Caries is a transmissible, infectious disease. When the disease is allowed to progress, surface cavitation and destruction of dental tissue occur over time. Due to their ability to stick to smooth tooth surfaces and produce copious amounts of acid, the mutans streptococci (MS) group of bacteria is considered one of the most important groups of pathogens in the cariogenic process.20
Primary caregivers can transmit these organisms to their children, which results in MS colonization of the child’s oral cavity.21
There is a direct relationship between adult caregiver MS levels and MS levels and dental caries prevalence in their children.21
Factors influencing colonization include frequent sugar exposure in infants and habits that allow salivary transfer from mothers to infants. Maternal factors, such as high levels of MS, poor oral hygiene, low socioeconomic status, and frequent snacking increase the risk of bacterial transmission to their infants.22
Infants have tested with high levels of MS even before the eruption of their first tooth.22
Therefore, it is critical to consider an infant oral care program in the context of a mother-child pair or dyad, which includes comprehensive maternal perinatal oral health care and treatment.
Dental professionals have begun to recognize the critical role a mother plays in ensuring her child’s oral health. Improving expectant mothers’ oral health by reducing pathogenic bacteria levels in their own mouths can delay the acquisition of oral bacteria in their children and may delay the development of early childhood caries.23
Restoring carious lesions, by itself, is insufficient to reduce a mother’s risk of transmitting cariogenic bacteria to her offspring. An effective perinatal program should institute a long-range, pre- and postpartum maternal strategy to reduce maternal MS and lactobacilli levels through therapeutic interventions and counseling on lifestyle modifications.23
Unfortunately, pregnant women often do not receive oral health care and education in a timely manner. Many women do not know they should seek dental care during their pregnancy and for the many others who do, they often encounter dentists unwilling to provide dental care during pregnancy. New mothers are more likely to be receptive to ideas that would improve their offspring’s oral health and both dental and obstetric providers have a prime opportunity to educate mothers on changes that could improve their children’s oral health.24
In 2010, the CDA Foundation published evidence-based guidelines for health profession on oral health for pregnant women and infants, which indicate that perinatal oral health care is not only safe but necessary to the oral and overall health of the pregnant mother but also that of her infant.23
In light of the importance of perinatal oral health in preventing early childhood caries, and the need to intervene early for mother and child in a “dual parallel track” of treatment and disease prevention management, collaborations and partnerships among all health professionals are encouraged to foster early and timely oral health care and referrals for expectant mothers.
The American Academy of Pediatrics has focused in improving children’s oral health through its Oral Health Initiative and Section on Pediatric Dentistry and Oral Health (aap.org/oralhealth). Through these efforts, pediatricians are becoming more educated on oral health and their role in preventing disease and referring to a dental home. However, many continue to be unaware of the AAP’s current oral health recommendations and more work needs to be done to disseminate this policy and raise awareness. Efforts to increase awareness of incorporating oral health evaluations into well-child visits are crucial since pediatricians often see children on an average of up to six times before age 2.
In addition to pediatricians, family practitioners, and other medical providers who see children frequently during infancy and early childhood are also ideally suited to assess young children for caries risk assessment and refer for dental care.25
A partnership between medical and dental professionals is important to increase patient awareness of the importance of establishing a dental home by the child’s first birthday, assessing caries risk, and coordinating care. As an important step in that direction, the AAP’s “Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents,” which focuses on health promotion and prevention for children and their families, not only advocates for a dental home but also provides extensive information, education and training opportunities, and materials on pediatric oral health for a broad range of practitioners. The AAP is currently conducting a Bright Futures Implementation Project, Brightening Oral Health, to pilot test an oral health risk assessment tool for the primary care practitioner. See .25
AAP-Recommended Sticker Version of Caries Risk Assessment Tools