Infantile caries: understanding, preventing and treating

Cavities in children are a common problem, but they shouldn't be taken lightly. As soon as the first baby teeth appear, the risk is already present.

Have you noticed a yellowish or brown spot ? Is your child complaining of sensitivity when eating or drinking? Even if it's a baby tooth, a cavity shouldn't be ignored. It can progress quickly , make chewing difficult, affect speech, and even impact the eruption of permanent teeth.

This article helps you identify the signs, understand the causes, and most importantly, learn how to treat it… and avoid it!

This is a progressive destruction of the tooth, caused by bacteria naturally present in the mouth. They transform the sugars in our diet into acids, which eventually attack the tooth enamel .

In children, this process can be faster. Baby teeth have thinner enamel and a more fragile structure, making them more susceptible to acid attacks. Infantile caries is defined as any lesion in a baby tooth , whether minor or well-established.

This condition can occur:

• Very early on, from the first years of life, on a single tooth,

• Or more broadly if it is not detected in time.

It's important to know that a cavity doesn't form overnight. It's often the result of an imbalance between diet , oral hygiene, and the bacterial flora of the mouth.

Two main forms are generally distinguished:

• The so-called "classic" caries , which appears in slightly older children (often after 5-6 years old). It is generally linked to a diet too rich in sugar and insufficient brushing of the teeth.

• Early childhood caries (often called "baby bottle caries"), which can appear before the age of 3.

Early eruption often affects the upper front teeth and progresses rapidly. It is frequently associated with:

• Regular consumption of sugary drinks in a baby bottle ,

• The habit of falling asleep with a bottle of milk or juice,

• Insufficient teeth cleaning from the moment the first teeth appear.

This form is particularly worrying because it can progress quickly and affect several teeth at the same time.

When a child eats or drinks something sugary, bacteria convert the sugar into acid , which attacks tooth enamel. The riskiest situations are:

• Snacking frequently throughout the day,

• Regularly drinking sugary drinks (juices, sodas, syrups),

• Consuming processed snacks full of hidden sugars,

• Falling asleep with a bottle of milk or a sugary drink,

• Eating sticky foods (like soft candies or fruit pastes) that stick to your teeth.

It's not just the amount of sugar that's the problem, but also the frequency. If a child consumes it often, their mouth remains in an acidic environment, which increases the risk of cavities. Even milk, which naturally contains sugar, can contribute to cavities if it's left on the teeth overnight.

If teeth brushing is irregular or done incorrectly, plaque accumulates. This thin layer contains bacteria that multiply in the presence of sugar. In young children, several things can make brushing difficult:

• They don't yet have enough coordination to brush properly.

• Sometimes we let them do things on their own too soon .

• The brushing is too short.

• We don't use a fluoride toothpaste that is suitable for their age.

Fluoride is important: it strengthens enamel and protects it better against acids. Without it, the enamel of baby teeth, already more fragile than that of permanent teeth, deteriorates more quickly.

It is recommended that an adult help or supervise brushing until around 6-7 years old, when the child begins to have better control of their movements.

We don't always think about it, but the bacteria that cause cavities can be passed from adults to children. Certain everyday actions facilitate this transmission:

• Share a spoonful,

• Clean the pacifier with your mouth,

• Taste the child's dish using the same utensil.

If the parents themselves have cavities or poor oral hygiene, the risk is greater. This doesn't mean all contact should be avoided, of course. But good dental hygiene habits within the family help reduce the risk of cavities in children.

At first, a cavity can go unnoticed. It's usually painless, but a few signs can alert you:

• A small , slightly dull white spot on the enamel,

• A localized, yellowish or light brown discoloration,

• A slightly rough area when you run your finger over it.

• A temporary sensitivity to cold or sweetness ,

• Slight discomfort during brushing.

This white spot often corresponds to enamel that is beginning to demineralize. At this stage, it is still possible to stop the progression with simple measures: application of fluoride, more suitable brushing , and some adjustments to the diet.

