Early Childhood Caries (ECC)
6 mins read

Early Childhood Caries (ECC)

Baby Bottle Tooth Decay, Baby Bottle Syndrome, Nursing Bottle Mouth, Early Childhood Caries (ECC); these are all terms for tooth decay in a child 6 years old or younger with:
• 1 or more decayed teeth
• Missing teeth (resulting from tooth decay)
• Filled surfaces in any primary (baby) tooth

Tooth decay in baby teeth leads to tooth decay in adult teeth.

It Can Happen to Your Child

According to their latest study (8/26/2005) the Centers for Disease Control and Prevention (CDC) found:
• A 15.2% increase of tooth decay in children 2-5 years old
• 28% of pre-school children have experienced tooth decay
• Over 4 million children nationwide are affected

ECC is concentrated (but not exclusive to) among underprivileged children. The study found that disadvantaged children:
• Were almost twice as likely to have tooth decay
• Had decay that was more than twice as severe as children of higher income families
• Were more than twice as likely to have untreated cavities as compared to more fortunate children
• Mexican-American children experienced the most cavities and had more untreated tooth decay than African-American or Caucasian children

Teeth are Vulnerable as Soon as They Erupt

Your baby’s teeth are at risk for decay as soon as they appear! ECC is an infectious disease that all too often progresses rapidly. The upper front teeth are the most likely to be damaged. They are some of the first teeth to appear and have the longest exposure. The tongue tends to protect the lower front teeth when a baby sucks on a bottle or breast.

Things to look for:
• brown spots along the gumline
• Sensitivity to cold, sweet or hard food

Decay can also form on the backs of teeth where it can go unnoticed.

Dental Checkups Are Well-Baby Checkups

ECC can lead to lifelong health issues! It is vital that your baby has regular six month checkups starting between “the 1st tooth and 1st year” because a dentist can treat ECC and prevent:
• Higher risk of decay in permanent teeth
• Hospitalization/emergency room visits
• Poor physical development especially height & weight
• Absence from school
• Decreased ability to learn
• Poor oral health which affects overall health
• Speech impediments
• Self-esteem issues

There are Several Factors That Lead to Tooth Decay

It begins with bacteria, especially mutans streptococci (MS). Plaque is a film of bacteria on teeth. Sugar (fermentable carbohydrates) is food for the bacteria which then produce acids. These acids attack the tooth enamel for 20 minutes or longer! This happens every time your baby drinks a sugary liquid and after multiple acid attacks teeth can begin to decay.

Your Dental Health Affects Your Baby’s

According to the American Academy of Pediatric Dentistry (AAPD) “caries is a transmissible infectious disease” and “the major reservoir from which infants acquire cariogenic bacteria [eg, mutans streptococci (MS)] is their mother’s saliva. In other words, mothers and/or primary caregivers pass on bacteria to their babies through sharing of utensils, blowing on baby’s food, licking a pacifier, etc. If the mother/caregiver has high levels of MS the baby has a greater risk of acquiring the bacteria sooner than babies whose mothers have low levels. So it is important for your baby, as well as yourself, to take care of your teeth!

Other family members and playmates can also transmit MS. If you eliminate saliva-sharing activities (sharing a bottle, spoon, pacifier, etc.) you can decrease the transmission of the bacteria.

Bottles, Sippy Cups, Pacifiers & Breastfeeding

All of these can contribute to the development of ECC. Frequent and prolonged exposure to liquids that contain sugar (fermentable carbohydrates):
• Juice
• Soda (even diet!)
• Formula
• Breast milk
by baby bottles, sippy (training) cups, and even breastfeeding can lead to tooth decay. The problem arises from these liquids pooling around the teeth allowing the bacteria to ‘feed’ on the sugar and produce acids that attack the teeth. This is especially true when you put your baby to bed with a bottle containing something other than water – this is a big No-No!

Other things not to do:
• Dip a pacifier in honey or other sweetener
• Give frequent between-meal snacks & beverages that are sugary
The American Academy of Pediatrics (AAP) recommends no more than 4-6 ounces of fruit juice per day for 1-6 year olds. Also, you should dilute juice with water to reduce the sugar content.

Both the American Dental Association (ADA) and the American Academy of Pediatric Dentistry (AAPD) advise parents and caregivers to:
• Discourage prolonged use of a sippy cup (it’s a tool for transitioning from a bottle to a cup)
• Encourage kids to drink from a regular cup by 1 year old
• Wean a baby from the bottle by 14 months old
• Help your child develop healthy eating habits
• Serve nutritious snacks
• Limit sweets to mealtimes

Dental Hygiene for Infants

Your baby should have his or her first checkup no later than their first birthday! Treat that first dental visit as you would a well-baby checkup with the pediatrician. The dentist will conduct a ‘caries risk assessment’ and provide you with guidance on taking care of your baby’s teeth.

One of the best things you can do to ensure your baby’s oral health is to clean his or her mouth. It is especially important to do this before naps & bedtime as saliva production decreases during sleep. Saliva helps wash the teeth but low amounts of saliva allow sugar to remain on them enabling the bacteria to have a feast!

Clean infants mouth/teeth:
• After each feeding and before bed
• Wipe their gums & teeth (if any) with a clean, damp gauze pad or washcloth
• When teeth begin appearing, brush them with a ‘smear’ of toothpaste (consult your pediatrician/dentist about fluoride) on a soft, age-appropriate sized toothbrush
• Floss when two teeth touch
For toddlers & pre-schoolers:
• Use a ‘pea-sized’ amount of fluoride toothpaste for 2-5 year olds
• Teach them to spit out, not swallow, toothpaste
• Floss their teeth
• Assist kids with their dental hygiene until they’re able to tie their own shoes, then supervise


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