Susceptibility of nursing-caries children to future approximal molar decay.

Children with nursing caries and those initially caries free were compared on recall for occurrence of lesions in approximal molar surfaces. Mean follow-up time was 36 and 45 months, respectively, for the 2 groups. Fifty-three per cent of the nursing caries children had 1 or more molar lesions on follow up compared to 15% for children initially caries free. Routine prescription of supplemental fluoride is explored for children with nursing caries. While nursing caries has been established as a distinct entity, 1-1° the susceptibility of afflicted children to posttreatment smooth-surface caries has not been determined. Theoretical arguments can be made both for and against the anticipated occurrence of new carious lesions in treated children. The major reason to suspect a lack of new lesions is discontinuation of the bottle by the time of second molar eruption between ages 2 and 3. By the time molar surfaces approximate, the offending nursing habit will have been discontinued for most children. A secondary consideration is the restoration of carious teeth, removing major foci of infection. Evidence would lead to the anticipation of new lesions on smooth surfaces of teeth not susceptible at the time nursing caries occurred. From cross-sectional data of untreated children, it has been found that as the proportion of children with multiple incisor lesions (without molar lesions) decreased in older age groups, the percentage of children with multiple incisor lesions plus molar lesions increased. 11 Nursing caries is thought to be a problem of overindulgence; if overindulgence continues in another form after bottle discontinuation, new lesions would be anticipated, lo Microbiologically, the long-term effects of early infection are unknown. The majority of infants do not have measurable levels of Streptococcus mutans in plaque by age 8 months, whereas essentially all children have S. mutans in plaque by age 6.12,13 S. mutans has been identified as an important pathogen in the occurrence of nursing caries. While the importance of infection timing is unresolved, susceptibility to infection has been shown to be greater in infant monkeys than in adolescent monkeys. 14 Use of the nursing caries model may contribute to the overall understanding of early caries with implications for the late primary dentition. A caries experience defined to include children with nursing caries has been suggested as the only severe caries experience in children younger than 21/2 years of age.11 The significance of nursing caries prevention thus may extend beyond the morbidity of this problem; depending on the susceptibility of nursing caries children to further decay, the importance of preventing nursing caries may determine the occurrence of significant disease into the late primary dentition. One must consider the practical implications as well as theoretical importance in developing part of the model for caries advancement in the primary dentition. The purpose of this study was to assess the susceptibility of children with nursing caries to new lesions of approximal surfaces of primary molars. Methods and Materials Children aged 40 months or younger and presenting for a dental examination were selected. Inclusion was based on dental caries pattern rather than nursing history. Initial radiographs were not a criterion since they were not available in all cases. 168 NURSING CARIES FOLLOW-UP: Johnsen et al. TABLE 1. Follow-up Data for Children with Nursing Caries and for Children Caries Free at Initial Dental Examination.