Preventing tooth decay in children rests on three habits: regular brushing with fluoride toothpaste from the moment the first tooth appears, limiting how often sugary foods and drinks are consumed, and regular dental check-ups. The enamel of baby teeth is thinner than that of permanent teeth, so decay can progress faster in baby teeth. For children at risk of decay, preventive treatments such as fluoride varnish and fissure sealants may also be considered.
Why Does Tooth Decay Develop in Children?
Bacteria in the plaque that builds up on tooth surfaces turn sugars from food into acid. This acid dissolves minerals in the enamel and causes decay to begin. How often sugar is consumed matters as much as how much. After each sugary food or drink, the teeth remain under the effect of acid for a while. Snacking at frequent intervals throughout the day prolongs the time the teeth are exposed to this effect.
The main factors that increase the risk of decay in children are:
- Frequent consumption of sugary foods and drinks during the day
- Falling asleep while drinking milk, fruit juice or sugary drinks from a bottle
- Teeth not being brushed regularly and thoroughly
- Not using fluoride toothpaste
- Untreated decay in the mother, father or siblings
Decay in baby teeth does not affect only that tooth. Pain, infection and early tooth loss can also affect a child's eating and the position of the permanent teeth. Why baby teeth need to be protected is covered in detail in the article Why Should Baby Teeth Be Treated?
When and How Should Toothbrushing Begin?
Toothbrushing begins when the first baby tooth appears in the mouth, usually around six months of age. Teeth should be brushed twice a day, and one of these should be last thing at night before bed. A children's toothbrush with a small head and soft bristles is used.
Young children cannot clean their teeth well enough on their own. Parents are therefore advised to brush their child's teeth, or help and supervise brushing, until at least the age of seven. After brushing, excess toothpaste is spat out but the mouth is not rinsed with water. This allows the fluoride to stay effective on the tooth surface for longer.
| Age | Amount of toothpaste | Fluoride content of toothpaste |
|---|---|---|
| 0–3 years | A thin smear on the brush, about the size of a grain of rice | At least 1000 ppm |
| 3–6 years | A pea-sized amount | 1000–1500 ppm |
| 7 years and over | A pea-sized amount | A family toothpaste containing 1350–1500 ppm fluoride can be used |
The fluoride content of toothpaste is stated on the packaging in ppm. It is important not to exceed the recommended amount, because young children may swallow some toothpaste while brushing. Children should not be allowed to eat toothpaste from the tube. The dentist may recommend a different toothpaste depending on the child's risk of decay.
Once the teeth start to touch each other, plaque can also build up between them. From this stage, cleaning between the teeth with dental floss can be added to daily care on the dentist's advice.
What Should You Pay Attention to in the Diet?
Preventing decay does not require banning sugar completely; the real aim is to reduce how often sugary foods and drinks are consumed. The following suggestions can help shorten the time the teeth are exposed to acid during the day:
- Limiting sugary foods and drinks to mealtimes
- Choosing snacks such as fresh vegetables, fruit, cheese and unsweetened yoghurt
- Offering mainly water and plain milk to drink
- Serving fruit juice in small amounts with meals rather than throughout the day
- Not frequently eating sweets that stick to the teeth or dried fruit
- Giving nothing but water at night after the teeth have been brushed
What Should You Pay Attention to With Bottles and Night-Time Feeding?
Letting a child fall asleep while drinking from a bottle, especially milk, fruit juice or sugary drinks, increases the risk of decay. Because saliva flow decreases during sleep, sugars from drinks stay on the teeth for longer. This type of decay usually starts on the upper front teeth.
If a child is put to bed with a bottle, it should contain only water. Dummies should not be dipped in honey, sugar or sugary liquids. Moving to drinking from a cup can be encouraged from six months, and it is recommended that the bottle is given up at around one year of age.
Breastfeeding has important benefits for the child. While night feeds continue, cleaning the teeth regularly and keeping up with dental check-ups become especially important.
Preventive Treatments a Dentist Can Provide
During the examination, the dentist assesses not only existing decay but also the child's risk of decay. The type and frequency of preventive treatments are decided according to this risk.
Fluoride Varnish
Fluoride varnish is a preventive treatment that contains a high concentration of fluoride and is painted onto the tooth surface in a thin layer. It aims to reduce the likelihood of decay by making the enamel more resistant to acid. The application is quick and painless. In children at risk of decay, it can be repeated at regular intervals, and the frequency is decided by the dentist.
