Early Childhood Caries (ECC) is a particularly aggressive form of cavity formation in young children. It is characterized by rapid development of cavities beginning on the upper front teeth, usually on the back side where it is not noticed by parents until late. The cavity pattern progresses to the first baby molars. ECC typically is diagnosable before 16 months of age, though, due to its location in hidden areas of the teeth may not be noticed by parents until the cavities are severe. The combination of events necessary for ECC to develop includes a dietary component and existing chemistry in the mouth. Therefore, a child with ECC may have a sibling with a similar diet pattern but different mouth chemistry who does not have ECC.
ECC is preventable. It is the most important driving reason to have a dental visit before the child's first birthday. Learn how to avoid this devastating disease.
Due to the aggressive nature of the cavity formation these young children often end up needing their dental work done under general anesthesia, often in a hospital operating room, at the age of 18 to 24 months. If, however, we diagnose the problem early, it is possible to stop the cavity process and avoid the impending dental work. Stopping the cavity process, which is critically important whether we have to do fillings or not, requires diligent attention to the home care routine for the teeth. We have outlined the steps below.
- Step 1 Identify the cause of the early caries and stop whatever that is. Without excellent cooperation with this step at home all the rest of our efforts will be in vain. We will loose a lot of time, spend a lot of money, and still need to do immediate conventional treatment on a worsened condition.
- Step 2 Remineralizing with topical fluoride and calcium/phosphate applications at the office and at home. All the fluoride research the last 40 years demonstrates (first) the beneficial effect of fluoride is topical. We don’t need to swallow it to get the benefit. And (second) the fluoride can actually trap calcium and remineralize areas where the cavity has started. It is healing the cavity.
- Step 3 Monitor carefully! We recommend follow-up visits monthly until we are comfortable the cavity process is arrested, followed by check-ups at a 3-month interval.
A. If caries is progressing we want to identify it quickly while as many options for treatment as possible are still available.
B. If we need to modify the program, or add to the program, we want to identify the need and reasons at the earliest interval possible.
I want to emphasize: If this program is followed correctly, it is highly successful. If the program is not followed adequately it is not successful and leads to a delay in treatment and a worsening of the problem. If at any time in the process you feel you cannot fulfill what is being requested in your home care activities, let us know so we can adjust the program appropriately and/or discuss the alternative decisions you will want to make before the problem gets worse.
How does it happen? A cavity, very simply is a hole. The body “cavity” of the Thanksgiving turkey is what you fill with stuffing. A cavity in a tooth is a hole. It is made by the bacteria of the contagious disease “caries.“
In order to have a dental cavity we need four ingredients. A tooth, the right bacteria, food for the bacteria (simple carbohydrate) and some time for the bacteria to make the hole. The bacteria responsible for caries thrive on simple carbohydrate (sugars and cooked starches) and grow to form a complex biofilm of 600+ different species of bacteria. This takes time, 24 hours, just to get the bacteria organized. (Note: If you clean those bacteria off your teeth, your teeth are safe for 24 hours)
That biofilm then generates acids that can dissolve calcium out of the teeth, weakening the tooth structure and eventually making the hole. This takes time too, months of time. During this process the affected area slowly turns chalky white as the enamel softens. As the white lesion progresses, it gets porous enough that stain from food or bacteria begins to penetrate and the white lesion darkens to brown. Finally, the structure gets soft enough that pieces chip out and parts dissolve away leaving the hole. Note also, before the enamel collapses the acids have penetrated to the softer inner portion of the tooth where the cavity grows faster. When the enamel finally collapses, we find the cavity inside the tooth is much larger than the hole in the enamel. Picture if you will an inverted mushroom with the narrow stem as the hole in the enamel and the large cap of the mushroom is the larger hole inside the tooth. Cavities take time to develop though the collapse of the enamel may seem like an overnight event.
It is important to realize; in the early stages of the disease, when calcium is being lost, but the integrity of the enamel still exists, the decay process can be stopped and even reversed. We would love to show you how. Also remember, cavities start on the outside of your teeth. Cleaning a cavity and filling it can stop the cavity from creating an abscess. However, filling the cavity does nothing to stop the disease from creating another cavity in a new place. Stopping the disease can only be done by you at home. And filling the cavity will never restore the lost integrity and strength of the tooth. Lets prevent holes in your teeth!