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
    • "This is of high importance because at this early age comprehensive treatment of carious teeth is often only possible under general anesthetics . Moreover, such a therapy results in high expenses, which emphasizes the importance of primary prevention (Casamassimo et al., 2009). The aim of our study was to assess current knowledge of employed or self-employed midwives about caries etiology, their attitude toward their role in early caries prevention, prophylactic measures recommended during pregnancy, and after birth, for the infants. "
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    ABSTRACT: Purpose: To assess midwives' knowledge about oral health and early caries prevention during perinatal care for mothers and babies. Study design and methods: A survey developed by the investigators was conducted among midwives to assess their knowledge about caries etiology, their attitude toward their role in early caries prevention, and prophylactic measures recommended during pregnancy, and after birth, for their babies. Self-administered questionnaires were sent to 180 midwives in hospitals and 323 midwives from a midwives' association in Hesse, Germany. Results: Response rates were 46% (83/180) and 56% (181/323); a total of 264 questionnaires were evaluated. Most midwives were familiar with the term Early Childhood Caries (ECC), over 90% knew the role of acidic bacteria, carbohydrates, and insufficient oral hygiene in caries etiology. A vast majority of the midwives considered caries prophylaxis as essential, and saw this topic as part of their core area of competence. Only 60% informed the pregnant women in their care about pregnancy gingivitis. Almost all midwives gave recommendations about caries prophylaxis. The risk for developing ECC was explained to the pregnant women and mothers/parents by 92% of the midwives. Recommendations concerning regular dental visits for small children were given by 80% of the midwives. Clinical implications: The time-intensive medical care of families through advanced practice nurses or midwives offers opportunities for better education about caries prophylaxis. A consensus of all the involved healthcare professional groups, including dentists, obstetricians, advanced practice nurses, midwives, pediatric nurses, and pediatricians, is needed to provide uniform recommendations for prophylaxis and prevention of ECC.
    MCN The American Journal of Maternal/Child Nursing 07/2014; 39(4):253-259. DOI:10.1097/NMC.0000000000000045 · 0.90 Impact Factor
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