Early Childhood Caries (ECC) is the technical term for tooth decay affecting children from infancy through age six. ECC is the most common chronic disease of childhood in the United States, surpassing both asthma and hay fever. Tooth decay in primary teeth is a serious public health concern because these teeth are necessary for proper chewing, speech development, and maintaining space for the permanent teeth. If left untreated, ECC can cause significant pain and infection, potentially requiring tooth extraction and impacting a child’s overall growth and well-being.
Prevalence and Early Risk Factors
Cavities in toddlers are common, often beginning as soon as the first tooth erupts. Approximately 28% of American children between the ages of two and five have experienced tooth decay. Early acquisition of the bacteria responsible for decay is a major factor that increases a child’s lifetime risk of developing cavities.
The risk for developing ECC is not distributed equally; broad, systemic factors play a significant role. Children from lower socioeconomic groups, including those who are uninsured or covered by public health insurance, face a higher likelihood of decay. Neighborhood factors, such as living in rural communities or areas without access to optimally fluoridated water, also correlate with increased risk. Community water fluoridation offers a protective effect, and research suggests it is effective in reducing the disparity in dental health between children from different socioeconomic backgrounds.
Specific Behavioral and Dietary Causes
Tooth decay is driven by specific bacteria, primarily Streptococcus mutans, that metabolize sugars consumed in the diet. This metabolism produces acid, mainly lactic acid, which causes the pH level in the mouth to drop below 5.5. At this lower pH, the enamel, the hard outer layer of the tooth, begins to dissolve through demineralization.
A frequent cause is “Baby Bottle Tooth Decay,” which results from prolonged exposure to sugary liquids. This includes putting a child to sleep with a bottle containing milk, juice, or formula, or allowing frequent, extended sipping throughout the day. During sleep, saliva flow significantly decreases, removing the mouth’s natural ability to wash away acids and buffer the low pH, allowing the decay process to accelerate rapidly.
The bacteria are typically acquired through vertical transmission from the primary caregiver. This transfer often occurs through saliva-sharing behaviors, such as a parent tasting food before feeding the child or cleaning a pacifier by putting it in their own mouth. The earlier a child is colonized with these bacteria, the higher their risk of developing ECC. Frequent consumption of high-sugar or high-carbohydrate snacks and drinks provides the fuel needed for these bacteria to thrive and produce damaging acid attacks.
Strategies for Prevention and Intervention
Prevention of early childhood caries relies on a three-pronged approach encompassing hygiene, diet, and professional dental care. Proper oral hygiene must begin even before the first tooth appears by wiping the infant’s gums with a clean, damp cloth after feedings. Once the first tooth erupts, parents should brush the child’s teeth twice daily using a soft-bristled, age-appropriate toothbrush.
For children under the age of three, only a smear or rice-grain-sized amount of fluoridated toothpaste should be used to prevent excessive ingestion. After age three, the amount can be increased to a pea-sized portion. Since toddlers lack the manual dexterity to clean effectively, a parent must continue to assist with or perform the brushing until the child is about ten years old.
Dietary changes focus on limiting the frequency of sugar exposure rather than just the total amount of sugar. Parents should ensure that children are weaned from a bottle by their first birthday, and a child should never be put to bed with a bottle containing anything other than plain water. Snacking should be limited to mealtimes to give the teeth a chance to recover from acid attacks.
Professional dental care is an important intervention, starting with the child’s first dental visit by their first birthday. This early visit establishes a “dental home” and allows the dentist to assess risk and provide anticipatory guidance. Dental professionals can apply concentrated fluoride varnish treatments, typically every three to six months, to strengthen the enamel and help reverse early decay. For older toddlers and children, dental sealants may be applied to the chewing surfaces of back teeth to create a physical barrier against bacteria.