other factors, such as linear enamel defects and malnutrition, may play an important
role in the aetiology of this condition.
There is some circumstantial evidence that, in a few cases, ECC may be associated
with prolonged, on-demand breast-feeding. Breast milk contains 7% lactose and,
again, frequent, prolonged, on-demand consumption appears to be an important
aetiological factor. Most affected children sleep with their parents, suckle during the
night, and are often still being breast-fed at 2 or more years of age. It is important to
appreciate that this does not imply that normal breast- feeding up to around 1 year of
age is bad for teeth, but that prolonging on-demand feeding beyond that age possibly
carries a risk of causing dental caries. Experiments in animal models suggest that
cows' milk (which contains 4% lactose) is not cariogenic, although some clinical
studies have suggested that the night-time consumption of cows' milk from a bottle
might be associated with early childhood caries in some children. Whether or not
cows' milk has the potential to contribute to caries is currently uncertain.
Key Points
- Early childhood caries (ECC) is an all-encompassing term that can be used to
describe dental caries presenting in preschool children. - The most commonly presenting pattern of ECC is often called 'nursing caries' or
'bottle mouth caries', where the upper anterior primary teeth are carious but the lower
anterior teeth are usually spared. - A prime aetiological factor is frequent consumption of a sweetened or fruit-based
drink from a bottle or dinky feeder. - Enamel defects and malnutrition may also play a role in the causation of ECC.
279H
Fig. 7.1 Early childhood caries
presenting as nursing caries in a 2-year-
old child.280H
Fig. 7.2 Extensive caries affecting
primary molars in a 4-year-old child.