Fissure Sealants
The chewing surfaces of the back teeth have deep grooves and pits called fissures. Because these areas cannot be fully cleaned with a toothbrush, decay often starts there. A fissure sealant is a flowable material applied to these grooves. By covering the surface, it reduces the build-up of food and plaque and aims to reduce the likelihood of decay.
Fissure sealants are usually applied after the permanent back teeth have come through; the first permanent molars generally appear at around six years of age. In some cases, they can also be applied to baby molars. Because the material can wear down or partly come away over time, its condition is checked at dental visits.
Regular Check-Ups
Regular check-ups allow decay to be noticed while it is still at an early stage. When a child's first dental examination should take place and how often check-ups are planned is explained in the article When Should a Child Have Their First Dental Examination?
What Are the Early Signs of Decay?
Decay often shows itself through changes that can be noticed before pain begins. In the early stage, dull, chalky white spots may appear, especially on the part of the upper front teeth close to the gums. Over time, these spots can turn into brown or black discolouration and a cavity in the tooth surface.
Some early-stage lesions can be stopped with fluoride treatments and good oral care. At which stage decay needs a filling is covered in the article How Does Tooth Decay Progress? When Is a Filling Needed?
You should see a dentist if you notice the following:
- White, brown or black spots on the teeth
- A hole or break in the tooth surface
- Sensitivity triggered by hot, cold or sweet foods
- The child avoiding chewing on one side
Assessment should not be delayed if there is swelling around a tooth or in the face, toothache with a fever, or pain that wakes the child at night.
Does a Parent's Oral Health Affect the Child?
Bacteria that cause decay can pass from caregivers to the child through saliva. For this reason, parents having their own decay treated and looking after their oral health also supports their child's oral health. Not sharing spoons and forks and not cleaning a dropped dummy in your own mouth can help reduce this transmission.
Children mostly pick up habits by watching their parents. Brushing teeth together as a family at the same time makes it easier for brushing to become a natural daily routine for the child.
Frequently Asked Questions
At what age should children start using fluoride toothpaste?
Fluoride toothpaste can be used from when the first baby tooth appears. A smear about the size of a grain of rice is enough for children under three, and a pea-sized amount for children over three.
What happens if a child swallows toothpaste?
When the recommended amount of toothpaste is used, the amount swallowed is small. Children should not be allowed to eat toothpaste from the tube, and it should be kept out of their reach. If you suspect a child has eaten a large amount of toothpaste, contact a poison information service or a healthcare provider.
What can be done if a child does not want to brush their teeth?
Brushing at the same time every day, letting the child choose their own toothbrush and brushing together can help establish the habit. Even if the child wants to brush on their own, a parent should check the teeth afterwards and clean any areas that were missed.
Is fluoride varnish safe for children?
Fluoride varnish is a preventive treatment applied by the dentist in small amounts and is widely used in children. After the application, the dentist's advice on eating, drinking and brushing should be followed.
How long do fissure sealants last?
Fissure sealants can stay in place for a long time. However, they can wear down or partly come away with chewing forces. Their condition is checked at dental visits and they are renewed if necessary.
Does fruit juice harm children's teeth?
Even natural fruit juices contain sugar and can increase the risk of decay when consumed frequently. It is better to choose whole fresh fruit and to give fruit juice in small amounts with meals.
Can decay be completely prevented with these measures?
Regular brushing, a balanced diet and preventive treatments can significantly reduce the risk of decay, but may not eliminate it completely in every case. For this reason, regular check-ups are necessary so that any decay can be noticed early.
Which preventive methods a child needs is decided according to their age, eating and brushing habits, use of fluoride, whether they have had decay before and the risk of decay identified by the dentist during the examination.
Editorial contact: info@unluakademi.com
Born in Denizli in 1995. She completed her high school education at Denizli Anatolian High School between 2009-2013. She completed her undergraduate education at Ege University Faculty of Dentistry between 2013-2018.
She worked actively at a private oral and dental health polyclinic between 2018 and 2021. As of 2022, she is pursuing a doctorate in the Pedodontics department at Aydın Adnan Menderes University.
She has participated in numerous congresses and trainings related to pediatric dentistry.
She serves as a pediatric dentist at Ünlü Akademi Dental Polyclinic.
