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Tooth decay in children: Everything you need to know

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Dr Teresa Li
July 18, 2023

Just because baby teeth fall out doesn't mean you should ignore tooth decay in children. Cavities not only influence the health and wellbeing of your child, they can affect the development of adult teeth. 

Did you know a National Child Oral Health study shows  tooth decay affects 27% of Australian children aged 5-10 years?

While awareness and education around decay in children's teeth is improving, the stages of tooth decay are harder to identify in children than adults. 

The good news? Early detection and treatment is possible.  With proper oral hygiene, at-home care and regular dental care, there's plenty that parents can do to manage children's tooth decay. It starts with knowing the causes. 

Causes of tooth decay in children

Children’s tooth decay happens gradually and can be tricky for busy parents to pick up on. Being aware of the main causes can help to prevent the problem before your little one feels any pain. 

Tooth decay is caused by the bacteria in plaque, which creates a build-up of acids on the surface of the tooth. The bacteria in plaque thrives on sugary foods, particularly those containing a high pH level.

Dried fruit, fizzy drinks, fruit juices, processed food, citrus and sweets are among the worst offenders at rotting children’s teeth. 

If the acid sits on the tooth long enough, tooth enamel breaks down and cavities form. Over time, little ‘nooks’  will begin to form in your child’s teeth, allowing bacteria to settle even further. If left untreated, the ‘nooks’ will form into cavities and can become large enough to trap food particles. This accelerates the rate of tooth decay.

Children’s tooth decay fact: Your child has around 20 minutes from their first bite of a sugary snack before bacteria starts to create acid.

There are many ways the bacteria in plaque can build up to cause tooth decay in children, including:

  • Sugary diet: Bacteria in the mouth feed on sugar. Foods that contain a lot of sugar and carbohydrates stick to the surface of the teeth, providing a perfect environment for tooth decay to thrive.
  • Poor dental hygiene: Your child should brush their teeth at least twice a day, and after every snack or treat. Get your little one into the habit of flossing regularly. Always supervise children under eight years.
  • Fluoride deficiency: Fluoride strengthens the enamel of each tooth, which helps resist tooth decay. Kids should start using a fluoride toothpaste once they are 18 months old.
  • Dental crevices: It can be harder for kids to brush their teeth if they have dental crevices, which can trap plaque and promote tooth decay. Your dentist will be able to check for dental crevices.

  • Dry mouth: Saliva plays a huge role in 'washing away' bacteria and plaque. Kids who suffer from dry mouth have an increased chance of tooth decay and forming cavities.

  • Baby bottle: Does your kid fall asleep with a bottle of milk or juice in their mouth? If so, try to wean them from the habit. Falling asleep with sugary drinks can accelerate the stages of tooth decay, even for babies and toddlers. Read more in our Bottle Rot article here.

Dentist teaches child how to properly brush their teeth.
Make sure your child is using a fluoride toothpaste, is flossing daily and don't forget to supervise them when they're brushing their teeth.

Signs of tooth decay in children

Early detection of your child’s tooth decay can stop a small lesion from turning into a damaging cavity.

Outside of regular dental check-ups, be on the lookout for repeating patterns of pain, pressure and sensitivity. Complaints of pain can be tricky to decipher in small children, but a pattern can tell you all the difference between a cavity and a one-off, unrelated problem. 

If pain only happens when your little one is chewing, or in the presence of hot/cold temperatures, it may be a cavity. Cavities that have had time to develop will be visible as dark areas in crevices. It’s worth checking your child’s teeth as a part of their regular tooth brushing routine. 

Tooth decay fact: certain medical treatments will increase the chances of tooth decay. Children are less likely to be included in this list, but it's worth knowing.

Your child might not be able to tell you where their pain is coming from. Parents should be on the lookout for the following signs of tooth decay in children, which can occur at all stages:

  • Complaints of toothache, particularly if there’s a pattern (i.e. at mealtimes, or ongoing heat/cold sensitivity)
  • A visible hole in the tooth
  • White, brown or black spots on the tooth
  • Swollen, sore or bleeding gums
  • Complaint of a bad taste in the mouth
  • Bad breath
  • Fevers
  • Irritability 

Take your child to see a GP if their temperature is above 38°C and they have any of the following symptoms:

  • Vomiting and refusing to drink 
  • Sudden drowsiness
  • Problems with breathing
  • Pain that doesn’t get better with pain relief medication

Concerned about tooth decay in child’s teeth?

Book your child’s next check-up online now or download our Tiny Teeth Matter for everything you need to know about caring for your little one’s smile

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Stages of child tooth decay

While tooth decay in children can be damaging, the good news is – cavities don’t form overnight. If you can identify kids' tooth decay in the early stages, you will save a lot of unwanted tears! 

Here are the stages of child tooth decay to watch out for: 

Stage one: white spots

As plaque begins to build up on the tooth, small white spots will start to form. This process is known as demineralisation. This very early stage of tooth decay is reversible with the right treatment.

Stage two: enamel decay

At this stage of decay, teeth can't restore the minerals they need. A lesion forms inside of the tooth, which breaks down the enamel under its surface. If left unchecked, the surface of the tooth might break. Make sure you visit your dentist right away if this happens.

