Role of Maternal Nutrition in Early Childhood Caries

To an extent not fully appreciated by healthcare workers, many of the determinants of the oral health of an individual is likely determined in the first 1000 days of life.  The tissues and systems involved during this period are the formation of the primary dentition, development of the immune complex, and the acquisition of the indigenous microbiota via vertical transmission, mother to child.   Unfortunately, a pervasive, yet difficult influence to quantitate is malnutrition.  With a significant number of children and their mothers living at or below poverty levels, choices of nutrition and preventative health care are limited.   Poor nutrition including diets high in carbohydrates and low in protein can lead to developmental defects of the forming dentition, collectively called enamel hypoplasia (EHP).   Prematurity and other adverse birthing outcomes can also result in damage to the forming teeth, particularly evident in the maxillary anteriors.  After teeth emerge, EHP and other surface defects promote early colonization of known cariogenic bacteria such as the mutans streptococci and lactobacilli.  Ensuing diets high in sugar and carbohydrates further contribute to accelerated and rampant progression of dental caries.   We have recently defined this syndrome as hypoplasia-associated severe early childhood caries (HAS-ECC).  Both prospective and case-control studies support our contention that children in poverty, malnutrition and/or experiencing adverse perinatal event(s) are far more likely to develop rampant or severe early childhood caries than other groups of children.  Histological sections of teeth dutifully record adverse events in the layers of enamel and dentin and presence and position of these developmental defects inform the infant’s life history.  By putting all these parts of the puzzle in place, we feel that the resolution of this severe form of caries can be ameliorated or eliminated from children at risk.