22 Nursing and early childhood caries

Summary

Kelly-Ann is only 3. She has been brought to the dentist by her mother because her upper front teeth are ‘wearing away’ (Fig. 22.1). What has caused this and how may it be treated?

Fig. 22.1 Early cavitation in nursing caries.

History

The teeth apparently never came through properly and were never white like the rest of her teeth. There has been no pain from the teeth and Kelly-Ann is eating and drinking normally.

Medical history

Kelly-Ann is a healthy infant. She has had all her vaccinations and has had no illnesses. She has never been on any medication.

Examination

Extraorally there is no swelling and no facial asymmetry. Intraorally she is in the full primary dentition with the second primary molars having just erupted. There is caries affecting the upper incisors and cavitation in all first primary molars.

What is the cause of this pattern of decay?

‘Nursing caries’, or ‘nursing bottle mouth’ or ‘bottle mouth caries’.

What can cause this?

Consumption of a sweetened drink or fruit-flavoured drink from a bottle or dinky feeder, especially if the feeder is constantly in the mouth or the child falls asleep with it in the mouth.

Persistent on-demand breastfeeding at night after 12 months of age (child is allowed to sleep on the breast) may cause caries in exceptional circumstances. There are many biological and social variables that confound this complex relationship.

As can be seen, the term ‘nursing caries’ is probably the most accurate as it encompasses both breastfeeding and bottle feeding.

Why are the teeth affected in this pattern?

Teeth become carious in the order in which they erupt (Fig. 22.2) with the exception of the lower primary incisors, which are protected by two major mechanisms: the position of the submandibular ducts that open adjacent to these teeth; the position of the tongue in suckling, which covers the lower incisors.