Risk For Severe Early Childhood Caries

Early childhood caries, also known as baby bottle caries, baby bottle tooth decay, and bottle rot, is a syndrome characterized by severe decay in the teeth of infants or young children. Early childhood caries (ECC) is a very common bacterial infection. Its prevalence is epidemic; in the US its rate is highest in minority and rural populations, at times infecting over 70% of the children. A large body of scientific evidence indicates that ECC is an infectious and transmissible disease, with Streptococcus mutans the primary microbiological agent in the disease. The disease process begins with the transmission of the bacteria to the child, usually from the primary caretaker, the mother. Mothers with untreated dental disease present a very high risk to their children.
Physicians and dentists recommend that babies’ and toddlers’ teeth and gums be cleaned after every feeding or meal, starting from their teeth's first emergence.Preventive programs with young children should begin at the earliest time possible. Fluoridated water will have a very positive effect on this disease. Other chemotherapeutics found to be effective include topical fluoride (fluoride varnish), fluoridated dentifrice (toothpaste), and PVP-iodine.
Parental tooth cleaning, especially with a very small amount of fluoridated dentifrice, is helpful when accomplished at least once a day. Twice a day is even better. Given that fermentable carbohydrates provide fuel for the harmful bacteria, dietary interventions are appropriate, but very difficult to implement. A counseling approach, providing the parent with choices has been found effective. The sugar substitute xylitol has been found to be effective at reducing levels of harmful micro-organisms in the mouth, and has recently been promoted as a cavity reducing agent in the form of disposable wipes.
New York University College of Dentistry's Dr. Page W. Caufield, a professor of cariology and comprehensive care has received a five-year, $1.83 million grant from the National Institute of Dental and Craniofacial Research (NIDCR), part of NIH, to conduct research to help identify those at risk for severe early childhood caries, a disease that can destroy most of a child's teeth by age six. 
The grant enables Caufield's team, led to create a genetic profile of Streptoccocus mutans, the fast-acting, potent bacterium that causes the condition, which disproportionately affects children in underserved socioeconomic groups. 
"Through profiling we will uncover genetic differences between virulent, disease-causing S. mutans strains and those strains found in children who are caries-free," said Dr. Caufield. 
In an earlier phase of their research, which was also funded by the NIDCR, Dr. Caufield and his team discovered that mothers transmit S. mutans to their babies, a process believed to occur when the baby passes through the birth canal and comes in contact with transient bacteria originating in the mother's oral cavity. Plaque created by the bacteria covers the baby's teeth when they emerge and can erode some teeth in as little as one year. The earlier study identified S. mutans gene sequences common to a group of 50 medically-underserved New York City Hispanic children with severe early childhood caries. 
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