Dental: Cavities in Baby Teeth

 Helping Hand Logo

Cavities (tooth decay) in baby teeth used to be known as baby bottle tooth decay. Now it is called early childhood caries. Caries is the medical word for cavities.

Children of any age can get cavities, but they form faster in baby teeth than in adult (permanent) teeth. They can start to develop as soon as baby teeth come in, usually between 6 months to one year of age.

Causes of Cavities in Baby Teeth

  • Cavities are caused by sugar and a type of bacteria living in the mouth. Bacteria in the mouth change sugar in foods and drinks, including breast milk, into an acid that can eat into the hard, outer layer (enamel) of teeth.
  • The enamel of baby teeth is thinner than the enamel of permanent teeth. This makes it easier for the acid to harm the teeth and cause cavities.
  • Each time your child drinks or eats something, the acid can form within 20 minutes. Acid stays on the teeth unless removed.
  • Saliva (spit) helps wash away some of the acid. When sleeping, the flow of saliva slows down and a baby swallows less often. Then, bacteria have more time to change sugars into acid.
  • The upper front teeth and first molars are damaged first. The first signs of decay are white spots on the teeth. These may later turn into brown holes.

There is no way to avoid eating sugar. Most foods have some. This includes:

  • healthy foods – breast milk, formula, cow milk, fruit and vegetables
  • foods high in carbohydrates – cereals, crackers, bread and chips
  • foods with added sugar – cookies, chocolate milk, juice, Gatorade®, Kool-Aid® and sticky fruit snacks

How to Prevent Cavities and Have Healthy Teeth

Children are at risk for cavities when they drink or eat things with sugar often, during the day or at night and do not clean their teeth afterwards.

  • Clean your baby's teeth, gums and tongue at least twice a day with a clean wet cloth after feeding and at bedtime. Clean again after giving any medicine that has sugar (Picture 1).Clean your baby's mouth with a clean wet cloth twice a day.
  • Brush teeth with fluoride toothpaste as soon as the first tooth comes in, at least twice a day.
  • Use a bottle at feeding time only. Do not use a bottle or breastfeeding as a pacifier.
  • Do not put your baby to bed with a bottle of formula or breastmilk.
  • If your baby falls asleep while breastfeeding, remove your breast from their mouth.
  • Once the first tooth appears, avoid night feedings and frequent, on-demand feedings.
  • Wean your baby from a bottle to a cup by 12 months of age.
  • Do not give a child under one year of age, sugary drinks, juice or water. Do not add sugars, like honey, to drinks.
  • After 12 months, offer water between meals and after eating anything sugary to rinse the mouth. Do not give your child other things to drink except at meals. They can occasionally have 4 ounces of 100% juice at a meal. Read the bottle’s label to be sure that you are not giving juice drink.
  • Avoid giving gummy snacks and foods that can stick and stay on teeth for a long time.
  • Avoid licking the pacifier, spoon or cup that your child uses. This can pass your mouth’s bacteria to your child.Before age 3, use fluoride toothpaste about the size of a grain of rice. After age 2, use a pea-size amount.
  • Make sure your baby gets fluoride. It makes teeth stronger and helps protect them from tooth decay.
    • For children younger than 3, use fluoride toothpaste about the size of a grain of rice. For children age 3 and older, use a pea-size amount (Picture 2). They should try to spit out the toothpaste. It is safe to swallow small amounts if your child does not spit yet.
    • Avoid rinsing after brushing so that the fluoride is not washed away.
    • After your child’s first tooth appears, the dentist or dental hygienist may put a coat of fluoride on their teeth.

If you have any questions, ask your dentist or call the Dental Clinic at (614) 722-5650.

Dental: Cavities in Baby Teeth (PDF), Spanish (PDF), Somali (PDF)

HH-IV-12 © 2010, Revised 2021, Nationwide Children’s Hospital