What is tooth decay in children?

Tooth decay is the breakdown or destruction of tooth enamel, the hard outer surface of a tooth. Tooth decay can lead to cavities, also called dental caries. These are holes in the teeth. Cavities can get bigger with time if left untreated. A cavity can reach deep within a tooth, where the nerve endings are, leading to pain and sensitivity.

What causes tooth decay in a child?

Tooth decay is caused by bacteria and other things. It can happen when foods containing carbohydrates (sugars and starches) are left on the teeth. Such foods include milk, soda, raisins, candy, cake, fruit juices, cereals, and bread. Bacteria that normally live in the mouth change these foods, making acids. The combination of bacteria, food, acid, and saliva form a substance called plaque that sticks to the teeth. Over time, the acids made by the bacteria eat away at the tooth enamel, causing cavities.

Which children are at risk for tooth decay?

All children have bacteria in their mouth. So all children are at risk for tooth decay. But the following may raise your child’s risk for it:

• High levels of the bacteria that cause cavities

• A diet high in sugars and starches

• Water supply that has limited or no fluoride in it

• Poor oral hygiene

• Less saliva flow than normal

What are the symptoms of tooth decay in a child?

Tooth decay may be a bit different for each child. Here is a common way that teeth develop decay and cavities:

• White spots begin to form on the teeth in areas affected. These spots mean that the enamel is starting to break down. They may lead to early sensitivity in the teeth.

• An early cavity is seen on the tooth. It has a light brown color.

• The cavity becomes deeper. It turns a darker shade of brown to black.

The symptoms of tooth decay and cavities vary from child to child. Cavities don’t always cause symptoms. Sometimes children don’t know they have a cavity until their dentist finds it. But your child may feel:

• Pain in the area around the tooth

• Sensitivity to certain foods, such as sweets and hot or cold drinks

How is tooth decay diagnosed in a child?

Your child’s dentist can often diagnose tooth decay based on:

• A complete history of your child

• An exam of your child’s mouth (oral cavity)

• Dental X-rays

How is tooth decay treated in a child?

Treatment will depend on your child’s symptoms, age, oral hygiene, and general health. It will also depend on how severe the condition is.

For children, some early tooth decay may be managed with conservative methods such as removal of plaque, cleansing the dental decay, remineralizing the teeth, use of supplemental fluoride, and dental sealants.

In most cases, treatment will require removing the decayed part of the tooth and replacing it with a filling. Fillings are materials placed in teeth to repair damage caused by tooth decay. They are also called restorations. There are different types of fillings:

• Direct restorations. These need a single visit to place a filling directly into a prepared hole. These fillings may be made out of silver, fine glass powders, acrylic acids, or resin. They are often tooth-colored.

• Indirect restorations. These may require 2 or more visits. They include inlays, onlays, veneers, crowns, and bridges. These are constructed with gold, base metal alloys, ceramics, or composites. Many of these materials can look like natural tooth enamel.

How can I help prevent tooth decay in my child?

You can help prevent tooth decay in your child with these simple steps:

• Start brushing your child’s teeth as soon as the first tooth appears. Brush the teeth, tongue, and gums for 2 minutes twice a day with a fluoride toothpaste. Or watch as your child brushes their teeth.

• For children younger than 3 years old, use only a small amount of toothpaste, about the size of a grain of rice. Starting at age 3, your child can use a pea-sized amount of toothpaste.

• Floss your child’s teeth daily after age 2.

• Make sure your child eats a well-balanced diet. Limit snacks that are sticky and high in sugars. These include chips, candy, cookies, cake, and soda drinks.

• Prevent the transfer of bacteria from your mouth to your child's. Don't share eating utensils. And don’t clean your baby’s pacifier with your saliva.

• If your child uses a bottle at bedtime, only put water in it. Juice and formula contain sugars that can lead to tooth decay.

• Talk with your child’s healthcare provider or dentist about using a fluoride supplement if you live in an area without fluoridated water. Also, ask about dental sealants and fluoride varnish. Both are put on the teeth.

• Schedule routine dental cleanings and exams for your child every 6 months.

Key points about tooth decay in children

• Tooth decay is the breakdown of tooth enamel. It can lead to holes in the teeth called cavities or dental caries.

• Tooth decay is caused by bacteria in the mouth. These bacteria make a sticky substance called plaque that can eat away at a tooth’s enamel.

• Poor oral hygiene can raise your child’s risk for tooth decay.

• A dentist can diagnose tooth decay with an exam and X-rays.

• Treatment may require removing the decayed part of the tooth and replacing it with a filling.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also, know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.