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Primer for Parents

From causes to care: everything you need to know about childhood tooth decay.



Childhood tooth decay, technically known as Early Childhood Caries or ECC, is the number one chronic childhood disease in the U.S. today, affecting over 7 million American children under the age of 6. It is an infectious disease in which acid-producing bacteria dissolve the enamel surface of a tooth.

The disease, while largely preventable, continues to be a critical health concern. The U.S. Centers for Disease Control and Prevention (CDC) is investing millions of dollars annually to combat and reduce early childhood tooth decay. Although the greatest increase in the rate of tooth decay is in children 2-5 years, it remains the most common chronic disease in children aged 5-17, five times more common than asthma (59% vs. 11%).

Early Childhood Caries shouldn’t be considered simply a dental disease, as it can have significant and long-term effects on a child’s general health. Health professionals regard ECC as an outcome of a pervasive social and behavioral trend towards sugar-based fluids and foods in children’s daily diets, for which the caregiver is ultimately responsible.

Once established, Early Childhood Caries requires treatment. Undetected, the bacteria may penetrate the underlying dentin of the tooth and progress into the soft tissue, causing the formation of cavities and discomfort. If not treated properly, dental caries can lead to incapacitating pain and bacterial infection, which can ultimately lead to extraction of the tooth. Pain and suffering due to untreated tooth decay can cause problems for children in eating, speaking and attention to learning.

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Get the facts: statistics from the U.S. Centers for Disease Control and Prevention (CDC)

Dental caries in children:

  • 28% of children aged 2-5 experience decay in their baby teeth
  • 50% of children have had tooth decay by age 11
  • 68% of 19 year olds have had tooth decay in their permanent teeth
  • Children of low income families are twice as likely to experience decay than children of higher income families
  • 52 million school hours are lost each year due to dental disease
  • Prevention of tooth decay in children aged 2-5 begins at birth. Daily use of effective oral health care products like the ones produced by Branam Oral Health is essential for all children.

Dental caries in adults:

  • 27% of adults age 20-39 have untreated dental caries
  • 21% of adults age 40-59 have untreated dental caries
  • 19% of adults age 60+ have untreated dental caries

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What is Early Childhood Caries and how do kids get it?

Early Childhood Caries is the technical term for a bacterial infection that causes tooth decay. The infection occurs when normal healthy bacteria in the mouth are replaced by acid-producing bacteria. These infectious bacteria are the root cause of the disease, which is most often spread via normal daily activity such as sharing utensils. An acidic oral pH environment caused by excessive sugar-based foods and drinks can also cause cavity-causing bacteria to flourish.

A significant amount of scientific evidence now exists that establishes the connection between the oral health of the parent and child. While studies conclude that children are not born with caries, they frequently contract the disease through normal daily interaction with their parents, grandparents or caregivers. The transmission of the caries disease occurs when the child is kissed or when food is sampled by the adult for taste or temperature. Transmission can also occur when a child’s pacifier is ‘cleaned’ in the parent’s mouth, or when the child falls asleep with a sugary substance in a bottle or sippy cup.

The Early Childhood Caries disease spans all socio-economic groups and is almost always preventable by following a very simple daily regimen.

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The role of pH

Understanding prevention and treatment of dental caries starts with understanding the role of oral pH. All bacteria - good and bad – that live in the mouth are dependent on a certain pH level to survive. Healthy bacteria flourish in a neutral to slightly alkaline environment. Acid-producing bacteria that adhere to teeth, dissolve tooth enamel and cause cavities thrive in acidic pH conditions. The caries infection can be effectively eliminated by neutralizing the oral pH in the mouth. This can be achieved by reducing sugars and starches in the diet, early preventive care, and by the daily use of effective oral care products.

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Food for thought

What you eat and how often you eat can have a profound impact on tooth decay. Frequent snacking and eating foods that break down into simple sugars in the mouth (called fermentable carbohydrates) increase the risk of tooth decay. Fermented sugars such as glucose and sucrose and natural fruit juice sugars like maltose and fructose are all digested in the mouth. Unlike these sugars, xylitol is digested in the stomach. Bacteria on teeth adhere to sugars from fermentable carbohydrate foods and produce acids. As the oral environment becomes more acidic, the acids dissolve minerals in the tooth enamel (called demineralization). In a healthy mouth, agents in saliva and “good” bacteria raise the pH back to neutral and teeth re-mineralize. Tooth decay occurs when minerals are being lost faster than they are replaced.

