The demography of early childhood caries
Hill, Gemma Modell
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Early childhood caries (ECC) is a rampant, infectious dental disease that affects children up to age six, with effects lasting well into their adulthood. ECC predicts high rates of morbidity in adulthood, is one of the most frequently found childhood illnesses, and is theoretically preventable. Lesion formation follows a particular pattern based in part on the pattern of primary tooth eruption, and is similar to caries formation at any age, with the balance of demineralization and remineralization. Commonly observed effects of ECC include failure to thrive due to pain and discomfort with eating, decreased attentiveness and socialization, and increased number of missed school days. The lesions associated with ECC are often very painful and frequently remain untreated in high-risk populations. Unfortunately, children’s oral health needs are often overlooked in research and public health practices, leaving many untreated and suffering. Risk indicators for ECC include socioeconomic status and race or ethnicity. One of the most critical risk factors for the disease is dietary quality, which has been studied to some extent in attempts to discern the epidemiology of ECC, and which has been shown to have causative effects on the disease process. What has not been studied, however, is how these risk indicators and risk factors interrelate to contribute to the high prevalence of ECC in the United States. Without studying the effect that an overlap in associated risks for these problems has, it is not possible to create a truly comprehensive public health prevention program that will efficaciously decrease the incidence of early childhood caries. Multiple studies have shown the effects of poor diet quality on the development of ECC. When studying nutritional intake alone, ECC is far more common in groups consuming a less healthful diet. Not only does dietary intake affect the formation of caries, caries experience also affects the ability to consume a nutritious diet. Socioeconomic status has also been cited as a crucial determinant of risk for developing ECC. Those children living at or below the Federal Poverty Line are at high risk for disease, regardless of their race or ethnicity. This is hypothesized to relate to nutrition, as healthier diets are frequently found to be more costly than cariogenic diets, which rely heavily on refined and processed grain products. Nutrition is the single risk factor that bridges the risk indicators of socioeconomic status and race or ethnicity. For this reason, improving dietary quality and nutritional status may prove to be the most effective method of decreasing the prevalence of ECC in the United States. Future studies should focus on effective methods to educate the population to alter the quality of the American diet as a whole. By doing so, the prevalence of this disease can be reduced, and more children can have successful, happier, and healthier childhood years. Creating better oral health in children will decrease morbidity for both oral and systemic disease in adulthood, ultimately improving the overall health of the population of the United States.
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