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Early Childhood Tooth Decay (ECTD) is more complicated than was originally suggested 20 years ago. The multifactorial aspect of ECTD is not only a dental problem. To truly prevent this illness, health and social service professionals must be involved. Health professionals can be supportive of parents by helping them to develop parenting skills which could prevent ECTD. Early recognition, behaviour modification and targeted prevention are necessary to decrease the incidence of Early Childhood Tooth Decay.

Current Terminology

Early Childhood Tooth Decay has been referred to in the past by many names including: Nursing Bottle Mouth (Fass, 1962), Milk Bottle Mouth (1962), Baby Bottle Syndrome (1970), Nursing Bottle Caries (1970), Baby Bottle Tooth Decay (1983), Nursing Caries (Ripa, 1983). The most current title: Early Childhood Caries (1994) is unsatisfactory because it does not provide an anatomical reference and is not a term clearly understood by the public.

In light of this the Ontario Association of Public Health Dentistry (1999) recommends the term Early Childhood Tooth Decay be used when referring to this condition.


Currently the most popular definition is: one or more carious lesions (cavities) in the maxillary anterior (upper six front) teeth in a child three years of age or younger.

Risk Factors for Early Childhood Tooth Decay*

Prolonged exposure of teeth to fermentable carbohydrates (sucrose, fructose, lactose, etc.):

  • through the use of bottle, breast, tippee cups, plastic bottles with straws
  • high sugar consumption in infancy
  • sweetened pacifiers
  • long term sweetened medication
  • going to sleep with a bottle containing anything but water
  • prolonged use of the bottle beyond one year
  • nursing without cleaning teeth



Physiological Factors:

  • factors associated with enamel development: malnutrition, prenatal health, prenatal nutritional status of mother and child
  • possible enamel deficiencies with low birth weights
  • mother and child's lack of exposure to fluoridated water
  • window of infectivity: mother and baby's infection by streptococci


 Other Risk Factors: 

  • poor oral hygiene
  • sibling history of ECTD
  • education of caregivers
  • lower social economic status
  • limited access to dental care
  • deficits in parenting skills / child management

*Risk factors are not in order of importance. No one risk factor is responsible for ECTD.


Preventive Messages for Health Professionals to Share with the Public

  • Caregivers can establish oral hygiene habits with children early.
  • Caregivers can prevent the spread of dental disease. Objects that have been in the caregiver's mouth should not be shared with children, i.e.: pacifiers, feeding utensils, food.
  • Extended and repetitive breast or bottle feeding should be followed by wiping your child's teeth and gums.
  • Do not put your child to bed with a bottle. If your child must have a bottle at sleep time, only put water in the bottle.
  • Pacifiers should not be dipped in anything sweet.
  • Lift the lip. Once a month check your child's teeth. If you see white, chalky spots or brown spots on your child's teeth, visit a dentist right away.
  • Start cleaning your child's teeth as soon as the first tooth appears. Your child's teeth should be cleaned thoroughly once a day.
  • Only use an amount of fluoridated toothpaste the size of a grain of rice when brushing your child's teeth.
  • Use toys, music, singing, rocking, hugging or a pacifier to quiet your child instead of a bottle, breast or food.
  • When children can sit unassisted, they should start to drink from a cup.
  • Give children a variety of nutritious and non sugary foods. Offer plain water if children are thirsty.
  • Regular dental visits are important for you and your child.
  • For more information on dental health or if you cannot afford dental care contact your local public health unit.
Produced by the Ontario Association of Public Health Dentistry
Reference: Burt B, Spencer J, Schou L. Proceedings: Conference on Early Childhood Caries. Community Dentistry and Oral Epidemiology. Vol. 26, Supplement Number 1, 1998;1-119.


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