The treatment of early childhood caries can have a significant economical burden and treatment relapses are frequent. Effective intervention by means of topical antimicrobial agents can reduce the burden of early childhood caries. The main aim in prevention and treatment should focus on inhibition of the growth of oral bacteria. This is a comprehensive review of the literature on the various antimicrobial agents which are proven to be effective in management of this carious progression. The review identified that there is a significant data to suggest use of antimicrobial agents in management of early childhood caries. Antimicrobial agents aid in better management of patients with early carious lesion. The relapse rates are less, when the treatment is combined with the use of antimicrobial agent. 1. Introduction Early childhood caries (ECC) also known as baby bottle caries, baby bottle tooth decay, and bottle rot is a disease characterized by severe decay in the teeth of infants or young children. This begins as soon as the teeth erupts and can rapidly progress to extensive decay of all primary teeth [1]. Frequent consumption of liquids containing fermentable carbohydrates (e.g., milk, formula, juice, soda, etc.) increases the risk of dental caries which results from prolonged contact between sugars in the liquid and cariogenic bacteria in the teeth. Improper feeding practices without appropriate preventive measures can also lead to this distinctive pattern of caries in susceptible infants and toddlers. The microbial flora mainly involved in ECC is S. mutans (MS) [1, 2]. Caries is mainly formed by the accumulation of salivary proteins and adhesive glucans on the enamel surface. Which allow the attachment of S. mutans onto the teeth surfaces. These bacteria produce lactic acid during the carbohydrate metabolism which can cause demineralization of enamel surface and cavitation of tooth surface. With sufficient time, the cariogenic microorganisms in the presence of fermentable carbohydrates can alter the critical pH which can induce demineralization of tooth substance, and progress to loss of tooth structure or cavitations [1–3]. The major reservoir from which infants acquire S. mutans is their mothers commonly termed as Window of Infectivity and/or also from other primary caregivers [2, 3]. This period is believed to be during the time that teeth are erupting, from seven or eight months until 36 months. However, a single treatment of mothers with an oral antibacterial may not be sufficient to prevent mutans streptococci transmission and subsequent caries
References
[1]
P. DenBesten and R. Berkowitz, “Early childhood caries: an overview with reference to our experience in California,” Journal of the California Dental Association, vol. 31, no. 2, pp. 139–143, 2003.
[2]
R. O. Mattos-Graner, Y. Li, P. W. Caufield, M. Duncan, and D. J. Smith, “Genotypic diversity of mutans streptococci in Brazilian nursery children suggests horizontal transmission,” Journal of Clinical Microbiology, vol. 39, no. 6, pp. 2313–2316, 2001.
[3]
A. P. Dasanayake, P. W. Caufield, G. R. Cutter, and H. M. Stiles, “Transmission of mutans streptococci to infants following short term application of an iodine-NaF solution to mothers' dentition,” Community Dentistry and Oral Epidemiology, vol. 21, no. 3, pp. 136–142, 1993.
[4]
R. Harris, A. D. Nicoll, P. M. Adair, and C. M. Pine, “Risk factors for dental caries in young children: a systematic review of the literature,” Community Dental Health, vol. 21, no. 1, pp. 71–85, 2004.
[5]
Y. Kawashita, M. Kitamura, and T. Saito, “Early childhood caries,” International Journal of Dentistry, vol. 2011, Article ID 725320, 7 pages, 2011.
[6]
E. L. Dini, R. D. Holt, and R. Bedi, “Caries and its association with infant feeding and oral health-related behaviours in 3-4-year-old Brazilian children,” Community Dentistry and Oral Epidemiology, vol. 28, no. 4, pp. 241–248, 2000.
[7]
A. Mohan, D. E. Morse, D. M. O'Sullivan, and N. Tinanoff, “The relationship between bottle usage/content, age, and number of teeth with mutans streptococci colonization in 6–24-month-old children,” Community Dentistry and Oral Epidemiology, vol. 26, no. 1, pp. 12–20, 1998.
