Tooth decay (also known as caries or cavities) is the most common chronic childhood disease in the United States (even more prevalent than asthma!). Dental cavities affect 50% of first-graders and as many as 80% of 17-year-olds. Research has shown that children with cavities miss millions of hours of school due to dental symptoms and as a result their academic performance suffers. Infants and toddlers can be affected by cavities as well. Once a child’s diet includes anything other than breast milk then the erupted teeth are susceptible to decay.

So what exactly is tooth decay and how do you get a cavity? Tooth decay (cavities) is actually a disease caused by bacteria. It is not a life threatening disease and it is actually very preventable with proper oral hygieneYour mouth is full of all kinds of bacteria that normally live there. These bacteria all stick together and form plaque that sticks to your teeth. The main bacteria contained in plaque that causes cavities is called Streptococcus mutans. Strep mutans and some other bacteria break down sweet foods and starchy foods (view our diet section) to produce acid! The acid eats away at your teeth and dissolves the minerals in your tooth. Our body naturally fights this acid with the saliva in your mouth. The saliva buffers against the acid and makes it less likely to erode the minerals from your teeth. There are also minerals dissolved in your saliva that can be deposited on your tooth to replace some of the minerals that acid eats away. If the acid is allowed to stay in contact with your teeth too long or too frequently then eventually it eats away enough minerals that you end up with a hole in your tooth. This hole is a cavity!

Early Childhood Caries (Baby Bottle Cavities)

One form of cavities that pediatric dentists are unfortunately all too familiar with is Early Childhood Caries (ECC). Early Childhood Caries causes rapid and severe destruction of baby teeth, usually starting with the front teeth. Early Childhood Caries was formerly known as baby bottle tooth decay because is commonly associated with children that go to sleep while breast-feeding or bottle-feeding. ECC is actually associated with the frequent consumption of sugary liquids like soda, juice, or sweet tea in the bottle, sippy cup, or just a plain, regular cup. Consumption of these types of drinks is especially problematic when it occurs at night when a child sleeps with a bottle or sippie cup. In addition, children are at risk of getting ECC even if they are sleeping with a bottle or sippie cup containing milk or breast- feeding at night. At night, the flow of saliva decreases which diminishes the natural self-cleansing action of the mouth. ECC begins with destruction of the upper front teeth and then spreads to the back teeth on the top or bottom. Due to the destructive nature of these cavities the teeth sometimes need to be pulled or fixed with stainless steel crowns. Due to the young age of these affected children and the number of teeth affected, some children with ECC have to be treated under general anesthesia in the hospital

Early Childhood Caries

Most common locations for cavities

There are two areas of the teeth that are more likely to get cavities than others. Back baby molars and the permanent molars have very deep grooves and pits on the chewing surface. These grooves and pits are perfect places for bacteria to hide and your toothbrush bristles often cannot reach into these grooves and pits to remove the bacteria. Even if you are brushing well you may not be able to get all of the bacteria out of the pits and grooves and eventually you may get cavities. These deep grooves and pits can be removed by placing dental sealants in them. The other location where you are susceptible to cavities is between the teeth where the teeth touch together. Once again, this is an area where bacteria can hide and not be reached by a tooth brush. If your teeth touch together tightly (most adult teeth do and many children’s teeth do as well) then your tooth brush bristles cannot get between them to remove the bacteria. Luckily, these bacteria can be removed with floss! Floss can get between your teeth and remove the bacteria that toothbrushing will otherwise miss. For this reason flossing needs to be done daily!

Preventing cavities

Tooth decay is a preventable disease. With a lot of diligence and good habits you can keep your child from ever getting a cavity. Practicing good oral hygiene and making sure that you children eat a proper diet and avoid problematic foods and drinks can remove the sources that cause cavities. Check out or sections on diet and oral hygiene One extremely important tip is to make sure that infants and toddlers are not going to bed with a bottle or sippie cup or frequently drinking sweet drinks (soda, juice, sports drinks) from a bottle or sippie cup. Getting your child started early with dental visits is a great way to stay on top of things and make sure that everything is being done to keep your child cavity free!

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