Circuit 2, station 5

Dental caries stands as the most prevalent chronic ailment in childhood, exerting adverse repercussions on future dental and holistic well-being. This proclivity towards lifelong dental care subsequently engenders substantial societal expenditures. Of particular concern is the substantial impact on children hailing from socioeconomically disadvantaged backgrounds, who exhibit a heightened susceptibility to suboptimal oral health, including dental caries. Thus, it becomes imperative to delineate and comprehend the determinants that underlie dental caries, with the aim of mitigating oral health disparities in the future.

While the contribution of dietary carbohydrates to caries aetiology is well-established, the intricate relationship between infant feeding practices and the development of childhood caries remains comparatively enigmatic, occasionally leading to equivocal interpretations. The World Health Organization (WHO) has unequivocally advocated for breastfeeding, particularly exclusive breastfeeding on demand within the first hour postpartum for up to 6 months, with continued partial breastfeeding recommended for up to 2 years (WHO, 2002). Nevertheless, a Lancet review in 2016 expounded upon the lifelong consequences of breastfeeding, revealing dental caries as the sole adverse health outcome linked to prolonged breastfeeding. This assertion is corroborated by two additional systematic reviews, which affirm the heightened risk of childhood caries associated with extended breastfeeding durations.

However, a noteworthy caveat pertains to the omission of comprehensive consideration of the role played by family socioeconomic position (SEP) in previous investigations, a pivotal confounding factor exerting influence over both infant feeding practices and dental caries. Furthermore, few inquiries have encompassed an evaluation of other nutritional factors, such as the consumption of carbohydrate-laden foods in conjunction with breastmilk or bottle-feeding. Consequently, an element of uncertainty prevails regarding whether dental caries is intrinsically linked to the carbohydrate content within breastmilk or alternatively arises due to a confluence of contributing factors. It is also imperative to acknowledge that a substantial proportion of prior research has been conducted in non-European contexts, thus impeding the universal applicability of findings to European populations, given the considerable disparities in caries prevalence and oral healthcare systems across countries. Furthermore, the presence or absence of artificially fluoridated water sources within specific regions may have exerted a modulating influence on earlier research outcomes.

The development of carious lesions, including those commonly seen in nursing caries, arises from the interplay of three key factors:

1. The presence of pathogenic microorganisms in the oral cavity.
2. The availability of fermentable carbohydrates that serve as a substrate for microbial metabolism, leading to the production of organic acids.
3. Tooth surfaces that exhibit susceptibility to dissolution in the presence of these acids.

For the progression of these lesions to the point of clinical diagnosis, it is imperative that these three factors interact synergistically over a sufficient duration.

When assessing a child for caries, ensure you:

1. Inquire with the parents regarding their child’s feeding patterns, paying particular attention to nocturnal bottle usage, on-demand breastfeeding, and the use of sweetened items like honey-coated pacifiers.
2. Provide parental education on the connection between severe tooth decay and prolonged bottle or breast feeding, the habit of nursing during the night, and the use of sweetened pacifiers. Discourage the continuation of these habits.
3. Encourage the parents to feed the infant only while cradling them in their arms.
4. If the parents insist on providing a nighttime bottle to help the child sleep, recommend filling it with plain water.
5. Instruct the parents to clean the infant’s teeth following each feeding.
6. Initiate the process of transitioning the child from breastfeeding or bottle feeding.