Early Childhood Caries

Overview


Early Childhood Caries (ECC) is a bacterial infection causing severe tooth decay in children or infants. It is an infectious and transmittable disease often caused by bacteria that is transferred to children from caregivers with untreated oral health disease. The risk of developing ECC increases when teeth are exposed to bacteria causing caries in addition to frequent consumption of sugary liquids like juice, milk and soda. As soon as teeth develop they are susceptible to decay from anaerobic bacteria, and infant’s teeth are no exception. For this reason, many dentists recommended that caregivers clean infant’s gums and teeth after every meal. Frequent late night bottle-feeding is often associated with ECC because the sugars in bottled drinks cling to infants’ teeth without being cleaned, and these sugars interact with the bacteria that cause caries and decay teeth. ECC impacts children worldwide, and in North America its prevalence ranges from 11% to 72%[1] depending on population.

Health Impact


Early Childhood Caries is a significant problem disproportionately impacting children of lower economic families and Latino children in the United States.[2] [3] It “has a complex etiology linked to the provision of pacifying bottles of juice, milk, or formula, which allows the sugar contents to pool around the upper front teeth, mix with cariogenic bacteria, and give rise to rapidly progressing destruction[4] .” As a particularly vexing health concern, researchers note that “the mechanism of interaction between socioeconomic status, stress, poor oral hygiene, and nutrition is evident, but remains largely unexplained."[5]

The anaerobic bacteria that causes ECC, Streptococcus mutans, is the same bacteria that causes all forms of tooth decay, and having ECC increases risks of developing caries in permanent teeth. The bacteria damage the structure of the tooth and produces caries, or cavities, in the teeth. If left unchecked, caries causes pain, infection, and tooth loss. Furthermore, studies have shown connections between oral health problems and systemic health concerns, such as cardiovascular disease.
ECC is an infection that has socioeconomic, nutritional, and behavioral health connections. On a socioeconomic level, risk of developing ECC can increase when regular dental care in not obtainable, and not everyone can afford dental visits. On a nutritional level, sugary liquids increase the risk of developing ECC, even if the liquids are considered healthy, like juice or milk. From a behavior health standpoint, ECC risk increases when tooth brushing or gum cleaning does not occur.

Medical Anthropology Research


Medical anthropological research on this issue has paid particular attention to Latino communities in the United States. Heide Castañeda, Iraida Carrion, Dinorah Martinez Tyson, and Nolan Kline have conducted research on ECC among Latino children of migrant farmworkers in Florida.[6] Similarly, in California, Sarah Horton and Judith Barker conducted research about latino caregivers’ perceptions of their U.S. born children’s oral health.[7] In both studies, research found oral health literacy was high, noting place-specific barriers to improved oral health. In Florida, barriers included the cost of care and lack of providers. In California, barriers included a need for more effective oral health promotion and culturally unique notions of milk being associated with strong teeth.

Applied Impact


Addressing easily preventable infections like ECC requires policy efforts to address dental care disparities. Studies like the one conducted by Castañeda et al. suggest that addressing ECC requires increased access to preventative dental care for all populations. Since ECC is a bacterial infection transmitted from caregivers to infants, insuring access to dental care for both caregivers and children is a necessary component of reducing the risk of developing ECC. Adults without access to preventive dental care increase the risk of their passing cariogenic bacteria to their children, but access to dentists may be difficult due to the cost of care. Policies to make dental care more accessible for adults are therefore necessary. Furthermore, oral health is not given the same level of attention as systemic health, as demonstrated by a lack of a dental safety net in the United States. Policy efforts should also focus on developing an oral health safety net such as ubiquitous low cost or free dental clinics that can do preventive or restorative dental care.In addition to policies aimed at increasing access to dental care, economic policies to ensure all populations have access to nutritious food are also needed. Access to nutritious foods is an important component of oral health. Since risk of developing caries is exacerbated by consumption of high-sugar foods, access to nutritious and low sugar food is necessary. Economic conditions directly impact food access; nutritious foods are often more expensive than high-sugar less nutritious food. Any efforts to reduce the risk of developing ECC or any oral health pathology must address access to nutritious food as well as economic constraints that prevent access to better quality foods.

