Many people do not realize that cavities in children's teeth (or dental caries) is the most prevalent infectious disease in North America with an estimated 60-90% of school-aged children affected. Areas without fluoridated water, with reduced access to oral care and of lower socioeconomic status are at the highest risk. Early chilhood caries (ECC) is a severe form of tooth decay affecting the anterior teeth and first molars. Severe-ECC affects all the teeth as demonstrated in the adjacent photo. ECC is a serious health concern and dramatically affects a child's quality of life.

I am often asked, "Why should I worry about these teeth anyway? They are only baby teeth and will just fall out eventually." 

To understand why we need baby teeth, let's just consider why we need teeth at all:

The number one reason is nutrition. The consumption of nutritious foods is critical to the proper growth and development of children. If we take away the teeth, we remove the child's ability to chew and consume these nutrients. Painful teeth and infection will also affect a child's ability to eat and in turn affect growth and development. ECC, infection and reduced nutritional intake are associated with comorbidites such as asthma, diabetes, cardiac conditions, digestive problems and obesity.

Secondly, primary teeth are critical to maintain the space required for proper eruption of the permanent dentition. Early loss of primary teeth can result in severe crowding and malocclusion; which can have a dramatic effect on masticatory function and social confidence. In some cases, the crowding may result in impaction during eruption and subsequent extraction of an otherwise healthy tooth or teeth.

A third reason for primary teeth is social development. Decayed and missing teeth are a cause for social embarassment and can lead to developmental problems such as poor interpersonal skills and behavioural issues.

Many people are also not aware that dental caries is in fact an infectious disease. Not only will it spread within an individual's oral cavity, but it can be transmitted from person-to-person. How is this possible? There are bacteria of various virulence levels meaning that some bacteria or more cavity-causing than others. We are not born with these cavity-causing bacteria in our oral cavity. There is a dental term known as "the window of infectivity" which defines the age range at which babies are first exposed to these cavity-causing bacteria by another individual (most often Mom or Dad sharing food with the infant). Once the oral cavity is "infected" with these bacteria we must control their cavity-causing ability through good oral hygiene and nutrition practices.

How can we prevent ECC?

Oral hygiene practices must start early, even before the eruption of the first tooth. There are baby gum brushes available on the market or even the use of a clean, damp cloth to wipe away food debris and bacteria from an infant's gums. Begin brushing habits at the eruption of the first tooth. A children's toothpaste of the approriate age or even no paste at all to prevent the infant from swallowing too much toothpaste. Brush a minimum of twice per day and preferrably after every meal. Introduce childrens floss to clean between teeth as soon as adjacent teeth are present. Use a disclosing agent to show the older children where plaque exists and then brush until the dye is removed from all surfaces. Begin to bring your child to the dentist at the eruption of the first teeth - this is primarily to allow the children to become familiar with the dental envirnoment and to educate both the child and parents on oral hygiene and nutrition. Remember, MSI coverage in Nova Scotia for children's dental treatments is available until the age of 10.

Proper nutrition is just as important as oral hygiene. Reduction of sugar intake is important. The frequency of sugar intake must be controlled as well. Avoid chewy candies and chewy fruit snacks as much as possible. Do not allow children to sip on juice all day long or go to bed with a bottle (especially with juice). Children must be encouraged to drink from a cup as soon as possible (preferrably by age 1). The use of "sippy" cups and bottles are discouraged beyond this age. The best snacks between meals are fresh fruits and vegetables with water as the between meal drink of choice. Remember, brushing after each meal is ideal!

Cavities develop quickly in primary (baby) teeth and can double in size in a matter of only 6 months. Frequent check-ups with your dentist are important to catch these problems early and to determine the risk factors and sources of these problems. 

If you have any questions or concerns about your children's oral health, please contact Dr. Luke Haslam at Basinview Dental Centre, and we would be happy to answer your questions. To read more on ECC, please refer to this document prepared by the Canadian Dental Association:

Dr. Luke Haslam

68 Water St., Digby, NS