Rotten teeth kids

Rotten teeth or tooth decay is the breakdown or destruction of tooth enamel that affects the teeth of infants and young children. Tooth decay is a diet-related disease that damages teeth. Tooth decay may also be called nursing caries or baby bottle tooth decay. Rotten teeth is found usually on the upper front teeth but other teeth may also be affected. Enamel is the hard outer surface of a tooth (see Figure 1). Tooth decay can lead to cavities or dental caries. These are holes in the teeth.

Baby teeth are important. If baby teeth are lost too early, the teeth that are left may move and not leave any room for adult teeth to come in. Also, if tooth decay is not prevented, it can be costly to treat, cause pain, and lead to life-threatening infections.

Tooth decay can occur when acid is produced from plaque, which is a sticky, slimy substance made up mostly of the bacteria that builds up on your child’s teeth. If plaque is allowed to build up, it can lead to further problems, such as dental caries (holes in the teeth), gum disease or dental abscesses, which are collections of pus at the end of the teeth or in the gums. Bacteria that live in your child’s mouth thrive on the sugars and starches in the food and drinks your child eat and drink. These germs feed on sugars in food and drinks and produce an acid that damages the tooth surface. Over time, this acid eats away at the surface of the tooth, creating holes or ‘cavities’.

Children are not born with decay-causing bacteria in the mouth. These bacteria are passed to the child by their parents or caregivers through food tasting and/or through cleaning a dummy or teat in their own mouths. By keeping their own mouth healthy, parents can reduce the risk of decay in themselves and their children.

Oral hygiene should start from birth, even before teeth erupt (come through). Start by cleaning your child’s gums after feeds and then start cleaning teeth as soon as they come through.

Plaque builds up due to frequent snacking, sipping sugary drinks and not cleaning your teeth well. When plaque clings to your child’s teeth the bacteria in their mouth make acids that can eat away at the outermost layer of the tooth, called the enamel. The result is a cavity or a hole that can grow bigger and deeper over time. Once cavities have formed in the enamel, the plaque and bacteria can reach the dentine (the softer, bone-like material underneath the enamel). As the dentine is softer than the enamel, the process of tooth decay speeds up. If your child have a tooth cavity it’s important to get it repaired as soon as possible.

Without treatment, bacteria will enter the pulp (the soft center of the tooth that contains nerves and blood vessels). At this stage, the tooth nerves will be exposed to bacteria, usually making your child’s tooth painful. The bacteria can cause a dental abscess in the pulp and the infection could spread into the bone, causing another type of abscess.

Plaque also causes gingivitis, which is gum disease that can make your child’s gums red, swollen, and sore. Your child’s gums are those soft pink tissues in your mouth that hold their teeth in place. If your child doesn’t take care of his/her teeth, cavities and unhealthy gums will make their mouth very, very sore. Eating meals will be difficult.

Cavities are decayed areas of your child’s teeth that develop into tiny openings or holes. The three types of cavities are shown here in Figure 1. Smooth surface cavities occur on the smooth sides of your child’s teeth, while root cavities develop on the surface over the roots. Pit and fissure cavities occur on the chewing surface of your child’s teeth. Remember, not cleaning your child’s teeth well, frequent snacking and sipping sugary drinks are the main culprits behind cavities. The first sign of tooth cavity or decay may be a sensation of pain when your child eat something sweet, very cold or very hot. Sometimes decay will show as a brown or white spot on the tooth.

Tooth decay may not cause any pain. However, if your child has dental caries he/she might have:

• toothache – either continuous pain keeping your child awake or occasional sharp pain without an obvious cause
• tooth sensitivity – your child may feel tenderness or pain when eating or drinking something hot, cold or sweet
• grey, brown or black spots appearing on their teeth
• bad breath
• an unpleasant taste in their mouth

Dental caries (tooth decay) remains the world’s most common chronic disease in both children and adults, even though it is largely preventable. They’re especially common in children, teenagers and older adults. But anyone who has teeth can get cavities, including infants.

If your child doesn’t go to the dentist to have the cavities treated, the acids can continue to make their way through the enamel, the cavity will get larger and affect deeper layers of your child’s teeth and the inside parts of their tooth where the nerve endings are can begin to decay. They can lead to a severe toothache, infection and tooth loss. Regular dental visits and good brushing and flossing habits are your best protection against cavities and tooth decay.

Although tooth decay is a common problem, it’s often entirely preventable. The best way to avoid tooth decay is to keep your child’s teeth and gums as healthy as possible.

