Be Alert about Childhood Caries

Tooth Decay or Childhood Caries, when you should be alert? Explains Dr Gyanendra  Kumar, Dentist, Maulana Azad Medical College, Delhi. 
Early childhood caries is a “virulent” form of dental caries that can destroy the teeth of preschool children and toddlers. Early childhood caries can also be defined as the occurrence of any sign of dental caries on any tooth surface during the first 3 years of a child’s life. Economically disadvantaged children are the most vulnerable to ECC.

Early childhood caries is an infectious disease, and the Streptococcus mutans bacteria is the main causative agent. Not only does S. mutans produce acid, it also thrives in acid. High sugar levels in the mouth increase the acid levels on the teeth. In children with ECC, oral Streptococcus mutans levels routinely exceed 30% of the cultivable dental plaque flora.


The clinical pattern of ECC is rampant and characteristic: First affecting the primary upper anterior teeth, followed by the upper primary molar teeth. The initial appearance of early childhood caries is white areas of demineralization on the surface of the enamel along the gum line of the upper incisor teeth. These white spot lesions progress such that they later become cavities that have been discolored. The mandibular incisors are protected by saliva and the position of the tongue during feeding. The ECC process may be so rapid that the teeth appear to have cavities “from the moment they erupt.”

The first event in the natural history of ECC is primary infection with S. mutans. The second event is the accumulation of S. mutans to pathologic levels, due to prolonged exposure to sugars. The third event is demineralization of enamel, which leads to cavity formation in teeth.

Early infection with S. mutans is a significant risk factor for future development of dental caries. Colonization of an infant’s mouth with this bacteria is usually the result of transmission from the child’s mother. S. mutans can apparently colonize the mouths of infants even before their teeth erupt. Children at high risk for early childhood caries may develop carious lesions on their upper front teeth soon after they erupt into the mouth. As the disease progresses, decay appears on the biting surfaces of the primary upper first molars.

New strategies for combating the infectious component using topical antimicrobial therapy appear promising.

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