caries, dental (tooth decay)

Consider these statistics:

5% of babies have some tooth decay by 9 months of age
15% by twelve months
17% by four years of age
moderate perdontal disease is found in 40% of children over 12
pregnant women with poor oral health are 7 times more likely to deliver prematurely and are at much higher risk for low birthweight babies

Dental caries (tooth decay) is basically an infectious disease. When the first teeth erupt, they can be colonized by Streptococcus mutans, the predominant bacteria of dental plaque. This bacterium converts sugars and carbohydrates in the mouth to acid, which dissolves and weakens the tooth enamel - tooth decay.

Babies mainly pick up the Strep. mutans germ from their mothers during delivery (it is also found in the genitourinary tract) or after birth by kissing or other direct contact with saliva (and also from others around them via air droplets (coughing, sneezing) or handling). The most vulnerable time for infection is between 6 and 31 months. Mothers with high levels of Strep. mutans infection due to poor oral hygeine are most likely to infect their children. The later in childhood that a child becomes infected, the lower his lifetime risk of infection.

Thus prevention of tooth decay in children requires

delay or prevention of Streptococcus mutans infection, or suppressing the germ's activity
attention to mother's oral health before and after childbirth, since she is the prime source of infection
attention to the child's diet and general nutrition
fluoride supplementation

Mothers with oral hygeine problems of course need treatment before and after birth. Oral hygeine instruction, cleaning, dietary counselling, and tooth treatments such as topical fluoride and chlorhexidine antiseptic are helpful to cut down the rate of Strep. mutans germ transmission to babies.

The biggest single modifiable factor for babies is the diet. Normal amounts of sugars and carbohydrates in the young child's diet reduce the risk of cavities developing. Sleeping with a bottle or walking around with a bottle in the hand all day is the ideal setup for Strep. mutans to do its work on the soft baby teeth (nursing bottle caries).

Breast milk does not promote cavities unless solid foods are in the diet. However, if solids are in the diet, the cavity-promoting potential of breast milk is even higher than that of some formulas. For children who breast feed longer than the first year, the rate of cavities was 10 times higher than that of babies already weaned.¹ Pediatric dentists recommend

a thorough tooth cleaning several times a day
fluoride supplements
early professional checkups starting at 1 year

Fluoride supplementation is of course very important, and the latest recommendations are discussed in detail elsewhere.

Dentists can not only apply fluoride treatments to the teeth, but sealants that keep decay bacteria out of inaccessible pits and crevices in the teeth.

The current expectation among scientists is that perhaps a vaccine against Streptococcus mutans will make infection and thus the rate of tooth decay in children drop dramatically.

The bottom line is that caries prevention for children

begins before they are born with good nutrition and oral health for their mothers and continues with
attention to diet to bolster general health as well as to reduce the availability of decay-promoting carbohydrates and sugars in the mouth
and appropriate dental monitoring and preventive care

¹Hallonsten et al, International Journal of Pediatric Dentistry 5:149-55, 1995

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