Feature - Early Childhood Caries

Dentist Dr Trevor Holcombe (MSc) of smilefocus explains what Early Childhood Caries (ECC) is, what causes it, and how ECC can be prevented from damaging babies' teeth. Numerous terms have been used over the years to describe Early Childhood Caries, such as "nursing bottle caries", "nursing bottle syndrome", "bottle mouth caries", "baby bottle caries" and "baby bottle tooth decay". 

The American Association of Paediatric Dentists (2008) defines ECC as the presence of one or more decayed, missing or filled surfaces in any primary tooth in a child at 71 months of age (less than six years) or younger. Regardless of the term that is used, numerous studies have shown that the rates of Early Childhood Caries (ECC) are increasing in both first-world and third-world countries.

Studies have repeatedly shown that the oral health of the parent or care giver has a direct impact on the oral health of the child, and the likelihood that the child will develop ECC. Caregivers can include all those who are responsible for behavioural practices of the child such as fathers, older siblings, extended family, nannies and day care staff, especially as they can be also be involved in the development of ECC.

ECC can be a progression of dental caries found in the primary (baby) teeth. The costs of treatment can be high due to the age of the child and their consequent inability to cooperate for treatment in a traditional dental setting. This often results in treatment being performed under general anaesthetic (GA) in the hospital setting. Furthermore, clinical outcomes can be poor with continued recurrence of the disease in both the primary and permanent dentition. In severe cases of the disease, additional dental, medical and psycho-social complications can arise including orthodontic issues, nutritional challenges and speech impediments.

Caries is caused by many factors and depends on the interaction of bacteria and food over time. The main bacteria known to cause dental caries is Mutans Streptococci (MS). It grows in the mouth of the newborn and if there is a large number present, it is a key factor in the development of ECC. At birth the mouth is sterile, and one of the key risk factors for ECC is the transfer of MS bacteria from the mother or caregiver’s saliva to the newborn child. There is a much bigger chance of this happening when the mother or caregiver has high levels of MS. The critical age is approximately 7 months, just before the eruption of the teeth. This study showed the importance of targeting mothers while pregnant (or shortly after birth) for education and/or intervention and establishing contact with the newborn by the age of 7 to 12 months.

It is essential for all caregivers to be dentally healthy, i.e. to have no dental decay or gum disease. If the caregivers have good oral health they are less likely to pass on the MS bacteria to the child. In addition, the ongoing oral health advice during pregnancy and continued into the early years reduces the number of the decay-producing bacteria, which in turn reduces the decay rates in early childhood. Early education also develops good toothbrushing and oral hygiene in the whole family.

Dr Trevor Holcombe MDSc (Paediatrics)(Queensland)

Smilefocus - Family, Cosmetic, Orthodontics and Implant & Restorative

 Camden Medical Centre, 1 Orchard Boulevard, Singapore 248649


Dr Holcombe has over 30 years in dentistry and 20+ in paediatrics, including orthodontics and oral surgery.