Table of Contents
Executive Summary
Early Childhood Caries (ECC) is defined as the existence of decayed, missing, or filled primary tooth surfaces in children aged 71 months or younger (Fejerskov & Kidd, 2008). Dental caries is an international public health challenge, especially among children. If left untreated, it leads to pain, causing difficulty in chewing and smiling, thus affecting the social and emotional wellbeing of the child. ECC is caused by multiple factors, which include poor oral hygiene, formation of plaque, and time and frequency of the consumption of sugary drinks (Benjamin, Reisine, & Tinanoff, 1998).
Other causes associated with early childhood caries are nocturnal feeding and prolonged breast feeding (Declerck et al., 2008). The main factor linked to the etiology of caries is the frequent consumption (more than 3 times a week) of sugary snacks in between meals. (Folayan, Sowole, Kola-Jebutu & Owotade, 2012). To combat this issue, preventive measures like dietary counseling and reinforcement of proper oral hygiene practices with fluoridated toothpaste and the use of dental sealants should be implemented. Future research recommendations include the development of behavior strategies and collaborations between dental and public health workers to employ preventive and early interventive measures.
Barriers to Achieving Optimal Oral Health
- High, frequent intake of sugar
- Bottle-feeding children at night
- Lack of optimal fluoride exposure
- Lack of dental insurance
- Wrong beliefs about care of primary teeth and barriers to access professional dental care
- Preventive dental care not given priority.
Impacts of ECC
ECC leads to loss of baby teeth, pain and damage to permanent teeth, vulnerability to caries and gum disease throughout life, unclear speech, restricted smiling, poor school performance, ears, sinus, and brain infections, lack of sleep, malnutrition due to difficulty in chewing and low self-esteem
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Scope of the Problem
Former U.S. Surgeon General David Satcher once called tooth decay a “silent epidemic.”
Dental caries is a chronic disease that, in children, is five times more common than asthma, and seven times more common than hay fever (Ezer, Swoboda, & Farkouh, 2010).
According to the American Academy of Pediatric Dentistry, childhood caries among children is more prevalent than diabetes, asthma, and childhood obesity. ECC affects approximately 23 percent of 2-5-year-olds, and is one of the most common chronic childhood diseases in the United States (CDC, 2012).
ECC, in USA, is more common among children in low socioeconomic groups or minority racial and ethnic groups (Beltran-Aguilar et al., 2005).
Policy Statement by AAPD
To combat this silent epidemic, some policies advocated by AAPD are:
- As soon as the first tooth erupts in the oral cavity (around 6 months of age), parents should brush the child’s teeth twice daily, using a soft tooth brush and a pea-sized amount of fluoridated toothpaste
- A dental home should be established and a risk assessment for caries should be done within 6 months of the eruption of first tooth
- Preventive measures, including counseling on dietary habits, proper oral hygiene, and screenings, should be carried out by the dentists and medical providers
- Proper sealant application and topical fluoride application should be conducted
- Consumption of sugary drinks and frequent snacking should be avoided.
- Infants should not be put to bed with a milk bottle in their mouths and should be encouraged to drink from a cup by their first birthday
- Community water fluoridation
Critique of Current Policies
Many Medicaid expansions and Affordable Care Act subsides are being provided for pediatric dental care, but there are still too few dentists available to see children who are on Medicaid. To expand pediatric dental care, Midlevel Dental Providers (MLDPs), such as dental therapists and advanced dental hygienist practitioners, are trained to increase access to oral health services in designated dental shortage areas (Rodriquez, Galka, Lacy, Pellegrini, Sweier et al, 2013). The focus of policies for both the Medicaid and Children’s Health Insurance Program (CHIP) should be on the prevention rather than the treatment of ECC (Foster, 2015).
Policy Recommendations
· Annual well-child dental checkups should be carried out like annual well-child medical checkups.
· In annual physical examinations, the importance of oral hygiene instruction and nutritional emphasis should be stressed.
· A surveillance system for ECC should be established by the CDC.
· In the collaboration between health care workers and medical professionals, emphasis should be laid on the education of infant oral health aimed at prevention and early intervention (Lopez, 1998).
· Taxes should be put on sugary drinks to prevent catastrophic consequences. Regulated taxes on sugary drinks can be imposed, and the funds accumulated from the taxes can be used to fund the poor families to buy fresh food. (Divaris, 2018).
Conclusion
The challenge of ECC still exists, and the gap needs to be bridged between parental education and action in preventing caries. There remains an abundance of disparity and lack of awareness among the population about oral health care. Future directions aim in educating people and creating cross-sector partnerships between dental and medical professionals and public health workers. With new research in progress to “Zero Out Early Childhood Caries,” and with proper education, better oral habits, development of new policies, and proper intervention, this public health problem can be alleviated, leading to healthier, more confident kids for tomorrow.
