Childhood Tooth Decay: Dental Caries (Cavities) in Children

Table of Contents

A common myth among parents is that there’s no need to treat cavities on the baby’s teeth as they’ll fall out. 

That’s not true. Baby teeth need filling in all cases, no matter what.

Childhood Tooth Decay

A baby has a set of twenty teeth, 10 in each arch. Teeth like baby molars and baby canines fall at the age of 11 or 12. For example, if your child gets a cavity in the baby molar at the age of 4,  you can’t wait for eight years for it to fall out. There are two reasons for this:

  1. First, If the cavity isn’t in its arrested stage, it will involve the tooth pulp very quickly and cause tooth pain, requiring a baby root canal treatment called pulpectomy.  Sometimes, an extraction may be necessary if the tooth isn’t salvageable, even with a pulpectomy treatment, or if the child isn’t cooperative. An uncooperative child is treated under conscious sedation or general anesthesia, which is expensive unless you have the right insurance. Later, you’d also require a space maintainer at the site of the extracted tooth to prevent the shifting of adjacent teeth into the missing tooth space. 
  2. Secondly, baby caries show rampant behavior. These cavities spread too fast from one tooth to another. Leave the cavity on the tooth for too long, and you’ll also see the adjacent teeth having caries. 

Let’s learn about tooth decay in children so that you, as a parent, can better care for the primary and permanent teeth in your children. 

Childhood Tooth Decay In-depth 

% of childhood tooth decay

Definition of childhood tooth decay

Childhood tooth decay is a chronic illness seven times more prevalent than hay fever and five times more common than asthma. Nearly 1 in 5 children under the age of 5 have faced dental decay, which compromises their overall health, sleeping, social well-being, and school performance.

The process is similar to adult tooth decay involving the tooth enamel and dentine.

Plaque is a sticky substance made up of sugars and bacteria that cover the surfaces of our teeth. If the plaque isn’t cleaned or removed within 24 hours, it will turn into tartar and calculus over months and years.

Continuous action of bacterial acids in the presence of sugar will affect the tooth enamel and dentine, causing a hole in it. These holes get bigger with time if left untreated and may cause your child pain or sensitivity.

Risks of tooth decay 

It is essential to understand that three major factors combine to form a dental cavity or caries.

These are the primary teeth of your child, the substrate in the form of sugar, and the bacteria.

Controlling the amount of harmful bacteria by proper brushing and flossing habits and limiting sugar intake can significantly reduce the risk of caries. Apart from this, here’s the list of risk factors that cause dental cavities:

– high level of harmful bacteria. 
– improper brushing and flossing habits. 
– excessive intake of refined carbohydrates like chocolates and sweets. 
– reliance on carbonated drinks and sweet juices for the beverages
– reduced salivary flow
– inadequate fluoride intake

Common causes of childhood tooth decay

Cavities occur when plaque builds on the tooth and is under the action of acid produced by bacteria. Improper hygiene maintenance and skipped flossing and brushing routines are the significant causes.

The excessive intake of carbs is a substrate for bacteria to act on and produce acid that eats up your child’s teeth. The earlier children
are exposed to these bacteria, there is a greater risk of developing caries.

How do you recognize your child has a cavity? 

Not every time your child will complain about the pain if it has dental caries.

You must regularly inspect or look into the mouth to see any signs of caries, or you may schedule frequent visits with the dentist. A few signs that may indicate caries:

1) dark spot or brownish hue on the teeth
2) white spots on the tooth
3) child being fussy 
4) gum swelling
5) sensitivity to cold and hot foods. 

If you suspect a cavity, immediately check it with a pediatric dentist to prevent its spread.

Impact of Childhood Tooth Decay on Oral Health

If child's tooth health is neglected

Childhood decay has a significant impact on the life of a child. The impacts are as follows: 

Diminished Quality Of Life

Early loss of a baby tooth can delay the eruption of a permanent tooth, which can diminish the overall quality of life.

The tooth may erupt in an improper position, leading to a crooked tooth, or may warrant an orthodontic treatment.

Some children don’t like metallic braces and can’t bear the pain of orthodontic treatment.


The mouth is the gateway to your child’s overall health. With tooth pain and tooth infection or missing teeth, the quality of life of your child will be compromised, and he will not be able to eat a balanced diet. This can cause malnutrition.

Delayed Or Insufficient Growth

When you suffer pain and are unable to eat proper food to gain the rightly needed nutrition, your child may suffer from growth-related problems.

For example, with less calcium intake, bones will not grow to their full length and full potential, leading to delayed or insufficient growth.

