FOR IMMEDIATE RELEASE
Monday, October 20, 1997
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Chris Martin
Jann Ingmire
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New Perspectives on Baby Bottle Tooth Decay
WASHINGTON -- The way dentists detect and prevent tooth decay in infants and children may undergo a change in the near future. That's according to Dr. Norman Tinanoff, D.D.S., M.S., interim department chair, department of pediatric dentistry at the University of Connecticut School of Dental Medicine, who will present at the American Dental Association's (ADA) 138th Annual Session in Washington, D.C., on Monday, October 20. Dr. Tinanoff will argue that the term "baby bottle tooth decay," which is often used to describe children who frequently take a bottle of milk or juice before or during sleep and have rampant tooth decay, may now be inaccurate. "We've noted several things in both our research and research in other countries. First, a majority of U.S. preschool children take, or have taken, a bottle to bed, but not all children get cavities," he pointed out. In one study, approximately 40 percent of children between six and 24 months were put to bed with a bottle, yet only a small percentage developed decay.
He pointed out that in many cases parents and dentists will assume the bottle is the main culprit when other factors may be working to create rampant tooth decay.
Research in certain underdeveloped nations as well as U.S. inner-city populations has shown that infant malnourishment may contribute to a condition called hypoplasia, or a poor development of the tooth's enamel. If the enamel, or hard surface that protects the tooth from decay, does not develop perfectly in the baby while he or she is in the mother's womb, that infant will be higher risk for tooth decay once the mother passes on the bacteria that cause tooth decay.
And it is this passage of bacteria that also presents researchers with another challenge, he said. Earlier research suggested that mothers pass on the bacteria that causes tooth decay to the child, between 22 and 26 months.
"Research has now shown children as young as 11 months old are getting infected with mutans streptococci," he said. If further research shows that the dental decay process can start at a very young age, then parents will have to do a better job of bringing their children to the dentist by the child's first birthday, as recommended by the ADA and the American Academy of Pediatric Dentistry. Parents wait too long to bring their child into the dental office. On average, most children don't see the dentist until age 4.
Dr. Tinanoff also pointed out that researchers are taking a closer look at diet and its effect on tooth decay in infants and young children. Recent research has pointed out that many fruit juices and infant formulas put infants at significant risk for tooth decay while milk may not be as cavity-causing as was once thought. He theorized that the phosphoproteins in milk may inhibit the enamel dissolution, antibacterial factors in milk may interfere with the oral microbial flora and bacteria that cause tooth decay may not be able to feed off lactose, the sugar in milk, as readily as sucrose (table sugar).
Given that tooth decay in young children is still rampant in some segments of the U.S. population and that costs associated with treating these children may exceed $1,000 per child, need is high for developing preventive strategies that will effectively lower the rate of tooth decay among these children.
Recent educational approaches have had mixed results, Dr. Tinanoff reports. Intensive education programs using manuals, counseling booklets, posters and bumper stickers with messages about preventing tooth decay had only limited success. Individual counseling with parents may not always be effective. Still other approaches that reduce the mother's level of bacteria have shown promise. In one study, 37 first-time mothers with high levels of mutans streptococci were given a preventive regimen, including use of chlorhexidine, to reduce their levels of the bacteria. Follow-up data showed the bacteria levels of the 3 year olds were 41 percent compared with 70 percent in the control groups. And the cavity rate in the first group was much lower than the control too.
Dr. Tinanoff and others are now advocating a new term to replace baby bottle tooth decay. Early childhood caries is favored to characterize rampant tooth decay in infants and young children.
"But it's more than semantics at work," he said. Moving dentistry away from focusing on just the bottle may allow the profession to get a better handle on more effective prevention models.
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