Early childhood caries: Risk and prevention

Cleaning of baby teeth, according to experts, is important because it helps them avoid dental problems later in their lives.

They say babies normally grow their first teeth at around six months; and that the first teeth to come out are at the lower front. Most children will usually have all their milk teeth by the age of three.


Christine Uwamwezi, president of Rwanda Dental Association working at Inkuru Nzinza Orthopedic Hospital in Gikondo, Kigali, says early childhood caries is the presence of one or more decayed, missing, or filled primary teeth in children below the age of five.

Also known as nursing bottle syndrome, the complication begins with white spot lesions in the upper primary incisors, along the margin of the gingiva, Uwamwezi says.

She says that if the disease goes untreated, the caries can progress, leading to complete destruction of the teeth and the gums.

The risk factors when it comes to early childhood caries are mainly microbiological, dietary, and environmental.

To prevent problems in the future, Uwamwezi says mothers should always start cleaning their baby’s gums as early as possible.

“As long as the child has started breastfeeding or is on formula milk, it’s important for mothers to start cleaning the gums using a clean piece of cloth or cotton immersed in water,” she says.

This should be done every time the baby has been fed, she says.

Uwamwezi says that the practice should continue until the first tooth/teeth are seen.

However, she says, before that, it’s not advisable to clean the gums with toothpaste—only after teeth have come out—using small amounts of fluoride toothpaste.

When cleaning, she says, it’s important to make sure there is no starch or remains left on the teeth that can lead to the formation of cavity.

Children need to go for dental checkups on a regular basis. File photos


Uwamwezi explains that early childhood caries is a preventable, infectious disease that is caused by certain types of bacteria that live in the mouth.

“The bacteria, called plaque, normally sticks to the teeth, it then feeds on what the baby eats, especially sugars, including milk,” she says.

She adds that the bacteria then begins making acids as it digests the food a few minutes after consumption. These acids, Uwamwezi says, can break down the tooth’s outer surface and dissolve valuable minerals.

“This then results in cavities, and is common in children who snack frequently or go to sleep with a bottle containing milk or other liquids that aren’t water,” she says.

Epimak Kayiranga, a dentist at University Teaching Hospital of Kigali (CHUK), says the problem with many parents is that they don’t understand that breast or formula milk have natural sugars, which can contribute to the decaying process.

When baby teeth are not cleaned often, it creates a perfect environment for bacteria to develop, he says.

Although parents need to feed their children, Kayiranga says they should be cautious about taking care of their teeth to avoid dental problems that come early in a child’s life.

However, he notes that it’s also important to avoid sharing baby’s stuff, such as cutlery, because the bacteria from an adult can pass through the saliva to the baby, if they (adults) have it.

Also, he says that using proper techniques when it comes to feeding and cleaning baby teeth is important.

“Parents should play an important role when it comes to detecting early decay in their children, and in case of a problem, it’s important to visit a dentist for help,” he says.


Uwamwezi says that there are cases where parents seek help from dentists concerning the teeth of their children, which in some cases are stained.

This, she says, is normally brought about by poor cleaning or not cleaning the infant’s teeth at all.

She says that parents need to change the perception about  first teeth—majority think that first teeth aren’t supposed to be cleaned at all, which is false and can lead to serious complications later as far as the oral hygiene of the child is concerned.

Dr Pacific Nkusi, a dentist at Oshen-King Faisal Hospital, says failure to start cleaning baby teeth can lead to tooth decay.

He says the rapid decay of baby teeth stems from frequent exposure, for a long period of time, to liquids containing sugars, and that the upper front teeth are mostly affected.


According to experts, baby teeth normally pave the way for a smooth and aligned eruption of permanent teeth.

Nkusi says any disturbance or disruption of the milk teeth can create several problems that in most cases can be avoided, only by taking good care of them.

“When baby teeth are not taken care of, it can lead to complications that in most cases may require uprooting of teeth before the child starts developing the permanent teeth,” he says.

He says this is risky because it creates possibility of crowded teeth when the permanent teeth come out.

He explains that when the milk teeth are lost prematurely, there are consequences, and some of them will delay coming out, or there will be premature eruption of the permanent tooth.

Also, he says, there could be development of abnormal muscle cavity and habits such as tongue thrust in the newly created space, which he says may lead to further disruption in the bite.

Additionally, Kayiranga says the child’s speech may be altered, known as speech defects, and, the child could develop poor nutrition and feeding issues.

To avoid all this, he says that it’s essential for parents or caregivers to make sure their children brush their teeth twice a day, depending on their age.

And, he says helping infants clean their gums and teeth will help keep dental problems at bay.

Kayiranga notes that flossing daily and maintaining regular good hygiene, feeding on a low sugar diet, as well as consulting a dentist on a regular basis, should be taken seriously.



General hygiene is important and parents should always maintain it, especially when it comes to children. It helps avoid infections and other conditions that come along with poor hygiene.

Lucie Uwinkesha, In-charge of community and environment health at Muhima Hospital


Consulting a dentist in case of problem concerning a child’s teeth is important. Parents should avoid the habit of seeking native medicines to cure any dental problems in children. This can lead to further problems, which is not healthy.

Karen Mugisha, Health worker


Including calcium rich foods such as milk, cheese, yoghurt and some leafy greens in a child’s diet is important. On the other hand, avoiding sugary foods and drinks is the way to go because it prevents cavities.

Joseph Uwiragiye, Nutritionist


It’s important for parents to always consult a physician on the nutrition of the child. It helps the child maintain a healthy diet as well as keep them away from foods that can harm their teeth, and eventually, affect overall health.

Julius Habimana, General practitioner