Tooth decay - young children

Baby teeth help children to eat and speak. They also guide the permanent adult teeth into position, so it is important to take care of your child's teeth right from the start.

Process of tooth decay

Bacteria in the mouth feed on sugars from foods and drinks. These bacteria produce acid, which can damage the outer surface of the tooth (the enamel).

Saliva helps to repair this damage, but if over time there is more damage than repair, it leaves a cavity or 'hole' in the tooth, also called tooth decay

Image: Dental Health Services Victoria

Every child is at risk of tooth decay. The enamel (hard outer layer) of baby teeth is much thinner and softer, putting them at greater risk of decay. The good news is that tooth decay is largely preventable.

Causes of tooth decay in young children

Evidence suggests that a more severe type of early childhood tooth decay (called early childhood caries) can occur if babies and infants are put to bed with a bottle of breastmilk, milk, infant formula or sweet drink. As the baby sleeps, milk can pool in the mouth and the lactose sugar in the milk feeds the bacteria that cause decay. Saliva flow is low during sleep, so does not protect against damage. The upper four front baby teeth are most commonly affected. Other names used to refer to this condition include ‘nursing bottle caries’, ‘infant feeding caries’ and ‘baby bottle decay.

Early childhood tooth decay might also occur if toddlers drink sweet drinks, such as fruit juices, cordials or soft drinks. Avoid sugary foods and drinks, especially between meals. Eating foods or drinks with sugar too often throughout the day can also lead to tooth decay.

Signs of early childhood tooth decay

Tooth decay develops over time and can be difficult to see in the early stages.

Tooth decay may show as:

• a dull white band on the tooth surface closest to the gum line – this is the first sign of decay and is hard for parents to spot
• a yellow, brown or black band on the tooth surface closest to the gum line – this shows progression to decay
• teeth that look like brownish-black stumps this is advanced decay.

Importance of early detection of tooth decay in young children

In the very early stages, early childhood decay can be reversed with advice and possibly treatment by a dentist or other dental practitioner. Because the early stages can be difficult to spot, in most cases early childhood decay is not picked up until the later, more serious stages. At this time it cannot be reversed and the child may need major dental treatment.

Dental check-ups are important to detect the early signs of tooth decay

It is recommended that children have regular dental check-ups, starting when their first tooth appears or by 1 year of age. Check-ups should be done by a dentist or other dental practitioner. Other mouth checks can also be done by a trained non-dental professional such as a maternal and child health nurse, general practitioner, or Aboriginal Health Practitioner.

Make sure children of all ages continue to have dental check-ups. Ask your dentist or other dental practitioner how often your child needs a dental check-up.

Preventing tooth decay in young children

You can help prevent tooth decay in young children by introducing healthy eating and good cleaning habits early on.

Healthy feeding and eating habits help to prevent tooth decay

To prevent tooth decay:

• Don't put baby to bed with a bottle.
• Never put sweet drinks in a baby’s bottle.
• Never dip dummies in sweet substances, such as honey, jam or sugar.
• Start teaching your child to drink from a feeding cup from about six months of age. By around 12 months, they should be drinking only from a cup.
• Children can start to eat solid foods from around six months of age. Offer a wide range of nutritious foods with a variety of textures and flavours.
• For children over 12 months, fluoridated tap water is the best drink for oral health. Plain full-fat milk is also a healthy drink choice. Children can drink low-fat milk from two years of age.
• Fruit juice is not necessary or recommended for children because of its high sugar content and acidity, both of which can cause tooth decay.
• Continue to offer a wide range of nutritious meals and snacks, and limit foods and drinks containing sugars, especially between meals.
• When it comes to teeth, it’s best to not eat too often. Avoid constant grazing throughout the day. Periods of not eating give the surface of the teeth more rest from acid attacks that occur after eating.
• Ask for sugar-free medicines if possible.

Cleaning teeth helps to prevent tooth decay

Cleaning your child’s teeth helps remove the bacteria that cause decay.

• Start to clean your baby’s teeth as soon as the first tooth comes through. Use a wet cloth or a small children’s toothbrush with water.
• From 18 months to five years of age, use a small pea-sized amount of children’s low-fluoride toothpaste on a small toothbrush with soft bristles.
• At six years of age children can use a pea-sized amount of standard fluoride toothpaste.
• If you live in an area that does not have fluoride in the drinking water, ask your dental practitioner about the right toothpaste for your child.
• Brush teeth and along the gum line twice a day; in the morning and at night before bed.
• After brushing, spit out toothpaste but don't rinse. The small amount of fluoride toothpaste left on the teeth helps to protect them.
• Children need an adult to help them brush their teeth until they can do it well by themselves (usually about eight years of age).

Chalky teeth and risk for tooth decay

About one in six children have ‘chalky teeth’. This can look like creamy-brown or very white spots – like the colour of chalk; particularly on the molars (back teeth). Both the baby molars (which come through at around age two), and the permanent adult molars (which come through at around six years of age), can be affected.

Teeth can become ‘chalky’ if the enamel (tooth surface) doesn't harden properly when the tooth is forming in the developing foetus. Because these teeth are weaker, they have a much higher risk of tooth decay.

Taking your child for a dental check-up by age 1 will help with early identification and care of this problem.

Chalky teeth can sometimes be confused with tooth decay. If you notice anything unusual about your child’s teeth, always see your dentist or other dental practitioner as soon as possible.

Where to get help

• Your dentist or other dental practitioner
• Oral Health Victoria provides public dental services through the Royal Dental Hospital Of Melbourne and community dental clinics for eligible people. For more information about public dental services call (03) 9341 1000, or 1800 833 039 outside Melbourne metro.
• Australian Dental Association ‘Find a Dentist’ or call (03) 8825 4600
• Your maternal and child health nurse