What are the primary factors that contribute to dental caries in children?

Primary Factors for Parent-Focused Dental Caries Prevention Posters

For posters targeting parents, focus on three easily understood factors: frequent sugar consumption (especially sugary drinks and snacks), prolonged bottle feeding beyond 12-24 months, and inadequate fluoride toothpaste use—these are the most modifiable and evidence-based causes of childhood dental caries. 1

Core Messages for Parent Education

Sugar and Frequent Eating

• Frequent consumption of sugary foods and drinks is the primary dietary cause of cavities because bacteria in the mouth ferment these sugars to produce acid that erodes tooth enamel 2, 1
• The frequency of sugar exposure matters more than the total amount—constant snacking and sipping create repeated acid attacks on teeth 1
• Limiting eating occasions to four or fewer per day significantly reduces cavity risk 1
• Sugar-containing acidic drinks are particularly harmful because they combine direct acid erosion with bacterial acid production 3

Bottle Feeding Practices

• Prolonged bottle feeding beyond 12-24 months dramatically increases cavity risk, particularly when bottles contain milk, juice, or other sugary liquids 1
• Never allow children to sleep with bottles containing anything other than water—nighttime feeding allows sugars to pool around teeth for extended periods 1
• Breastfeeding up to 12 months actually reduces cavity risk by half, but breastfeeding beyond 24 months (especially at-will nighttime feeding) increases risk 2.4-fold 1
• If breastfeeding beyond 12 months, wipe gums and teeth after nighttime feeding to minimize sugar exposure 1

Fluoride Toothpaste Use

• Start brushing with fluoride toothpaste (1,000-1,100 ppm) twice daily as soon as the first tooth erupts—this is one of the most effective prevention measures 1
• Fluoride works by being constantly present in small amounts in saliva and plaque, not just by being incorporated into developing teeth 2
• Inadequate fluoride exposure is a major modifiable risk factor that reduces teeth's resistance to acid damage 1

Additional Important Factors (Secondary Messages)

Poor Oral Hygiene

• Inadequate tooth brushing allows bacterial plaque to accumulate, creating an environment where cavity-causing bacteria thrive 2, 1
• Parents must help young children brush their teeth—children cannot effectively clean their own teeth independently 1
• Poor oral hygiene in parents and siblings increases the child's risk because cavity-causing bacteria are transmitted from caregivers to children 1

Bacterial Transmission

• Mothers and caregivers are the primary source of cavity-causing bacteria (Streptococcus mutans) that colonize children's teeth 1
• The critical "window of infectivity" occurs between 19-31 months of age when these bacteria most easily establish themselves 1
• Earlier bacterial acquisition is associated with maternal cavities, sibling cavities, and poor caregiver oral hygiene 1

Practical Poster Design Recommendations

Visual Simplicity

• Use three main icons: a sugary drink/snack with a prohibition symbol, a baby bottle with a clock showing "stop by age 1-2," and a toothbrush with fluoride toothpaste
• These represent the most actionable and evidence-based prevention strategies that parents can immediately implement 1

Avoid Complexity

• Do not include complex concepts like bacterial colonization mechanisms, enamel demineralization chemistry, or socioeconomic factors—these are not actionable for parents 2
• Focus on what parents can control: feeding practices, sugar frequency, and fluoride toothpaste use 1

Common Pitfalls to Avoid

• Do not suggest that eliminating all sugar is necessary—the evidence shows that limiting sugar to less than 10% of total energy intake (ideally less than 5%) and reducing eating frequency is sufficient 1
• Do not imply that cavities are inevitable—emphasize that consistent fluoride toothpaste use and limiting sugar frequency can maintain low cavity risk 2
• Do not overlook the importance of timing—the first dental visit should occur by 12 months of age, not when problems develop 1
• Avoid technical terminology like "cariogenic bacteria," "demineralization," or "fermentable carbohydrates"—use plain language like "cavity-causing germs" and "sugar that feeds bad bacteria" 4, 5