Habits and Social Norms Leading to

Childhood Caries

By: Kenva Smith RDH,

MPH Student
 Introduction
Almost 100% of adults globally have experienced a dental cavity

In the United States, statistics indicate that 90% of adults aged 20 and older have
encountered at least one cavity in their lifetime

According to the CDC, 25% of adults 20-64 years of age currently have at least one
untreated cavity.

The Global Oral Health Status Report of 2022 approximated 2 billion people
worldwide have cavities in their permanent teeth and 514 million children
have cavities in their primary teeth
 Introduction
• Tooth decay is the primary chronic,
infectious disease among children in
the U.S according to the American
Academy of Pediatric Dentistry
• More prevalent in low-income children
o around 57% of adolescents aged 12-19
experienced a cavity in a permanent tooth
 Cause of a Cavity
• Dental plaque contains millions of
bacteria
• Bacteria metabolize dietary
sugars and fermentable carbohydrates in
the mouth
o Streptococcus mutans
Cause of a Cavity

• Metabolize carbohydrates to produce

acid
• Acid lowers oral pH
• Demineralization of the enamel occurs
due to acid production(5.5 or lower)

This Photo by Unknown author is licensed under CC BY.

 Levels of Prevention
• Methods for primary, secondary, and
tertiary levels of prevention of tooth decay
• Primary prevention: halt or lower the risk of
cavities
• Halting this disease process involves the removal
of one of the apices from the triangle
o Host - the susceptible tooth
o Agent - bacterial plaque
o Environment - one with frequent and
extended exposure to fermentable
carbohydrates
Levels of Prevention
• Regular dental appointments are
primary preventative measures where
the dental professional can
o give individualized oral health
education,
o assess current risk,
o evaluate for incipient cavities and good
oral hygiene
• Secondary preventative measures are
taken when there are early signs of
tooth decay

This Photo by Unknown author is licensed under CC BY.

Caries in Children
• Dental caries are transmissible and can be
passed between persons both horizontally and
vertically
• S. mutans can inhabit the mouths of infants
before the eruption of their first tooth
• Early Childhood Caries is commonly referred
to as “baby bottle decay”
• The American Dental Association defines ECC
as the existence of one or more decayed,
noncavitated or cavitated lesions, missing, or
filled tooth surfaces in any primary tooth in
children 6 and under
Potential Barriers to
Care
• Dental anxiety can be exhibited as
o delayed or missed appointments,
o challenges in administering treatment,
o elevated stress during dental visits
o poorer oral health outcomes
• Negative attitudes impact both parent
and child
o Therefore, dental anxiety should be
addressed within the whole family

This Photo by Unknown author is licensed under CC BY-SA-NC.

Common Practices and Misconceptions

• What are some common acts and

beliefs about infant and child oral
care that might contribute childhood
caries?
Common Practices and
Misconceptions
• Poor nutrition and bottle-feeding habits
• Lack of awareness
• Failure to schedule and maintain regular dental visits
• Dietary and feeding habits are established during 1st year
of life that can potentially influence food choices and
habits later
• Feeding patterns can be complex
o Breastfeeding
o bottle feeding
o introduction to solid foods and other drinks
Common Practices and Misconceptions

• Daily, high-frequency breastfeeding, bottle

feeding (or both) within the first year of life was
linked to a greater prevalence of ECC and S-ECC
• The risk of cavities do not increase with
exclusive breastfeeding within this period
 Common Practices and Misconceptions
• ~50 million academic hours
are lost annually due to caries-related
dental pain in children
• Asymptomatic tooth decay in primary
teeth is not always taken seriously
• Primary teeth are placeholders
• Children learn transferrable oral hygiene
practices
• Decay/damage of primary tooth could
affect permanent tooth

This Photo by Unknown author is licensed under CC BY-SA.

 Recommendations
• Dental professionals often recommend
o Wipe infant gums and tongue 2x daily
o Breastfeeding as the primary form of nutrition for the
first few months of life
o Use soft bristle toothbrush and water when teeth start to
erupt
o 1st dental visit when 1st tooth erupts*
o Do not put child to bed with anything other than
water
o Fluoride to remineralize teeth structure
Conclusion
• ECC is a common, preventable disease
with a complex etiology involving diet,
oral hygiene, and caregiver knowledge and
practices
• Research highlights the multifactorial
nature of early childhood caries and the
necessity of comprehensive preventive
strategies
• ECC remains a significant public health
problem
o Parental/caregiver education
o Establish more preventative community
programs
Questions ?
THANKS FOR LISTENING
 References
• AAPD. (2023). MCT: Tips for parents. American Association of Pediatric
Dentistry.
https://www.mychildrensteeth.org/age-group-resources/tips-for-parents/
• ADA. (2023a, July 18). Caries risk assessment and management. American
Dental Association.
https://www.ada.org/en/resources/research/science-and-research-institute/or
al-health-topics/caries-risk-assessment-and-management