Online Resources




The embedded video includes information on recognizing and preventing ECC.

In addition, the California Dental Association and National Institute of Health also provides information on ECC
http://www.cda.org/popup/early_childhood_caries

http://www.nlm.nih.gov/medlineplus/ency/article/002061.htm

Further Reading


Huntington, N. L., Kim, I. J., & Hughes, C. V. (2002). Caries risk factors for Hispanic children affected by early childhood caries. Pediatric Dentistry, 24, 536e542.

Marshall, T. A., Eichenberger-Gilmore, J. M., Broftt, B. A., Warren, J. J., & Levy, S. (2007). Dental caries and childhood obesity: roles of diet and socioeconomic status. Community Dentistry & Oral Epidemiology 35:444e458.

Nurko, C., Aponte-Merced, L., Bradley, E. L., & Fox, L. (1998). Dental caries prevalence and dental health care of Mexican-American workers’ children. Journal of Dentistry and Children, 65, 64e72.

Peres, M. A., Latorre, M. R. D. O., Sheiham, A., Peres, K. G. A., Barros, F. C., Hernandez, P. G., et al. (2005). Social and biological early life influences on severity of dental caries in children aged 6 years. Community Dentistry and Oral Epidemiology 33(53):63.

Ramos-Gomez, F. J., Tomar, S. L., Ellison, J., Artiga, N., Sintes, J., & Vicuna, G. (1999). Assessment of early childhood caries and dietary habits in a population of migrant Hispanic children in Stockton, California. American Society of Dentistry for Children Journal of Dentistry for Children, 66, 395e403.

Watson, M. R., Horowitz, A. M., Garcia, I., & Canto, M. T. (1999). Caries conditions among 2e5 year-old immigrant Latino children related to parents’ oral health knowledge, opinions, and practices. Community Dentistry and Oral Epidemiology. 27(8):15.

Willems, S., Vanobbergen, J., Martens, L., & Maeseneer, J. D. (2005). The independent impact of household-and neighborhood-based social determinants on early childhood caries: a cross-sectional study of inner-city children. Family & Community Health, 28, 168e175.

References



  1. ^ Berkowitz RJ. 2003 Causes, Treatment and Prevention of Early Childhood Caries: A Microbiologic Perspective. Journal of the Canadian Dental Association(5):304-307b.
  2. ^ Horton, S., & Barker, J. C. 2008 Rural Latino immigrant caregivers’ conceptions of their children’s oral disease. Journal of Public Health Dentistry, 68, 22e29.
  3. ^ US Department of Health and Human Services (USDHHS). 2000 Oral health in America: A report of the Surgeon General. Rockville, MD: US DHHS, National Institute of Dental and Craniofacial Research, National Institutes of Health.
  4. ^ Castañeda, Heide, Iraida V. Carrion, Nolan Kline, and Dinorah Martinez Tyson (2010) False Hope: Effects of Social Class and Health Policy on Oral Health Inequalities for Migrant Farmworker Families. Social Science and Medicine 71 (11): 2028-2037.
  5. ^ Castañeda, Heide, Iraida V. Carrion, Nolan Kline, and Dinorah Martinez Tyson (2010) False Hope: Effects of Social Class and Health Policy on Oral Health Inequalities for Migrant Farmworker Families. Social Science and Medicine 71 (11): 2028-2037.
  6. ^ Castañeda, Heide, Iraida V. Carrion, Nolan Kline, and Dinorah Martinez Tyson (2010) False Hope: Effects of Social Class and Health Policy on Oral Health Inequalities for Migrant Farmworker Families. Social Science and Medicine 71 (11): 2028-2037.
  7. ^ Horton, S., & Barker, J. C. 2008 Rural Latino immigrant caregivers’ conceptions of their children’s oral disease. Journal of Public Health Dentistry, 68, 22e29.