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.
• 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.
• Tooth decay can cause pain or infection. It can also affect your child’s growth and development.
• Signs of decay include white patches or brown spots on teeth, red or swollen gums, holes in teeth or broken teeth.
• Prevent decay with good dental care, healthy eating and drinking, and regular dental check-ups.
• If you think your child has tooth decay, see your dentist.
• A dentist can diagnose tooth decay with an exam and X-rays.
• Treatment requires removing the decayed part of the tooth and replacing it with a filling.

Figure 1. Tooth decay 

When does tooth decay start?

Decay can start as soon as the tooth appears in the mouth.

Whitish marks on the tooth surface close to the gum line maybe an early sign of tooth decay. At this early ‘white spot’ stage, the decay process can be stopped and/or reversed by the use of fluoride.

If it is left untreated it can quickly progress to become a hole that will need dental treatment. This more advanced stage of decay will have a yellow-brown or black appearance on teeth.

How do young children get dental decay?

Decay is more likely to occur in infants or toddlers who:

• fall asleep sucking a bottle filled with a sugary liquid
• fall asleep sucking a dummy dipped in a sweet substance such as honey
• have prolonged (more than one year) on-demand breastfeeding
• have poor oral hygiene
• have a diet high in sugar, with lots of snacks.

Falling asleep while sucking a bottle or dummy dipped in a sweet substance is particularly damaging to the teeth because less saliva is produced during sleep. Saliva has an important role in washing away the harmful plaque acids.

Frequent snacking can also contribute to tooth decay because there is less time between eating to allow teeth to recover from plaque acid attacks.

Will a dummy or thumb sucking harm my child’s teeth?

No, but they will encourage an open bite, which is when teeth move to make space for the dummy or thumb. They may also affect speech development. That’s why you should avoid using dummies after 12 months of age.

Thumb sucking won’t cause permanent problems, as long as the habit stops by the time your child gets their second teeth, but it can be a hard habit to break.

Discourage your children from talking or making sounds with their thumb or a dummy in their mouth, and don’t dip dummies in anything sweet, such as sugar or jam.

Why do children need fluoride?

Fluoride is an important mineral for all children. Bacteria in the mouth combine with sugars and produce acid that can harm tooth enamel and damage teeth. Fluoride protects teeth from acid damage and helps reverse early signs of decay. Make sure your children are drinking plenty of water and brushing with toothpaste that has fluoride in it.

Is fluoridated water safe for my children?

Yes. The American Academy of Pediatrics, along with the American Dental Association and the Centers for Disease Control and Prevention (CDC), agree that water fluoridation is a safe and effective way to prevent tooth decay.

What is dental fluorosis and will fluoridated water mixed with infant formula increase the risk?

Although using fluoridated water to prepare infant formula might increase the risk of dental fluorosis, most cases are mild.

Fluorosis usually appears as very faint white streaks on the teeth. Often it is only noticeable by a dental expert during an exam. Mild fluorosis is not painful and does not affect the function or health of the teeth.

Once your child’s adult teeth come in (usually around age 8), the risk of developing fluorosis is over.

Should I mix infant formula with fluoridated water?

According to the American Dental Association, it is safe to use fluoridated water to mix infant formula. The risk if mixing infant formula with fluoridated water is mild fluorosis (see below for more information on this condition). However, if you have concerns about this, talk with your pediatrician or dentist.

What if I prefer not to use fluoridated water for infant formula?

If you prefer not to use fluoridated water with formula, you can:

• Breastfeed your baby.
• Use bottled or purified water that has no fluoride with the formula.
• Use ready-to-feed formula that does not need water to be added.

What if we live in a community where the water is not fluoridated? What can we do?

Check with your local water utility agency to find out if your water has fluoride in it. If it doesn’t, ask your pediatrician or dentist if your child is at HIGH risk for dental caries (also known as tooth decay or a cavity). He or she may recommend you buy fluoridated water or give you a prescription for fluoride drops or tablets for your child.

How else can my child get fluoride?

There are many sources of fluoride. Fluoridated water and toothpaste are the most common. It is also found in many foods and beverages. So making sure your child eats a balanced diet with plenty of calcium and vitamin D is a great way to keep teeth healthy. Your dentist or pediatrician may also recommend a topical fluoride treatment during well child or dental visits at various stages of your child’s development.

When should my child start using fluoride toothpaste?

