Children's Health and Wellness

Tooth Decay (Caries or Cavities) in Children

What is tooth decay (caries or cavities)?

Tooth decay (destruction of tooth enamel) is the disease known as caries or cavities. Tooth decay is a highly preventable disease caused by bacteria and other factors. It can happen when foods containing carbohydrates (sugars and starches), such as milk, soda, raisins, candy, cake, fruit juices, cereals, and bread, are left on the teeth. 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.

Who is at risk for tooth decay?

We all host bacteria in our mouths which makes everyone a potential target for cavities. Risk factors that put a person at a higher risk for tooth decay include:

  • High levels of the bacteria that cause cavities

  • Diets high in sweets, carbohydrates, and sugars

  • Water supplies with limited or no fluoridation

  • Poor oral hygiene

  • Reduced salivary flow

  • Age (children and older adults are at an increased risk for tooth decay)

What is the common progression of tooth decay and dental caries?

The following is the common progression of tooth decay and dental caries, but each child may experience it differently:

  • White spots begin to form on the teeth in areas being affected. These spots suggest demineralization (breakdown of enamel) and may lead to early sensitivity.

  • Early cavity (hole) appears on the tooth that has a light brown color.

  • Cavity (hole) becomes deeper and color turns a darker shade of brown to black. 

What are the symptoms of tooth decay and dental caries?

The symptoms of tooth decay and dental caries vary from child to child.

  • None. Cavities don't always show up with symptoms. Sometimes children don't know they have them until they are found by a dentist during an exam (looking in the mouth and visually inspecting) or by dental X-rays. 

  • Sensitivity to sweets, food and/or cold beverages. 

How is tooth decay diagnosed?

Dental caries is usually diagnosed based on a complete history, exam of your child's mouth, and dental X-rays. This may be done by your child's healthcare provider or your child's dentist

How can tooth decay be prevented?

Preventing tooth decay and cavities involves 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 fluoridated toothpaste, or supervise them brushing their 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 3 years of age, use a pea-sized amount of toothpaste.

  • Floss your child's teeth daily after age 2.

  • Make sure your child eats a well-balanced diet and limit or eliminate snacks that are sticky and high in sugars, such as chips, candy, cookies, and cake. 

  • Talk with your child's healthcare provider or dentist about the use of supplemental fluoride, if you live in an area without fluoridated water.

  • Also ask about dental sealants and topical fluoride varnish. Both are applied to the teeth.

  • Schedule routine (every 6 months) dental cleanings and exams for your child.

  • What is the treatment for tooth decay?

    Treatment, in most cases, requires removing the decayed part of the tooth and replacing it with a filling.

    What are fillings?

    Fillings (also called restorations) are materials placed in teeth to repair damage caused by tooth decay (caries or cavities). Advances in dental materials and techniques provide new, effective ways to restore teeth.

    There are several different types of restorations, including:

    Direct restorations

    These need a single visit to place a filling directly into a prepared cavity or hole. Materials used for these filings include dental amalgam, also known as silver fillings; glass ionomers; resin ionomers; and composite (resin) fillings.

    Amalgam fillings have been used for decades, and have been tested for safety and resistance to wear. Dentists have found amalgams to be safe, reliable, and effective for restorations.

    Glass ionomers are tooth-colored materials made from fine glass powders and acrylic acids. These are used in small fillings that don't have to withstand heavy pressure from chewing. Resin composites are made from glass with acrylic acids and acrylic resin.

    Indirect restorations

    These require two or more visits and include inlays, onlays, veneers, crowns, and bridges. These are constructed with gold, base metal alloys, ceramics, or composites. At the first visit, a dentist will prepare the tooth and make an impression of the area that will be restored. At the second visit, the dentist will place the new restoration into the prepared area. Some offices use newer technology called CAD/CAM (computer-aided design or computer-aided manufacturing) that allows them to make the indirect restoration in the office and deliver it at the same appointment, saving the patient a return visit.

    For an indirect restoration, a dentist may use an all-porcelain, or ceramic, application. This material looks like natural tooth enamel in color and translucency. Another type of indirect restoration may use porcelain that's fused to metal. This provides additional strength. Gold alloys are used often for crowns or inlays and onlays. Less expensive alternatives to gold are base metal alloys that can be used in crowns and are resistant to corrosion and fracture. Indirect composites are similar to those used for fillings and are tooth-colored, but they aren't as strong as ceramic or metal restorations.

    Online Source: Fluoride Use in Caries Prevention in the Primary Care Setting, American Academy of Pediatrics
    Online Source: Guideline on Infant Oral Health Care, American Academy of Pediatric Dentistry
    Online Source: Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies, American Academy of Pediatric Dentistry
    Online Source: Frequently Asked Questions, American Academy of Pediatric Dentistry
    Online Source: About Dental Amalgam Fillings, FDA
    Online Source: Alternatives to Dental Amalgam, FDA
    Online Source: Cavities, American Dental Association
    Online Source: Decay, American Dental Association
    Online Source: Babies and Kids, American Dental Association
    Online Editor: Geller, Arlene
    Online Medical Reviewer: Kapner, Michael, DDS
    Online Medical Reviewer: Sather, Rita, RN
    Date Last Reviewed: 8/1/2016
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