Notes on Parenting

Insights for parenting babies, toddlers, teens, and young adults.

Saturday, March 12, 2011

Early Childhood Caries

I still remember how shocked I was to find out my friend's son had so many cavities. He was barely two and had six cavities! Why? They ate a healthy diet and he had never had a bottle, so it couldn't be baby bottle mouth, could it?

The dentist told her it was because she breastfed him at night and that she needed to stop immediately. She had questioned this advice and decided to seek other opinions. She was now taking a very active approach to dental management. She carried toothpaste and a toothbrush in her bag and was brushing his teeth or giving him a special "gum" to chew after everything he ate. Despite all her active management, and even though he did wean after age 2, he still developed two more cavities.

As someone who had been fairly lackadaisical in young child dental care, I was confused. My kids had breastfed at night, my kids ate sugar, I only brushed their teeth occasionally when they were little because I hated the fight. Why were my kids' teeth perfectly fine and her son kept developing new cavities? Was it really just good genetics?

It turns out that her son had a bacterial infection called Early Childhood Caries (ECC) that has only recently been classified. In fact it was in 1994 that the CDC stopped using the terms "bottle mouth" and "nursing caries", acknowledging that ECC was an infectious disease NOT caused by bottles or breastfeeding.

ECC is caused by bacteria that are transmitted from person to person by saliva - usually from mother to child. They are site specific, meaning a baby will not be colonized until they have teeth. The main culprit bacteria is called Streptococcus mutans, or S. mutans for short. These bacteria feed on sugar and produce acid as a byproduct. A study done in 1996 at the University of Helsinki found that kids with lots of cavities had extremely high concentrations of these bacteria, while cavity free children had very low levels. ECC is the most prevalent infectious disease in America. It is more than five times common than Asthma.

"High-caries-index patterns run in families and are usually passed from mother to child (although a small percentage can be passed from a primary caregiver, the father, or siblings), from generation to generation; the children of high-caries-index mothers are at a higher risk of decay; approximately 70 percent of caries are found in 20 percent of our nation's children; a mother's dental hygiene and diet, as well as those of the primary caregiver and entire family, can significantly contribute to the development of ECC in her child" - Kevin Hale DDS

So in short, breastfeeding or bottle feeding has nothing to do with how many cavities your child gets. If you are dealing with a lot of cavities in your child, he or she probably has high levels of this S. mutans bacteria. To stop the cavities, you must lower the levels of these bad bacteria in your child's mouth. Many dentists are still uneducated about this disease. Treatment must be aggressive. One of the things flouridated toothpaste does is remineralize the teeth, helping to protect against and stop cavities. A 1996 study found that a combination vitamin D, vitamin C, and calcium reversed early decay in children.

My friend's son finally stopped having tons of cavities. It took several months of very active management and the elimination of refined sugar for a while from his diet. In the mean time I learned that it wasn't just genetic luck that kept me and my children from having lots of cavities. Yet another reason to teach my children not to share cups with other people!

This article written by Malina, who has gotten better about regularly brushing her 2 year old's teeth.,0
S. K. Gupta et al., "Reversal of Fluorosis in Children." Acta Paediatr Jpn 38, no. 5 (October 1996): 513-519. 
 Brian Palmer, "Breastfeeding and Infant Caries: No Connection," ABM News and Views 6, no. 4 (2000): 27. 
Harold C. Slavkin, "Streptococcus mutans, Early Childhood Caries, and New Opportunities," National Institute of Dental and Craniofacial Research (NIDCR),
S. Alaluusua et al., "Oral Colonization by More than One Clonal Type of M.S. in Children with Nursing Bottle Dental Caries," Archives of Oral Biology 41, no. 2 (1996): 167-173.

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