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What causes early childhood cavities?

Certain bacteria in the mouth produce acid that can cause dental decay. These bacteria start living in the baby’s mouth during early infancy and are usually picked up from family members who come in close contact with the baby. For this reason it is not good to kiss a baby on the lips or for a parent to lick the baby's pacifier to clean it. The oral bacteria that cause cavities thrive when there is constant exposure to sugars in baby formula and juice. That is why it is not good to let a baby sleep with a bottle. Cavities are also more common when a toddler eats something sticky like a fruit snack or candy and has it stick to the teeth. The result is prolonged exposure to carbohydrate that promotes bacterial growth right next to the teeth. That is why brushing the teeth helps to prevent cavities by cleaning both sugars and bacteria away from the surface of the teeth.

Tooth decay in infants and toddlers is often referred to as Baby Bottle Tooth Decay or Early Childhood Caries (cavities). It most often occurs in the upper front teeth, but other teeth may also be affected. In some unfortunate cases, infants and toddlers have experienced decay so severe that the teeth cannot be repaired and need to be removed. The good news is that decay is preventable. You can help prevent tooth decay for your child by following the tips below:
  • Lower the risk of the baby’s infection with decay-causing bacteria. This can be done two ways: by improving the oral health of the mother/caregiver which reduces the number of bacteria in her mouth and by not sharing saliva with the baby through common use of feeding spoons or licking pacifiers and giving them to babies.
  • After each feeding, wipe the baby’s gums with a clean, damp gauze pad or washcloth. When your child’s teeth begin to erupt, brush them gently with a child’s size toothbrush and water. (Consult with your child’s dentist or physician if you are considering using fluoride toothpaste before age two.)
  • When your child can be counted on to spit and not swallow toothpaste (usually not before age two), begin brushing the teeth with a pea-sized amount of toothpaste. The ADA recommends fluoride toothpaste; ask your dentist about your child’s fluoride needs.
  • Brush your child’s teeth until he or she is at least six years old.
  • Place only formula, milk or breastmilk in bottles. Avoid filling the bottle with liquids such as sugar water, juice or soft drinks.
  • Infants should finish their bedtime and naptime bottles before going to bed.
  • If your child uses a pacifier, provide one that is clean -- don’t dip it in sugar or honey, or put it in your mouth before giving it to the child.
  • Encourage children to drink from a cup by their first birthday and discourage frequent or prolonged use of a training (sippy) cup.
  • Encourage healthy eating habits that include a diet with plenty of vegetables, fruit and whole grains. Serve nutritious snacks and limit sweets to mealtimes.
  • Ensure that your child has adequate exposure to fluoride. Discuss your child’s fluoride needs with your dentist or pediatrician.
Early childhood cavities, or ECC, is caused by extended exposure to sugary liquids. A pacifier covered in honey may be appealing to your baby, but it can also cause serious tooth decay. The same is true for a bottle that has anything other than water in it.

Continue Learning about Children's Oral Health

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.