Life-Threatening Infection

If a tooth becomes infected and involves the pulp, the subsequent tooth abscess can potentially damage the permanent tooth that will grow when the primary tooth falls out.

Sometimes, a tooth infection can exacerbate and lead to life-threatening diseases like cellulitis. 

Poor School Performance

In the U.S., over 34 million school hours are lost each year due to dental problems. The pain from tooth decay may hinder many young children from speaking, playing, going to school, or paying attention in class.

This will eventually affect his performance in school and will highly affect his learning capability and social interaction within and outside school premises.

Children with poor oral health are more likely to miss school and are less likely to do all the required homework.

What is Early Childhood Caries? 

Caries among young children, or early childhood caries (ECC), is a remarkably rapid form of tooth decay. ECC is also called baby bottle tooth decay since a common cause of the disease is putting children to bed with a bottle of juice or milk.

Children given bottles of juice, milk, or formula to drink during the day or overnight are prone to developing ECC.

The sugar content in these beverages pools around the upper front teeth and mixes with caries-producing bacteria, leading to rapidly progressing tooth destruction.

ECC can be of two types: 

  1. Rampant Caries
  2. Nursing Bottle Caries 
 Rampant Caries Nursing Bottle Caries 
Involved Teeth  Seen in any age, primary and permanent teeth Seen in infants and toddlers, only in primary teeth 
Teeth Nerves InvolvementGeneralized spread of caries with teeth nerves involvementThe specific form of rampant caries involves teeth nerves 
Cause of Caries Frequent intake of sweet and sugary foods and decreased water intake Use of pacifiers coated with honey, bottled milk with sugars, breastfeeding 
Characteristic Features All teeth are involved Lower teeth are involved 
Treatment Flouride application, parent education, pulpotomy or pulpectomy depending on tooth decay stage, space maintainers. Flouride application, parent education, pulpotomy or pulpectomy depending on tooth decay stage, space maintainers. 
PreventionPatient education and fluoride therapy Parent education and fluoride therapy 

Consequences of Children Visting The Dentist Late 

The AAPD, American Academy of Pediatrics, American Dental Association, and Academy of General Dentistry recommend a first dental visit by the first birthday or when the first tooth comes in.

Research conducted by AAPD  with over 2000 infants at Nationwide Children’s Hospital in Columbus suggests that the odds of a child having tooth decay at the first dental visit more than doubles for every year of increased age.

“For parents who think postponing the first dental visit will help their budget, the opposite is more likely.

Children who had their first appointment after age four had $1,054 of dental treatments, while children who had their first appointment before age four had $694 during eight years of follow-up.”
Arthur J. Nowak, D.M.D., M.A., professor emeritus of pediatric dentistry and pediatrics, University of Iowa Colleges of Medicine and Dentistry

“Evidence increasingly suggests that to prevent caries successfully, we must begin within the first years of life. If appropriate preventive measures are applied early—in infancy—it may be possible to raise a cavity-free child.”
Paul Casamassimo, D.D.S., M.S., Chief Policy Officer, American Academy of Pediatric Dentistry

How to Select The Right Dentist For Your Children?  

One-third of parents (31 percent rank toothaches as the least severe ailment compared to tummy aches, earaches, headaches, and sore throats.

A pediatric dentist has an essential dental degree with further specialization in pediatrics, making them specialist doctors for your children. Choose the right dentist for your children, and here’s how you can choose according to AAPD.

• Does the dentist have special training or interest in treating children?
• Is the dental office set up for children? For example, does it offer toys, books, games, and child-sized furniture?
• How does the dental office manage emergencies?
• Is the office conveniently located near your home, work, or child’s school?
• Does the practice accept your dental benefits plan?
• Was your child seen promptly?
• Were you asked for your child’s complete medical and dental history?
• Did the dentist or staff talk to your child, encouraging involvement in the visit and oral health?
• Were you informed about your child’s tooth development, the causes and prevention of dental disease, and appropriate dental care at home?
• Were your questions treated with concern and respect?
• Was the visit positive for your child?

Prevention of Childhood Tooth Decay

The foundation of adult oral health is established during preschool when a child develops dental health patterns and corresponding caries risk.

Early prevention is the key to a positive attitude about oral health in later years. The first tooth appears in your child’s mouth at the age of 6 months.

It would be best if you started brushing your child’s teeth since then with a child’s toothbrush.

Preventing tooth decay, especially early childhood caries, would be impossible without proper attention to your child’s oral care. 