[8]
J.-A. Marrs, S. Trumbley, and G. Malik, “Early childhood caries: determining the risk factors and assessing the prevention strategies for nursing intervention,” Pediatric Nursing, vol. 37, no. 1, pp. 9–15, 2011.
[9]
American Academy of Pediatric Dentistry and Council on Clinical Affairs, “Guideline on perinatal oralhealthcare,” 2013, www.aapd.org/media/Policies_Guidelines/G_PerinatalOralHealthCare.pdf.
[10]
American Academy of Pediatric Dentistry. Clinical Affairs Committee—Infant Oral Health Subcommittee, “Guideline on infant oral health care,” Pediatric Dentistry, vol. 34, no. 5, pp. 148–152, 2012.
[11]
American Academy of Pediatrics, Committee on Native American Child Health, Canadian Paediatric Society, and First Nations, Inuit and Métis Committee, “Early childhood caries in indigenous communities,” Pediatrics, vol. 127, no. 6, pp. 1190–1198, 2011.
[12]
Assembly of First Nations and First Nations Information Governance Committee, First Nations Regional Longitudinal Health Survey (RHS) 2002/03: Results for Adults, Youth and Children Living in First Nation Communities, Assembly of First Nations, Ottawa, Canada, 2nd edition, 2007.
[13]
R. Harrison, “Oral health promotion for high-risk children: case studies from British Columbia,” Journal of the Canadian Dental Association, vol. 69, no. 5, pp. 292–296, 2003.
[14]
V. C. Marinho, H. V. Worthington, T. Walsh, and J. E. Clarkson, “Fluoride varnishes for preventing dental caries in children and adolescents,” Cochrane Database of Systematic Reviews, vol. 7, Article ID CD002279, 2013.
[15]
R. E. Marquis, “Antimicrobial actions of fluoride for oral bacteria,” The Canadian Journal of Microbiology, vol. 41, no. 11, pp. 955–964, 1995.
[16]
I. Zickert and C. G. Emilson, “Effect of fluoride-containing varnish on Streptococcus mutans in plaque and saliva,” Scandinavian Journal of Dental Research, vol. 90, no. 6, pp. 423–428, 1982.
[17]
E. D. Beltrán-Aguilar, J. W. Goldstein, and S. A. Lockwood, “Fluoride varnishes: a review of their clinical use, cariostatic mechanism, efficacy and safety,” Journal of the American Dental Association, vol. 131, no. 5, pp. 589–596, 2000.
[18]
S. Twetman, “Prevention of early childhood caries (ECC)—review of literature published 1998–2007,” The European Archives of Paediatric Dentistry, vol. 9, no. 1, pp. 12–18, 2008.
[19]
B. Ogard, L. Sepp？, and G. R？lla, “Professional topical fluoride applications—clinical efficacy and mechanism of action,” Advances in Dental Research, vol. 8, no. 2, pp. 190–201, 1994.
[20]
J. Arends and J. Schuthof, “Fluoride content in human enamel after fluoride application and washing: an in vitro study,” Caries Research, vol. 9, no. 5, pp. 363–372, 1975.
[21]
J. A. Weintraub, F. Ramos-Gomez, B. Jue et al., “Fluoride varnish efficacy in preventing early childhood caries,” Journal of Dental Research, vol. 85, no. 2, pp. 172–176, 2006.
[22]
C. H. Chu and E. C. Lo, “Promoting caries arrest in children with silver diamine fluoride: a review,” Oral Health & Preventive Dentistry, vol. 6, no. 4, pp. 315–321, 2008.
[23]
A. Rosenblatt, T. C. M. Stamford, and R. Niederman, “Silver diamine fluoride: a caries ‘silver-fluoride bullet’,” Journal of Dental Research, vol. 88, no. 2, pp. 116–125, 2009.
[24]
J. D. B. Featherstone, “Delivery challenges for fluoride, chlorhexidine and xylitol,” BMC Oral Health, vol. 6, supplement 1, article S8, 2006.
