Research issues in early childhood caries.

Research is needed to establish what nomenclature and case definition for early childhood caries (ECC) are most relevant to health care professionals and to the public. Profiles or indexes for predicting the prevalence of ECC in communities should be developed on the basis of the socioeconomic factors, immigrant status and ethnic/racial backgrounds of populations. Future research should target risk factors of ECC, particularly prenatal and perinatal histories, nutritional status and microbiologic factors. Determining the relation of malnutrition of infants and young children, low birthweight, complicated pregnancies and traumatic births with the development of enamel linear hypoplasia deserves research attention. Factors that affect how and when infants and young children are colonized by mutans streptococci also need further study. The evaluation of chemotherapeutic preventive agents will likely yield more fruitful interventions for prevention than trying to change behaviors. Research in young children to prevent ECC, however, has particular ethical considerations. Withholding treatments or administering placebos to vulnerable subjects is not acceptable. Consequently, future clinical research likely will determine the relative rather than the absolute effectiveness of preventive regimens; the former requires large sample sizes and may necessitate multi-center studies. Human studies may be hampered by problems of recruitment, compliance and transiency of subjects. Because federal support for research on dental caries has declined in recent years, a special initiative that focuses specifically on ECC may be necessary to obtain adequate funding for research on the disease.