By Dr Kiran Koora, MDS (Paedodontist)
In this article, I would like to discuss tooth decay in young children. Early childhood decay of teeth is also known as early childhood caries (ECC). Tooth decay may be visible as early as 10 months of age. It typically presents in children as white lines or spots on the upper front teeth, which are among the first teeth to erupt and the least protected by saliva. This decay may even enter the underlying bone structure, which can hamper development of the permanent teeth. If the decay is allowed to progress, the surrounding tissue will become inflamed and an abscess will form.
Let us now take a look at the causes of early tooth decay in children. The etiological factors are not fully understood, however the most important factor is the inappropriate use of night-time or day-time bottle or breast feeding as a pacifier. During night time, the flow of saliva is reduced. Also, the swallowing reflex decreases. Along with these two factors, if a child has a bottle of milk in their mouth for a long time, more time is provided for the accumulation of carbohydrates in the mouth. These carbohydrates are acted upon by bacteria to produce acid which damages the teeth.
Other factors:
– Bottle feeding beyond the weaning age, ie beyond 12-15 months
– Bottle feeding at night always poses a serious threat especially if the teeth are not cleaned after feeding
– Malnutrition
– Over indulgence of parents
Stages of ECC
Mild
Moderate
Severe
Treatment of ECC
This is aimed at
– discontinuation of night-time feeding habit
– parental counselling
– dietary counselling
– filling procedures
– preventative education
Discontinuation of night-time
feeding
If the cause is identified as night-time feeding, the immediate cessation of the habit is not advised; rather a gradual withdrawal is recommended. Feeding with the cup or spoon should be encouraged. Serial dilution of the contents of the bottle with water has been recommended over a period of 1-2 weeks so that eventually the child drinks only plain water. Feeding at night is to be strictly avoided. Clearance of the milk can be achieved by intake of water after the feed.
Parental counselling
– The parent should be questioned about the feeding habits of the child, especially regarding nocturnal bottles and pacifiers dipped in sweetening agents.
– The parents should be instructed that teeth should be cleaned after every feed.
– In the case of considerable emotional dependence on the bottle, suggest plain water.
– The parents should be asked to try weaning the child from using the
bottle as a pacifier while in bed.
Dietary counselling
– Parents are advised to maintain a diet record of the child for one week which includes the time and the amount of food given to the child as well as the type of food, with special emphasis on the sugar content.
– The mother in particular must know the harmful effects of sugar. The elimination of, or at least the gradual reduction of sugar is the key.
– Depending on the child’s age and chewing capacity natural food like fruits should be given.
– Oral hygiene instructions must be implemented by the time of the first primary tooth eruption.
Filling procedures
To perform treatment efficiently and effectively for a child with ECC, medical immobilization, conscious sedation or general anaesthesia may be necessary. The success of restorations may be influenced by the child’s response to the chosen behaviour management technique. Alternative restorative treatment (ART) technique uses only hand instruments to remove the decay, and filling is done with fluoride releasing cements. This technique doesn’t use any dental drills or injections, so it is a less painful procedure.
Preventive procedures
Preventive procedures start with cleaning and polishing. Parents should maintain the child’s oral hygiene. For infants and toddlers, cleaning the oral cavity starts with gum pads, using wet gauzes. If the child feeds on the bottle or suckles, water should be provided before placing on the bed. Proper brushing techniques should be installed according to the age of the child. Fluoride supplementation can help in preventing the occurrence of new disease.
According to the American Academy of Pediatric Dentistry (AAPD) guidelines, infants should be weaned from the bottle at 12-14 months of age. AAPD guidelines for preventing nursing bottle caries are:
– Do not put your baby to bed with a bottle at night or at nap time. During sleep the flow of saliva decreases so it cannot ‘wash’ away the sugar. Sleeping with a bottle or a cup also allows these liquids to pool around their teeth for long periods of time to cause decay/cavities.
– If you must put them to bed with a bottle fill it with water or give them a clean pacifier.
– During the day do not give your baby a bottle filled with sweet drinks to use like a pacifier.
– Reduce frequent sugar consumption.
– Don’t add sugar to your baby’s food to make it taste better.
– Do not dip a pacifier in anything sweet like sugar or honey.
– By their 1st birthday teach them how to drink from a cup.
– Drink fluorinated water or if your water does not have fluoride ask your dentist for vitamins with fluoride.
– Oral hygiene measures should be implemented by the time of eruption of the first primary tooth.
– An oral health consultation visit within 6 months of eruption of the first tooth, and no later than 12 months of age is recommended to provide education for the parents about the prevention of dental
disease.
If you suspect that your child has a dental problem take them to see their dentist as soon as possible.