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Contagious Cavities

Posted on 5/14/2014 by Crafton Dental
You've heard the warning before: Don't share saliva with your baby. No sharing utensils, food, or toothbrushes. No "cutting" grapes in half with your own teeth. No cleaning the crud off the corner of her mouth with a little spit on your finger. No blowing on your baby's hot food or tasting it yourself first. All of these things can spread mama's saliva to baby and infect her mouth with cavity-causing bacteria.

Are cavities contagious? If so, what can I do about it?
Bacteria that colonize the mouth cause cavities, or dental caries. Mutans streptococci (MS) are the most common bacteria implicated, but several other species are also associated with caries. The bacteria consume food particles, particularly sugar and starch, and produce acid, which causes demineralization of the tooth.

We aren't born with bacteria-infested mouths - we have to be infected. Cavities are contagious in the sense that MS can be passed from mom's saliva to baby's mouth, where they quickly set up shop. MS is detected in some infants within the first few months of life, even before their first teeth erupt, and studies conducted in the 1980's identified mom as the primary source of bacterial colonization in an infant's mouth.

Studies have also shown that children colonized with MS earlier in life have a greater risk of cavities in childhood. For example, Kohler et al. studied 78 Swedish children, beginning at 15 months and continuing until age four. Of the children that were colonized with MS at two years of age, a full 89% had cavities by the time they were four. Among the children infected between ages three and four, only 36% had cavities at age four. Preventing or even just delaying colonization may protect children from later tooth decay, since soft baby teeth are extra-susceptible to decay in the first few years of life.

Because of the link between maternal infection with MS and the risk for early childhood caries, several studies have looked at interventions to reduce mom's MS load. In one study, 77 first-time moms with infants 3-8 months old and with high infection rates of MS were randomized to control and intervention groups. The intervention group received a dental decay prevention program that included oral hygiene and dietary counseling, teeth cleaning, fluoride treatment, and excavation of large cavities. The intervention was effective; it reduced mom's salivary MS counts by 10-fold. At three years of age, children of the intervention moms had a 2.6-fold reduction in MS colonization and a 2.7-fold reduction in cavities. Kids in the intervention group still had fewer cavities than the control kids at age 7, several years after the intervention program ended.

Xylitol gum has also been tested as an alternative approach to reducing maternal MS infection and thus, transmission to baby. Xylitol inhibits the growth of MS and decreases their ability to stick to teeth. To date, three studies have found that when mom chewed xylitol gum 2-3 times per day, beginning before baby’s teeth erupt or even during pregnancy, MS colonization of baby’s mouth was delayed and caries were reduced at age 5. This approach is low-cost and an easy addition to good dental hygiene and care.

Other identified risk factors for early childhood MS infection have included nighttime nursing, early introduction of solid foods, exposure to sugar, and opportunities to share saliva (infant sucking on adult finger, sharing food, pre-tasting food). On the other hand, infants whose gums were cleaned daily had a lower incidence of infection.

How can I reduce my MS infection rate and stop/slow the spread to my child?
•  See your dentist regularly for check-ups and cleanings, especially during pregnancy. Most dental procedures are safe during pregnancy, but check with your obstetrician to be sure.
•  Ask your dentist for a refresher on oral hygiene to be sure your daily routine is up to speed.
•  Beginning during pregnancy, chew xylitol gum several times per day. Look for products with xylitol as the first ingredient. Studies suggest that you need 5-6 grams of xylitol per day to reap the full benefits.
•  Minimize saliva sharing. Although I scoffed at this, the dose and frequency of MS exposure probably matter. A little saliva sharing may be unavoidable, but do what you can.


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