My child is so young. Why do they have holes in their teeth?

Early Childhood Caries: Causes, Treatment, Prevention

What Is “Early Childhood Caries”?

Tooth enamel is a hard protective layer of teeth whose job is to protect the tooth from chewing, biting, crunching, and grinding. Although enamel is a calcified tissue and the hardest substance in the human body, it cannot repair damage from decay because it contains no living cells.

That’s why tooth enamel needs to be protected by good dental hygiene habits, and a balanced diet since your child’s first tooth appears in their mouth.

Tooth Decay in Children

The enamel in baby teeth is softer and thinner than permanent teeth, making them more susceptible to tooth decay and cavities.

Tooth decay, also called dental caries, can be defined as permanently damaged areas in the teeth. Tooth decay can occur both in adult teeth and baby teeth.

Early childhood caries (ECC), also known as baby bottle tooth decay, infant feeding caries, or nursing bottle caries, is very prevalent and refers to tooth decay in young children.



You are probably wondering about the relationship of the name bottle with ECC. One of the most common causes of tooth decay in children is that some parents usually send the baby to bed with a bottle of formula or milk in their mouth. Therefore, the baby’s teeth are exposed to sugar long enough to make the enamel weak and prone to decay.

Saliva is the body’s natural first line of defence against decay, but saliva flow is low during sleep and cannot wash away sugar out of your child’s mouth into their stomach and prevent tooth decay.

What Causes Tooth Decay in Children?

Tooth Decay Process

If your child’s teeth are exposed too often to sugary stuff, the bacteria in the mouth and within dental plaque will feed on the sugar and produce acid as a waste product. These acids attack the tooth enamel, making it vulnerable to damage.

The weakened enamel is no longer strong enough to work as a protective covering due to having holes or cavities in the tooth. That’s when tooth decay starts to show its early signs.

Children may have an increased risk for tooth decay because:

  • they have softer and thinner enamel
  • might be exposed to too many sugary foods and drinks
  • do not practice proper oral hygiene
  • may not brush their teeth adequately and regularly


Did you know your child can receive cavity-causing bacteria from your or other family members through saliva? The more your child’s mouth is in contact with the saliva of others, the higher risk of tooth decay they have.

Make sure your child does not use other people’s eating utensils, not even yours, to reduce the risk of transmitting cavity-causing bacteria.

Dental plaque refers to a sticky substance that constantly forms on the teeth and must be removed regularly to prevent tooth decay, bad breath, and other dental problems.

Good dental hygiene, proper daily brushing and flossing, and regular dental checkups are ways you and your child can try to get rid of plaque buildup on your teeth.

 Signs of Tooth Decay

Unfortunately, tooth decay may not show any apparent signs on a baby tooth at its early stages. Your child may not even feel any pain or discomfort when tooth decay is at its earliest stage, so you may not notice that a cavity is forming on your child’s teeth until the later, more serious stages.

When To See a Dentist

Your child will get their first primary teeth at around six months of age. That’s when they should have their first dental checkup with a paediatric dentist.

Regular dental checkups with your child’s dentist can be especially beneficial because a pediatric dentist can spot any warning signs and prevent cavities before they turn into a more complicated dental health issue.

Here are some warning signs parents should be on the lookout for:

 1- Emergence of white spots on the tooth surface near the gum line. This early sign which typically goes undetected may cause tooth sensitivity in the child.

2- Emergence of yellow, brown, or black spots on the baby teeth near the gum line.

3- Your child may start to feel pain around the affected area.

4- Your child’s baby teeth may start to get a darker shade of brown to black. That usually indicates that the cavity has become deeper.

5- Young children may become fussy and cry more often since they cannot state the source of their inconvenience.

6- Your child may avoid eating because of discomfort and possible pain they feel around the affected tooth.

How to Prevent Tooth Decay In Children

Dental Care Tips For Good Dental Health

Here are some useful tips for preventing tooth decay in baby teeth and improving their oral health:

  • Avoid sending your child to bed with a bottle of milk, formula, or fruit juice.
  • Avoid dipping your child’s pacifier in anything sweet.
  • Start brushing your child’s teeth as soon as their first baby teeth emerge in their mouth.
  • Healthy eating is also vital to having healthy primary teeth and adult teeth.
  • Cavities occur if your child eats sugary foods and drinks without brushing teeth with fluoride toothpaste.
  • Children with a sweet tooth may have a higher risk of developing ECC. You can prevent decay by limiting your baby’s intake of sweet drinks like fruit juices and soft drinks.
  • Schedule a dental appointment for your child as soon as they get their first teeth and no later than their first birthday to ensure their oral health.
  • When you brush teeth for your child, be on the lookout for any warning signs of cavities.
  • Teach your children to drink from a feeding cup when they turn six months.
  • Children who are eighteen months to five years old can use low fluoride toothpaste.
  • Children aged six and more can use a pea-sized amount of fluoride toothpaste to brush their teeth twice a day.
  • One of the key points in having proper oral health is applying the correct technique of brushing. Since children may not be able to brush their teeth properly, parents are recommended to observe their children’s brushing until they reach eight years old and can brush their own teeth properly.

Fluoride can prevent cavities by strengthening the enamel. According to the American Academy of Pediatric Dentistry: all children should wash their teeth twice a day with appropriate amounts of fluoridated toothpaste.

Ask your child’s pediatric dental professional to see whether your child requires fluoride supplements.

How Is Tooth Decay Treated in Children?

Tooth decay needs to be addressed by a professional pediatric dentist. Severe tooth decay can cause pain, infection, and discomfort for your child and may even affect their nutrition, speech and jaw development.

The type of dental treatment for tooth decay will be determined based on the extent of the decay.

Below you can see common treatment options a dentist may decide to go for to treat tooth decay and improve your child’s oral health:

  • Fluoride varnish
  • Dental Fillings
  • Dental Crowns
  • Root Canal
  • Tooth Extraction

Brisbane Dentist for Children

You are welcome to call us on Brisbane Kids Dentist on 07 3343 4869. You can also book online and schedule an appointment.