Ранний детский кариес: причины, профилактика и лечение.

Dental disease of young children
Early childhood caries (ECC), formerly known as nursing bottle caries, baby bottle tooth decay, night bottle mouth and night bottle caries, is a disease that affects teeth in children aged between birth and 71 months. ECC is characterized by the presence of 1 or more decayed (non cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth. ECC has been shown to be a very common, transmissible bacterial infection, usually passed from the primary caregiver to the child. The main bacteria responsible for dental cavities (dental caries) are Streptococcus mutans (S. mutans) and Lactobacillus.

Early childhood caries (ECC) is a multifactorial disease,   with risk factors including but not limited to, cariogenic bacteria, diet practices and socioeconomic factors. burdening millions of children and continuing  into adulthood with pain and potentially lower quality of life. There are several studies by Locker and Mota Veloso reporting that there is a two way relationship that exists between dental caries and levels of education, household income that affect quality of life and social positioning.

Early childhood caries can be prevented through the combination of the following: adhering to a healthy nutritional diet, optimal plaque removal, use of fluoridation on the tooth surface once erupted, care taken by the mother during the prenatal and perinatal period and regular dental visits. The following are recommendations to help prevent ECC.

Dietary habits and the presence of cariogenic bacteria within the oral cavity are an important factor in the risk of ECC. ECC is commonly caused by bottle feeding, frequent snacking and a high sugar diet. In regards to preventing ECC through bottle feeding, it is fundamental not to allow the child to sleep using 'sippy cups' or bottles as this is a large factor contributing to baby bottle decay/caries.

On eruption of the first primary tooth in a child, tooth brushing and cleaning should be performed by an adult. It is suggested that it is suitable to brush children's teeth until they reach the approximate age of 6 years; when they will begin to develop  adequate dexterity and cognition needed for adequate brushing by themselves. It is encouraged to watch children brushing their teeth until they are competently able to brush.

Fluoride is a natural mineral that naturally occurs throughout the world – it is also the active ingredient of many toothpastes specifically for its remineralizing effects on enamel, often repairing the tooth surface and reducing the risk of caries. Enamel hypoplasia is a developmental defect of enamel that occurs during tooth development, mainly pre natal or during early childhood. Teeth affected by enamel hypoplasia are at a higher risk of caries since there is an increased loss of minerals and therefore the tooth surface is able to breakdown more easily in comparison to a non hypoplastic tooth.

It is recommended thar parents and caregivers take their children to a dental professional for examination at six months of age and no later than the child’s first birthday.

The approach to managing Early Childhood Caries involves a combination of restoring or removing the decayed teeth. Dentists also focus heavily on early intervention strategies, which include the application of protective fluoride treatments directly to the teeth, guiding families through proper dental care routines, and offering nutritional advice to prevent further decay. During the initial dental visit, which plays a pivotal role, the dentist evaluates the child's dietary and oral hygiene habits. By doing so, they can identify behaviours that may contribute to tooth decay. These assessments take into account the child’s age and their social, behavioural, and medical background.

For children identified as having a low risk of tooth decay, the focus is on monitoring and preventive care rather than immediate dental treatments. Regular dental visits are encouraged to identify any new signs of decay early on. Early stages of decay (white spots) and initial enamel damage are managed with non invasive preventive methods and are closely watched over time. High risk children typically need more intensive treatment. This may include early restorative work to repair and address any existing decay to prevent further deterioration of the teeth. Since ECC affects children under the age of 5 years, dental treatments under general anesthesia may be necessary in select cases. However, there's a notable concern with this method: despite the initial success of the treatment, decay can recur, with some cases reported as early as 6 months post treatment.

In managing Early Childhood Caries, dental professionals also have Silver Diamine Fluoride (SDF), a dual action liquid that combats tooth decay. SDF combines the bacteria battling power of silver with the tooth strengthening properties of fluoride. This solution is brushed directly onto the affected areas, eliminating the immediate need for drilling and making it a less invasive treatment option. SDF is known for its cost effectiveness and ease of application. It effectively halts decay but does not rebuild the tooth structure; hence, a tooth treated with SDF may still require a filling or crown to restore its shape and function. One notable downside is the black staining of the decayed areas after SDF application. Despite this, the discoloration can be masked with a white filling material, a cosmetic concern that may be less significant for baby teeth that will eventually be replaced by permanent teeth. The quick application process of SDF makes it particularly beneficial for young children and patients who find it difficult to remain still during dental procedures, potentially reducing the need for sedation or general anesthesia. However, the usage of SDF is not without debate. Further high quality research is required to fully understand its effectiveness, necessity, and potential adverse effects. This consideration gains importance in the context of FDA advisories regarding the use of general anesthetics and sedation in young children. Nonetheless, the American Dental Association endorses SDF as an effective means to manage dental decay in a conservative manner.

When it comes to repairing teeth affected by Early Childhood Caries, the extent of tooth decay will guide the choice of treatment. For moderate to severe decay, stainless steel crowns are a common option. These crowns are ready made and can be tailored to fit over a child’s primary molar. The crowns are then fixed in place to restore the tooth. An alternative method for fitting these crowns is the Hall Technique, which does not require the decayed parts of the tooth to be removed first.

For less invasive treatments, Atraumatic Restorative Treatment (ART) is an option. ART involves the partial removal of decayed tooth material with hand tools and sealing the cavity with a bonding material. This approach is particularly suitable for young patients because it is quicker and less likely to cause distress. It’s also beneficial when maintaining a tooth is important for spacing in the mouth, paving the way for permanent teeth to erupt properly in the future. However, it’s important to note that while ART is a valuable treatment, especially in areas where dental facilities are limited, studies suggest that fillings done with ART may be more prone to failure compared to those done with more traditional methods. Despite this, ART remains a recommended practice for managing tooth decay in young children under challenging conditions.