Dental problems, mainly cavities and tooth decay, are visible after a certain age, most probably after the fifties. However, people who don’t take care of their teeth and eat food items harmful to their teeth might have dental problems in their mid-thirties or forties.   

On the other hand, people who are more health-conscious and take care of their teeth with proper oral hygiene can enjoy healthy teeth even in their fifties and sixties. However, children between the ages of 5 and 11 are also highly vulnerable towards various dental problems.    

Early childhood caries (ECC) is one of the dental problems among children under age 6. In this article, we are going to discuss aboutearly childhood caries, its causes, stages of ECC, management of ECC and the right treatment for early childhood caries.  

What is Early Childhood Caries?

Early childhood caries or ECC is the decay of teeth among children under age six. However, it is also referred to as “baby bottle tooth decay” defined as the presence of one or more decayed or missing tooth surfaces in the primary tooth, which can further spread to molars and multiple surfaces.  

ECC can cause pain, discomfort or infections, and if untreated, can permanently damage the teeth. It is not a single cavity but a pattern of dental problems driven by exposure to sugars, poor oral hygiene, and bacteria.

Signs and Symptoms of Early Childhood Caries

The initial signs and symptoms of early childhood caries are white chalky lines or spots near the gum line on upper front teeth.Furtherwith progression, these dull, chalky white spots turn into brown or black cavities, causing tooth sensitivity and making it difficult or painful while chewing and speaking.  

ECC can also be spotted if there are any visible holes or pits in the teeth, or swelling or drainage around a tooth. This causes not only severe pain and discomfort but also leads to poor sleep among the children.  

Stages of Early Childhood Caries

The stages of ECC depend on the age of the children. However, children 71 months or younger typically progress through four main stages. Each stage shows a certain level of ECC condition with changed appearance and different symptoms. Let’s find out in detail what the 4 stages of dental caries indicate.  

Stage 1: White Spot Stage

This is the stage of initial demineralisation in which the appearance of teeth becomes faint, chalky white or opaque bands along the gum line that usually happens on the upper front teeth. The main symptoms of this stage are that the enamel feels rough but is not yet broken, and there is no feeling of pain.  However, at this stage, ECC can be fully controlled through fluoride treatments, with oral hygiene and healthy diets.

Stage 2: Decaying of Enamel

The appearance of teeth changes, the white spot becomes softer and starts breaking down with the formation of small and rough cavities. The symptoms of this stage are a discolouration level shifted to yellow or light brown due to the breakdown of enamel. And the child will start feeling the mild temperature sensitivity in the teeth.

Stage 3: Dentin Decay

This is the stage called damaged lesion in which cavities reach deeper and spread wider, entering into the softer layer of the teeth, or you can say beneath the enamel. The symptoms of this stage of ECC are cavities that usually turn dark brown or black, and your child will start to realise significant pain and discomfort while chewing food. And the sensitivity level becomes more sensitive towards mild hot or cold food and beverages.

Stage 4: Pulp Damage and Advanced Deterioration

This is the advanced deterioration stage in which the tooth decay becomes severe enough to reach the tooth’s nerve (pulp).  In various serious conditions, the crowns of the teeth are completely damaged, leaving only small root stumps. In this stage, your child can feel severe pain and swelling in the gums with the possibility of abscesses, making sleeping and eating difficult in daily life. 

What Causes Early Childhood Caries?

There are various factors causing the ECC, such as poor oral hygiene, frequent exposure to sugars and cavity-causing bacteria. This is usually linked to prolonged bottle-feeding, as the child’s sugar, added milk drinking habit attracts bacteria that eat such sugar and produce the acid that causes early childhood caries.  

Types of Early Childhood Caries

The ECC affects children 71 months or younger. However, based on severity and pattern, ranging from localised enamel defects to widespread destruction of almost all primary teeth, ECC is classified into three clinical types.   

Type 1: This is a mild, or you can say moderate, type of ECC in which white spots mainly affect the upper front teeth or back teeth. This can be caused by a combination of semisolid or solid cariogenic foods and a lack of proper oral hygiene.

Type 2: This is a moderate to severe type of ECC that affects the front surfaces of the upper incisors and possibly the molar teeth. However, the lower teeth can remain unaffected, and it can be caused by inappropriate bottle feeding, at-will breastfeeding or both, attracting the harmful bacteria at frequent levels.

Type 3: This is the severe type of ECC, aggressively spreads and affects most of the teeth, including lower, upper, front and back teeth that might not be affected in early stages. This is mainly caused by a heavy combination of high-sugar diets, poor oral hygiene, and prolonged exposure to fermentable carbohydrates.   

What is a Risk Factor for Developing Early Childhood Caries?

ECC is mainly caused by prolonged exposure to sugars and a lack of proper dental hygiene. However, the strongest risk factors include frequent consumption of sugary foods or drinks. Not using the fluoride toothpaste also causes high levels of decay-causing bacteria in the mouth. The development of ECC is mainly associated with daily lifestyle, genetics, and socioeconomic factors. Let’s find out the top risk factors.

