Dental Caries



Dental caries is the process of tooth structure demineralization, ultimately leading to cavitation (cavities). Over time, bacterial metabolism of carbohydrates produces acid, leading to tooth demineralization. The presence of one or more decayed, missing, or filled primary tooth surfaces in children <6 years old constitutes “early childhood caries” (ECC).


  • 28% of 2- to 5-year-olds suffer from ECC, which is most prevalent in disadvantaged populations, with those <3 years old largely untreated.
  • Although the prevalence of ECC has not changed in the last few years, filled teeth have increased, indicating more treatment is being provided.
  • ECC may lead to increased emergency department visits and hospital admissions, higher treatment costs, loss of school days, delayed growth and development, and diminished ability to learn.

Risk Factors

  • Dental caries is multifactorial
    • Factors increasing duration of sugar on teeth: frequent consumption of sugars (including prolonged bottlefeeding), sugary beverages, sticky sugars, medications sweetened with sucrose, inconsistent brushing/flossing after meals, pouching of food, tightly spaced teeth that are difficult to clean
    • Factors leading to dry mouth (less saliva, less acid buffering): mouth breathing, albuterol inhalers, psychiatric medications
    • Factors leading to weaker tooth enamel: lack of systemic or topical fluoride, developmental enamel defects
    • Epidemiologic factors: low socioeconomic status, previous caries experience
    • Microbial risk markers: mutans streptococci (MS) and Lactobacillus species
  • Health-related risk factors
    • Developmental delay—oral hygiene difficult
    • Cerebral palsy—crowded dentition, difficult to brush
    • Conditions requiring frequent, high nutrient oral feedings
    • Conditions treated with medications that dry the mouth—psychiatric conditions


Dental caries develops when oral bacteria, primarily MS, ferment carbohydrates into organic acids, over time demineralizing tooth enamel. Continuous demineralization of tooth enamel leads to enamel cavitation.

MS has been shown to be vertically transmitted from caregiver to child, leading to the concept of ECC as an infectious disease. Horizontal transmission between family members and caregivers also can occur.

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