• Early detection of early childhood caries may prevent the need for dental treatment.
  • Babies under four to six months need only breastmilk or formula.
  • Tooth cleaning should begin as soon as your infant’s first tooth appears.
Every child is at risk of tooth decay. The enamel (hard outer layer of teeth) is much thinner and softer on baby teeth, making them at greater risk of decay. The good news is that tooth decay is largely preventable.

Causes of tooth decay in young children

Bacteria (Mutans streptococci) in the mouth feed on sugars from foods and drinks. These bacteria produce acid which damages the outer surface of the tooth (the enamel). Saliva repairs this damage, but if over time there is more damage than repair, it leaves a cavity or ‘hole’ in the tooth.

Children are not born with the bacteria that cause tooth decay. Caregivers pass the bacteria to babies through their saliva. For example, by ‘cleaning’ a dummy in the mouth and then giving it to the child. The risk of passing the bacteria to babies is greater if the caregiver has tooth decay that is not treated, so it is important that caregivers also look after their own oral health.

Process of early childhood tooth decay

The tooth decay process is also called ‘caries’. Early childhood caries is severe tooth decay that affects the baby teeth of young children. In the later stages, teeth have brown or black areas. 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’. These names are used because the evidence suggests that early childhood caries can occur if babies are settled to sleep with a bottle of milk or formula (or other sweet drinks). Milk can pool in the mouth and the lactose sugar in milk feeds the bacteria that cause decay as the baby sleeps. Saliva flow is low during sleep, and so does not protect against the damage.

Early childhood caries might also occur if toddlers constantly sip on sweet drinks, such as fruit juices, cordials or soft drinks, during the day. Avoid sugary foods and drinks, especially between meals.

Signs of early childhood tooth decay

Early childhood caries 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 and usually remains undetected by parents
  • a yellow, brown or black band on the tooth surface closest to the gum line that indicates the progression to decay
  • teeth that look like brownish-black stumps indicates that the child has advanced decay.

Importance of early detection of tooth decay in young children

In the very early stages, early childhood caries can be reversed with treatment by a dentist or other oral health professional. Unfortunately, because the early stages can be difficult to see, 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.

Preventing tooth decay in young children

While you can’t get rid of all the bacteria that cause tooth decay in young children, it is possible to keep them under control and help to repair everyday damage to teeth, by having good feeding habits, cleaning your child’s teeth regularly and getting them regular dental check-ups.

Good feeding habits help to prevent tooth decay

Babies only need breast milk or infant formula for the first six months. Once your baby has finished feeding, remove the baby from the breast or bottle. Don’t put baby to bed with a bottle as this practice can cause tooth decay.

Start teaching your child to drink from a feeding cup from about 6 months of age. By around 12 months, they should be drinking only from a cup.

For children over 12 months, water is the main drink. 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 under 12 months, because of its high sugar content and acidity.

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.

  • Never dip dummies in sweet substances, such as honey, jam or sugar.
  • Ask for sugar-free medicines if possible.
  • Look in your child’s mouth regularly to spot early signs of decay.

Cleaning teeth helps to prevent tooth decay

Cleaning or brushing 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 six years of age, use a small pea-sized amount of children’s low-fluoride toothpaste on a small, soft toothbrush.
  • At six years of age children can use standard fluoride toothpaste.
  • Brush teeth and along the gum line twice a day; in the morning and at night before bed.
  • Children will need an adult to help them brush their teeth until they can do it well by themselves (usually about eight years of age).

Dental checks can spot the early signs of tooth decay

Children should have an oral health assessment by the time they turn two. This check may be done by a dentist or other dental professional, or a health professional, such as a maternal and child health nurse or doctor.

Older children should continue to have check-ups. Ask your dentist or other oral health professional how often your child should have a dental check-up.

Where to get help

  • Your maternal and child health nurse
    • Community dental clinics:
    • The Royal Dental Hospital of Melbourne:
      • General enquiries or to make an appointment Tel. (03) 9341 1000 or 1800 833 039 outside Melbourne metro 8.30 am to 5 pm, Monday to Friday
      • Dental emergencies Tel. 1300 360 054 8.30 am to 9.15 pm, Monday to Friday, 9 am to 9.15 pm, weekends and public holidays
  • Your private dental clinic:
  • Orthodontist
  • Psychologist, to help with stress management
  • Physiotherapist

Things to remember

  • Healthy baby teeth are important for the development of adult teeth.
  • Don’t put your baby to sleep with a feeding bottle.
  • Start cleaning your baby’s teeth as soon as the first tooth appears. At 18 months, start using low-fluoride toothpaste. At six years of age, children can use standard fluoride toothpaste.
  • Early treatment of decay may prevent the need for major treatment.
  • Infant Feeding Guidelines: information for health workers, 2012, National Health and Medical Research Council, Canberra. More information here.
  • Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, 2011, ‘Oral health messages for the Australian public. Findings of a national consensus workshop’, Aust Dent journal, vol. 56, pp. 331-335. More information here.
  • Outcome of fluoride consensus workshop 2012 to review Fluoride Guidelines from 2005, 2012, Australian Research Centre for Population Oral Health. More information here.
  • Law V, Seow WK, Townsend G 2007, ‘Factors influencing oral colonization of mutans streptococci in young children’, Australian Dental Journal, vol. 52, no. 2, pp. 93-100. More information here.
  • Wan AK, Seow WK, Walsh LJ et al. 2001, ‘Association of Streptococcus mutans infection and oral developmental nodules in pre-dentate infants’. Journal Dental Research, vol. 80, pp. 1945-1948. More information here.

More information

Mouth and teeth

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This page has been produced in consultation with and approved by: Dental Health Services Victoria

Last updated: April 2015

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Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.