Pediatric dentistry

Dental Caries (Tooth Decay) in Children

The American Academy of Pediatric Dentistry (AAPD), the recognized leader in children’s oral health, today emphasized that the frequency and duration of oral exposure to foods and drinks with large amounts of sugar should be given the same consideration as diet itself when it comes to preventing tooth decay and cavities in children.

“Most parents know that they need to watch what their kids eat and make them brush regularly.  Unfortunately, many are not aware that letting kids sip on sugary drinks for hours or putting them to bed with a bottle of milk can be just as harmful,” says Dr. Phil Hunke for the AAPD. “These habits can expose teeth to sugar for extended periods of time, increasing the risk of tooth decay.”

Infants’ teeth begin to erupt around the age of 6 months, but some children do not have their first tooth until 12 to 14 months. Most children have their first full set of teeth by age 3. These primary teeth are susceptible to decay as soon as they appear in the oral cavity, and dental caries matter more than most people think.


The American Academy of Pediatrics considers early childhood caries to be the number one chronic disease affecting young children. Dental caries in infants or early childhood caries is often referred to as baby bottle tooth decay. The decay may be so severe that the affected tooth may need extraction. When primary teeth are lost too early, the surrounding teeth may drift into the empty space. This movement makes it difficult for the permanent teeth to have proper room for eruption, causing these teeth to be crooked or crowded.

Role of Bacteria

Dental caries is preventable. The American Dental Association recommends that parents take their children to a dentist within six months after the first tooth appears, but no later than the child’s first birthday. Cavity-causing bacteria can be transmitted from caregiver to infant, so parents should also visit their dentist to help ensure their own oral health. Caregivers should refrain from cleaning the infant’s pacifier with their mouth or sharing eating utensils with the infant.

Oral Hygiene Home Care

Parents may begin cleaning their infant’s mouth during the first few days of birth by wiping the gums with a clean, moist gauze pad or washcloth. When teeth begin to erupt into the oral cavity, the parent may gently brush the infant’s teeth twice a day with a child-size toothbrush and water. A pea-sized amount of fluoride toothpaste may be added for children older than 2 years old, and the child must be able to spit out the toothpaste. Flossing should begin once two teeth come in contact.

Parents should care for their child’s teeth until they feel comfortable that the child is able to care for his or her own teeth. Starting children early with good oral hygiene can lead to a lifetime of good dental health.


An inadequate amount of fluoride may increase an infant’s risk for early childhood caries. Fluoride strengthens the enamel of teeth, making them more resistant to decay. It is found in toothpaste, mouthrinses and often added to community tap water. Bottled water may not contain fluoride. Parents should discuss with a dentist or pediatrician the fluoride needs of their child. Fluoride supplementation may be recommended.


Dietary factors contributing to dental caries in infants has been considered by both the American Academy of Pediatrics and the American Dental Association. Increased risk for dental caries has been affirmed to be associated with an excessive intake of sugar by an expert panel of the World Health Organization.

Nutritional recommendations for infants include:

  • Providing the infant only formula, milk or breast milk in bottles. Liquids such as sugar water, juice or soft drinks should be avoided.
  • Infants should also finish their bedtime and nap time bottles before going to bed.
  • A pacifier should never be dipped in sugar or honey.
  • The child should be encouraged to drink from a cup by his first birthday.
  • During the transition to solid foods, parents should provide nutritious foods.

Following these recommendations will reduce the amount of sugar exposure to the infant’s teeth.

When an infant’s first tooth appears, parents should discuss with their dentist about scheduling the first dental visit. Parents should treat the first dental visit as they would a checkup with the infant’s physician. Once there, the dental team will be able to provide proper guidance on how to care for the infant’s teeth.


Tooth Decay in Children

If the doctor found the child beginning caries, the most likely treatment of bottle teeth is not required. The expert will protect the enamel from further destruction with the help of painless and effective procedure – the application of fluoride varnish or fluoride compounds of silver. Then, when the baby will gain permanent teeth, the dentist can conduct sealing fissures – hollows between the elevations of the tooth – which will prevent bacterial plaque that destroys the enamel. If the caries progresses, without sealing is not enough. The doctor quickly and almost painlessly remove diseased tissue and sealed will fill tooth. Otherwise, the decay can go into the pulpit in a child, and then to periodontitis.

Preventing Tooth Decay: Daily Dental Care Tips

  • Treatment of caries in childrenTeach your child to brush and floss every day. Clean your baby’s gums with a soft cloth or gauze pad to remove plaque before the first teeth come in. When your child’s first teeth come in, clean his or her teeth with a soft toothbrush. And use a very small amount (a smear) of fluoride toothpaste. When your child is age 2 years, it’s okay to start using a pea-sized amount of toothpaste. Start flossing your child’s teeth when he or she has teeth that touch each other. For more information, see the topic Brushing and Flossing a Child’s Teeth.
  • Take good care of your own teeth and gums. Saliva contains bacteria that cause tooth decay. Keep your own teeth and mouth healthy so you are less likely to transfer these bacteria to your baby. Avoid sharing spoons and other utensils with your baby. Also, don’t “clean” your baby’s pacifier with your mouth.
  • Prevent prolonged contact with sugars in formula and breast milk.Remove a bottle from your baby’s mouth before he or she falls asleep. This practice helps prevent mouth bacteria from producing acids that cause baby bottle tooth decay. Also, clean your baby’s teeth after feeding, especially at night.
  • Be smart about juice. Juice is not part of a healthy diet. Compared to a piece of fruit, fruit juice doesn’t have the valuable fiber, it usually has more calories, and it is absorbed differently. Unless the label says that a fruit drink is 100% juice, beware that many fruit drinks are just water, a little juice flavoring, and a lot of added sugar. If you must give juice, water it down. The American Academy of Pediatrics advises no more than 4 fl oz (120 mL) to 6 fl oz (180 mL) of 100% fruit juice a day for children 1 to 6 years old.1 This means ½ cup to ¾ cup.
  • Introduce cups for drinking beverages at age 12 months or earlier.By this age, frequent bottle-feedings, especially with juice or other high-sugar liquids, make a child more likely to develop tooth decay. At night, you could fill the bottle with plain water. During the day, offer an empty cup for your child to play with. For more information, see the topic Weaning.
  • Provide your older baby or toddler with healthy foods. Give your child nutritious foods, and combine them in ways that help reduce the risk for tooth decay. For example, offer meals that include whole grains, vegetables, and fruits. Mozzarella and other cheeses, yogurt, and milk are good for teeth and make great after-meal snacks. They help clear the mouth of harmful sugars and protect against plaque. Make an effort to rinse or brush your child’s teeth after he or she eats high-sugar foods, especially sticky, sweet foods like raisins.

Normal amounts of fluoride added to public water supplies and bottled water are safe for children and adults. If your child needs extra fluoride, your dentist may recommend a supplement or a gel or varnish that he or she would apply to your child’s teeth. Use supplements only as directed. And keep them out of reach of your child. Too much fluoride can be toxic and can stain a child’s teeth.

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