Background

Dental caries remains the most prevalent chronic childhood disease in the US, five times more common than asthma and seven times more common than hay fever. 1-3 This disease, known as early childhood caries (ECC)(formerly termed nursing bottle caries or baby bottle tooth decay), is currently defined as the presence of one or more decayed (that is, cavitated or noncavitated lesions), missing (due to caries), or filled surfaces in any primary tooth in a child age 6 or younger. 4 Among children under the age of 3, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). 4 ECC is prevalent among young children, particularly in underserved populations and racial/ethnic minorities. 5 Approximately 75% of ECC is found in approximately 8% of children between the ages of 2 and 5. 6 Compared to other age groups, where caries rates remain unchanged, the caries rate among preschoolers has increased to 28%. 7, 8 It is well-documented that caries is a transmissible infectious disease in which pathogenic risk factors prevail over protective factors, producing demineralization of tooth structure. If the disease is allowed to progress, surface cavitation and dental tissue destruction will result. Mutans streptococci (MS) is considered one of the most important pathogens in the cariogenic process because of its ability to stick to smooth tooth surfaces and produce copious amounts of acid. It is recognized that these micro-organisms can be transmitted from caregiver to child through close contact with or through the exchange of saliva (vertical transmission)—for example, through kissing on the mouth, sharing utensils or cups, and so forth. Caregivers with high levels of pathogenic bacteria in their mouths can communicate these bacteria into a child’s mouth even before the eruption of the first tooth. It has been shown that infants with high levels of MS or those with early colonization are more likely to develop ECC. 9-13