New research offers insight into early childhood tooth decay

Early childhood caries is a painful form of tooth decay that plagues young children. If severe enough, ECC can require a surgical procedure to rectify. As such, it is important for parents of young children to take the necessary cautionary steps to prevent the development of this harmful condition. Use what you have learned in your dental assistant training to warn your patients of the potential risks that threaten the health of their children’s teeth. A new study of the biofilm that is thought to cause ECC has shown that there is more to the condition than was previously assumed. The research done by the University of Pennsylvania School of Dental Medicine showed that a cohesion of bacteria and fungus is responsible for the rapid tooth decay of those suffering from ECC.¹

A Definition of ECC from the American Academy of Pediatric Dentistry

Caries is defined by the American Academy of Pediatric Dentistry as the demineralization of tooth enamel induced by biofilm (commonly called plaque).² Enamel is the thin, hard, translucent material that makes up the outermost layer of the tooth. Improper oral hygiene leads to the degeneration of this layer. The most common culprit of enamel degeneration is plaque. This glue-like substance is the result of dietary starch and sugar combining with the bacteria Streptococcus mutans. Plaque then sticks to the teeth and plays host to other forms of bacteria. The bacteria convert any sugars they come into contact with into acids that begin to break down the tooth enamel. In order for a child’s tooth decay to be classified as ECC, there must be at least one decayed, missing or filled tooth that was damaged as a result of caries in a child less than 71 months old.³

The effect of the fungus Candida albicans on caries

The commonly held belief prior to the publication of the University of Pennsylvania’s research in Infection and Immunity was that S. mutans was fully responsible for the formation of caries in both adults and children. However, it now seems as though the fungus Candida albicans plays a crucial role in the proliferation of tooth decay in children. According to the paper “Symbiotic relationship between Streptococcus mutans and Candida albicans synergizes the virulence of plaque-biofilms in vivo,” the inter-kingdom collaboration between the bacterium and the fungus is what makes ECC so devastating for the teeth of youngsters.⁴ The team behind this research found that the process by which S. mutans binds to teeth can be utilized by Candida to transform the normally benign fungus into a harmful plaque substrate.

Candida is a relatively common fungus that is usually found on the cheeks and tongue. It is not known to colonize teeth, as their hard, smooth surface makes it difficult for Candida to get a foothold. That being said, analysis of the biofilm coating the teeth of children suffering from ECC found a substantial number of Candida spores among the S. mutans bacteria. The presence of the fungus initially confused researchers, as it was not clear how it was able to colonize the teeth. Further examination revealed that S. mutans and Candida both use the same exoenzyme to convert sugar in the environment into a sticky substance that allows for the adherence to teeth and S. mutans.⁵ As such, the fungus is able to comprise the majority of the biofilm, binding both teeth and bacteria together. With the introduction of dietary sugar, the bacteria initiates a process that produces an acid known to break down tooth enamel. Since the Candida is effectively holding the bacteria against the tooth, it doesn’t take long for the acid buildup to cause significant damage.

Minimizing the risk of developing ECC

Dental hygienists and dental assistants working in a pediatric dentistry practice may come across cases of ECC. It is an especially common condition in lower-income areas where children are exposed to more sugary drinks and snacks. In order to prevent a case of ECC from developing, dental assistants should warn parents of the following dangers:

Bottles and pacifiers pose significant threats: Do not fill a bottle with sugary drinks such as punch or soda. When a young child uses a bottle, the sucking motion required to draw liquid through the rubber nipple ends up soaking the teeth in whatever the child is drinking. Young children will often keep a bottle in their mouth as they sleep or walk around. This will only speed up the decay of tooth enamel as the sugars from the drink coat their mouth.⁶

Limiting sugar intake is the most effective prevention measure: When it comes to preventing tooth decay, cutting off the source is the most effective measure. This means eliminating as much sugar as you can from your child’s diet. It also means making sure that your child’s teeth are clean should they eat sugar. Be sure to wipe very young children’s teeth and gums with a clean washcloth after feeding.

Reading the leading journals and keeping up-to-date on the latest threats to dental health is an important part of your ongoing dental assistant education.

¹ “Symbiotic relationship between Streptococcus mutans and Candida albicans synergizes the virulence of plaque-biofilms in vivo.” M. L. Falsetta, M. I. Klein, P. M. Colonne, K. Scott-Anne, S. Gregoire, C.-H. Pai, M. Gonzalez, G. Watson, D. J. Krysan, W. H. Bowen, H. Koo. Infection and Immunity, 2014; DOI: 10.1128/IAI.00087-14

²“Definition of Early Childhood Caries” Council on Clinical Affairs, American Academy of Pediatric Dentistry, 2008, http://www.aapd.org/assets/1/7/D_ECC.pdf

³“Definition of Early Childhood Caries” Council on Clinical Affairs, American Academy of Pediatric Dentistry, 2008, http://www.aapd.org/assets/1/7/D_ECC.pdf

⁴ “Bacterium, fungus team up to cause virulent tooth decay in toddlers.” American Society for Microbiology. ScienceDaily, 12 March 2014, www.sciencedaily.com/releases/2014/03/140312132625.htm 

⁵ “Bacterium, fungus team up to cause virulent tooth decay in toddlers.” American Society for Microbiology. ScienceDaily, 12 March 2014, www.sciencedaily.com/releases/2014/03/140312132625.htm

⁶ “Tooth decay – early childhood.” National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/002061.htm