Pediatric Dentistry – Dentistry for Your Child

Tooth decay in kids, also called as early childhood caries, is the most common infectious disease occurring in childhood. Tooth decay develops as soon as the first tooth erupts due to acid that is produced by sugar fermenting bacteria.

These bacteria develop penetrating biofilm and plaque that can be brushed daily and cleaned during regular dental checkups.  Thus, healthy dental habits should be initiated at an early age.

Otherwise, children can be at risk for not only tooth decay, but early childhood caries, a precursor to serious infections, pain, and discomfort.

What are the forms of tooth decay in children?

Early childhood caries in children may present as nursing caries, also known as baby bottle tooth decay, and rampant caries.

The more prevalent nursing caries are specific to infants and toddlers.  These types of dental caries are primarily associated with poor feeding practices such as bed time bottle feeding, pacifiers dipped in sweeteners, late introduction to drinking from a cup etc.  The patterned presentation of caries occurs in upper front teeth and upper and lower back teeth.

Acute caries are considered rampant, widely involving all the teeth and not sparing the surfaces that are immune to decay like the lower front teeth.  Acute caries can occur in primary and permanent teeth and commonly present pulp exposure.

Early pulpal involvement generally requires pulp therapy to treat caries. However, the etiology of rampant caries is multi factorial; a combination of frequent snacking, high sugar diet intake, decreased salivary flow etc. or one of the aforesaid can exclusively initiate the cascade of rampant caries.

What causes tooth decay ?

The oral cavity naturally harbors bacteria.  Tooth decay develops when the baby’s mouth is infected by acid producing bacteria, which creates a biofilm over the enamel.  Food, bacteria, saliva, and acid amalgamate to form plaque, which sticks to the tooth.

If the plaque is not removed by regular brushing, acid and bacteria present in the plaque penetrate and eat the protective enamel, structurally harming the tooth and forming cavities.


Causes for tooth decay

  • Increased intake of sticky sugary foods between meals increase the sugar substrate for bacteria to ferment it and produce acid.
  • Prolonged exposure of oral cavity to sugar-sweetened beverages
  • Bed time feeding with milk or liquids other than water cause nursing caries in infants.
  • Use of pacifiers dipped in honey or sweeteners
  • Decreased salivary flow
  • Genetic background- inherited caries risk
  • Poor oral hygiene
  • Transfer of bacteria to child’s mouth via communal utensils

What are the signs of tooth decay in children?

Symptoms vary from child to child. Cavities can sometimes be symptom less. Children may not even be aware of having a cavity in their mouth until the time of discovery by the dentist.

It is therefore highly recommended that children be taken to the dentist every six to twelve months to check on the status of his/her teeth. Early detection of caries or a risk assessment helps your child smile and eat healthy for lifetime.

Tooth decay may appear as white spots on the teeth or on the gum line of front teeth in early stages. This may gradually progress and change into a light brown color and further turn darker to form hole or a cavity.

The child may feel sensitive to hot or cold food or beverages. The child may also feel pain around the tooth or gums in presence of tooth decay.

How to treat tooth decay in children?

Treatment of tooth decay depends on the condition of the tooth. If risk for caries is assessed at early stages, it can be managed by applying topical fluoride.

Fluoride treatment depends on the severity of the tooth’s condition. In cases where pulp is not involved, the dentist removes the decayed part and performs a filling procedure.

If caries has extensively progressed beyond enamel and dentin, pulp therapy is required, and prefabricated stainless-steel crowns are placed on the tooth when the structural integrity is damaged. If the cavity progressed beyond pulp therapy, the tooth is extracted and space maintainer is inserted to maintain the arch length.

How to prevent tooth decay in children?

Prevention is always preferred over treatment and the associated burden. It is important to initiate preventive, healthy measures at the infant stage. This encourages good oral health from childhood into adulthood. Parent education during pregnancy is crucial to preventing dental diseases of their offspring.

Following the simple steps below can help your child maintain a healthy smile.

  • In infants and toddlers, gently wipe the gums with wet gauze after feeding.
  • Never put your child to bed with a bottle other than water. This increases the exposure of your child’s teeth to oral bacteria and acids.
  • Avoid using pacifiers dipped in sweeteners for long period.
  • As soon as the first tooth erupts, start brushing with a gentle tooth brush.
  • Check on your child’s diet. Limit excess intake of sugars, sticky foods, and sugary drinks and juices.
  • Limit frequent snacking between meals. Make sure your child eats a well-balanced diet.
  • Fluoride gives additional protection to your child’s teeth. Get a consultation by dentist to check if your child needs fluoride supplements. If your drinking water does not have enough fluoride, the dentist may recommend fluoride supplements such as a fluoride tooth paste, fluoride mouth wash, or an applicable fluoride varnish.
  • Get a caries risk assessment for your child as early as possible and take your child for regular dental checkups every six months.