Dental Caries (Early Childhood Caries, Tooth Decay, or Cavities)—Child Care and Schools

What is dental caries?

Tooth decay (dental caries) is the most common chronic infectious disease of childhood, leading to holes (cavities) that damage tooth structure. Early childhood tooth decay has consequences beyond appearance—it can cause severe pain, speech difficulties, poor nutrition, and disrupted sleep. It can lead to abscesses and infections of the bone underneath the cavity as well as serious infections elsewhere in the body, such as the brain, lungs, or heart. Treatment for tooth decay can require expensive dental services, which in young children may necessitate general anesthesia and treatment in an operating room. Fortunately, dental caries is nearly entirely preventable.

The caries process begins when plaque builds up on teeth, usually because of poor toothbrushing habits and inappropriate nutrition. Plaque is a sticky substance produced by bacteria that live near the gumline. Children become infected with the bacteria that cause caries early in life, often through transfer from adults and other children.

The bacteria in plaque break down sugars from food and beverages, producing acids that can damage the hard surface of teeth, called enamel . After consuming sugary food or drinks, it can take up to 40 minutes for the saliva to neutralize the acids to return the mouth to safe pH levels.

What are the signs or symptoms?

Caries begins as a change in color of the tooth, usually starting with white spots at the gumline on the upper front teeth. This indicates that acid is beginning to break down the hard enamel surface. These spots can be hard to see, even for a physician or dentist.

If left untreated, the tooth may turn yellow, brown, or black as the decay continues. The damage can lead to pain, and the child may eventually be left with a broken-off stub of tooth. Severe infections of the root of the tooth, gum, and jawbone can occur, with the risk of further complications. Because primary teeth have thinner enamel than permanent teeth, this process can occur quickly, often within just a few months. Untreated tooth decay or infection in baby teeth can lead to tooth loss, pain, and the spread of infection to the underlying adult tooth.

Dental caries in a child

ROCIO B. QUINONEZ, DMD, MS, MPH

Close-up of a child's gumline with 5 front teeth exhibiting various stages of decay, a few teeth showing brown and black spots on the surface, and others where the tooth has decayed almost back to the gumline.

How is it spread?

The bacteria that cause caries are transmitted through seemingly innocent acts that involve sharing saliva. Examples include sharing cups, spoons, or toothbrushes; moistening a pacifier or cleaning it in someone’s mouth before giving it to a baby; pre-tasting food; and, less commonly, kissing on the mouth.

How do you control it?

To prevent early childhood caries, focus on 5 measures:

• Start toothbrushing with fluoridated toothpaste once the first teeth erupt. Toothpaste amount should be the size of a grain of rice or tiny smear.

• Harden the enamel with appropriate fluoride intake and exposure, such as fluoridated water or supplements prescribed by a health professional.

• Limit total juice consumption (diluted or undiluted) as follows:

  • – Infants younger than 1 year: Avoid giving any juice, unless medically indicated.

  • – Children 1 to 3 years: Maximum of 4 ounces per day.

  • – Children 4 to 6 years: Maximum of 6 ounces per day.

  • – Children 7 to 18 years: Maximum of 8 ounces per day.

  • – Avoid other sugary beverages. Encourage the child to drink water after eating or drinking juice to minimize exposure of the teeth to acid.

• If any juice is offered, limit juice to a single sitting. Avoid letting the child carry around or sleep with drinks. Do not allow prolonged sipping from bottles or sippy cups.

• Teach children to drink from a cup as soon as they are ready to learn how to do it, usually by age 1 year.

What are the roles of the educator and the family?

• Personal oral care: Educators should care for their own teeth by brushing 2 times a day, preferably after the first meal of the day and before bed, modeling good habits for children. Educators should attend regular dental checkups.

• Child oral health

  • – Brush children’s teeth with fluoride toothpaste at least 2 times a day, preferably after meals and before bed.

  • – Teach and practice toothbrushing in early childhood education settings. If brushing with fluoride toothpaste occurs at home twice a day, toothpaste may not be required at the program. However, because many families do not accomplish twice-daily toothbrushing at home, do not assume it is occurring.

  • – While wiping an infant’s gums before teeth erupt can establish hygiene habits and clear milk residue, there is no strong evidence that wiping alone prevents dental caries.

  • – After a child’s first tooth comes in, begin brushing twice daily.

    • ❖ Children younger than 3 years should use a smear of fluoridated toothpaste (size of a grain of rice).

    • ❖ At age 3 years, children should use a pea-sized amount of fluoridated toothpaste.

  • – Encourage all children to spit after brushing, although many may not do so consistently until about age 8 years. It is safe to swallow this amount of fluoride toothpaste.

  • – Children need supervision and assistance with toothbrushing until age 8 years. Educators should wash hands with soap and water before assisting a child with toothbrushing. Focus on cleaning the gumline and inter-tooth spaces that trap food. Ideally, children’s teeth should be flossed at least once a day (with assistance until 8 years of age), either at home or at the center if time allows.

• First dental visit: Schedule within 6 months of the first tooth and no later than 12 months of age. This is an ideal time for fluoride varnish and preventive care. Children with chronic health needs should be scheduled for a dental visit as soon as the first tooth comes in and every 3 to 6 months thereafter. Checking the child’s teeth should also be part of routine preventive health care provided by the child’s health professional.

• Additional preventive practices

  • – Avoid tasting or testing the temperature of food for infants and using the same spoon to feed.

  • – Clean child-mouthed toys before sharing.

  • – Encourage regular oral health examinations every 6 months for adults and children to reduce the concentration and possible damage of caries-causing bacteria on their teeth.

  • – Limit snacking, meals, milk, and beverages other than water to planned times spread at least 2 to 3 hours apart. Avoid grazing on food and sugar-containing fluids (eg, milk, juice) throughout the day. Infants younger than 1 year should not be offered juice.

  • – Avoid sweet or sticky foods as snacks. If eaten, follow up with crunchy foods (eg, apple, celery).

  • – Avoid bottle propping or drinking from a bottle while napping as this causes prolonged contact of sugars on the teeth and promotes caries. Always provide water after meals for children older than 6 months to rinse off some food or drink substance from the surface of the teeth.

Exclude from educational setting?

No.