Cavities in Small Children: A Guide for Parents and Caregivers
Medically reviewed by Dr. Boris Kleyman, Pediatric Dentist
What Are Cavities? | How Do Cavities Happen? | Baby Teeth & Cavities | Should Cavities be Treated? | Front Teeth | Treatment | Prevention | Healthy Diet
What Are Cavities?
Cavities – or dental caries – are holes in the teeth that are caused by decay. Cavities are the result of tooth decay that worsens over time; eventually, the cavity will eat away at the entire tooth, causing it to fall out or need to be removed by a dentist.
Cavities, and tooth decay in general, is almost entirely preventable with good oral health habits and regular dental visits. Unfortunately, dental decay and cavities are far too common in children; it is one of the most common infectious diseases in children. According to the Center for Disease Control and Prevention (CDC), about 20% of children ages 5 to 11 have at least one untreated decayed tooth.
There are some genetic factors to your child’s likelihood for cavities, but nearly all decay can be prevented with proper oral healthcare. This guide is designed to help you understand the ways you can start excellent oral health routines early in your child’s life, and how to handle any dental decay that may arise.
How Do Cavities Happen?
Cavities are caused by bacterial growth that destroys the enamel, or hard protective surface, of the teeth. The bacteria eats the sugars left behind from food or drinks, and the acidic waste they leave behind slowly eats away at the protective enamel. Over time, this causes the tooth to decay, leading to cavities, or holes in the teeth. Very serious cavities will eventually take over the tooth, causing it to die at the root; it will either fall out or need to be removed.
The same bacteria also produces plaque, which is a yellowish chalky substance that sticks to the teeth, and degrades the enamel over time. Even with excellent brushing and flossing, plaque can still stick to the teeth, which is why visits to the dentist are important for kids and adults, so the dental team can remove the plaque from the teeth. If left on the teeth, plaque can lead to gingivitis, periodontitis, and other gum issues and diseases.
Can Baby Teeth Have Cavities?
Baby teeth can get cavities: according to a 2014 report by the American Academy of Pediatric Dentistry, about 60% of American children have had a dental cavity by the age of 5. And while dental decay is almost entirely preventable, a lack of education and affordable access to dentists have caused the incidence of dental decay in children to rise in recent years.
“Bottle rot”, also known as “baby bottle tooth decay”, is a common cause of early dental decay in babies and toddlers. This early rot is caused by prolonged sucking on a bottle filled with milk, juice, or other beverage besides water, especially if the child is put to sleep with a bottle. The sugars naturally found in these drinks pool around the baby’s new teeth, causing them to start to rot. Dipping a pacifier in sugar of syrup can cause the same issues.
To prevent baby bottle tooth decay, never put your baby to bed with a bottle filled with anything but water. Never dip the pacifier in sugar, honey, or other sweets. Limit juice and soda, and keep your child’s sugar intake as low as possible.
Begin tooth brushing as soon as the first tooth appears, starting with a clean washcloth and progressing to a soft-bristled toothbrush. Visit the dentist within six months of their first tooth, and no later than the first year.
Cavities in children’s teeth are common, but preventable: with proper education, access to affordable quality dentistry, and a healthy diet, all children can enjoy a lifetime of excellent oral health!
Should Cavities in Baby Teeth be Treated?
Baby teeth fall out, but they still need to be cared for. Preventing cavities and dental decay in baby teeth is very important for the future health of their adult teeth. And baby teeth that are rotted, fall out prematurely, or need to be removed can creative issues with the healthy development of adult teeth.
When baby teeth – also called primary teeth or milk teeth – decay or rot, this can cause the permanent teeth to grow in improperly. In turn, this can cause health issues later in life, and require expensive orthodontia or even surgery, as well as pain, discomfort, and embarrassment.
