Dental Caries in Children

Dental caries is an infectious and transmissible disease initiated by a heterogeneous group of gram-positive bacteria present in the biofilm that forms on teeth soon after eruption. This complex community of bacteria, termed dental plaque, contains Streptococcus mutans, which is a necessary agent for the production of dental caries. S. mutans has been shown to be transmissible from parents or caregivers to infants at the time of tooth eruption. The dental health of direct caregivers thus becomes an important factor in the prevention of dental caries.

Dental caries disease is usually classified by four different factors:
(1) according to anatomic site of the lesion,
(2) according to the severity or rate of progession of the lesion,
(3) according to age patterns at which lesions predominate, and
(4) according to therapies that can induce decay.

Caries can occur in teeth of persons of any age, but when the disease occurs in children younger than 3 years, the condition is termed early childhood caries. Previously, most descriptions of early childhood caries focused on the period of nursing, giving rise to the term nursing bottle caries. It is now recognized that early childhood caries can be present in the absence of bottle- or breast-feeding and conversely does not always result from inappropriate bottle- or breast-feeding practices, indicating that other host susceptibility factors are involved.

Complications
Regardless of age or circumstance, all carious lesions must be eradicated by some means. Failure to do so eventually leads to invasion of the pulp chamber of the tooth with inflammation, pain, swelling, and exudation. Since the tooth pulp is encased within a rigid structure, necrosis of the tissue within the pulp chamber occurs because of the increased pressure, which prevents blood flow. An ensuing buildup of toxic products in this space will force extension of the process into the tissue surrounding the root apices, forming an abscess within the bone. Cellulitis with acute pain ensues with swelling of soft tissues as the products drain to the outside. If the body defense mechanisms respond adequately, the infection may transiently resolve, but an acute recurrence is common.

Treatment
Interruption of the caries process is the aim of any treatment with subsequent rebuilding of lost tooth structure utilizing choices from an array of methods . Depending on the extent to which the damage has progressed, this may involve entering the pulp chamber, cleansing and sterilizing the internal space within the crown and root, and obturating that space. A final resort is extraction of the tooth with subsequent replacement also by a variety of means. Restorative care and simple extractions in children over three years of age are readily provided using local anesthesia. Very young children, the developmentally delayed child, and those needing extensive treatment may require sedation or general anesthesia to receive the best quality of care.

Prevention
Strategies for the prevention of dental caries depend on the age of the individual. However, in general the strategies are aimed at increasing the resistance of enamel, reducing or altering the flora of the oral cavity, and changing eating habits including the content of the diet. For the very young child, preventing the initiation of early childhood caries involves regular visits to a dentist for parental counseling and support in managing the prevention plan.
Oral hygiene measures should be implemented by the time of eruption of the first primary tooth. An oral health dental consultation visit within 6 months of the eruption of the first tooth is recommended to educate parents and caregivers and provide anticipatory guidance for the prevention of dental disease. In children older than 3 years of age, strategies focus on attempts to break the chain of events leading to dental caries. Fighting dental plaque by means of disruption with a toothbrush and floss is recommended throughout life. Fluoride use in community water supplies, application by the dental practitioner, and self-directed use as in toothpaste, coupled with dietary discretion all are effective. Modification of the diet includes reducing the quantity and frequency of between meal snacks and adherence to balanced meals daily. Snack food items that are not sticky or sugar laden but are attractive and compatible with the dietary customs of the family are very helpful. Sealants (flowable composite resin) applied to the occlusal surfaces of the teeth to block access to the deeper structures of the dentition are also very important and an effective element of any preventive program. This preventive service can be of benefit to either the primary or permanent dentition but is especially beneficial to the permanent molars.