Decay can begin the moment a tooth comes through the gum, because from that moment the tooth is exposed to bacteria, sugar and acid. There is no protected period. A child's first tooth typically appears around six months, and it is vulnerable from that day. This is why a first dental visit is recommended around the time teething starts rather than at school age.
If your child's first teeth have come through, we are happy to take a look and show you what to watch for.
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Why does decay start so early in children?
Three things line up at once, and they line up early.
Baby tooth enamel is thinner
Enamel on a baby tooth is roughly half the thickness of adult enamel. The distance from the outer surface to the nerve is much shorter, so decay that would take years to become serious in an adult tooth can do so in months.
The bacteria arrive from the household
Babies are not born with the bacteria most associated with decay. They acquire them, usually from a primary carer, through ordinary shared contact — tasting food from the same spoon, cleaning a dummy in an adult's mouth. This is not a reason for guilt or for avoiding normal closeness. It is simply why a carer's own dental health has some bearing on a child's.
Feeding patterns are frequent by design
Frequency drives decay more than quantity does. Every exposure to sugar produces an acid attack lasting roughly twenty to thirty minutes, and saliva needs the gaps in between to repair the damage. Infant feeding is frequent by nature, and that is normal — but a bottle of milk, juice or cordial taken to bed, or a sipper cup carried around all day, removes the gaps entirely.
What does early childhood decay look like?
Not like a hole, at first.
- Dull white or chalky bands along the gumline, most often on the upper front teeth
- Those bands turning yellow, then brown, over the following months
- Teeth that look as though they have a shadow near the gum
- A child chewing on one side, or refusing cold food and drink
- Disturbed sleep, or irritability that nobody connects to a tooth
- Swelling of the gum above a tooth, or a small pimple-like lump
The upper front teeth are usually affected first, partly because they are the first through, and partly because the tongue does not cover them during feeding the way it covers the lower front teeth.
The chalky white stage is worth knowing about, because at that point the surface is still intact and the process can often be halted with fluoride, better cleaning and changed drinking habits. Once the surface breaks, that option closes.
If you have noticed a white or brown line near your child's gum, it is worth having checked.
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What actually prevents it?
Ordinary things, done consistently.
- Clean the first tooth on the day it appears. A soft cloth or a small soft brush is enough at the beginning.
- Use fluoride toothpaste in the amount appropriate for the age. Australian guidance is a smear of low-fluoride toothpaste from around 18 months, moving to a pea-sized amount of standard toothpaste from about age six. Spit, do not rinse.
- Nothing but water in a bottle or sipper between meals. Milk, formula, juice and cordial all feed the same process when they are sipped over hours.
- No bottle in the cot. Saliva flow drops during sleep, so anything left pooling around the teeth overnight has nothing working against it.
- Brush the last thing before bed. For the same reason.
- Supervise until around age eight. Children want to do it themselves long before they have the coordination to do it well. Letting them start, then finishing the job yourself, works better than a fight.
- Fissure sealants once the back adult teeth arrive. The deep grooves trap food and resist brushing; a sealant covers them without any drilling. See fissure sealants.
When should the first visit be?
Around the time the first tooth appears. That visit is not treatment — at Berala Dental it is an introduction. The child sits in the chair and looks in the mirror first, every instrument is shown and named before it is used, and nothing goes near their mouth without being explained. There is a toy at the start or the end, sometimes both.
The point of starting that early is partly clinical and partly practical. Clinically, it catches the chalky stage rather than the hole. Practically, a child who has been to the dentist a dozen times before anything is ever needed does not find the chair frightening.
Very occasionally a baby is born with a tooth already through, or one appears in the first weeks. Where it is loose enough to pose a feeding or choking risk it needs assessing straight away, which is why there is no minimum age for an appointment.
What does treatment cost if decay is already there?
For eligible children aged 0 to 17, the Medicare Child Dental Benefits Schedule is bulk-billed at Berala Dental, covering up to $1,158 per child over two calendar years for covered items including check-ups, cleans, X-rays, fluoride, fillings, pulpotomies, stainless steel crowns and fissure sealants. Medicare pays the clinic directly, so there is no out-of-pocket cost for those items. You can check eligibility here.
Where a child is not eligible: a check-up, clean and X-rays is $150 under age 10 and $250 from age 10. A filling on a baby tooth starts from $250. A stainless steel crown is $250. A pulpotomy with a crown is $550 in total. These assume no health fund contribution; a fund may pay part of it depending on your policy, and a written quote is provided before treatment begins.
Quick answers
Can a one-year-old get cavities?
Yes. A tooth is susceptible from the day it comes through, and decay in the upper front teeth of very young children is one of the more common patterns seen. It typically begins as a chalky white line at the gumline rather than a visible hole.
Is milk bad for a baby's teeth?
Milk at mealtimes is not a problem. Milk sipped continuously from a bottle or taken to bed is, because the sugars stay in contact with the teeth for hours with no saliva flow to counter them.
Should I use fluoride toothpaste on a toddler?
Australian guidance supports low-fluoride toothpaste in a smear from around 18 months, with the amount and strength increasing with age. Because guidance varies with local water fluoridation and individual risk, it is worth confirming what suits your child.
Do decayed baby teeth need treating if they will fall out anyway?
Usually yes. Untreated decay is an active infection that causes pain and disturbed sleep, can affect the adult tooth developing above, and losing the tooth early can crowd the teeth that follow. See what actually happens when a baby tooth is lost early.
Starting early is the whole point
Almost everything about children's decay is easier when it is found at the chalky stage rather than the painful one. No question is a silly one, and a first visit is meant to be one of the easier things in a family's week.
Berala Dental has provided children's dentistry in Berala since 2002.
Call (02) 9649 6468 · Book online · WhatsApp
You can also read about children's dentistry at Berala Dental, what happens at a child's first dental visit, or whether your child is CDBS eligible.
Written and reviewed by Humzah Aly, Oral Health Therapist. This article is general information only and is not a substitute for personalised dental advice. Please see a dental practitioner to discuss what is right for your child.
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