Tooth Decay in Babies and its Consequences

Introduction

Don't underestimate those tiny teeth! Baby teeth play a crucial role in a child's health and well-being, even though they are temporary. But what happens if they get damaged or lost too early due to decay?

Importance of baby teeth

The first set of teeth in each person is often referred to as baby teeth, milk teeth, primary, or deciduous teeth. Children have 20 primary teeth, which are eventually replaced by permanent teeth over time.

• Baby teeth play several important roles in a child's development. Firstly, they are essential for chewing food properly, which is crucial for proper digestion and nutrition
• Secondly, baby teeth help in speech development, as they work together with the tongue, and lips to form sounds correctly¹
• Additionally, they contribute to the aesthetic appearance of a child. Baby teeth serve as space maintainers for permanent teeth. They hold the space in the jaw until the permanent teeth are ready to come in

Tooth decay, or caries, occurs due to the action of bacteria in the mouth. These bacteria metabolise sugars, producing acids that eventually lead to the breakdown of tooth enamel and subsequent tooth decay. It is a public health problem, especially in young children.

According to the statistics of the sixth National Dental Epidemiology Programme survey of 5-year-old children in England, in 2022, 29.3% had experienced enamel or dentin decay, and 6.8% of these children required one or more teeth extractions.² Tooth decay in baby teeth is known by several names, including early childhood caries, baby bottle-fed caries, nursing caries, and rampant caries.³

Causes of decay in baby teeth

Feeding practices

• Prolonged bottle use, especially with a higher sweet content at bedtime, correlates significantly with baby teeth decay
• Even nocturnal breastfeeding after 12 months of age increases the risk of decay due to prolonged contact with milk and reduced saliva production at night^1,4,5

Frequent snacking

Regular consumption of starch-containing chips and high-sugar snacks like candies, cookies, and ice cream, is associated with a higher prevalence of tooth decay among children.⁵

Poor oral hygiene habits

• Improper technique and reduced frequency of tooth brushing play a significant role in the occurrence of tooth decay in children^6,7 
• Additionally, children who brushed their teeth unaided had a significantly higher proportion of plaque compared to those who received adult assistance
• Despite recommendations, only 50% of five-year-olds and 15% of eight-year-olds were helped by parents in brushing their teeth⁸

Non fluoridated area

Fluoridation reduces the incidence of tooth decay.

• Children residing in areas with non-fluoridated water exhibit higher rates of tooth decay compared to those in non-fluoridated areas
• According to the Water Fluoridation: Health Monitoring Report for England 2022 higher fluoride concentrations are linked to a 4% reduction in dental caries prevalence among 3-year-olds and a 5% reduction among 5-year-olds, with corresponding severity reductions of 38% and 32%, respectively
• There was a 60% lower incidence rate of hospital admissions for carious tooth extraction compared to those with the lowest fluoride concentrations⁹

Appearance of baby tooth decay

• Tooth decay begins with the formation of white spots along the gum line of affected teeth. This is usually missed by parents and the child
• As decay advances, light brown discolourations are seen on the tooth surface
• With further progression, the cavities deepen, encircling the teeth neck as a dark brown to black collar
• If left untreated, the crowns are destroyed leaving root pieces
• The decay is generally first seen on the upper front teeth (4 incisors), and they are often involved concurrently

Consequences of tooth decay in baby teeth

Pain and discomfort

Tooth decay commonly presents with pain, initially as sensitivity and later progressing to intermittent and continuous discomfort.

• The pain intensifies when consuming sweets or hot/cold drinks. It makes eating difficult, subsequently affecting nutrition
• Due to poor appetite, children with nursing caries are significantly more likely to weigh less than 80% of their ideal weight¹⁰
• Children with caries reaching the pulp faced a higher risk of having a below-normal BMI compared to children without such infections
• Severe pain may necessitate hospitalisation, extraction of decayed teeth and even treatment under general anaesthesia or sedation¹¹
• Pain from decayed teeth may worsen when lying down, potentially disrupting sleep patterns

Tooth decay affects the overall quality of life in children.

