Early Childhood Tooth Decay

What Causes Tooth Decay?

Several specific types of bacteria that live on the teeth cause tooth decay. When sugar is consumed, the bacteria use the sugar and then manufacture acids that dissolve the teeth and cause an infection in the tooth. This infection is called decay, or a tooth cavity.  It is sometimes also referred to as “dental caries.”

It’s important to remember that a tooth cavity is a real infection in your body!  If it goes untreated, the infection can continue to spread to other places, including your jaw bone or cheek.  The infection can even enter the blood stream and spread to other places in your body.  

Tooth decay is considered a “multi-factorial” infection and is the number one infectious disease in childhood.  That means there are actually lots of factors that contribute to it!  Some of these include:

  • Oral Hygiene Practices at home (tooth brushing and flossing) and check-ups with the dentist
  • Diet (foods, beverages, snacks and treats… and the number of times per day they are consumed!)
  • The Tooth (teeth may grow in with defects that make the tooth prone to getting a cavity)
  • Bacteria (everyone has different types of germs in their mouth… some are meaner than others!)
  • Fluoride Levels (in toothpaste, oral rinses, water supply, or prescribed by the dentist)
  • Immune System (how your body is able to fight against germs and infections… everyone is different!)
Some factors can be controlled, and some cannot. The dentist will analyze your child’s risk for cavities during dental check-ups. This is called a Caries Risk Assessment.  The doctor may make some recommendations based on what she sees. Talk to us to learn more!  

What Is Early Childhood Tooth Decay?

According to the American Academy of Pediatric Dentistry, Early Childhood Caries (ECC) is defined as any  tooth cavity, missing tooth (from a cavity), or tooth filling in a child under 6-years old.  

A child younger than 3-years old with any sign of a cavity is considered to have Severe Early Childhood Caries (S-ECC).  Older children may also be classified as having Severe Early Childhood Caries depending on how many teeth are affected and the child’s age.    

You may think this sounds “drastic.”  Why is this definition so strict?  Think about it: some of these teeth have only been in your child’s mouth for one or two years!  Baby teeth continue to grow into the mouth until 2 1/2 to 3 years of age and they will stay there until your child is 10-to-14 years old! If the pediatric dentist sees signs of a tooth cavity early in your child’s life, it’s a red flag that some help is needed. The doctor and her staff will work with your child and family to find out why this is happening and what your changes your family can make to continue healthy oral health practices as your child grows.  Remember, adult teeth will start to grow into the mouth when your child is about 6-years old. Ask our staff to learn more!

Some Tips To Avoid Early Childhood Tooth Decay


  • Establish a Dental Home by your child’s first birthday. Visiting the pediatric dentist early will help avoid future dental problems.
  • Your baby may start “cutting teeth” at 6-months of age or earlier! With the eruption of the first baby tooth, start brushing your child’s teeth in the morning and before bedtime. This is an important habit to establish. For tips on brushing your infant’s teeth, click here, or ask your pediatric dentist!
  • Stop nursing or bottle-feeding while your child is asleep at night if possible. Most 6-month-olds do not require those extra calories in the middle of the night for healthy growth!  
  • Continue nursing as long as you or your infant would like. Avoiding “on-demand” breast feeding as your infant continues to grow will help your baby learn and maintain good eating practices.  
  • Start to teach your baby to drink from a cup at about six months of age. This can be a messy learning process!  Plan to stop using a bottle by 12 to 14 months at the latest. By 12 months, your child should be able to drink from an open cup. 
  • Don’t dip your child’s pacifier in honey or sugar.
  • The American Academy of Pediatrics does not recommend that your child take a bottle into the crib and feed unsupervised. This practice could lead to dental caries, ear infections, and possible choking. However, if your infant requires a bottle or sippy cup to go to sleep, use only water! Do not let your child go to sleep with a sippy cup or bottle containing milk, formula, or juice.  
  • Start brushing with your child as soon as they have teeth! This can be a difficult task, so don’t lose heart. Ask your dental staff for tips and pointers to make brushing easier. Starting healthy habits early will help your child learn the importance of taking care of their teeth.  Brushing will get easier the more you work at it!
  • Brush your child’s teeth twice a day, in the morning and before bedtime. Brushing at night before bed is most important and should be the last thing your child does before getting tucked in!
  • Children should have adult supervision while brushing until they are 6-to-8 years old. For very young children, this will involve actual brushing by an adult. Older children are encouraged to brush alone first and have an adult brush afterwards. Children don’t have the coordination in their hand and wrist to brush well alone.  They may miss some teeth altogether! Ask your pediatric dentist for tips on how to brush your child’s teeth.  
  • Once front or back teeth touch together, you should start flossing with your child. This will be reviewed during check-ups by our dental staff, be aware teeth might start touching together as early as 1-2 years of age.
  • Children should avoid soda pop and other sugary beverages which aren’t healthy for their growth! The AAP and AAPD recommend one cup of 100% juice (6-to-8 oz) per day.  It’s best to drink this during a meal or snack, not in-between!! Kids can drink white milk and water throughout the day if they are thirsty.  
  • Avoid sippy-cups and other closed-cups while your child is playing. Teach your child to sit and drink from an open cup when they are thirsty.  If a sippy-cup is used during play, put only water in it! Avoid  drinking juice in a sippy cup.  
  • Limit meals and snacks throughout the day. Children should have three meals and two snacks. Grazing or frequent feedings may lead to tooth cavities.  
  • Choose healthy foods. Foods high in sugar and sticky foods are more likely to cause tooth cavities. Sweets and candies are ok every once in a while (like at birthday parties or holidays), but they shouldn’t be an “every day” or “every week” thing! Making treats rare will actually make getting one a special event to your child.
  • Your kids watch everything you do, so be healthy yourself! If you take care of your teeth, eat healthy foods, and get dental check-ups, your child will pay attention to taking care of their own body as well.   

What Is Fluoride?

Fluoride helps make teeth strong and prevents tooth decay. Fluoride is an element found in nature and is very safe in small quantities. For teeth, it works in two different ways:  topically and systemically.  

Topical Fluoride is any fluoride applied directly to teeth. This type of fluoride is not swallowed and does not enter your body. It is used in toothpaste, fluoride rinses, and fluoride treatments during your dental check-ups. It works really well and helps strengthen the outside of your tooth! Certain kids may need extra topical fluoride, and the pediatric dentist may give you a prescription toothpaste or mouth rinse

Children under 3 years of age should only brush with a smear of fluoride toothpaste two times a day. Children older than 3 years of age should brush with a pea-sized amount of fluoride toothpaste two times a day. The amount is important so that kids don’t accidentally swallow too much. Check with your doctor if you have any questions!

Systemic fluoride is fluoride in city water supplies or in prescriptions from your doctor that are ingested and absorbed by the body. Teeth that are developing in your child’s jaw bones will use this fluoride to make the whole tooth stronger (not just the outside)! This type is most important while teeth are “growing” in the jaws, or until your child is about 12 years old.  

If the water where you live does not have enough fluoride, your doctor may prescribe fluoride supplements (fluoride drops or pills). You would give these drops or pills every day, starting when your child is about six months old. Only give as much as the directions say to use because too much fluoride can cause spots on your child’s teeth. Some children need to take fluoride prescriptions until they are 12 to 16 years old (or until you move to an area with fluoride in the water). This should be reviewed with your doctor, so be sure to discuss it at your next dental check-up!