all identified to have significantly increased in salivary levels in CA patients, whereas proteinase-3, carbonic anhydrase 6, and statherin were found to have significantly increased in salivary levels in CF subjects. 
&nbsp;

Hence, salivary protein levels may be valuable biomarkers for the diagnosis of caries. However, further prospective investigations are necessary to confirm their diagnostic utility<a href="#accordion">[3]</a>. 
&nbsp;

Key Points

<ul>
	<li>Childhood caries, also called baby bottle tooth decay, is a dental problem that affects children&rsquo;s teeth.</li>
	<li>The bacteria that cause childhood caries feed on sugars and form acid, which wears down the enamel on a kid&#39;s teeth.</li>
	<li>Babies are more susceptible to childhood caries since their teeth are still developing, and their enamel is thinner and smoother than that of grownups.</li>
	<li>The presence of brown or white spots on the teeth is the most classic symptom of childhood caries.</li>
	<li>Childhood caries, if left untreated, can cause discomfort, infection, and loss of teeth.</li>
	<li>The easiest way to avoid childhood caries is to restrict sweetened beverages and foods and take a child to a dental professional for routine checkups. 
	&nbsp;</li>
</ul>
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[1] Çolak H, Dülgergil ÇT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med. 2013;4(1):29.

[2] Dye BA, Arevalo O, Vargas CM. Trends in paediatric dental caries by poverty status in the United States, 1988--1994 and 1999--2004. Int J Paediatr Dent. 2010;20(2):132–43.

[3] Ahmad P, Hussain A, Carrasco-Labra A, Siqueira WL. Salivary proteins as dental caries biomarkers: A Systematic review. Caries Res. 2022;

[4] Anil S, Anand PS. Early Childhood Caries: Prevalence, Risk Factors, and Prevention. Front Pediatr. 2017;5:157. Published 2017 Jul 18. doi:10.3389/fped.2017.00157