As plaque begins to build up on the tooth, small white spots will start to form.
If you can identify kid's tooth decay in the early stages, you will save a lot of unwanted tears!

Stage three: dentin decay

At this stage of tooth decay, your child will start feeling some amount of pain. The dentin is the layer of your tooth that lies between the enamel and the pulp. Once the decay eats through the enamel, it will begin to break down the dentin.

A dental filling is the best treatment to prevent the bacteria from spreading any farther.

Stage three: pulp deterioration

The pulp is the centre of the tooth. As the decay infects the pulp, it will stop producing dentin. Instead, pus will form around the pulp, killing all the blood vessels and nerves inside the tooth. 

When the decay reaches the pulp, your child will be in a lot of pain. At this stage of tooth decay, the only treatment option is a root canal.

Stage four: abscess formation

This is the most painful stage of tooth decay. Once the decay reaches the root tip of the tooth, an abscess will form. This can cause the gums and tongue to swell, and it risks infecting the surrounding bones.

Your child will need immediate treatment, which could include a root canal, an extraction, or another type of oral surgery to remove the abscess.

Stage five: loss of tooth

Tooth extraction is the only option if earlier stages of tooth decay have been untreated. Early identification of your child’s tooth decay is key to saving your little one’s natural teeth and avoiding long-term consequences. 

If you’re concerned about your child’s teeth rotting at any stage, contact us today to talk about different treatment options or book them in for a dental check-up as soon as possible.

How to treat tooth decay

Unfortunately, there's no way to reverse the damage of children’s tooth decay at home. As soon as you detect child tooth decay, it’s best to take them in to see the dentist. They will assess the stage of decay and talk you through treatment options. 

Once a cavity forms, brushing can no longer slow down the damage caused by bacteria. The bacteria has had the opportunity to ‘sit’ in the cavity and create even more decay.  A filling is the most common and effective treatment for a cavity, typically lasting around 10 years.

However, a filling isn’t a permanent defence from future cavities. Without the proper preventative care at home, new cavities can form around the edges of a filling.

A dentist examines a child’s mouth to determine the stage of tooth decay.
As soon as you detect child tooth decay, it's best to take them in to see the dentist. They will assess the stage of decay and talk you through treatment options.

If a cavity reaches the nerve at the dentin below the enamel, the pain can become excruciating. In this case, the most likely treatment option will be a root canal, which will protect the formation of adult teeth below and prevent the spread of infection.

It's difficult to combat children's tooth decay without the guidance of a professional. Even those with the best dental hygiene can get cavities. It's not always possible to rely only on children's testimony, or looking with the naked eye. 

To fully prevent, detect and treat children's tooth decay, kids need great care at home, strong oral hygiene and routine check-ups at the dentist.

At TL Dental, we believe in getting kids comfortable with the dentist from an early age. Want to ensure your child’s next visit to the dentist is a relaxed and (dare we say) enjoyable one? Easily book an appointment online now — it only takes a few clicks!

Preventing tooth decay in children

As they say, prevention is the best cure - especially when it comes to decay in children’s teeth. Curbing children’s tooth decay before it gets to its final, painful stage begins with good oral care at home.

Put simply: if plaque sits unchecked on the surface of your kid’s teeth, it rapidly increases the rate of developing cavities. 

As we mentioned earlier, diet plays a huge role in prevention. Sweet acidic foods get turned into plaque very quickly. If your kid’s diet is high in carb-rich foods, processed snacks, sugars, fruit juices and fizzy drinks, you're giving tooth decay a head-start.

As any parent knows, it’s almost impossible to eliminate sweet foods entirely (bribes or birthday parties, anyone?) so—realistically—your best plan of attack is to be proactive with brushing. Make sure your child brushes their teeth thoroughly at least every morning and night. Especially after special treats!

We can prevent children’s tooth decay by teaching them  good oral care at home.
Curbing children's tooth decay before it gets to its final, painful stage begins with good oral care at home

A quick word on sugar-free: it’s easy to assume that sugar-free versions are fair game. But all fizzy drinks and most sugar-free treats are acidic enough to temporarily weaken enamel and allow bacteria to thrive.

The best ways to prevent tooth decay in children: 

  • Teach good oral hygiene as soon as children get their first teeth
  • Brush after every meal: half of all Australians brush their teeth at least twice per day. When possible, brush your child’s teeth after lunch (and treats), too
  • Try a finger toothbrush after snacks—they're fun, easy to use, and fast
  • Offer veggie-based snack alternatives first 
  • Floss early: it can take a while to get the hang of it, but encouraging your child join in your flossing routine will pave the way for good habits later on
  • Stick to fluoride-based toothpaste 
  • Non-alcoholic mouthwash is safe for adolescents and will help guard against gum disease

While tooth decay in children can be harmful if untreated, it doesn’t need to be an extra source of stress for busy parents. Prevention, early detection and treatment are possible with proper oral hygiene and dental care.

If you’re concerned about possible decay at any stage, don’t hesitate to come in for a dental check-up - and save yourself a literal toothache later!

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