Study finds high caries prevalence in Filipino toddlers

Iveta Ramonaite, Dental Tribune International

Wed. 3. July 2024

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CALOOCAN, Philippines: According to the World Health Organization, 514 million children have caries of the primary dentition. Additionally, data from 2021 shows that early childhood caries (ECC) affects almost half of preschool children worldwide. Official surveys from the Philippines have reported consistently high prevalence rates of ECC for 5-year-olds, but the rate for younger children has not been well documented. Concerned by this lack of data, researchers have recently investigated the prevalence of ECC in the country in children under 2 years old. They found that nearly a third of the children examined suffered from ECC.

Senior author Dr Waranuch Pitiphat. (Image: Waranuch Pitiphat)

“ECC has been tolerated as a regular childhood disease for many years. Parents tend to overlook it because of the misconception that primary teeth are less important compared with permanent teeth,” senior author of the study Dr Waranuch Pitiphat, associate professor of dental public health at Khon Kaen University in Thailand, told Dental Tribune International. She is also the director of the clinical and public health research training in oral health for South East Asia project, a programme aimed at enhancing and supporting skill development and knowledge of clinical research in dentistry in the region.

Discussing the prevalence of ECC in South East Asia, Dr Pitiphat noted: “In South East Asia, there seems to be a universal pattern of high prevalence of ECC. Published studies from this region appear understated in literature, presumably because of the lack of regular official reports. When reports are available, prevalence rates are often confirmed to be alarming, and carious teeth are usually left untreated. In Thailand, for example, ECC is also a significant public health issue. Studies indicate that the prevalence of ECC among preschool children is remarkably high. According to a national oral health survey, over 50% of 3-year-old children in Thailand suffer from ECC. This high prevalence underscores the urgent need for preventive measures and public health interventions.”

Early onset of caries in children

There are different reasons why a child might develop caries from an early age. For example, research shows that mothers with poor oral health habits can pass on Candida albicans to their infants, possibly through skin-to-skin contact or through feeding, contributing to the development of caries. Unfortunately, having caries early on may lead to hospital admissions, and poor oral health habits could later affect a child’s performance in school.

“While parents may not realise that dental caries alone may have detrimental effects on their children’s quality of life, having ECC or severe ECC in very young children who are not yet able to speak and properly express any kind of discomfort will have a negative impact on their growth and development, aside from the more obvious consequences,” Dr Pitiphat said.

Strong need for baseline data and ongoing research

Dr Pitiphat explained that public healthcare workers in the Philippines have been providing preventive and interceptive procedures to combat ECC, such as pit-and-fissure sealants and topical fluoride application. However, they appear to have had minimal effect on prevalence rates reflected in official surveys. She says that, for planning and policy-making to be successful, proper baseline data and ongoing research are essential. “To catch the attention of stakeholders—including parents, healthcare workers, teachers and policymakers—valid and comprehensive data must be presented,” she noted.

Frequent eating and poor oral care as the main culprit

In the study, the researchers sought to determine ECC prevalence and its association with socio-demographic indicators, feeding practices and oral health behaviours among children aged 24 months and below in the Philippines. For that purpose, they observed healthy young children aged 4–24 months in primary health centres. Each child’s caregiver was interviewed, and all the children underwent dental examinations.

The researchers found that 29.2% of the 703 children in the study had already developed ECC, including both non-cavitated and cavitated lesions, and had an average of 6.7 erupted teeth. Factors significantly influencing ECC prevalence included the child’s age, caregiver’s low educational level, continued breastfeeding, frequent eating and visible dental plaque observed by the caregiver and by the paediatric dentist who performed the oral examination.

“ECC has been tolerated as a regular childhood disease for many years.”

“This shows that ECC starts very early after tooth eruption, especially in babies with frequent eating patterns and poor oral care habits,” Dr Pitiphat commented. She explained that, although, understandably, infants and babies usually have incremental feeding schedules every 2–3 hours throughout the day, parents must recognise the importance of regularly cleaning milk residue from both the hard and soft tissue in the oral cavity.

“Our findings indicate that Filipino toddlers often feed at least six times in a day without sufficient oral cleaning. Visible plaque was observed by caregivers and confirmed during dental examination. These factors—frequent feeding and visible plaque—are strongly associated with ECC,” Dr Pitiphat noted.

In light of the findings, the researchers believe that healthcare providers should prioritise appropriate oral healthcare education of caregivers and prioritise preventive measures in the first two years of a child’s life or earlier. Additionally, they noted that caregivers’ understanding of the impact of dietary and oral hygiene patterns is key to preventing the disease.

“Successful implementation of correct early oral healthcare will help prevent ECC from the outset, as well as mitigate risks of malnutrition, stunting, obesity and other serious chronic illnesses later in life,” Dr Pitiphat stated. “This study underscores the need for early intervention and ongoing education to improve long-term health outcomes,” she concluded.

The study, titled “Prevalence and risk indicators of early childhood caries among toddlers in Caloocan City, Philippines: A cross-sectional study”, was published online on 31 May 2024 in BMC Oral Health.