Tuesday, 26 July 2011

Dental Caries in Children

Published in Panorama

Ensuring that toothy smile

How wonderful it is to watch the cute gummy smile curl the sides of an infant’s lips, the first time since its grand entry into this world! And then the smile changing to a toothy one as its first tooth erupts! Well, how often and for how long are we, parents, ensuring this perfectly pearly smile as caries and other dental problems plague little ones much earlier in their lives today, than perhaps they did decades ago!

Dr.Uma Easwara, Specialist Pedodondist, Canadian Specialist Hospital explains, “Once the first tooth comes into the mouth, it starts a long period of tooth eruption for the baby and by the age of two and a half years all the twenty milk teeth of the baby are in the mouth. Unfortunately for some toddlers and preschool children the milk teeth develop some problems very early, much to the agony of both the parents and the child. Most often we come across toddlers and preschool children with brownish or blackish discoloration of the tooth. On examining these children we find that they have developed decay of the teeth, a condition called dental caries.”

Despite rapid advancement in dentistry and widespread use of fluorides, dental caries remains a major oral health problem in most industrialized countries, affecting 60-90% of schoolchildren and the vast majority of adults. Worldwide, dental decay is one of the most common chronic infectious diseases among children, being five times more common than asthma. 17% of children aged 2 – 4 years in the USA, already suffer from dental decay! The figures for Early Childhood Caries range from 3% to 53%. The crucial fact is: Dental decay which begins in very early childhood is a preventable health problem, emphasizes Dr.Uma.

The pattern of decay reveals Dr.Uma is typically the involvement of many teeth being affected, with tooth decay developing rapidly, often soon after the teeth have erupted. “Tooth surfaces usually at low risk of developing caries are affected such as the facial surfaces of upper front teeth with the obvious consequence of affecting the child’s facial appearance. It is this pattern of caries that has been labeled variously as ‘baby bottle tooth decay’, ‘nursing caries’ and ‘night bottle mouth’.

As suggested by these terms, the prime cause of such caries is inappropriate bottle feeding. One of these might also be attributed to the use of a sugar-containing liquid in a bottle at night-time, reveals Dr.Uma. Early Childhood Caries (ECC) is used to describe any form of caries in infants and pre-school children below five years, explains Dr.Uma.

What are the risk factors contributing to caries? Dental caries is an infectious disease induced by diet, explains Dr.Uma. Excessive and too frequent intake of sweets is a major contributory factor. “A wide range of risk factors have been found to be significantly related to early childhood caries. Frequent consumption of sweetened liquids e.g., juice, milk formula, soda, increases the risk of caries due to prolonged contact between sugars in the consumed liquid and decay causing bacteria on the susceptible teeth. Frequent bottle feeding at night, breast-feeding on demand, and extended and repetitive use of a no-spill training cup are associated with, but not definitely implicated in, ECC. The evidence points most consistently to a young child being most likely to develop caries if at a young age they acquire the decay causing bacteria.”

How do children get the decay-causing bacteria? Dr.Uma explains, “When a baby is born its mouth is absolutely free of bacteria. The caries causing bacteria also do not come into existence till the first tooth erupts. This is because the bacteria need a surface to stick onto; this happens only at the time of the eruption of the first tooth. The major source from which infants acquire the bacteria in the mouth is their mother’s saliva, unfortunately. How much would be transmitted from the mother to the child depends on the amount of caries causing bacteria that the mother has. Therefore infants and toddlers whose mothers have high levels of bacteria, a result of untreated caries, are at greater risk of acquiring the bacteria than children whose mothers have low levels.”

Why is ECC a cause for concern? The reason is simple: a child with ECC has a higher risk of developing new decayed teeth in both the milk and permanent teeth, may require hospitalizations and emergency room visits, have insufficient physical development (especially in height/weight), loss of school days and increased days with restricted activity, diminished ability to learn, and diminished oral health-related quality of life, reveals Dr.Uma. “Some young children with ECC may be severely underweight because of associated pain and the disinclination to eat. Sometimes the decay progresses to involve the tooth tissue causing severe pain and possibly swelling also. Let’s not forget the additional factor of increased treatment costs and time spent in getting the treatment done for the child,” adds Dr.Uma.

How is ECC treated? Dr.Uma explains, “The decayed teeth can be filled to seal all active decay process and also to ensure that no niches are available for the bacteria to lodge, thereby progressing the decay process. If the child is too young to cooperate for the treatment the child’s teeth can be treated by administering sedation or general anesthesia so that all the teeth that need treatment can be restored in one sitting itself. Depending on the amount of decay present, the decayed teeth can be restored by using different types of dental materials.”

Prevention rather than treatment, is doubtless the best course of action. This may be done by a number of factors including sound oral hygiene and partaking of a diet that does not predispose the child to caries, explains Dr.Uma. “Prevention of ECC begins as early as during pregnancy and also during the first few months of birth. Mothers-to-be should optimize nutrition during the last few months of pregnancy and during the infant’s first year, when outer layer tooth (enamel) is undergoing maturation. This is the period when the enamel is highly susceptible to changes that would affect the formation of the enamel. These changes manifest as developmental defects in the enamel. A consistent association exists between enamel defect and ECC; hence a child with a developmental defect of enamel is at a higher risk of developing ECC.”

Prevention of ECC also encompasses inculcating good oral hygiene measures for the baby, emphasizes Dr.Uma. “It’s never too soon to start taking care of your baby’s gums and teeth. With regular cleaning, your baby will have a beautiful and healthy smile right from the start. If yours is a younger toddler, it works best to start brushing her teeth right away, even if she has only a few of them. This way, dental hygiene becomes a part of your child's daily routine before she becomes the typically combative toddler afflicted with a case of the "no's." Also, make brushing a family activity; let your child watch you as you brush your own teeth, and remember to liven it up. If you act as if brushing teeth is one of the most enjoyable things you do in your day, she may attack it with more gusto.

Take Care of Gums and Teeth of your Child:

• Even before your baby’s first tooth appears, you can clean his gums. Gently wipe them after each feeding with a clean, damp washcloth.
• Oral hygiene measures should be implemented by the time of eruption of the first primary tooth. Clean them gently with a soft infant toothbrush. Use just water—not toothpaste!
• Do not put your infants to bed with a bottle. Avoid on demand night time breast-feeding after the first primary tooth begins to erupt.
• Encourage your infant to drink from a cup as he /she approaches her first birthday. Wean your infant from the bottle at 12 to 14 months of age.
• Avoid repetitive consumption of any sweetened liquid from a bottle or no-spill training cup.
• Avoid giving junk food to your child. Not only does it gives unnecessary calories but also causes hyperactivity in the children and is bad for teeth too. Let it be an occasional treat once a fortnight or once a month.
• The mother or the primary caregiver’s should also get her dental examination done in order to reduce chance of transmission of bacteria and lessen the infant’s or child’s risk of developing ECC.
• Avoid sharing cutlery with your infant.
• Schedule an oral health consultation visit within 6 months of eruption of the first tooth and no later than the first birthday to learn about prevention of dental disease.
• If you detect any discoloration on your child’s teeth get it checked and treated if required. Do not wait for the pain to occur before you report to the dentist.
• Even if your child does not have any dental problems schedule six monthly routine checkups. This allows the child to be familiar with the dentist. If you take your child to a dentist when in pain, his fear will get reinforced and will resist treatment that needs to be given to him.


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