Oral Health

Sharing Cavities–All in the Family? – A Q&A with Burton Edelstein, DDS, MPH

Burton Edelstein, DDS, MPHDr. Edelstein is Founding Director of Children’s Dental Health Project, a Washington based research and advocacy organization committed to improving children’s oral health and dental care. He is Chair of Social and Behavioral Sciences at the Columbia University School of Dental and Oral Surgery where he is also an associate professor of health policy in the Mailman School of Public Health. He practiced pediatric dentistry in Connecticut and taught at the Harvard School of Dental Medicine for 21 years before committing to full time health policy practice. As a 1996-97 Robert Wood Johnson Health Policy Fellow, he served as health aide to US Senate Democratic Leader Tom Daschle of South Dakota, during development of the State Child Health Insurance Program (SCHIP). Dr. Edelstein was dental consultant to the US Department of Health and Human Services on its oral health initiatives from 1998-2001, chaired the US Surgeon General’s Workshop on Children and Oral Health and authored the child section of the US Surgeon General’s Report “Oral Health in America.” He is a graduate of Harpur College, SUNY Buffalo School of Dentistry, Harvard School of Public Health and the Boston Children’s Hospital pediatric dentistry residency program. His work has been recognized by the American Academy of Pediatric Dentistry (Pediatric Dentist of the Year), Association of State and Territorial Dental Directors (Distinguished Service Award), Harvard School of Dental Medicine (Distinguished Alumnus Award) and American College of Dentists (Service Award). We recently had the opportunity to interview Dr. Edelstein about the Maternal Child Transmission, a well-known issue in the dental community yet one that is not so well-known among the general population.

Q. In layman’s terms what is the “Maternal Child Transmission”?

A. Maternal Child Transmission is the passage of decay-causing bacteria (i.e., “cariogenic” bacteria, including particularly a group called mutans streptococci) from mother to baby. This transmission requires the presence of a tooth and, thus, typically begins around four to six months. The incidence of Maternal Child Transmission depends on direct transmission of saliva and frequent exposure with the bacteria by the mother. Though the published research focuses on transmission from mother to child, it is possible that a primary caregiver other than the mother can also pass decay-causing bacteria to the child. In this Q&A, however, the transmitting adult will always be referred to as the mother since that is where the research has been focused.

Q. What are the differences between the terms “caries,” “cavities” and “tooth decay?”

A. Caries is the biological process that causes tooth destruction leading to holes in the teeth that are the cavities. Tooth decay is a general term that includes both the decay process (caries) and the resulting tooth defect (cavity).

Q. What has the research told us about caries onset?

A. Three things are required for dental caries activity to become established-one or more susceptible tooth surfaces, “cariogenic” bacteria and sugar (particularly sucrose). We’ve known for many years that the mutans streptococci group of bacteria plays a major role in caries development. In addition, we’ve also known for the past few decades that these bacteria can be transmitted by way of saliva from mother to child. Evidence for this Maternal Child Transmission comes from several studies revealing that the genetic makeup of the mutans streptococci in mothers and their babies are similar or identical. Studies have also shown that if we can reduce the amount of mutans streptococci in mothers’ mouths we can prevent or delay caries activity in their children’s mouths.

Q. What are the culprits?

A. The actual dynamics of transmission of caries-causing bacteria from mother to baby are very complex. Transmission depends on factors such as the frequency and quantity of the saliva transferred to baby and its concentration of decay-causing bacteria. If transmission is only modest, the decay causing bacteria will become only a small percentage of all bacteria in a child’s mouth, and the child will be relatively resistant to cavities. At the opposite extreme, children who are often exposed to high levels of these bacteria at an early age are likely to become very cavity-prone. One important culprit is the concentration of decay-causing bacteria in the mother’s mouth. The more experience the mother has had with cavities, the higher the “load” of cavity-causing bacteria is likely to be even if that individual has had her teeth repaired; most filling materials are good at replacing parts of teeth lost to decay but have no effect on the bacteria that cause cavities in the first place.

Although there are no studies that explain absolutely how this transmission occurs, examples include cleaning the baby’s pacifier (binky) in the mother’s mouth before giving it to the baby, pre-chewing the baby’s food or using the spoon the mother eats with to feed the baby. The younger the child is when these decay-causing bacteria are “implanted,” the greater the child’s immediate and long-term risk of developing cavities. Because decay-causing bacteria grow in greater volume than other bacteria on the teeth, children as young as 12 months who have any visible plaque on the front teeth should be considered as high-risk for early tooth decay-even if the teeth themselves look healthy. In addition, if the baby is fed sugar containing foods or drinks at the time of bacterial transfer, the bacteria are more likely to establish themselves on the child’s teeth.

Q. What role can the National Healthy Mothers, Healthy Babies Coalition (HMHB) and our members play in combating this problem?

A. HMHB and its members can educate families, medical and dental providers, and policymakers about the importance of oral health and its role in general well-being. HMHB can facilitate a cross-disciplinary, family-centered approach to oral health and can encourage policymakers to improve access to safe and effective oral health care.

Check out this additional resource on the topic.
Dental Caries in Preschool Children: Epidemiology, Mechanisms, Prevention and Care Delivery

The Children’s Dental Health Project (CDHP) is dedicated to assisting policymakers, health care providers, advocates and parents in improving children’s oral health and increasing their access to dental care. Contributing editors to this Q & A include pediatrician David Krol, MD, a Soros Advocacy Fellow with CDHP and faculty of the Columbia University School of Medicine, health care administrator Anne De Biasi, MHA, who is the CDHP Washington Director and Burton Edelstein, DDS, MPH, the Project’s Founding Director and pediatric dentist.