Potential Consequences of Cavities and Decay in Baby Teeth
- Disrupted speech development or speech impediments
- Pain and soreness when biting and chewing food
- Chronic pain, soreness, inflammation of the teeth and gums
- Headaches and jaw aches
- Sensitivity to hot or cold on the teeth
- Bad breath
- Improper development of adult teeth, requiring invasive orthodontic care or surgery
- Decay spreading to other teeth, or infecting permanent teeth
- Tooth or gum infections
Cavities in Children: What to Look For
While not all dental decay is visible to the naked eye, there are certain signs to look out for when it comes to decay in children’s teeth.
Your child should visit the dentist every 6 months, whether you see signs of decay or not. Regular cleanings and checkups are an important part of oral health, and will allow the dentist and their team to catch any warning signs of rot, and prevent spread with careful cleanings, treatments, and any sealants or other interventions.
Between visits to the dentist, make sure your child brushes and flosses every day. Look out for any signs of decay or rot, and bring your child to the dentist between regular visits if you see any.
Signs of dental decay to look for in children’s teeth:
| Early/Mild Tooth Decay | Moderate Tooth Decay | Advanced Tooth Decay |
|---|---|---|
| Look out for chalky white spots on the teeth. These spots are caused by a lack up calcium, and a build-up of plaque on the teeth, which leads to breakdown of the enamel. The enamel is the shiny, hard white covering of the tooth surface, which protects the root and pulp within. The early process of breakdown is called demineralization. Dental decay can be slowed or reversed at this early stage, by adjusting the diet, adding calcium and fluoride supplements, and brushing and flossing more regularly. | As the process of demineralization continues, the enamel breaks down further. At this more advanced stage of decay, lesions begin to form on the surface of the tooth. These will look like light brown spots on your child’s teeth. As the decay worsens, the spots get darker brown and eventually black. Your child may complain of tooth pain or soreness, gum inflammation, trouble chewing or swallowing, or headache and/or jaw aches. | Eventually, the decay reaches past the enamel, and into the interior of the tooth. This is called the dentin, the material between the enamel surface and the pulpy interior connected to the roor. Once the rot has reached the dentin, the decay is considered a cavity, which will need to be cleaned out and filled. At this stage, the tooth may be extra sensitive to hot or cold sensations, and cause consistent pain. You may see dark brown or black spots on the surface. If left untreated, the decay will spread to the pulp center of the tooth, which can only be treated with a root canal. Eventually, this rot will cause the tooth to abscess, and it will either fall out or need to be removed. |
Remember, not all dental decay is visible to the eye. Other symptoms to look out for that may indicate dental decay or a cavity in your child’s teeth:
- Sensitivity to hot or cold on the teeth
- Inflamed gums
- Pain or discomfort in the teeth or gums
- Headaches or jaw aches
- Bad breath
- Sour taste in mouth
If your child is exhibiting or complaining of the following, bring them in to the dentist immediately for evaluation. And schedule regular visits with your child’s dentist for cleanings and checkups.
Can Cavities Occur in Children’s Front Teeth?
Yes, cavities can occur in all of the teeth. Cavities in the side teeth and back teeth (premolars and molars) are more common, due to their position in the mouth, which makes them harder to clean, as well as the pits and grooves that assist in biting and chewing food, but can provide ideal spaces for bacteria to grow.
Because front teeth are smoother, with fewer grooves, they tend to be less common sites for bacterial growth and dental decay. However, front teeth can certainly decay. Two common reasons for cavities in the front teeth are prolonged use of a baby bottle filled with milk or juice, or neglecting to floss, which can cause cavities between the teeth.
To prevent front tooth cavities in babies or toddlers, never put them to bed with a bottle of milk or other liquid besides water. These liquids will pool around their teeth and cause bacterial growth which leads to decay. Pacifiers should never be dipped in any sugar or syrup.
Dental decay is infectious, and it spreads to other teeth. If the back teeth have rot, it can spread to the front teeth, and vice versa. Regular brushing and flossing will help keep teeth clean and prevent bacteria from spreading across the teeth. Introduce flossing as soon as your child’s teeth touch, generally between 2 and 3 years old.
How Do You Treat Cavities in Baby Teeth?
