What are the causes and prevention methods of early childhood caries?

Causes of Early Childhood Caries

Primary Etiological Factors

Early childhood caries results from the interaction of three essential elements: cariogenic bacteria (particularly Streptococcus mutans), fermentable carbohydrates as substrate, and prolonged/frequent exposure time. 1

Bacterial Colonization

• Infants acquire cariogenic bacteria primarily from their mothers through vertical transmission, with colonization requiring the presence of erupted teeth 1
• The critical "window of infectivity" for Streptococcus mutans colonization occurs between 19-31 months of age, making this period crucial for preventive intervention 2, 1
• Earlier bacterial acquisition is associated with maternal caries, sibling caries, and poor oral hygiene practices in caregivers 2
• Mothers serve as both the primary source of dental knowledge and the main transmitters of cariogenic bacteria to their children 2, 1

Dietary and Feeding Factors

Prolonged bottle feeding and frequent sugar consumption are the most significant modifiable risk factors for early childhood caries. 1

• Prolonged bottle or breast feeding provides fermentable carbohydrates that create an acidogenic oral environment, lowering pH and promoting enamel demineralization 2, 1
• The frequency of sugar exposure directly correlates with caries risk—the number of eating occasions and duration of sugar contact with teeth are critical determinants 1
• Breastfeeding up to 12 months reduces ECC risk by half through immune-modulating effects, but breastfeeding beyond 24 months (especially at-will nighttime feeding) increases caries risk 2.4-fold (RR: 2.4; 95% CI: 1.7-3.3) 1
• Early childhood caries affects an estimated 1-11% of urban infants and is characterized by rapid, extensive dental decay often associated with prolonged feeding practices 2
• The intake frequency of sugary foods is the single most influential factor for early childhood caries development 3

Host Susceptibility Factors

• Enamel developmental defects increase susceptibility to caries by providing areas of weakened tooth structure 4
• Newly erupted teeth are most vulnerable to caries, as enamel maturation is incomplete 5
• Indigenous children may experience earlier primary tooth eruption, contributing to earlier bacterial colonization and increased ECC risk 5

Oral Hygiene Practices

• Poor oral hygiene creates an environment favorable to bacterial proliferation and acidogenic plaque formation 2
• Inadequate parental education about oral health care leads to subsequent dental problems, as children cannot control these factors independently 2
• The age of starting tooth brushing and frequency of brushing are significantly associated with ECC development 3

Fluoride Exposure

• Suboptimal fluoride exposure (either from water supply or topical sources) reduces the teeth's resistance to acid demineralization 2
• Fluoride works both systemically (incorporated into developing teeth) and topically (in saliva and plaque) to prevent caries 2, 1

Socioeconomic and Behavioral Factors

• Low socioeconomic status correlates with increased caries risk due to limited access to preventive care and healthy foods 4
• Ethnic minority status is associated with higher ECC prevalence 4
• Parental oral health knowledge directly influences children's caries risk—mothers with poor oral health knowledge have children at higher risk 3
• Consumption of sugary foods before bedtime significantly increases caries risk 3

Clinical Risk Assessment

Children with previous caries experience, visible white spot lesions, visible plaque, or high levels of mutans streptococci should automatically be classified as high risk for caries. 4

• Caries susceptibility testing (such as Cariostat) can identify children at elevated risk 3
• The combination of frequent sugar intake, poor oral hygiene, and high bacterial colonization creates the highest risk profile 3, 4