Children’s Oral Health & the Primary Care Provider

Children’s Oral Health & the Primary Care Provider

Epidemiology and Risk Factors for Early Childhood Caries

Module 2

Discuss the epidemiology of Early

Childhood Caries (ECC)

Discuss the factors that place children at

higher risk for developing ECC

Discuss clinical findings that are

predictive of high ECC risk

Module 2 Objectives:

How Do Cavities Develop?

Streptococcus mutans

Carbohydrates

Acid formation

Demineralization

Tooth destruction

Teeth Sugar

Bacteria

DecayDecay

How Do Cavities Develop?

Streptococcus mutans

Carbohydrates

Acid formation

Demineralization

Tooth destruction

Teeth Sugar

Bacteria

Decay

Acids persist for 20-40 minutes after eating Frequency of sugar ingestion more

important than quantity

Sugar Consumption & Risk of ECC

Safe zone

Dangerzone

pH

6 7 8 9 10 11 12 1

Bottle Breakfast Snack Sippy-cup Sippy-cup Lunch

J. Douglass BDS, DDS H. Silk MD A. Douglass MD

Time

Risk Factors for

Early Childhood Caries

(ECC)

Studies show low cariogenicity of bovine

milk

Phosphoproteins in milk inhibit enamel

dissolution

Cariogenicity increases when bovine milk

serves as a vehicle for sugary substances

Bottle-feeding: Risk of ECC

Epidemiological studies of breastfeeding

& ECC are rare

Possibility that deleterious dietary practices

other than breastfeeding cause ECC

Breast milk alone is not cariogenic

Breast milk becomes highly cariogenic in the

presence of other sugars

Breastfeeding: Risk of ECC

Nocturnal feeding plays a role in caries

development

When practiced for prolonged periods of time

Related to reduction of salivary flow during sleep

Highest risk:

Nighttime sugary liquids and/or prolonged on-

demand nighttime breastfeeding combined with

poor oral hygiene

Risk Factor for ECC:Nocturnal Feeding

Ad lib consumption from bottle or sippy-cup throughout

the day or from a bottle taken to bed: Leads to frequent exposure of teeth to carbohydrate,

contributing to caries

Linked to malnutrition & short stature

Replaces more nutritious foods & blunts appetite

Fruit juices offer no nutritional benefits over whole fruit

Sugary beverages have no nutritional value

In older children: sugary beverages (especially soda)

also contribute to the epidemic of obesity

Risk Factors for ECC:Juice and Sugary Beverages

Daily frequent exposure to sugary foods is associated

with increased ECC risk.

Sugary foods that are especially cariogenic:

Sticky foods that are retained in the mouth for

prolonged periods of time & not easily washed out by

saliva

Consumed as between meal snacks (>2X/day)

Risk Factors for ECC:Cariogenic (Sugary) Snacks

Early contamination with SM increases ECC

risk

Mothers with high levels of SM tend to have:

High level of decay

Poor oral hygiene

Frequent sugar consumption/snacking

Children with high levels of SM

High dental caries rates within family

members increases child’s risk

Risk Factors for ECC:Transmission of Streptococcus mutans

(SM)

Practices that Allow Transmission of Streptococcus mutans

Visible plaque correlated with high

levels of Streptococcus mutans

Infants & Toddlers:

Visible plaque is an indication of poor &

inconsistent daily oral hygiene

Risk Factor for ECC:Poor Oral Hygiene

No regular use of fluoride toothpaste

Drinking non-fluoridated water

Risk Factor for ECC:Inadequate Fluoride

More caries (treated and untreated)

More missing teeth

Poor oral hygiene due to behavior problems

Higher prevalence of gingivitis and periodontal

diseases

Inadequate dietary habits

Risk Factor for ECC:Children with SpecialHealth Care Needs

(CSHCN)

More difficulty obtaining dental care than any

other population

Frequent exposure to sugary medications

Medication side effects (xerostomia: salivary flow)

Compromised immune system

Enamel hypoplasia

Enamel Hypoplasia

Risk Factor for ECC:Children with (CSHCN)

Inadequate prenatal care

Drug abuse

Genitourinary or oral infections (periodontal disease)

Alcohol or tobacco use are associated with:

Premature and/or Low Birth Weight Baby

Enamel Hypoplasia

Prematurity is also associated with Enamel

Hypoplasia

Risk Factor for ECC:Deleterious Habits During

Pregnancy

Ethnic & Cultural factors

Children from families with: Low-income

Low educational levels

Low dental health literacy

are more likely to have caries

Risk Factor for ECC:Socioeconomic Status

What Clinical Findings Are Predictive of High Caries

Risk?

Previous Caries Experience

One of best predictors of future caries (Reisine et. al,

1994)

For children under age 5, a history of decay should

automatically classify a child as high risk

Not useful caries-risk predictor for infants and

toddlers

(not enough time for ECC to

be expressed)

Visible Plaque

One of the best predictors of future caries risk in young children

Screening for visible plaque is relatively easy and inexpensiveDental Plaque

Initial stage (precursor) of the caries process Equivalent to caries for infants and toddlers Often observed at the gum line and

accompanied by plaque and bleeding gums

Chalky, white spots on primary teeth are demineralized areas and are considered early

decay

White Spot Lesions

From White Spots to

Frank Caries

Enamel Defects & Stained Pits and Fissures

Enamel hypoplasia

Stained pit and fissure surfaces of primary

teeth

Consider both indicative of increased caries

risk

Stained Pits and Fissures

Enamel Hypoplasia

Perceived Risk by Health Care Professional

Experienced practitioners are reasonably able

to predict caries risk with high levels of

accuracy

Presence of Braces and Oral Appliances

Caries Risk Assessment and Management

Any observable decay or demineralization (white spots):- Refer for dental care as soon as possible

Any factors on the oral screen or parent interview that increase the child’s risk for caries:- Refer for dental care

Uncertain caries risk:- Refer for dental care

Refer to I-Smile Coordinator for care coordination & to ensure that dental care is established

Re-assess to ensure the child has been evaluated by a dentist & has established regular dental care & a dental home

I-Smile Coordinators

I-Smile coordinators are dental hygienists who serve as prevention experts and liaisons between families, health care professionals, and dental offices to ensure completion of dental care. Coordinators are located in regional public health agencies and provide local community support throughout Iowa. A coordinator can:

I-Smile Coordinator contact information can be found at: www.idph.state.ia.us/hpcdp/oral_health.asp or

I-Smile hotline 1-866-528-4020

• Assist with dental referrals for young children.• Provide Medicaid dental billing information.• Offer education for healthcare professionals regarding

children’s oral health, including screening and fluoride

varnish training.

Dental caries develop in the presence of teeth, bacteria & sugars

Human & bovine milk have low cariogenicity

Ad lib use of a sippy cup or bottle filled with juice or sugary beverages is a significant risk factor

Previous caries & visible plaque are the best predictors of future caries for young children

Enamel defects & stained pits or fissures increase risk of caries

Summary: Oral Health Module 2