Emphasis on preventive care is meant to help you save your child from the pain and discomfort that comes with caries.

Also, you can save a lot of money as a parent if your child’s oral care is adequately maintained and monitored. Here are a few steps to achieve ideal oral care for your children. 

1 – Building oral hygiene maintenance habits 

Brushing is critical to maintaining oral hygiene.  Ensure that you supervise your child’s brushing or that you brush their teeth yourself with the help of a soft-bristled toothbrush as soon as the first tooth erupts in the mouth.

Brush twice daily for at least two minutes each time. Flouride toothpaste must be used to prevent tooth decay. Children under three must use smear-sized toothpaste, while children above three should use pea-sized until age 6. 

Supervise the brushing until six years of age because the swallowing reflexes of your child are still underdeveloped until he is 6. This approach will prevent accidental ingestion of the toothpaste while brushing.

2 – Flouride treatment 

Fluoride is a natural mineral found in soil, water, and foods. However, an adequate amount of fluoride is needed to make your child’s teeth strong. For six years, use fluoride toothpaste with 1000ppm fluoride concentration.

Over six years, the ideal fluoride concentration is 1450ppm.  A sufficient amount of fluoride helps prevent dental decay.  Professional fluoride therapy, like fluoride varnishes and gels, is sometimes needed to meet the body’s fluoride demand. 

3 – Fissure sealants 

Pits and fissures of the back tooth harbor bacteria. Deep fissures are sealed with sealants to prevent the plaque from accumulating and causing caries.

Research shows that sealants have managed to avoid decay by 51% compared to no sealants. You may talk about this with your pediatric dentist to know more about it. 

4 – Regular dental checkups and cleanings for children

Schedule an appointment of your child with the dentist twice a year to rule out any tooth abnormality if it exists.

Tooth decay in young children will be troublesome for you as a parent, so taking care of their teeth is advised. 

Treatment of Childhood Tooth Decay

Childhood tooth decay or early childhood caries seek prompt attention.

Common dental treatments for childhood tooth decay

Flouride Treatment: 
Flouride is long known to reverse the signs of tooth decay. Homecare fluoride therapy or professional fluoride treatment can both work out to bring the strengthening action. 

Dental Sealants:
Although a preventive approach, dental sealants cover the deep grooves on the molars to prevent the caries from spreading into the adjacent tooth. 

Caries that have progressed beyond the initial stages need dental fillings. Composite, GIC, and resins are some materials used for fillings in children

Pulpotomy / Pulpectomy

If the cavity has reached the tooth nerves, Pulpotomy or Pulpectomy is done to partially or entirely remove the tooth nerves. Dental fillings and stainless steel crowns follow this. 

Tooth Extraction 
Tooth extraction may be necessary for the tooth beyond the saving scope. Space maintainers are needed to prevent the tooth from shifting into the extraction space.

Importance of early intervention and treatment

Early intervention is crucial to save your child from facing unnecessary pain and discomfort. Tooth pain is one of the primary reasons why children skip school in the US.

Moreover, healthy teeth allow your child to eat and speak correctly, which is impossible otherwise. It also promotes overall health and prevents your child from facing dental issues of massive complexity in the later part of life.

Tips for managing dental anxiety in children

Dental anxiety is widespread among children, and this keeps them from seeing their dentists. A pediatric dentist is a specialist dentist who is well-versed in managing children and helping relieve their anxiety on massive levels

1) Early Visits:

The earlier, the better. Take your child to the dentist around the first birthday to make them comfortable with the dental environment. 

Take your child to the dentist

2) Use Positive Reinforcement: 

This approach is associated with positive buck-ups and rewards like toys and stickers to boost their confidence. 

3) Set an Example: 
Parents and siblings would appear to be role models for the children. Siblings calmly getting treatment will positively reinforce their behavior. 

4) Explain in Simple Terms: 

Using words that children are familiar with can help build rapport. Like, placing a rubber dam during pulpotomy for isolation is called a raincoat dam by the dentist. 

5) Provide Distractions:

During the appointment, keep the child occupied with stories, songs, or videos to distract them from the procedure.


What are some habits that should be adopted to prevent early childhood caries? 

– Don’t fill your child’s feeder with sweet liquids
– Give your child a bottle of plain water between meals and before sleep. 
– Don’t let your child sleep with a milk bottle with added sweeteners and juices. 
– Consider limiting the meals per day for your child. 
– Allow your child to eat sweets or chocolates once a day only. 
– Encourage your child to finish his meals within 30 minutes. 
– Build your child’s brushing and flossing habits and reward them for routine maintenance.

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