Childhood Caries

Childhood Caries is a very devastating type of tooth decay for the young patients and their parents. It is an infectious disease. Several factors need to be combined to develop caries: bacteria, food for the bacteria (substrate) and time. These are the major factors involved in the caries process. The combination of the factors leads to disease, if one or more factors are missing disease may not develop.

Overall water fluoridation and other methods of fluoride application have resulted in reduction of caries rates. It requires our special attention. We believe that early recognition and intervention are essential to successful treatment AND prevention of disease progression.

Primary teeth usually start to erupt in the first year of life. The first teeth to erupt at approximately 6 months are the so called 'lower central incisors' followed by the 'upper central incisors'. At 12 months usually all lower incisors and all upper incisors are erupted. The eruption time is highly variable and can vary up to 6 months.

Bacteria
One of the important bacteria in dental caries is streptococcus mutans. S. mutans does not appear in the oral cavity of infants until after tooth eruption. S.mutans itself does not adhere to the teeth very well, it requires other plaque forming bacteria for initial colonization. Most likely infants become infected from their parents, siblings or other individuals with close contact and high levels of s.mutans. Only a minimum infective dose is necessary to develop caries. Disease prevention should include preventive therapy for the parents.

Substrate
The substrate for s.mutans comes from juice, milk, formula, or any other liquid sweetened with fermentable carbohydrates. Commercially available sugar teas lead to infant caries in Germany in the 70s and 80s ("Zuckerteekaries"). A favorite trick among parents in the UK used to be to thicken vitamin syrups with honey or other sugar syrup to ensure long feeding. Honey should be avoided in the first year of life. It has been associated with cases of infantile botulism. The botulism spores have also been detected in commercial corn syrups.