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Caries: What is it

Caries is the most common disease afflicting man. Dental procedures resulting from caries account for the most man hours spent on the dental chair. When caries affects children, the problem is compounded by their limited co-operation for dental procedures; yet 40% of our Singapore preschoolers have a form of decay known as Early Childhood Caries (ECC).

Early childhood caries shared by National Dental Centre Singapore

What is Early Childhood Caries?

This is an aggressive form of decay occurring in children below the age of six years. Typically, it attacks the teeth as they erupt - first, the upper anterior milk teeth, then the baby molars. Lower anterior teeth are usually unaffected because these teeth are protected by the tongue and saliva. Saliva has protective factors against decay. However, saliva is reduced during sleep. Children at risk of ECC continue to carry this risk to their permanent teeth.​

Symptoms of Early Childhood Caries

Chipping away of parts of the teeth is the first symptom as the enamel is decalcified by the acids. This can happen as soon as the tooth erupts. This progresses to discolouration and tooth sensitivity. Severe pain and even tooth fracture occurs when decay has progressed into the deeper layers of the tooth.

Risk Factors of Early Childhood Caries

ECC is a dental infection by strep. mutans bacteria spread from parent or caregiver to the infant. Transmission occurs through saliva, such as the sharing of food or eating utensils. The earlier the infant is affected, the higher the risk of the disease.

ECC is closely related to the prolonged use of a milk bottle especially at night. This can also happen with demand breastfeeding, when the child nurses at the breast throughout the night. The child uses the bottle or breast for comfort, or as a pacifier – a habit called ‘non-nutritive sucking’. Unfortunately, this habit is intertwined with sleep patterns. The child is unable to fall asleep without sucking on the milk bottle. Parents, therefore, report difficulty in stopping this habit, once it is entrenched.

Plaque is also a risk factor. Children with ECC have high levels of plaque. Failure to brush the child’s teeth properly contributes to the accumulation of caries-causing bacteria.

Not all children who nurse with a milk bottle at night develop ECC. Like all diseases, the risk factors above are modified by the child’s resistance to developing caries. This resistance is found in protective factors like type of saliva and quality of tooth structure. This explains why parents may have one child who has the same habit but does not develop the disease, whereas another one does.

Prevention of Early Childhood Caries

Parents should observe the following:

  • Do not share food or eating utensils with your baby. Caregivers should have good oral health to minimise the risk of infecting the child with strep.mutans. If you are an expectant mother, you can get yourself assessed by your dentist to minimise your risk of transmitting strep.mutans to your child. 
  • Never put your child to sleep with a milk bottle filled with milk or sweetened liquids in his mouth. Do not allow your child to suckle on demand from your breast when he is sleeping.
  • If your child needs a comforter between regular feedings, at night or during the day, give him a bottle of cool water instead.
  • Begin brushing your child’s teeth as soon as the first tooth erupts.
  • Wean your child off the bottle by age one and schedule his first dental visit.

Treatment for Early Childhood Caries

Treatment depends on how severely the teeth are decayed. Late presentation results in extractions as the only option. As the permanent teeth erupt between 6 – 12 years of age, there is a long time frame where the preschooler will be toothless. Bring your child to his first dental visit when he turns one.

This could compromise chewing and eating. Less severely affected teeth can be treated by fillings, or crowns. Almost always, general anaesthesia is required because of the extensive treatment needs, and the young age of the patient.

Please consult your Family Doctor if you have any concerns about your health.

Specialist services available at the following SingHealth institutions:

National Dental Centre Singapore
Tel: 6324 8802