Response to Weinstein: public health issues in early childhood caries.

Dr Weinstein's thoughtful overview of public health issues in early childhood caries (ECC) provides an excellent basis for further exploration. For public health to focus on a given problem several factors must be addressed: the disease must be widespread; the etiology or the prevention of the disease or condition must be known; this knowledge is not being applied; and resources for interventions must be available. Currently, appropriate data are not available for ECC and the problem is exacerbated because there is no case definition for the disease. Therefore it is difficult to make public health policy to address this disease. With the knowledge of case definition, prevalence, and efficacy of treatment, we are more likely to engender interest and funding for ECC. Studies in other countries have demonstrated that children who are malnourished, have low birth-weight or both, likely will have hypomineralized primary teeth and thus at risk of ECC. Low birth-weight infants (less than 2500 g) currently constitute over 7% of all US births. The impact of low birth-weight on oral health is not known. Weinstein favors the use of operator-applied preventive agents, yet little evidence is available on the safety and effectiveness of these agents among infants and young children. Further, they are unlikely to be cost-effective and they require frequent appointments, which is often difficult for poor families to manage. Community interventions hold the greatest promise for preventing ECC because larger numbers of people can be reached than in private practice clinical settings.