Early childhood caries
- Oral pathology
Caries in babies and toddlers starts on the upper front teeth, linked to sweet drinks and night bottles. Fluoride and feeding habits prevent it.
What it is
Early childhood caries is any caries in a child under six years. The typical pattern starts with white bands on the upper front teeth near the gum, which turn brown and break down; the lower incisors are protected by the tongue and are spared until late. It is linked to frequent sugary drinks, falling asleep with a bottle of milk or juice, sweetened pacifiers, frequent night feeds after the teeth erupt, and transmission of caries bacteria from caregivers. Severe forms cause pain, abscesses, poor eating and sleep, and affect growth and school.
How to recognise it
- Classic site: upper incisors at the gum line; the lower incisors are spared until late.
- Risk: bottle with milk or juice in bed, frequent sugary drinks, no fluoride toothpaste, caregiver with untreated caries.
- Brushing should start with the first tooth, using a smear (rice-grain size) of fluoride toothpaste, then a pea-sized amount from about three years.
- Fluoride varnish applied in primary care or by the dentist reduces caries in young children.
- First dental visit by the first birthday.
Differential and risks
- Untreated decay in baby teeth matters: pain, infection, early loss and crowding of the permanent teeth.
- Severe early childhood caries often needs treatment under general anaesthesia.
- Widespread unexplained caries, missed care and injuries may be signs of neglect.
Next step / Initial management
- Lift the lip at every well-child visit to look at the upper front teeth.
- Advise no bottle in bed, cup drinking from about one year, no sweet drinks, and brushing twice daily with fluoride toothpaste supervised by an adult.
- Apply fluoride varnish where the routine pathway allows, and refer every child with caries to the dentist.
- Pain, swelling or abscess: urgent dental referral.
Test yourself
Think of the answer, then tap the question to see it.
Why are lower incisors spared in early childhood caries?
The tongue covers them during sucking and saliva from the sublingual and submandibular glands bathes them.
When should brushing with fluoride toothpaste start?
With the first tooth, using a smear (rice-grain size) of toothpaste.
What is the single most important feeding habit to stop?
Falling asleep with a bottle of milk, juice or another sweet drink.
Connections
In Pharmacology1
Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.
Sources: Early Childhood Caries (StatPearls Publishing (NCBI Bookshelf), 2023); The Role of Fluoride on Caries Prevention (StatPearls Publishing (NCBI Bookshelf), 2023); Resolución 3280 de 2018: Rutas Integrales de Atención en Salud para la Promoción y Mantenimiento de la Salud y Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018).
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Representative model, for educational purposes only.