- Treatment of dental caries in the preschool child - S. A. Fayle
7.1 INTRODUCTION
Dental caries is still one of the most prevalent pathological conditions in the child
population of most Western countries. A UK study of 1.5-4.5-year-old children
demonstrated that 17% have decay, and in many parts of the UK up to 50% of the
child population has experience of decay by the time they are 5 years of age.
Successfully managing decay in very young children presents the dentist with a
number of significant challenges. This chapter will outline approaches to the
management of the preschool child with dental caries.
Key Points
- Dental caries is one of the most prevalent diseases in the preschool child population
of Western countries. - By 5 years of age up to 50% of the child population have experienced dental decay.
7.2 PATTERNS OF DENTAL DISEASE SEEN IN PRESCHOOL CHILDREN
7.2.1 Early childhood caries
Early childhood caries (ECC) is a term used to describe dental caries presenting in
the primary dentition of young children. Terms such as 'nursing bottle mouth', 'bottle
mouth caries', or 'nursing caries' are used to describe a particular pattern of dental
caries in which the upper primary incisors and upper first primary molars are usually
most severely affected. The lower first primary molars are also often carious, but the
lower incisors are usually spared⎯being either entirely caries-free or only mildly
affected (276HFig. 7.1). Some children present with extensive caries that does not follow
the 'nursing caries' pattern. Such children often have multiple carious teeth and may
be slightly older (3 or 4 years of age) at initial presentation (277HFig. 7.2). This
presentation of caries is sometimes called 'rampant caries'. There is, however, no clear
distinction between rampant caries and nursing caries, and the term 'early childhood
caries' has been suggested as a suitable, all-encompassing term.
In many cases, early childhood caries is related to the frequent consumption of a drink
containing sugars from a bottle or 'dinky' type comforters (these have a small
reservoir that can be filled with a drink) (278HFig. 7.3). Fruit-based drinks are most
commonly associated with nursing caries. Even many of those claiming to have 'low
sugar' or 'no added sugar' appear to be capable of causing caries. The sparing of the
lower incisors seen in nursing caries is thought to result from the shielding of the
lower incisors by the tongue during suckling, whilst at the same time they are being
bathed in saliva from the sublingual and submandibular ducts. The upper incisors, on
the other hand, are bathed in fluid from the bottle/feeder.
Frequency of consumption is a key factor. Affected children often have a history of
taking a bottle to bed as a comforter, or using a bottle as a constant comforter during
the daytime. Research has shown that children who tend to fall asleep with the bottle
in their mouths are most likely to get ECC, and this is probably a reflection of the
dramatic reduction in salivary flow that occurs as a child falls asleep. However, the
link between bottle habits and ECC is not absolute and studies have suggested that