If your child does have a cavity in their baby teeth, the dentist and their dental team will use their instruments and equipment to effectively correct the issue with as little intervention as possible.
The dentist will avoid pulling the tooth whenever possible: even though they fall out eventually, it’s important to let baby teeth fall out naturally, as they are working as placeholders for the permanent teeth while the skull and jaw bones grow to accommodate this larger set of teeth. Plus, your child needs their baby teeth for eating, chewing, swallowing, and speaking! While removing a tooth is necessary in certain rare cases, the dentist will usually be able to treat the decay using a sealant, cap, or filling.
If the cavity needs to be filled, the dentist and their team will drill out the rotten part of the cavity and fill it back in with a dental composite. The filling is made either of a white composite material, or with metal. Metal fillings are more noticeable, so many patients’ parents opt for the white filling, which blends with the teeth. However, metal fillings tend to be cheaper.
For most procedures, your child will be given local anesthesia so they don’t feel any pain at the cavity site. Some dentists also use nitrous oxide – also known as “laughing gas” – which helps to calm patients and provides a comfortable, pleasant sensation. If the procedure is more invasive, it may require full sedation, which is performed under the supervision of a licensed anesthesiologist in a licensed facility. This may be the best option for children with many cavities, since this requires a longer procedure that may cause fear or anxiety in children.
Before any procedures are begun, your child’s dentist will explain the treatment options and help you decide on the best option. A pediatric dental team is usually very skilled in helping children understand what’s happening, using no-fear language that calms their anxiety and prepares them for the experience.
If you ever have questions from your child’s dentist, don’t be afraid to ask! Excellent oral health is a family matter; understanding your child’s teeth is the best way to help them stay healthy and smiling.
How to Prevent Cavities and Decay in Baby Teeth
Dental decay is preventable – while genetics play a small factor in the health of your child’s teeth, proper oral healthcare and regular dentist visits are the most important parts of preventing cavities in baby teeth.
To prevent rotting in your child’s baby teeth – and later their adult teeth – follow these regular steps:
- Start cleaning teeth as soon as they come in
- Use a smear of toothpaste until age 3, and then a pea-size amount after age 3
- When your child is old enough to hold their own toothbrush, teach them to brush 2 times a day, and supervise carefully to make sure they brush each tooth and spit out toothpaste
- Use fluoridated toothpaste, and if your town or city doesn’t add fluoride to the tap water, talk to your child’s dentist about a fluoride supplement such a pill or liquid.
- Limit sugar intake, and give your child plenty of fresh veggies and whole grains for a healthy diet
Healthy Diets for Healthy Teeth: Which Foods to Avoid
The sugars in food and beverages are the root cause of dental decay. Sugar isn’t just found in candy and soda: sugar is found in many foods, including milk, juice, fruits, yogurts, and much more.
While a little sugar is okay for kids’ teeth, limiting sugars is important for a proper diet and healthy teeth. Brushing and flossing twice a day is also important!
Below are foods that are good for childrens’ teeth, and foods that are best to limit to a small amount:
- Fiber-rich fruits & vegetables: Crunchy raw fruits and veggies like apples, carrots, celery, broccoli stimulate saliva flow and are a tasty, healthy snack
- Antioxidants: grapes, raisins, beans, nuts
- Calcium-rich dairy: milk, cheese, and sugar-free yogurt; limit flavored milks
- Calcium-rich leafy greens: spinach, kale, chard, collards, and more
- Vitamin-D foods: fish & eggs
- Probiotics: yogurt, sauerkraut, kimchi
- Soft drinks/soda
- Juice (especially juice cocktails or juice with less than 3% juice)
- Hard or sticky candies: lollipops, hard sucking candies, etc.
- Sugary gum
- Sugary breakfast cereal
- Refined starches such as white flour: white bread, crackers, white pasta, etc
- Flavored milks & yogurts with added sugar
- Jams & jellies
- Cakes and other sugary baked goods
- Acidic fruits: lemons and oranges (if sucked on for lengthy amounts of time)