The American Academy of Pediatrics and the American Dental Association recommend using a “smear” of toothpaste on children once the first tooth appears and until your child is 3. Once your child has turned 3, a pea-sized amount can be used.

What causes tooth decay in kids?

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.

Baby teeth

A baby’s first tooth usually appears at around 6 months, however this can vary greatly. By the age of 3 a child should have a full set of 20 baby teeth (10 in each jaw). It is not uncommon for babies to experience some discomfort when new teeth break through the gums.

Healthy baby teeth allow a toddler to enjoy a nutritious diet, aid in proper speech development, enhance the child’s appearance and contribute to good self-esteem.

Baby teeth also help to maintain the space for permanent teeth, guiding them into their correct position.

Early loss of a baby tooth can reduce the space for the permanent tooth, resulting in crowded permanent teeth.

Table 1: General guide of when baby teeth appear

Tooth type	Age
Central incisors	6 to 10 months
Lateral incisors	10 to 16 months
Canine	17 to 23 months
1st baby molar	14 to 18 months
2nd baby molar	23 to 31 months

Figure 2. Baby teeth

Figure 3. Baby teeth coming in order

Abbreviations: mos = age in months; yrs = age in years

How to care for baby teeth

Baby teeth can start to decay as soon as they appear in the mouth. Frequent exposure to sugary liquids can destroy baby teeth.

You should wipe your baby’s gums with a wet facecloth or a clean gauze pad after each feed. You can brush your baby’s first tooth as soon as it appears with a soft toothbrush and a little water.

Fluoride should be added to your child’s diet at 6 months of age. Fluoride is a mineral that helps prevent tooth decay by hardening the enamel of teeth. The good news is that fluoride is often added to tap water. Give your baby a few ounces of water in a sippy or straw cup when you begin him or her on solid foods (about 6 months of age). The American Academy of Pediatrics, along with the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC), agree that water fluoridation is a safe and effective way to prevent tooth decay. Speak with your pediatrician to see if your tap water contains fluoride or whether your child needs fluoride supplements. Fluoride is not typically found in most bottled water.

According to the American Dental Association, it is safe to use fluoridated water to mix infant formula. The risk if mixing infant formula with fluoridated water is mild fluorosis (see below for more information on this condition). However, if you have concerns about this, talk with your pediatrician or dentist.

Older children should be supervised while they are cleaning their teeth. Children over 18 months can use a pea-sized amount of children’s low-fluoride toothpaste and should be taught not to swallow it. They should rinse with water after brushing.

To reduce the risk of tooth decay:

• never allow your baby to fall asleep with a bottle containing milk, formula, fruit juice or sweetened liquid
• don’t dip a dummy in sugar or honey
• clean the dummy before you give it to your baby
• visit your dentist by about 12 months.

If you are worried about your baby’s tooth development, call your dentist.

Cleaning baby’s mouth

Start cleaning gums before the teeth appear.

• At first, use a clean damp cloth to wipe the gums, and when a few teeth are present use a small, soft toothbrush with no toothpaste.
• When your child is 18 months, you can use a small pea-sized amount of low strength fluoride toothpaste.
• If your child is 6 or over, use a small amount of standard strength fluoride toothpaste and encourage your child to spit out, not swallow and not rinse after brushing.

Causes of tooth decay in babies

Tooth decay develops when a baby’s mouth is infected by acid-producing bacteria. Parents and caregivers can pass bacteria to babies through saliva. For example, bacteria is spread by sharing saliva on spoons or cups, testing foods before feeding them to babies, and cleaning off a pacifier in the parent’s or caregiver’s mouth.

Tooth decay also develops when the child’s teeth and gums are exposed to any liquid or food other than water for long periods or frequently throughout the day. Natural or added sugars in the liquid or food are changed to acid by bacteria in the mouth. This acid then dissolves the outer part of the teeth, causing them to decay.

The most common way this happens is when parents put their children to bed with a bottle of formula, milk, juice (even when mixed with water), soft drinks (soda, pop), sugar water, or sugared drinks. It can also occur when children are allowed to frequently drink anything other than water from a sippy cup or bottle during the day or night. Milk should be served only with meals and not offered throughout the day, at nap time or at bedtime. Although extended and frequent breastfeeding alone does not cause tooth decay, all breastfeeding mothers should be aware of and follow oral hygiene, fluoride, preventive dental care, and healthy diet recommendations.

