The increasing prevalence of edentulous state among children in Malaysia

The pediatric population in Malaysia has seen a rapid surge in the prevalence of early childhood caries (ECC). Based on surveys, the major predisposing factor for ECC among children in Malaysia seems to be the practice of long-term breastfeeding (up to 2 years) followed by prolonged bottle feeding which exceeds the time frame recommended by the American Academy of Pediatrics (up to 15 months).[1-3] In most of these cases, all the decayed primary teeth are extracted either under general anesthesia in a single setting or as an outpatient procedure involving several visits.[1] The extreme treatment strategy in such cases is because most ECC cases reach a pedodontist at a relatively advanced stage by which time extraction is the only effective treatment strategy. The delay in diagnosis and treatment can be attributed to the current dental health-care system. As dental treatment is a relatively costly affair,[4] most patients register for treatment in government facilities, for which the waiting period lasts for several months. Thus, at the time of examination, most children present with grossly decayed teeth. The overall sequence of rapid caries and multiple extractions results in a partial to complete edentulous state in children which often leads to several psychological problems including developing an inferiority complex.[5] Lack of teeth also discourages the children from a healthy food intake which, in turn, can lead to malnourishment. In addition, there is increased risk of the infection being transmitted from the primary teeth to the developing permanent tooth buds. To overcome these issues, it is important to educate the parents about the effects of long-term breast and bottle feeding. It is essential that appropriate prophylactic measures are employed to prevent the onset and spread of ECC. The government should take measures to reduce the waiting period for dental treatment in government hospitals. To conclude, preventive measures (reducing the bottle-feeding time), early diagnosis (reducing the waiting time in government hospitals), and early conservative treatment approach (protecting the primary teeth through the placement of restorative material including crowns) could aid in curbing the increasing prevalence of ECC and avoiding an edentulous state in children. Shivaranjhany Sivakumar