Early childhood caries and oral rehabilitation. A treatment quandary

Early childhood caries (ECC) is a virulent form of dental caries that can destroy the primary dentition of toddlers and preschool children. It occurs worldwide, afflicting predominantly disadvantaged children. Although Streptococcus mutans is the most likely causative agent, diet also plays a critical role in the acquisition and clinical expression of this infection. Early acquisition of S. mutans via vertical or horizontal transmission is a key event in the natural history of the disease that coupled with caries promoting feeding behaviours results in accumulation of these organisms to levels exceeding 30% of the total cultivable plaque flora, which in turn leads to rapid demineralization of the tooth structure. Inflicted children may also have other associated health problems, ranging from local infections to oral pain that manifest as difficulty in eating and sleeping, reduced growth and altered behaviour. Oral rehabilitation usually consists of restoration or surgical removal of carious teeth along with recommendations regarding feeding habits. Although treatment can be instituted in the dental clinic, it becomes costly sometimes when cooperative capacity of babies and preschool children necessitates the use of general anaesthesia. Primary prevention of ECC has largely been restricted to counselling parents regarding proper feeding behaviour, oral hygiene measures and new strategies that address the infectious component through use of topical antimicrobial therapy in order to defeat this common oral affliction.