Early childhood tooth decay is decay in the baby teeth of a child under six. It often starts as chalky white lines or spots near the gum, usually on the upper front teeth, and turns brown or black if it is not treated. Caught early, it can often be stopped without drilling. The main causes are frequent sugary drinks, bottles in bed and brushing without fluoride toothpaste.

What is early childhood tooth decay?

Early childhood tooth decay, also called early childhood caries or baby bottle tooth decay, is tooth decay in the primary (baby) teeth. It happens when bacteria in the mouth turn sugars into acid, and the acid slowly dissolves the tooth’s enamel. The World Health Organization lists tooth decay among the most common health conditions worldwide.

It is common, and it is not a sign of bad parenting. Many children with decay have parents who brush, but whose child’s teeth still get frequent sugar exposure, such as from sipping drinks through the day.

What does it look like?

Decay moves through stages, and you can often see them:

  1. White chalky lines or patches along the gum edge. This is the earliest stage, and it can still be reversed.
  2. Light brown spots where the enamel has started to break down.
  3. Dark brown or black spots and small holes as decay reaches the softer layer underneath.
  4. Pain, swelling or a pimple on the gum when decay reaches the nerve and an infection forms. A child may refuse to eat, cry when chewing, or wake at night.

Decay often starts on the upper front teeth and between the back teeth, where the brush does not reach. Lift your child’s top lip and look at the teeth near the gum every few weeks.

What causes it?

Decay needs sugar, bacteria and time. Common causes in young children:

  • Sipping through the day. Juice, flavoured milk, squash, or milk in a bottle or sippy cup that is carried around keep sugar on the teeth for hours.
  • A bottle at bedtime with anything but water. Saliva flow slows during sleep, so sugar sits on the teeth overnight.
  • Brushing without fluoride toothpaste, or not brushing before bed.
  • Frequent snacks such as biscuits, raisins and sweets between meals.
  • Bacteria passed through saliva, for example from sharing spoons or cleaning a dummy in the mouth.
  • Weak enamel or crowded teeth, which make cleaning harder.

It is the number of times sugar touches the teeth that matters more than the amount. Our guide to fluoride for kids explains how fluoride protects enamel.

Do baby teeth matter if they fall out anyway?

Yes. Baby teeth help your child chew, speak clearly and smile. They also hold space for the adult teeth underneath. Decay in a baby tooth can cause pain, spread as an infection to the gum and sometimes affect the developing adult tooth. Losing a baby tooth early can let others move into the gap. Read more about this in our guide to why “they fall out anyway” is a myth.

How do pediatric dentists treat it?

Treatment depends on the stage and on your child’s age and cooperation.

Very early white spots
fluoride varnish, better brushing and changes to drinks and snacks. At this stage the enamel can harden again, and no drilling is needed.
Decay that is not yet painful
silver diamine fluoride (SDF), a liquid painted on the tooth that stops decay from spreading and needs no drilling. It darkens the decayed area. See our guide to silver diamine fluoride.
A cavity
a filling.
A large cavity
a white (zirconia) crown, which covers and protects the whole tooth.
Decay that has reached the nerve
pulp treatment, sometimes called a baby root canal, followed by a crown. Where a tooth cannot be saved, it is removed.
Several teeth, or a very young or anxious child
treatment with laughing gas, or under general anaesthesia in hospital, so the work can be done in one session.

Our pages on fillings, white crowns and root canal treatment and sedation and hospital dentistry explain what each involves.

How can I prevent it?

Most decay is preventable with simple habits:

  • Brush twice a day with fluoride toothpaste as soon as the first tooth comes through, once in the morning and once last thing before bed. Use a smear of toothpaste, the size of a grain of rice, until age 3, and a pea-sized amount from 3 to 6. Spit, but do not rinse.
  • Help your child brush until about age 7 or 8.
  • Nothing but water after the bedtime brush, and no bottle in bed.
  • Move to a cup around 6 months, and aim to stop bottles by 12 to 18 months.
  • Keep sugar to mealtimes. Avoid sipping juice or sweet drinks between meals. Offer water, and milk with meals.
  • Do not share spoons, and do not clean a dummy with your mouth.
  • Book a first dental visit by your child’s first birthday, and then regular check-ups. See your child’s first dental visit.
  • Ask about fluoride varnish and sealants. Your dentist may suggest them for children at higher risk. See our cleaning, fluoride and sealants service.

The NHS and the American Academy of Pediatric Dentistry give similar advice.

When to see a pediatric dentist

Book a visit if your child has:

  • white, brown or black spots on a tooth
  • a toothache, or wakes at night in pain
  • swelling on the gum or a pimple that comes and goes
  • bad breath that does not improve with brushing
  • difficulty eating, or chewing on one side
  • a tooth that has been knocked or has a dark colour after an injury

Go to an emergency department or call 998 if your child has swelling of the face or neck, a fever with a bad tooth, or difficulty swallowing or breathing. A dental infection can spread.

How we can help at myPediaclinic

Our pediatric dentists see children from their first tooth. Dr. Mustafa Abdalla, Director of the Dental Department, treats childhood tooth decay, including fillings and pediatric crowns, and is trained in laughing gas and full dental treatment under general anaesthesia. Dr. Shaima Buhamer treats children from birth to 14, including full-mouth treatment under general anaesthesia and zirconia crowns. Dr. Sharifa AlHaj is trained in conscious sedation and provides laughing gas and general-anaesthesia dentistry.

We explain what we find, show you the options and agree a plan before any treatment starts. We bill three insurers directly for dental care and check your cover before the visit. Treatment not covered can be split into four payments with Tabby.

Frequently asked questions

Can a cavity in a baby tooth heal by itself?

Early white spots can harden again with fluoride, good brushing and fewer sugary drinks. Once there is a hole, it will not heal by itself and needs treatment. A dentist can tell which stage your child is at.

Is it safe to use fluoride toothpaste for a toddler?

Yes, in the right amount. A rice-grain smear under age 3 and a pea-sized amount from 3 to 6 protect teeth without a risk of swallowing too much. Brush with them, and teach your child to spit.

Does breastfeeding cause tooth decay?

Breast milk itself does not cause decay. Decay is linked to frequent sugars and poor cleaning. Once teeth are through, wipe or brush them before bed and ask your dentist for advice if you are feeding often through the night.

Is the silver colour from SDF permanent?

SDF turns the treated decay dark brown or black. The colour stays on the decayed area, and the tooth may later be filled or crowned if you want a better appearance. For many young children, stopping the decay without drilling is the priority.

Should I take my toddler to the dentist if there is no pain?

Yes. Decay often causes no pain until it is advanced. A check-up by age one lets the dentist find early signs, apply fluoride and advise you, before treatment is needed.

To book, message us on WhatsApp at 052 218 1662 or call reception on 04 430 5926.