Beyond the DMFT: The Human and Economic Cost of Early Childhood Caries

Department of Dentistry, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, USA.
Journal of the American Dental Association (1939) (Impact Factor: 2.01). 07/2009; 140(6):650-7. DOI: 10.14219/jada.archive.2009.0250
Source: PubMed


Early childhood caries (ECC) is the most common disease of childhood and often is accompanied by serious comorbidities affecting children, their families, the community and the health care system. This report describes morbidity and mortality associated with ECC and its treatment.
The authors reviewed the literature for descriptions and quantification of morbidity associated with ECC and organized a wide range of studies into a visual model--the morbidity and mortality pyramid--that begins to convey the breadth and depth of ECC's penetration.
ECC exacts a toll on children, affecting their development, school performance and behavior, and on families and society as well. In extreme cases, ECC and its treatment can lead to serious disability and even death. In finding access to care and managing chronic pain and its consequences, families experience stress and, thus, a diminished quality of life. Communities devote resources to prevention and management of the condition. The health care system is confronted with management of the extreme consequences of ECC in hospital emergency departments and operating rooms.
Traditional epidemiologic measures such as the decayed-missing-filled teeth (dmft) index do not adequately portray the effects of ECC on children, families, society and the health care system.
The impact of prevention and management of ECC requires the attention of health care professionals and decision makers and extends well beyond the dental office to regulatory and child advocacy agencies as well as public health officials and legislators.

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    • "Early childhood caries (ECC) is the most common oral disease in children. It affects approximately half of children worldwide and incurs enormous societal costs (Casamassimo et al., 2009). ECC leads to sustained demineralization of enamel and dentin, and the infection can spread from the affected tooth to the surrounding soft tissues, resulting in swelling and inflammation in highly progressed cases. "
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    ABSTRACT: Microbiota–based prediction of chronic infections is promising yet not well-established. Early Childhood Caries (ECC) is the most common infection in children. Here we simultaneously tracked microbiota development at plaque and saliva in 50 four-year-old preschoolers for two years; children either stayed healthy, transitioned into cariogenesis or experienced caries exacerbation. Caries onset delayed microbiota development, which is otherwise correlated with aging in healthy children. Both plaque and saliva microbiota are more correlated with changes in ECC severity (dmfs) during onset than progression. By distinguishing between aging- and disease-associated taxa and exploiting the distinct microbiota dynamics between onset and progression, we developed a model, Microbial Indicators of Caries, to diagnose ECC from healthy samples with 70% accuracy and predict, with 81% accuracy, future ECC onsets for samples clinically perceived as healthy. Thus, caries onset in apparently healthy teeth can be predicted using microbiota, when appropriately de-trended for age.
    Cell Host & Microbe 09/2015; DOI:10.1016/j.chom.2015.08.005 · 12.33 Impact Factor
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    • "Alterations in the composition of the oral microbiota are associated with the initiation and development of oral diseases such as dental caries and periodontal disease (Liljemark and Bloomquist, 1996). These diseases can lead to severe pain, impaired quality of life and infections such as cellulitis and osteomyelitis (Casamassimo et al., 2009; US-NLM, 2010a). More importantly, they can predispose patients to potentially fatal diseases such as infective endocarditis (Biswas et al., 2010; Nomura et al., 2013). "
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    ABSTRACT: Oral diseases, specifically dental caries and periodontal disease, are characterised by increases in pathogenic microorganisms, increased demineralisation and increased inflammation and levels of inflammatory markers. Despite the therapeutic strategies, oral diseases have elevated prevalence rates. Recent work has demonstrated that probiotic bio-therapeutics can decrease oral pathogen counts, including caries-causing Streptococcus mutans and oral inflammation. The aim of this work was to investigate putative probiotic bacteria, selected for S. mutans inhibition and for their oral health-promoting characteristics. The probiotic bacteria were screened for S. mutans inhibition, probiotic bacteriocin activity, salivary pH modulation, probiotic nutrient (sucrose) competition, probiotic co-aggregation with S. mutans, bacterial attachment to oral epithelial keratinocytes, bacterial nitric oxide production and bacterial antioxidant activity. The results indicate that Lactobacillus reuteri strains NCIMB 701359, NCIMB 701089, NCIMB 702655 and NCIMB 702656 inhibited S. mutans to non-detectable levels (<10 cfu/ml). L. reuteri strains also demonstrated the highest antioxidant capacity of the tested strains (7.73-13.99 µM Trolox equivalents), suggesting their use as both caries and periodontal disease therapeutics. Although Lactobacillus fermentum NCIMB 5221 inhibited S. mutans at lower levels, it significantly buffered the pH (4.18) of saliva containing S. mutans, co-aggregated with S. mutans (10.09%), demonstrated high levels of sucrose consumption (138.11 mM) and successfully attached to gingival epithelial cells (11%). This study identified four L. reuteri strains and one L. fermentum strain to be further investigated as oral disease biotherapeutics.
    Beneficial Microbes 07/2014; 5(4):1-14. DOI:10.3920/BM2014.0011 · 2.61 Impact Factor
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    • "Early childhood caries adversely affects all aspects of a child’s quality of life, including its learning ability [22-24]. Not to be ignored either is the effect on its parents’ quality of life [24], the financial burden of dealing with it [25], and the fact that caries in the primary dentition is a major risk factor for caries in the permanent dentition with life-long consequences [26]. "
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    ABSTRACT: Background : In a previously reported randomised controlled trial, advising first time mothers on the prevention of early childhood caries from before their child was born, decreased the prevalence of early childhood caries at 20 months of age 5-fold. Objective: We examined the effect of the intervention on the frequency and nature of dental visits up to 7 years of age. Methods: Of 649 expectant mothers who participated in the trial, 277 completed a “Child Oral Health Survey” 7 years later. Their answers were compared with those of a comparison group of 277 mothers selected at random among those living in the same area with a first child born in the same year enrolled with the South Australian School Dental Services (SA SDS). Results: Only 1.5% of children had a dental visit before 12 months of age and only 4% before 2 years of age unless a dental problem had arisen. The age at the first visit did not differ among groups, but the reasons for the visit did as did the number of visits and the need for treatment under sedation or anaesthesia. In the trial group, 34% of first visits were for pain, 29% for injury, and 29% for concern with appearance. In the comparison group, pain was the main concern in 49%, injury in 9.5%, and appearance in 25% (p=0.019). Over time, children in the trial had an average of 2.2 visits compared with 3.1 in the comparison group. In the intervention group of the trial, no child had required treatment under sedation or general anaesthesia compared with 2.9% in the control group, and 6.5% in the comparison group. Only 15% of mothers reported that they had received any information on caries prevention from health care professionals other than dental care practitioners. Conclusion: Providing first-time mothers with guidance on the prevention of childhood caries decreased the use of dental services to deal with problems in preschool children.
    The Open Dentistry Journal 06/2014; 8(1):104-8. DOI:10.2174/1874210601408010104
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