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

Tooth decay prevention for children

Most children want sweets, but you can help to prevent problems by making sure they don’t have a large amount or very often, and particularly not before bed, when saliva flow lessens. Try not to give sweets or sweet drinks as rewards.

The best snacks for your child are fruit and raw vegetables. Try tangerines, bananas, pieces of cucumber or carrot sticks. Other good snacks include toast, rice cakes and plain popcorn.

Dried fruit is high in sugar and can be bad for teeth, so only ever give it to children with meals – for instance, as a dessert – and never as a snack between meals.

Fizzy drinks can contain large amounts of sugar, which will increase the risk of tooth decay. Fizzy drinks (both those containing sugar and sugar-free or “diet” versions) also contain acids that can erode the outer surface of the tooth. The best drinks for children over one year old are plain still water or plain milk.

Even unsweetened juices and smoothies contain sugars and acids. Restrict your child to no more than one small glass (about 150ml) of fruit juice or smoothie each day and only at mealtimes.

Teeth are at most risk at night because there is less saliva in the mouth to protect them. Water is the best drink to give at bedtime, but if you do give milk, don’t add anything to it. Chocolate-flavored drinks and milkshake powder usually contain sugars, which will increase the risk of decay.

A regular teeth-cleaning routine is essential for good dental health. Follow these tips and you can help keep your kids’ teeth decay-free.

From brushing their first tooth to their first trip to the dentist, here’s how to take care of your children’s teeth.

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

• Start brushing your child’s teeth as soon as the first one appears. Brush the teeth, tongue, and gums twice a day with a fluoride toothpaste. Or watch as your child brushes his or her 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 children don’t eat or lick toothpaste from the tube.
• Make sure your child eats a well-balanced diet. Limit snacks that are sticky and high in sugars. These include chips, candy, cookies, and cake.
• 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 or formula contain sugars that can lead to tooth decay.
• Do not allow a bottle containing milk or sweetened liquids to remain in your child’s mouth after they have fallen asleep.
• If you child does need a bottle for comfort or for sleep, only provide cooled, boiled water in the bottle.
• Do not give cordial or juices in the bottle. Water is the best thirst quencher.
• Replace the bottle with a cup when your child is 6 to 12 months old.
• Do not dip your child’s dummy in any sweetened substances.
• Avoid sweet and sticky snacks.
• Talk with your child’s 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.

Toothbrushing tips

• Brush your child’s teeth for about two minutes twice a day: once just before bedtime and at least one other time during the day.
• Encourage them to spit out excess toothpaste, but not to rinse with lots of water. Rinsing with water after tooth brushing will wash away the fluoride and make it less effective.
• Supervise tooth brushing until your child is seven or eight years old, either by brushing their teeth yourself or, if they brush their own teeth, by watching how they do it. From the age of seven or eight, they should be able to brush their own teeth, but it’s still a good idea to watch them now and again to make sure they brush properly and for about two minutes.

How to help children brush their teeth properly

• Guide your child’s hand so they can feel the correct movement.
• Use a mirror to help your child see exactly where the brush is cleaning their teeth.
• Make tooth brushing as fun as possible by using an egg timer to time it for about two minutes.
• Don’t let children run around with a toothbrush in their mouth, as they may have an accident and hurt themselves.

Dentist visit

Maintaining good oral hygiene involves going to the dentist every 6-12 months. The dentist is able to:

• Recommend cleaning techniques and products;
• Clean plaque and calculus from the teeth;
• Fill cavities that could lead to further tooth decay;
• Administer fluoride treatments;
• Treat mild gingivitis before it turns into periodontitis;
• Take radiographs; and
• Reinforce oral hygiene instruction over long term.

Fluoride varnish and fissure sealants

• Fissure sealants can be done once your child’s permanent back teeth have started to come through (usually at the age of about six or seven) to protect them from decay. This is where the chewing surfaces of the back teeth are covered with a special thin plastic coating to keep germs and food particles out of the grooves. The sealant can last for as long as 5 to 10 years.
• Fluoride varnish can be applied to both baby teeth and adult teeth. It involves painting a varnish that contains high levels of fluoride on to the surface of the tooth every six months to prevent decay. It works by strengthening tooth enamel, making it more resistant to decay.
• From the age of three, children should be offered fluoride varnish application at least twice a year. Younger children may also be offered this treatment if your dentist thinks they need it.

Ask your dentist about fluoride varnish or fissure sealing.

