ECC has a debilitating effect on the development, speech, general health
and self-esteem of infants. It is a significant public health issue, the
dental manifestations of which are symptomatic of important underlying
maternal and pediatric problems.
The
initial lesion results from the demineralization of the enamel of a susceptible
tooth by the action of organic acids produced within plaque by acidogenic
microorganisms, including mutans streptococci, on fermentable sugars.
ECC
occurs most frequently in families living in poverty or in conditions
of economic disadvantage in whom antenatal and perinatal under- or malnutrition
may result in the formation of enamel of low resistance to attack.
The
most significant post-natal risk factors are the implantation of mutans
streptococci, usually from the mother; the frequent intake of sugar in
solution in the contents of feeding bottles and/or prolonged breast-feeding,
especially when the nipple is allowed to remain in the mouth of a sleeping
infant.
Primary
prevention consists of minimizing the implantation of mutans streptococci
by reducing MS counts of nursing mothers and increasing the resistance
of the enamel by insuring adequate maternal and infant nutrition and by
appropriate fluoride therapy.
Because
the condition can begin soon after the primary maxillary incisors erupt
(age 5.5 - 11 months), it is essential that parents and all personnel
involved in the health and welfare of infants be shown how to recognize
its early signs so that appropriate secondary preventive measures can
be instituted.
The
dimensions of ECC as a public health problem are such that it cannot be
solved by dental profesionals alone. Immediate steps should be taken to
give wide publicity to the nature and extent of ECC as a social issue
and to publicize how parents, as well as health and welfare workers can
recognize, prevent and control it.
Part
1: Case Study