To help you (and your children) keep the amount of acid created by the bacteria on your teeth to a minimum, follow these rules:

  • Limit between-meal snacks and if you snack, choose foods that aren’t fermentable carbohydrates.
  • Avoid fermented sugars (glucose, sucrose) and natural fruit juice sugars (maltose, fructose). Whenever possible, eat foods sweetened with xylitol instead.
  • Good snack choices are meats, nuts, cheese and milk. These foods actually help protect tooth enamel by neutralizing acidity and providing calcium and phosphorus needed to remineralize teeth.
  • OK snack choices are vegetables and firm fruits like apples and pears. Firm fruits have a high water content that dilutes acids and also help stimulate saliva, which has antibacterial properties.
  • Bad snack choices include candy, fermentable carbohydrates like cookies, cakes, bread and muffins, french fries, potato chips, bananas and dried fruit. These foods provide a plentiful source of sugar for harmful bacteria.
  • Reduce or eliminate sugar-containing drinks such as soft drinks, fruit juices, cocoa, chocolate milk and coffee and tea with added sugar.
  • Reduce the amount of acidic foods you eat (such as citrus and tomatoes) and eat them with other foods at meals.
  • Thoroughly brush your teeth a minimum of twice a day after meals to remove all plaque bacteria.
  • Chew gum or mints that contain xylitol to help prevent bacteria from adhering to teeth and to increase saliva flow to neutralize acids

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Tips for mothers-to-be

The best way to give your child a healthy smile for life is to start even before you get pregnant. Pregnancy causes hormonal changes that can increase your risk of gum disease, and your oral health can affect the health of your developing baby. If you are thinking of getting pregnant, follow these tips for good oral health:

  • Make a dental appointment before you get pregnant, so that your teeth can be cleaned and any dental problems can be treated.
  • If you’re pregnant, as a precaution, avoid treatments during the first trimester and the last half of the third trimester if possible. All elective procedures and x-rays should be postponed until after your baby is born. Routine dental care can be performed during the second trimester.
  • Follow good oral hygiene practices throughout your pregnancy. You should brush at least twice a day and floss once a day.
  • Eat a healthy, balanced diet and avoid sugary snacks and fermentable carbohydrate foods.
  • After your baby is born, schedule a thorough dental checkup. Chew gum containing xylitol to help prevent the dental caries infection and reduces the likelihood of passing the infection to your child.

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Sippy cups: it’s what’s inside that counts

Research shows that an estimated 52 million school hours per year are lost because of dental-related illnesses. Much of this is due to the usage of improper substances in sippy cups. While sippy cups can help children make the transition from bottle to cup, they are also one of the main problems behind early childhood tooth decay.

Parents fill the sippy cups with sugary substances such as fruit juices, chocolate milk and soda, not realizing that prolonged use of sippy cups filled with sweetened liquids can lead to an acidic oral environment and the formation of cavity-causing bacteria.

So what can you put in a sippy cup that won’t harm your child? Water and drinks sweetened with xylitol like Branam Cool-Aid are the best choices. Toddlers should use a sippy cup with a straw starting at around 18 months, as the straw reduces direct contact of liquid with teeth and allows children to drink the contents of the cup faster than using a nozzle or spout.

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The dangers of conventional pacifier usage

Abnormal oral development caused by prolonged pacifier use can also facilitate development of the caries infection and other dental problems. In recent years, there has been a widespread epidemic of prolonged pacifier use amongst toddlers. It is widely known and accepted within the dental community that babies should cease pacifier use by one year of age, preferably by 10 months. Many studies have been conducted by reputable institutions, both profit and non-profit, and have concluded that prolonged conventional pacifier use will likely cause one or more of the following:

  • Abnormal swallowing patterns
  • Tongue thrust habits
  • Open dental bites
  • Increased tooth crowding
  • Exaggerated face height
  • Dental and skeletal crossbites
  • Deformed jaw growth
  • Eustachian tube dysfunction which
    can lead to ear infections

Unlike conventional pacifiers, The Branam Ortho-Gibby soothes your baby while promoting normal oral development.

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If your child is using a conventional pacifier, you should cease usage by the time your baby reaches one year of age. This will allow the child to develop normal speech patterns and bite development, and promote a healthier oral environment.

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