Psychosocial and behavioral issues in early childhood caries

Rampant caries in infants and young children has long been recognized as a clinical syndrome referred to by various names, including nursing caries, nursing bottle syndrome, night bottle mouth, and baby bottle tooth decay. The common theme among these terms is the perceived central role of inappropriate use of the baby bottle in the etiology and progression of carious lesions. Use of the baby bottle is not the only, and may not be the most important, factor in caries development. Because of questions about the role of the baby bottle in caries among young children, the Centers for Disease Control and Prevention recently suggested that the term for this clinical syndrome be replaced with early childhood caries (ECC). The purpose of this paper is to evaluate the literature on the influence of psychosocial and behavioral factors in early childhood caries. Prevalence of caries and maxillary anterior decay varies greatly in developed and undeveloped countries and among socioeconomic groups in developed countries. However, relatively little is known about the onset and progression of the disease or the antecedents of ECC, such as high risk behaviors, cultural norms, health beliefs and attitudes, or health care delivery factors. Furthermore, studies that do exist are limited by small and possibly biased samples and a lack of clear case definition. Future research should aim to develop a clear case definition of ECC, differentiate patterns of caries and conduct community-based epidemiological studies in order to obtain accurate estimates of the etiology and epidemiology of ECC in the general population, as well as in high risk groups.