That is why you should never neglect a simple change of color, even if your child does not complain.

If left untreated, the cavity penetrates the enamel and reaches the dentin , the layer just below, which is much more sensitive. The symptoms then become more obvious and more bothersome.

You can observe:

• A small hole visible in the tooth,

• A dark brown , or even black, coloration

• Pain when chewing

• Spontaneous pain, sometimes in the form of throbbing ,

• Increased sensitivity to heat or cold ,

• Swelling of the gum around the tooth.

At this stage, it can develop into a deeper infection , such as an abscess . Your child may then refuse to eat or wake up at night due to pain. In this case, it is important to consult a doctor without delay. The earlier you act, the simpler and less stressful the treatment will be for your child.

If left untreated, the cavity penetrates the enamel and reaches the dentin , the layer just below, which is much more sensitive. The symptoms then become more obvious and more bothersome.

You can observe:

• A small hole visible in the tooth,

• A dark brown , or even black, coloration

• Pain when chewing

• Spontaneous pain, sometimes in the form of throbbing ,

• Increased sensitivity to heat or cold ,

• Swelling of the gum around the tooth.

At this stage, it can develop into a deeper infection , such as an abscess . Your child may then refuse to eat or wake up at night due to pain. In this case, it is important to consult a doctor without delay. The earlier you act, the simpler and less stressful the treatment will be for your child.

We often tend to downplay cavities in baby teeth , thinking they'll eventually fall out. However, leaving them untreated can have much more serious consequences than we realize, and quite quickly.

First, there's the pain . When the tooth gets close to the nerve, it becomes sensitive , especially at night. The child may then refuse to eat, avoid chewing on one side, wake up crying, or simply be more irritable.

Furthermore, the risk of infection should not be underestimated. A cavity that worsens can develop into an abscess at the root. This can cause a swollen cheek, fever, fatigue , and in some cases, the infection can even spread to surrounding tissues.

But that's not all: baby teeth aren't just for chewing. They also guide the permanent teeth . If a baby tooth is lost too early, the surrounding teeth can shift and take its place, which can then hinder the eruption of the permanent tooth. The result: teeth that overlap or grow in crooked.

Finally, there is the impact on morale. A damaged tooth, especially if it is visible, can really affect a child's confidence and prevent them from smiling without embarrassment.

When it is still shallow, the dentist will simply remove the damaged part of the tooth, then rebuild it with a suitable material.

Several options are possible:

• A simple filling (synthesis) with a composite material that blends into the tooth

• Applying a fluoride varnish if the cavity is just beginning,

• Sometimes, a small pediatric crown is placed to strengthen a weakened tooth.

Treatment is always tailored to the child's age. Many specialist dentists use gentle and reassuring methods to ensure the visit goes smoothly.

If the infection has progressed and reached the inside of the tooth, treatment may be a little more complex. Depending on the case, the dentist may suggest:

• A pulpotomy (to treat the living part of the tooth while preserving it),

• A pulpectomy (a deeper treatment of the roots),

• Or, if the tooth is too damaged, an extraction .

Removing a baby tooth is never taken lightly. If necessary, the dentist can place a small appliance to hold the space until the permanent tooth erupts.

In more delicate situations, or if the child is very anxious, care may exceptionally take place under sedation or general anesthesia, always in a secure medical environment.

In most cases, cavities in young children can be prevented. It's simply a matter of adopting a few simple habits, and starting as soon as the first teeth appear.

It all starts with brushing : twice a day, with a fluoride toothpaste suitable for the child's age. Fluoride helps strengthen enamel and make it more resistant. And until the age of 6 or 7, it's best to supervise brushing.

Then there's diet. What matters most isn't so much the quantity of sugar consumed, but how often. It's best to avoid snacking, save sweets for meals, and prioritize water as your main beverage. Also, be careful with sugary bottles at night: at night, saliva is less protective for teeth, and sugar can cause more damage.

Finally, let's not forget the dentist. A first visit around the age of one is recommended , followed by an annual check-up.