mechanisms of early childhood caries

Resident’s Name: Brian Schmid Date: 10/17/08
Article title: Biological mechanisms of early childhood caries
Author(s): W. Kim Seow
Journal: Community Dentistry and Oral Epidemiology
Volume (number): 26
Month, Year: 1998
Major topic: Mechanism of ECC and its unique relation to predisposing factors in children
Minor topic(s: Acidogenic bacteria and their effect on primary teeth
Type of Article: Literature review
Main Purpose: A professional review of the carious process, the individual traits of several of the contributing bacterial species.
Overview of method of research: Didactic review and discussion of the caries process

Findings: The salivary pellicle begins to adhere immediately after even thorough cleaning and acts as lubrication, acid buffer, prevention of crystal growth and helps remineralization. It also has many other protective factors such as antimicrobial systems, bacteria agglutins and bicarbonate buffering capacity. Saliva also includes immunological factors such as IgA, sIgA, IgG and phagocytes (the latter 2 typicallly come from gingival crevicular fluid). Once the pellicle is formed, Streptococcus species can begin adhering; most typically S. sanguis, oralis and mitis. As the biofilm develops the bacterial population sways toward Actinomyces. The biofilm produces both acid and alkaline products, the balance of which is essential in determining its cariogenicity. The mutans streptococci family has a number of traits which lends itself to the carious process; they create water insoluble adhesion glucans, production of intracellular polysaccharide which allow acidogenic activity during periods of limited exogenous carbohydrate consumption, high aciduric capabilities. Mutans species are not typically found in predentate children, since they typically need a non shedding surface to colonize. The infection rate increases as more teeth erupt into the mouth and the earlier colonization begins, the higher the likelihood of ECC. Dental malformation is another contributing factor to ECC, since it often creates an environment with deep noncleansible fissures, as well as enamel which is less resistant to acidogenic decay. Also, teeth, even those which are congenitally sound, are most susceptible to decay immediately upon eruption before they can undergo any post-eruptive maturation. Sucrose, which is the most common dietary sugar and the most closely linked to dental decay, is unique in that one of its byproducts is plaque dextrans which are essential in the adherence and thus the progression of dental decay. The review reports that bovine milk is not cariogenic since exposure to lactose did not sufficiently lower the pH to cause demineralization. The review does warn of human milk and on demand breast-feeding, milk formulas and acidic fruit drinks. Fluoride is noted to have a multivariable positive effect ton reducing cariogenic activity.

Key points/Summary : Dental caries is a complicated, multivariable disease which affects millions of children worldwide. The interpretation of universal and individual factors are essential in the prevention and elimination of this disease.

Assessment of article: A bit dry for my taste but it is a nice review of the basics of the microbiology associated with ECC.