Dental caries is largely preventable, but it remains one of the most common diseases of childhood—five times as common as asthma, and seven times as common as hay fever, according to the Centers for Disease Control and Prevention (CDC). The CDC states that 42% of children ages 2 to 11 have had cavities in primary teeth, and 21% of those ages 6 to 11 have had cavities in permanent teeth.1 Children will develop caries disease at different benchmarks of their early lives, with some adolescents being at a higher risk than others due to some very specific circumstances.
A recent THE NEXTDDS presentation on early childhood caries by Dr. Greg Psaltis, a pediatric dentist with over 30 years of experience, discusses the types of children who are at high risk for dental caries and stresses the role of the clinician in performing a comprehensive risk assessment as part of an effective oral hygiene regimen. Students need to learn why certain children may experience dental caries over others and understand the importance of a comprehensive risk assessment.
Here are the types of children at a high risk for dental caries and some of the key takeaways from the Psaltis presentation:
Socioeconomic, Premature Birth Rate, and Special Needs
A child’s risk of caries disease comes at the expense of how he or she is born, raised, and how he or she develops. Statistically, lower socioeconomic upbringings lead to a higher risk at dental caries as opposed to high socioeconomic standards.2 Children with premature birth rates, as well as special needs or disabilities, are also at a high risk.3 Since these children have less access to care and need to have more involved procedures (that become costly) due to their poor health, these roadblocks are correlated with a higher risk of dental caries.
Transfers from Healthcare Providers and/or Parents
In studying children at higher risk of caries disease, one interesting aspect is a factor that can be beyond their control. Typically, when a child is just learning how to adjust from being breastfeed to bottle-fed, or is having trouble eating, a healthcare provider or parent will demonstrate the motion of eating or drinking by putting the bottle or spoon into their mouths before giving it to the child. When this occurs, the bacteria from the healthcare provider or parent transfers over to the child, causing a high risk of caries.4
Children who eat sweet or starchy snacks are also at a higher risk, especially when they consume these treats more than three times daily.5 The frequency at which the child consumes the snacks is a bigger factor than the actual foods themselves. Eating these types of foods in pieces rather than the entire snack actually does more harm, as the continuous chewing raises the risk.6 Parents and guardians should be made aware of the fact that they need to dictate the child’s low-carb, less sugary diet, rather than the child dictate his or her own diet, which can be especially hard if the child is a picky eater. Fruits should be implemented over fruit roll ups!
With so many responsibilities involved in raising a child, it can be easy for parents to overlook the very serious threat posed by caries disease. Especially when it comes to something as simple as a shared spoon, or as long-term as an adjustment to the child’s diet, practitioners need to emphasize how much these important factors come into play with the risk of their child. With a comprehensive risk assessment, dentists can allow parents to keep their children healthy. Moving further into the CAMBRA Approach, identifying these patients who are at a high risk, then modifying their risk through various factors including diet and improving their overall health care routine will ensure safety.
 Healy M. Young kids' tooth decay hits 'epidemic' proportions. USA Today. http://www.usatoday.com/story/news/nation/2014/03/02/cavities-children-teeth/5561911/. Published March 3, 2014. Accessed November 28, 2016.
 Popoola BO, Denloye OO, Iyun OI. Influence of parental socioeconomic status on caries prevalence among children seen at the university college hospital, ibadan. Ann Ib Postgrad Med 2013;11(2):81-86.
 Norwood Jr. KW, Slayton RL. Oral health care for children With developmental disabilities. American Academy of Pediatrics. http://pediatrics.aappublications.org/content/131/3/614. Published March 2013. Accessed November 29, 2016.
 Ramos-Gomez FJ, Crystal YO, Ng MW, et al. Pediatric dental care: Prevention and management protocols based on caries risk assessment. J Calif Dent Assoc 2010; 38(10):746–761.
 Block SL. Put some ‘teeth’ into your pediatric preventive counseling. Healio.com/Pediatrics. http://m2.wyanokecdn.com/32e80aa87972ee67415ae2efb7474d04.pdf. Published September 2012. Accessed November 29, 2016.
 Psaltis G. Types of children at high risk for dental caries. September 2016. http://www.thenextdds.com/Podcasts/Types-of-Children-at-High-Risk-for-Dental-Caries/. Accessed November 30, 2016.