Understanding dental decay in young children (Early Childhood Caries)

If parents are not careful, tooth decay in children can begin very early. A large number of children in Singapore suffer from Early Childhood Caries (ECC). Read on to find out more about its causes and prevention.

A significant number of Singaporean children, aged six years and below, suffer from Early Childhood Caries (ECC) or tooth decay, which causes a huge amount of discomfort.

Many parents struggle with maintaining good dental hygiene for their children, and a number of parents are not well informed about ECC.

We spoke with Dr Toh Siew Luan, Paediatric Dentist at Thomson Specialist Dentistry, Novena Specialist Center to help parents better understand the causes, symptoms and impact of ECC.

Below she answers some of the most frequently asked questions by parents.

What is the most common dental problem seen in children?

Early Childhood Caries (ECC) or tooth decay is the most common dental problem seen in children. 40% of pre-schoolers in Singapore aged 3-6 have ECC.

How does the decay look like? What are the signs and symptoms?

Early decay appears as chalky white areas on the teeth, especially near the gum line.

As the decay progresses, minerals are lost from the teeth to form yellow or brown cavities (holes). The upper incisors (front teeth) are the most likely teeth to have caries.

Advanced decay appears as ‘broken teeth’ or cavities which are deeper and larger in area. When the bacteria advances to the pulp of the tooth, a dental abscess or ‘gum boil’ will appear. The child may complain of toothache and gum swelling. In severe cases, it may result in fever and a swollen face.

teeth decay in children

Sweets are not the only culprits of tooth decay in children.

How does the decay happen? Is it due to malnutrition / lack of calcium? My child does not eat sweets, why does he/she have decay?

Most of the time, ECC is not a result of malnutrition or calcium deficiency. In fact, it is often seen in children who are put to bed with a milk bottle containing milk or sweetened drinks. It is also seen in children who are on-demand feeding (breast/bottle) through the night after they have turned one.

Children who snack frequently, hold food in the mouth or have poor oral hygiene are also at risk of ECC.

Sweets are not the only culprit that causes tooth decay in children. Sugars are often hidden in a child’s diet, in foods such as biscuits, jam, sugar-coated cereals, juices, etc.

My older child eats the same food and is fed the same way as my younger one. Then why is it that my younger child has ECC but not his older sibling?

The bacteria that causes ECC can be transmitted from parents, caregiver or siblings to the child via saliva. The older child may not have had anyone transmit the bacteria to him when he was young.

However, as the older child develops decay later in life, he will pass his bacteria to the younger sibling resulting in decay of a greater severity and at an earlier age for the younger one. It is also harder for the caregivers to pay attention to a child’s teeth as the number of children in the family increases.

Now that you know the causes of tooth decay in children, or ECC, click on the next page to find out how to treat it.

Do we have to seek treatment for ECC? These are just baby teeth right?

Dental caries will progress to cause discomfort, toothache, gum swelling and fever. It can negatively affect the child’s self-esteem, ability to chew, sleep and performance in school.

Though these teeth are ‘temporary’, many of the teeth do not shed till the children are much older. Baby incisors shed around 6-8 years of age whereas the baby molars shed around 10-12 years of age.

Baby teeth hold spaces required for the adult teeth to erupt in good alignment. Early loss of baby teeth can result in crowding of the adult teeth.

What kind of treatment should we seek for ECC?

Depending on the extent of decay, the treatment modalities include: remineralization, dental fillings, pulp treatment, stainless steel crowns, composite crowns and extractions.

tooth decay in children

Supervised brushing can help prevent tooth decay in young children.

What if my child cannot cope with the treatment?

The kind of treatment delivered will depend on the type and extent of treatment required, as well as the age and coping ability of the child. When the child cannot tolerate treatment on the dental chair, there may be a need for sedation or general anaesthesia (GA).

Is GA for dental treatment safe for children?

Dental treatment under GA is generally safe for children and is commonly performed by a paediatric dentist with an anaesthetist in an operating room. Your paediatric dentist will be able to discuss the risks and benefits of the treatment.

How can you prevent tooth decay in children? Click on the next page to find out.

What can I do to prevent tooth decay in my child?

ECC is a preventable oral disease.

To prevent decay, it is important to develop healthy dental habits early. When your baby is little, do clean and wipe his mouth and gums with a cloth and water twice daily. When more teeth erupt, start using a toothbrush and brush your child’s teeth once in the morning and once before sleep.

When your child can spit, use a pea-sized amount of fluoride toothpaste. Brushing of teeth should be done or supervised by the adult till your child is 6-7 years old.

It is also important to develop healthy dietary habits in your child. Children should be weaned off the milk bottle just after they turn a year old. Don’t let them fall asleep with a bottle containing milk or juices and also reduce the frequency of sweet treats and drinks.

Lastly, bring your child to see the dentist for a check-up by the time they are one-year-old. Do not wait for your child to complain of a toothache before taking him to the dentist.

tooth decay in children

It is not enough to rinse your little one’s mouth; you must brush his teeth every night.

Can I just rinse the mouth after milk or let him drink water after his milk feed at night? He really needs the bottle to sleep.

The sugar in the milk can still cling onto the teeth despite rinsing and drinking water. Brushing after the milk feed is preferable.

What foods are bad for teeth?

Sweet and sticky food such as raisins, toffees and cookies are more damaging to the teeth. Food/drinks that are rich in sugar and high in acidity such as juices and fizzy drinks also have potential for causing tooth decay.

What can the dentist do to help prevent tooth decay in my child?

Procedures such as cleaning, topical fluoride application and fissure sealants are some of the simple procedures that can be done by the dentist to prevent tooth decay.