Early childhood caries: the timing of exposure matters more than the amount of sugar

Early childhood caries is the commonest chronic disease of childhood, and it progresses faster than caries observed in adults.

The reason is structural: primary enamel is thinner and less mineralised than permanent enamel, and a lesion crosses it in less time, reaching the pulp.

The classic pattern affects the upper incisors while sparing the lower ones, which are protected by the tongue and by the salivary duct openings. It is a picture recognisable at a glance.

The mechanism is not the quantity of sugar but the frequency and duration of exposure. A bottle of sweetened drink kept during sleep maintains an acidic pH for hours, with reduced salivary flow.

Hence the most effective instruction: nothing other than water in the night-time bottle, and no bottle left in the mouth during sleep.

The same applies to prolonged on-demand night-time breastfeeding after the teeth have erupted, which carries an analogous risk while being a subject to be raised with care.

Bacterial colonisation occurs through transmission, chiefly from the mother or the caregiver. Tasting food with the child's spoon or cleaning a dummy in one's mouth transfers Streptococcus mutans.

It follows that improving the mother's oral health in pregnancy and the first year reduces the child's risk. It is prevention carried out on one person to protect another.

Cleaning begins before the teeth, with a gauze over the gums, and continues with a small brush as soon as the first element erupts. The moment to start is not when the child cooperates.

The amount of toothpaste is the variable parents most often get wrong. Below three years a rice-grain amount is used; between three and six, a pea.

Concentration is chosen on risk as in adults, and in high-risk children a thousand ppm is indicated even early, in line with prevailing paediatric guidance.

The first visit is recommended by the first birthday or within six months of the first tooth erupting. It serves more to establish the family's habits than to examine the child.

In summary: frequency of exposure outweighs quantity, nothing sweetened in the night-time bottle, bacteria arrive by transmission from the caregiver, toothpaste amount must be measured, and the first visit is within the first year.