All of the following tooth conditions
and abnormalities require referral to a dentist for
further assessment and possible intervention.
||Fig 8. Tooth
caries (the disease process leading to tooth
decay, Figure 8) is a transmissible oral infection.
food is consumed, cariogenic bacteria (especially
Streptococcus mutans) is able to break down carbohydrates
(e.g., glucose, fructose, sucrose) in the mouth,
producing acids that cause mineral loss from
(See Module 4, section 4.3, The
Role of Food in Oral Health.) This mineral loss results in cavities when
the attack is prolonged
resistance and the ability of the teeth to heal (remineralization).
Resistance and healing ability are determined partly
by an individual’s physiology and partly
by health behaviors.
Early childhood caries (ECC), previously
termed nursing caries or baby bottle tooth decay,
can occur any time after teeth
erupt. ECC may occur in infants or children with
and prolonged exposure to beverages containing sugar
(e.g., fruit drinks, soda, fruit juice), milk, or
formula in a bottle
cup (a “sippy cup”) during the day or
at night. In addition, ECC has been associated
(1) frequent and prolonged breastfeeding, (2) frequent
snacking on foods containing sugar
(e.g., candy, cookies, cake), and (3) coating pacifiers
with sweeteners (e.g., sugar, honey, syrup).
Other risk factors for ECC include altered
salivary composition and volume (resulting from the
use of certain medications or malnourishment) and
blockage of saliva flow in a bottle-fed infant.
The first clinically detectable stage of a cavity
is the incipient lesion, which is characterized by
an opaque, white appearance. Although a certain amount
of mineral loss has occurred, the loss is predominately
in the subsurface of the enamel, with the surface
of the enamel essentially intact and amenable to demineralization.
If the lesion progresses, demineralization continues
to exceed remineralization. Further mineral loss eventually
causes structural weakening of the enamel.
The younger the age at which dental
caries begins, the greater the risk of future decay.
Both the level of caries attack and the infant’s
or child’s resistance can be managed through
oral health supervision that promotes positive health
behaviors including good oral hygiene, use of fluorides
and dental sealants, good dietary habits, and chemical
or physical reduction of dental plaque.