After brushing her son's teeth every night since they first pushed through the gums, Kamala Todd says she was dismayed to find signs of pitting behind his front teeth.
A visit to a dentist in Tsawwassen, B.C., confirmed that her son An'ostin, then nearly 3, had early childhood caries – tooth decay – the leading cause of surgery requiring general anesthetic in Canadian children.
Ms. Todd, who had watched a friend's child suffer from broken, decayed teeth and a painful abscess, says she feared "there was no real way to stop it."
Nevertheless, she followed her dentist's advice on how to arrest tooth decay. Ms. Todd stopped giving her son juice, crackers and dried fruit, which stick to the teeth. After meals and snacks, she gave him water or cheese to reduce tooth-eroding acids in the mouth. Her son began to chew gum made with xylitol, a natural sweetener that has an antibacterial effect. As well, Ms. Todd scheduled her son for ozone treatments, which some dentists believe can zap bacteria deep in the teeth.
Ms. Todd says An'ostin, now 5, has no further decay in his mouth, while the condition of some teeth has improved. Averting the need for major dental work is "pretty much just a maintenance thing now," she says.
Severe early childhood caries, in which several teeth have cavities or signs of decay, "seem to be on the rise," says Robert Sutherland, president of the Canadian Dental Association.
The widespread practice of putting a child to bed with a bottle filled with milk or juice is a major factor in the rise of early childhood caries, Dr. Sutherland says. While most parents wouldn't fill a bottle with soda pop, many tell themselves, "juices are healthy," he says.
But in fact, fructose in juice – and lactose in milk – bathe the teeth in sugars that increase acid production in the mouth, leading to demineralization and tooth decay.
A toddler or preschool-aged child with caries may suffer from acute or low-grade pain, Dr. Sutherland says. Although he or she may not complain, pain may alter the child's behaviour, "so they're not eating as well, they're not sleeping as well."
Left untreated, baby teeth may break, rot or fall out prematurely. Infection can get into the nerve of the tooth and affect the development of underlying adult teeth, which may put the child at risk for lifelong dental problems.
Early detection and treatment may prevent cavities from forming, Dr. Sutherland says. The Canadian Dental Association recommends that children see a dentist within six months of eruption of the first tooth and no later than one year of age. But anecdotal reports suggest there is a "knowledge gap" among dental-health professionals about the need for early dental visits, he adds.
In general, however, dentistry has been shifting away from the drill-and-fill approach toward a preventive model since the 1960s, when fluoride toothpastes came on the market, says Euan Swan, the association's manager of dental programs.
He notes that many dentists recommend additional products for use after brushing, such as MI Paste, which contains calcium and phosphate that can help remineralize teeth.
Dr. Swan confirms that chewing xylitol gum, eating cheese and rinsing with water after meals may all play a role in reducing bacteria, neutralizing acids in the mouth and preventing tooth erosion. "If you use everything that's at your disposal, you can alter the progression of tooth decay," he says.
But Dr. Swan does not recommend ozone treatments, which typically cost $60 to $80 per session. "Their effectiveness is questionable," he says.
Nevertheless, Arshbir Kler, a dentist at Nature's Design Dental Spa in Tsawwassen, B.C., says he's had a "reasonable amount of success" using ozone combined with remineralizing products. He adds the treatment, which delivers ozone gas through a tiny cup on the tooth, must be repeated several times at monthly intervals and is only suitable for early decay. "It's not going to work when you've got a hole in the tooth," he explains.
Dr. Kler, who treated Ms. Todd's son, says he uses a caries-detection laser as well as manual checks to determine whether teeth are remineralizing. He acknowledges that some teeth may respond well to dental care combined with lifestyle changes, while deeply decayed areas may still require filling.
"There is a limit to how much all of these things will do once you've got a significant break in the tooth, where food can get trapped," Dr. Kler says. But he adds, "there's a lot we can do if we catch it early."
Risk factors for early decay
A child may be at risk for early childhood caries if one or more of these conditions exist:
1. Living in an area with a non-fluoridated water supply.
2. Regular consumption of sugar between meals (including maple, honey or fruit sugars), or use of a bottle or sippy cup filled with any liquid other than water.
3. Teeth brushed less than once a day.
4. Health or behavioural problems that limit a parent's ability to brush the child's teeth.
5. Parent or caregiver has tooth decay. (Decay-causing mouth bacteria can be transferred to kids.)
6. Visible plaque (white or yellow deposits) on teeth.
7. A visible defect, notch, cavity or white chalky area on a baby front tooth.
8. Premature birth with low birth weight of less than 1,500 grams (3 pounds).
Source: Canadian Dental Association