How to brush your child’s teeth

Brush your child’s teeth by placing the tip of the toothbrush bristles towards the gum line and gently jiggling the brush, or moving it in tiny circles over the teeth and gums.

• Repeat the same brushing method on the inside surfaces of all teeth. For the chewing surfaces, use a light backward and forward motion.
• Remember plaque is soft, use the toothbrush gently as there is no need to scrub.
• Jiggle the toothbrush or move in tiny circles on the outside surfaces of the teeth and gums.
• Repeat the same method on the inside surfaces of the teeth.
• Use a light backward and forward motion on the chewing surfaces of the teeth.

What type of toothpaste should I use for my child?

It’s important to use a toothpaste with the right concentration of fluoride. Check the packaging to find out how much fluoride each brand contains.

• Children don’t need to use special “children’s toothpaste”. Children of all ages can use family toothpaste, as long as it contains 1,350-1,500 ppm (parts per million) fluoride.
• Children aged six and under who don’t have tooth decay can use a lower-strength children’s toothpaste, but make sure it contains at least 1,000 ppm fluoride.
• Below the age of three, children should use just a smear of toothpaste. Children aged three to six years should use a pea-sized blob of toothpaste. Make sure children don’t lick or eat toothpaste from the tube.

Your dentist may advise you or your child to use a toothpaste with a higher concentration of fluoride, if you need it.

How to prevent tooth decay in babies

• Whether you choose to breastfeed or bottle-feed, it is important to take good care of your baby’s teeth.
  • Birth to 12 months: Keep your baby’s mouth clean by gently wiping the gums with a clean baby washcloth. Once you see the first teeth, gently brush using a soft baby toothbrush and a smear (grain of rice) of fluoride toothpaste.
  • 12 to 36 months: Brush your child’s teeth 2 times per day for 2 minutes. Use a smear of fluoride toothpaste until your child’s third birthday. The best times to brush are after breakfast and before bed.
• Never put your child to bed with a bottle or food. This not only exposes your child’s teeth to sugars but can also put your child at risk for ear infections and choking.
• Do not use a bottle or sippy cup as a pacifier or let your child walk around with or drink from one for long periods. If your child wants to have the bottle or sippy cup in between meals, fill it with only water.
• Check to see if your water is fluoridated. Your child will benefit from drinking water with fluoride in it. If your tap water comes from a well or another non-fluoridated source, your child’s doctor or dentist may want to have a water sample tested for natural fluoride content. If your tap water does not have enough fluoride, your child’s doctor or dentist may prescribe a fluoride supplement. He or she may also apply fluoride varnish to your child’s teeth to protect them from decay.
• Teach your child to drink from a regular cup as soon as possible, preferably by 12 to 15 months of age. Drinking from a cup is less likely to cause liquid to collect around the teeth. Also, a cup cannot be taken to bed.
• If your child must have a bottle or sippy cup for long periods, fill it with water only. During car rides, offer only water if your child is thirsty.
• Limit the amount of sweet or sticky foods your child eats, such as candy, gummies, cookies, Fruit Roll-Ups, or cookies. Sugar is in foods like crackers and chips too. These foods are especially bad if your child snacks on them a lot. They should be eaten only at mealtime. Teach your child to use his tongue to clean food immediately off the teeth.
• Serve juice only during meals or not at all. The American Academy of Pediatrics does not recommend juice for babies younger than 6 months. If juice is given to babies between 6 to 12 months, it should be limited to 4 ounces per day and should be diluted with water (half water, half juice). For children 1 to 6 years, any juice served should be limited to 4 to 6 ounces per day.
• Make an appointment to have your child see the dentist before the age of 1. If you have concerns, the dentist can see your child sooner. Find a pediatric dentist in your area on the American Academy of Pediatric Dentistry Web site (https://www.aapd.org/publications/find-a-pd) or Insurekidsnow.gov​ (https://www.insurekidsnow.gov/find-a-dentist/index.html). If no dentist is available to see your child by age 1, your pediatrician can look inside of your child’s mouth, apply fluoride varnish, and talk with you about how to keep her healthy.

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 one 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.

Signs of tooth decay in babies

Tooth decay might first appear as white spots at the gum line on the upper front teeth. These spots are hard to see at first—even for a child’s doctor or dentist—without proper equipment. A child with tooth decay needs to be examined and treated early to stop the decay from spreading and to prevent further damage.

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
• Dental X-rays

How is tooth decay treated in a child?

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

In most cases, treatment requires 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.