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).
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
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
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
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
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.
Parents should observe
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
Please consult your Family Doctor if you have any concerns
about your health.
Specialist services available at the following SingHealth
National Dental Centre SingaporeTel: 6324 8802
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