Infection

Decay progresses to the deeper portion of the tooth leading to a periapical abscess occurring at the tip of the root.¹² It presents as a fluctuant swelling in the gums near the decayed teeth. If left untreated, there is a serious consequence of the spread of a tooth infection to the deep spaces of the head and neck. It can result in:

• Cellulitis
• Osteomyelitis
• Brain abscess
• Airway obstruction
• Carotid infection
• Sinusitis
• Septicemia
• Meningitis
• Cavernous sinus thrombosis
• Acute otitis media
• Orbital abscess
• Loss of vision^1,13,14

Impaired speech development

Temporary lisping may occur on premature loss of front teeth in children. They should resolve once the succedaneous permanent teeth erupt.

Impact on surrounding structures

• Untreated baby tooth decay will subsequently result in loss of the teeth
• Premature loss of baby teeth due to severe periapical infection can impact chewing ability and may influence the growth and development of the jaw¹⁵
• Infection in primary teeth can affect surrounding tissues, including the tooth germ of a permanent successor
• This can lead to issues like abnormal eruption or development, including changes in tooth shape or incomplete root formation
• There is a risk of space loss due to the adjacent teeth naturally moving into the space left by the missing baby tooth
• The space loss may lead to issues such as delayed or misplaced eruption of permanent teeth, causing misalignment and tooth crowding^15,16
• Children with cavities in their baby teeth are more likely to have cavities in their permanent teeth

Prevention of tooth decay in baby teeth

Diet habits

• The frequent consumption of sugary foods and drinks should be avoided
• Children should not eat or drink anything after brushing, except for water, before going to bed
• Babies should not be allowed to go to bed with a bottle filled with anything but water

Oral hygiene habits

• After each feeding, the baby's gums should be gently wiped with a clean, damp washcloth
• Once their first tooth emerges, daily brushing of the baby's teeth should begin
• Children should brush their teeth twice a day under the supervision of parents, at least until the age of 7
• Fluoride toothpaste should be used, with a smear for kids below three years and a pea-sized amount for those aged 3 to 6 years¹⁷

Dental checkups

• The first dental visit is recommended by 12 years of age or within six months after the eruption of the first tooth
• Periodic dental checkups should be scheduled at least once in 6 months
• You should ask your dentist for a fluoride supplement if you live in an area without fluoridated water
• Additionally, dental sealants and fluoride varnish should be considered, as both are applied to the teeth for added protection¹⁸

FAQs

When does tooth decay begin in babies?

Babies can develop tooth decay as soon as their teeth start coming in. One risk factor for this, known as "baby bottle tooth decay," is when babies' teeth are exposed to sugary liquids like milk, and formula for long periods.

When should I take my child to the dentist for the first time?

The first dental visit should be scheduled at 12 months of age.

How is tooth decay treated in children?

Management of tooth decay in children is decided based on the severity and extent of the condition.

• Fluoride treatments can help restore tooth enamel and reverse cavities in the early stages
• Restorations using dental cement are a common treatment option for cavities
• Crowns may be necessary for teeth with extensive decay to protect the tooth and reduce the risk of fracture
• Root canal treatments are performed when decay reaches the inner pulp of the tooth, aiming to repair and save the tooth
• Tooth extractions may be required for severely decayed teeth that cannot be restored

Summary

Baby tooth decay is caused by bacteria interacting with sugary foods on tooth enamel. It may result in pain, difficulty eating, and sensitivity to certain foods. Severe cases can lead to dental abscesses or infections. If untreated, can spread to other parts of the body, potentially causing serious health issues.

Additionally, untreated decay can lead to premature loss of baby teeth, which can affect nutrition, the proper alignment of permanent teeth and speech development. Therefore, it's crucial to maintain good oral hygiene practices, including proper brushing techniques and regular dental checkups, to prevent and address baby tooth decay effectively.