Overview

Tooth decay in children under the age of 6 is termed Early Childhood Caries (ECC). In Singapore, 55% of preschool children are affected by ECC. Whether caries occurs in adults or children, it is 100% preventable.

We are all familiar with the appearance of a hole or a cavity in our teeth. However, by the time a layman sees this cavity, it is irreversible and necessitates expensive dental intervention. This is particularly true in primary teeth, where you start off with thinner enamel and dentine. If there is a stage in the disease process where the disease can be reversed, would you be interested?

WHAT ARE WHITE SPOT LESIONS?

The process of tooth decay takes time and does not happen overnight. It usually begins with early signs of ECC, which present as White Spot Lesions (WSL) on tooth surfaces. These white spots appear as chalky areas on the enamel surface. They are often found under plaque.

WSL are signs of enamel demineralisation. The WSL is the precursor to the cavity. As demineralisation progresses, parents often complain that their child’s teeth keep breaking off, or they can scrape bits of tooth off. WSL can turn brown and the tooth surfaces will start to break off to form cavities.

Untreated cavities can lead to pain, swelling, loss of appetite and sleep, damage to the developing permanent teeth, or in severe cases, systemic infection.

WSL are not obvious to caregivers unless you look for them. They do not cause pain. It is only at this stage that decay can be reversed. Once the WSL has progressed to become a cavity, reversal is not possible.

Reversing early decay: Causes

In order to reverse WSL, you have to understand the factors that cause it. An interaction of many factors results in ECC. These causes include (but are not limited to):

• Pool oral hygiene resulting in accumulation of plaque
• Prolonged use of milk bottle filled with milk or sweetened liquids as a comforter to soothe the child to sleep
• On-demand breastfeeding throughout the night without considering oral care measures
• Streptococcus Mutans is a caries-causing bacteria which is transmittable from caregiver to infant through acts like sharing of food and eating utensils

Prevention

Prevention is the best option in the management of ECC. If you find a white spot lesion or lesions on your child’s teeth, you should bring your child to the dentist as soon as possible. You have a small window period whereby prevention and early treatment can be done.

While waiting for your appointment, read the checklist below for preventive steps recommended.

• Children are recommended to have their first dental visit by age one or when the first teeth erupt.
• Keep good oral health if you are pregnant and/or have a young child.
• Avoid filling your child’s nursing bottle with liquids such as sugar, water, honey or soft drinks.
• Do not allow your child to fall asleep with a bottle containing milk, formula, fruit juices or sweetened liquids.
• If your child needs a comforter between regular feedings at night or during the day, give him/her a bottle of cool water instead.
• Wean your child off the milk bottle by age one.
• Clean your child’s teeth with a damp washcloth or gauze pad after each feeding. Begin brushing your child’s teeth as soon as the first tooth erupts.
• Fluoridated toothpaste should be used. The type of toothpaste will be recommended by the dentist depending on child’s caries risk.

Early preventive dental visits enable the dentist to assess the child’s risk of getting ECC, catch the early signs of ECC (if any), and recommend appropriate customised preventive measures to arrest and prevent the progression of the disease.