• ADA. (2023b, August 30). Nutrition and oral health. American Dental
Association.
https://www.ada.org/resources/research/science-and-research-institute/oral-h
ealth-topics/nutrition-and-oral-health

• Aguilar, K. D. (2022, July). Take care of your child’s teeth. Take Care of
Your Child’s Teeth - MyHealthfinder.
https://health.gov/myhealthfinder/doctor-visits/regular-checkups/take-care-y
our-childs-teeth
• CDC. (2021a, January 25). Cavities. Centers for Disease Control and
Prevention.
https://www.cdc.gov/oralhealth/fast-facts/cavities/index.html#:~:text=Untre
ated%20cavities%20can%20lead%20to,in%20rare%20cases%20fatal%2C%
20results
.
• CDC. (2021b, December 9). List of tables. Centers for Disease Control and
Prevention.
https://www.cdc.gov/oralhealth/publications/OHSR-2019-list-of-tables.html

• CDC. (2022, April 6). Children’s oral health. Centers for Disease Control
and Prevention.
https://www.cdc.gov/oralhealth/basics/childrens-oral-health/index.html
• Chen, Y., Evans, J., & Feldlaufer, M. (2006). Horizontal and vertical
transmission of viruses in the honeybee, Apis mellifera. Journal of This Photo by Unknown author is licensed under CC BY.
References
• Colak, H., Dülgergil, C. T., Dalli, M., & Hamidi, M. M. (2013). Early
childhood caries update: A review of causes, diagnoses, and treatments.
Journal of natural science, biology, and medicine, 4(1), 29–38.
https://doi.org/10.4103/0976-9668.107257
• Damle, S. G., Yadav, R., Garg, S., Dhindsa, A., Beniwal, V., Loomba, A., &
Chatterjee, S. (2016). Transmission of mutans streptococci in mother-child
pairs. The Indian journal of medical research, 144(2), 264–270.
https://doi.org/10.4103/0971-5916.195042
• Dhamo, B., Elezi, B., Kragt, L., Wolvius, E. B., & Ongkosuwito, E. M. (2018,
May). Does dental caries affect dental development in children and
adolescents? Bosnian journal of basic medical sciences, 18(2), 198–205.
https://doi.org/10.17305/bjbms.2018.2841
• FDI. (2016, August). Caries prevention and management advocacy toolkit.
FDI Word Dental Federation.
https://www.fdiworlddental.org/caries-prevention-and-management-advocacy
-toolkit

• Feldens, C. A., Rodrigues, P. H., de Anastácio, G., Vítolo, M. R., & Chaffee,
B. W. (2018). Feeding frequency in infancy and dental caries in childhood: a
prospective cohort study. International dental journal, 68(2), 113–121.
https://doi.org/10.1111/idj.12333
• Johns Hopkins. (2019, November 19). Tooth decay (caries or cavities) in
children. Johns Hopkins Medicine.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/tooth-decay
-caries-or-cavities-in-children
This Photo by Unknown author is licensed under CC BY.
References
• Mbawala, H. S., Machibya, F. M., & Kahabuka, F. K. (2015). Assorted
Errands in Prevention of Children’s Oral Diseases and Conditions. InTech.
doi:10.5772/59768 https://www.intechopen.com/chapters/48185
• Nepaul, P., & Mahomed, O. (2020). Influence of Parents' Oral Health
Knowledge and Attitudes on Oral Health Practices of Children (5-12 Years) in
a Rural School in KwaZulu-Natal, South Africa. Journal of International
Society of Preventive & Community Dentistry, 10(5), 605–612.
https://doi.org/10.4103/jispcd.JISPCD_273_20
• NIDCR. (2022, November). Dental caries (tooth decay) in adults (ages 20 to
64 years). National Institute of Dental and Craniofacial Research.
https://www.nidcr.nih.gov/research/data-statistics/dental-caries/adults#table1
• NIDCR. (2023, February). Tooth decay. National Institute of Dental and
Craniofacial Research. https://www.nidcr.nih.gov/health-info/tooth-decay
• Rathee, M., & Sapra, A. (2023, June 21). Dental caries. StatPearls.
https://www.ncbi.nlm.nih.gov/books/NBK551699/#:~:text=Dental%20caries
%20is%20a%20common,the%20tooth%20structure%20over%20time
.
• Šimunović, L., Špiljak, B., Radulović, M., Vlahovljak, A., Ostojić, M., Krlev,
J., Ibrahimpašić, A., Vranić, L., & Negovetić Vranić, D. (2022). Relationship
between Children's and Parents' Dental Anxiety: A Cross-Sectional Study on
the Six European Countries. Dentistry journal, 10(11), 209.
https://doi.org/10.3390/dj10110209
• WHO. (2023, March 14). Oral Health. World Health Organization.
https://www.who.int/news-room/fact-sheets/detail/oral-health

This Photo by Unknown author is licensed under CC BY.