22 Nursing and early childhood caries
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?
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.
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.
Any liquid with sugar that is allowed to bathe the teeth on a frequent basis will cause caries. This is especially so at night when the protective function of saliva reduces as less saliva is produced. Even breast milk, formula milk or cows’ milk with their lowered natural sugars can still be cariogenic on this basis.
The term early childhood caries (ECC) is an additional term used to describe any caries presenting in the primary dentition of young children. Some children present with extensive caries that does not follow the ‘nursing caries’ pattern and have multiple carious teeth, and may be slightly older at 3, 4 or 5 years of age at initial presentation.