Dietary & Feeding Habits: The frequent use of nighttime bottles to feed the child with a bottle containing milk, formula, or sugar-added juices. Apart from that, the child is eating sticky or sweet snacks like candies or gummies. And lastly, on-demand breastfeeding or bottle-feeding without proper teeth cleaning.

Oral Hygiene & Dental Care: If you don’t take care of your child’s teeth with proper dental care and oral hygiene, ECC can develop easily. Not brushing the child’s teeth at least twice a day for at least two minutes, or not using fluoride-based toothpaste for brushing.  

Biological & Genetic Factors: Another risk factor for developing ECC can be due to the child being born with developmental defects of the tooth enamel. Apart from that, bacterial transmission is another major risk that can happen to the child from caregivers or siblings through shared utensils or kissing.

Socioeconomic & Environmental Factors: The people with low income or lower caregiver education levels are not able to afford the proper dental care, and are also at high risk of ECC. And the siblings of those who have a history of tooth decay are also more likely to be affected by ECC. 

How to Prevent Early Childhood Caries?

Prevention is better than cure, yes, preventing the ECC will not only help to control such dental problems in your children but also help them to avoid major dental problems in their lives. There are a few preventive measures you can follow to keep your child safe from ECC or any other dental problem.

Start Early: Whenever the first tooth erupts, start cleaning the tooth using the soft infant toothbrush and fluoride toothpaste to clean the tooth and clean the gums with soft cloths.

Brushing Habits: The right brushing technique is very important to avoid ECC. You need to supervise your child or help them to properly clean their tooth and make sure they brush twice and do it for at least two minutes.

Avoid Bedtime Bottling: Never put the milk bottle in your kid’s mouth at bedtime or when going to sleep. You should also avoid sugar-containing juices, formula drinks or sweetened liquids at bedtime. Overnight, bacteria attack your kids’ teeth, causing tooth decay and ECC.  

Using the Open Cups: Afterattaining the age of one, you should encourage your child to drink milk with open cups that reduce the exposure of teeth to sugar and other such drinks.    

Limit the Sugar Intake: You should avoid using sugar in milk or any other such drinks to reduce the sugar intake and limit the exposure to the tooth that attracts bacteria, causing tooth decay or ECC.

Avoid Bacterial Transfer:  You should also avoid sharing the feeding utensils or toothbrushes with your child. Also, avoid licking pacifiers or direct kissing on the mouth of your kids as it increases the risk of transmitting the cavity-causing bacteria from adult to child’s mouth.

Fluoride Treatments: Make sure your child is getting enough fluoride to strengthen tooth enamel, but always consult the best dentist in Greater Noida or near your city to get professional fluoride treatments.   

Timely Visit to Dentist: Last but not least, you should keep visiting the best pediatric dentist in Greater Noida or a kids dentist near your city to get regular check-ups of children’s teeth.  

Treatment for Early Childhood Caries 

The treatment for early childhood caries depends on the tooth condition and stage of ECC. The Preventive & Non-Invasive Treatments are suitable for early stages, while arresting treatments and restorative treatments are suitable for the stage of active decay and advanced cavities, respectively. And for the last stage or severe ECC conditions, the advanced management treatment is recommended to cure this child’s dental problem. 

Fluoride Treatments: In this treatment procedure, a highly effective, professional application that remineralises weakened enamel and protects from further damage. For toddlers, who struggle with traditional dental treatments, topical liquid is used to arrest active cavities quickly without drilling. 

Restorative Care: In the atraumatic restorative and interim therapeutic restorations technique, decayed tooth tissue is removed softly using the hand instruments. And later filling is done with fluoride-releasing Glass Ionomer Cement to prevent the teeth from any further caries.   

Pulp Therapy: When decay in the tooth reaches to the nerve, but the tooth is still salvageable, pulpotomy, as pulp therapy, can be used to save such teeth from ECC. 

Fillings & Crowns: For other serious conditions, dental tooth fillings and crowns are used to fill the composite resin or glass Ionomer. And if the situation is critical or pre-formed, pediatric crowns are placed to restore full function and prevent the tooth from breaking or cracking.

Tooth Extraction: This is thelast stage when no dental treatment procedure is suitable to save the teeth damaged due to ECC. The tooth is extracted carefully while maintaining enough space for the growth of the future adult tooth in your child.   

Conclusion

Early childhood caries is a dental problem among children under the age of six, also known as baby bottle tooth decay, causing cavities and the decay of teeth. Starts from initial symptoms of white chalky lines or spots near the gum line, which can progress to a severe stage, damaging the tooth enamel and dentin. 

However, with proper oral care and dental hygiene like avoiding bottle feeding at bedtime, minimising sugar intake and proper brushing habits, ECC can be prevented to a certain level. And in severe conditions, taking the early childhood caries treatment is a must to avoid major dental problems among the kids.