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,
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
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
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:
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
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
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.