[25]
Q. Zhang, W. H. van Palenstein Helderman, M. A. van't Hof, and G.-J. Truin, “Chlorhexidine varnish for preventing dental caries in children, adolescents and young adults: a systematic review,” European Journal of Oral Sciences, vol. 114, no. 6, pp. 449–455, 2006.
[26]
J. K.-C. Ma, B. Y. Hikmat, K. Wycoff et al., “Characterization of a recombinant plant monoclonal secretory antibody and preventive immunotherapy in humans,” Nature Medicine, vol. 4, no. 5, pp. 601–606, 1998.
[27]
D. M. van Lunsen, J. J. de Soet, K. L. Weerheijm, H. J. Groen, and J. S. J. Veerkamp, “Effects of dental treatment and single application of a 40% chlorhexidine varnish on mutans streptococci in young children under intravenous anaesthesia,” Caries Research, vol. 34, no. 3, pp. 268–274, 2000.
[28]
H. M. van Rijkom, G. J. Truin, and M. A. van't Hof, “A meta-analysis of clinical studies on the caries-inhibiting effect of chlorhexidine treatment,” Journal of Dental Research, vol. 75, no. 2, pp. 790–795, 1996.
[29]
S. Koontongkaew and S. Jitpukdeebodintra, “Amphiphilic property of chlorhexidine and its toxicity against Streptococcus mutans GS-5,” The Journal of Nihon University School of Dentistry, vol. 36, no. 4, pp. 235–240, 1994.
[30]
V. Law and W. K. Seow, “A longitudinal study of 0.2% chlorhexidine gel for removal of mutans streptococci infection in preschool children,” Australian Dental Journal, vol. 52, no. 1, pp. 26–32, 2007.
[31]
S. Petti and H. Hausen, “Caries-preventive effect of chlorhexidine gel applications among high-risk children,” Caries Research, vol. 40, no. 6, pp. 514–521, 2006.
[32]
M. Simratvir, N. Singh, S. Chopra, and A. Thomas, “Efficacy of 10% povidone iodine in children affected with early childhood caries: an in vivo study,” The Journal of Clinical Pediatric Dentistry, vol. 34, no. 3, pp. 233–238, 2010.
[33]
L. Lopez, R. Berkowitz, H. Zlotnik, M. Moss, and P. Weinstein, “Topical antimicrobial therapy in the prevention of early childhood caries,” Pediatric Dentistry, vol. 21, no. 1, pp. 9–11, 1999.
[34]
R. J. Berkowitz, “Causes, treatment and prevention of early childhood caries: a microbiologic perspective,” Journal of the Canadian Dental Association, vol. 69, no. 5, pp. 304–307, 2003.
[35]
L. Lopez, R. Berkowitz, C. Spiekerman, and P. Weinstein, “Topical antimicrobial therapy in the prevention of early childhood caries: a follow-up report,” Pediatric Dentistry, vol. 24, no. 3, pp. 204–206, 2002.
[36]
A. Tam, M. Shemesh, U. Wormser, A. Sintov, and D. Steinberg, “Effect of different iodine formulations on the expression and activity of Streptococcus mutans glucosyltransferase and fructosyltransferase in biofilm and planktonic environments,” Journal of Antimicrobial Chemotherapy, vol. 57, no. 5, pp. 865–871, 2006.
[37]
H. Lynch and P. Milgrom, “Xylitol and dental caries: an overview for clinicians,” Journal of the California Dental Association, vol. 31, no. 3, pp. 205–209, 2003.
[38]
L. Zhan, J. Cheng, P. Chang et al., “Effects of xylitol wipes on cariogenic bacteria and caries in young children,” Journal of Dental Research, vol. 91, no. 7, pp. 85–90, 2012.
[39]
E. S？derling, P. Isokangas, K. Pienih？kkinen, and J. Tenovuo, “Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants,” Journal of Dental Research, vol. 79, no. 3, pp. 882–887, 2000.
[40]
J. He, L. Chen, D. Heber, W. Shi, and Q.-Y. Lu, “Antibacterial compounds from Glycyrrhiza uralensis,” Journal of Natural Products, vol. 69, no. 1, pp. 121–124, 2006.
