Dra. Cléo Salustiano In this article
SummaryHow decay starts in baby teethPrevention, children's toothpaste and when to see a dentistFAQRead nextTooth Decay in Baby Teeth: Causes, Signs and What to Do
Quick summary of this article+
Decay in baby teeth needs care because it can cause pain, infection and early loss of the tooth, which holds the space for the permanent one. It starts as a dull white spot near the gum and is favored by frequent sugar intake and by falling asleep with a bottle or while breastfeeding. Prevention includes brushing done by an adult, fluoride toothpaste in a small amount (a grain of rice or a pea, depending on age) and fewer sweetened drinks between meals. Simple cases are handled with guidance, cleaning, fluoride and small fillings; extensive decay, pain or an abscess call for an assessment and, if needed, referral to a pediatric dentist. In Mooca, Dr. Cléo Salustiano (CRO-SP 170844) sees patients every day, from 8 a.m. to 10 p.m.
Decay in baby teeth needs care, even though the tooth will fall out one day. Baby teeth help children chew and speak, and they hold the space for the permanent teeth. When decay progresses, it can cause pain, infection and what many parents call "rotten teeth". The good news is that, when it is caught early, showing up as a chalky white spot near the gum, decay can often be controlled with hygiene, fluoride and changes in habits, many times without drilling.
Parents usually notice the problem when the tooth is already dark or broken. But the signs start earlier: dull white spots on the front teeth, especially in children who fall asleep breastfeeding or drink sweetened milk, juice or chocolate milk from a bottle several times a day. This is known as baby bottle tooth decay or early childhood caries.
Dr. Cléo Salustiano (CRO-SP 170844), a dentist in Mooca, explains why decay appears in baby teeth, how to recognize the signs, how to choose and use children's toothpaste and when a child needs an assessment.
This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the general dentistry page to learn how the treatment is done here and book your assessment.
How decay starts in baby teeth
Decay is caused by plaque bacteria, which use sugar from food to produce acids. These acids remove minerals from the enamel. Baby-tooth enamel is thinner than permanent enamel, so decay can progress faster. What matters most is not only the amount of sugar but how often: snacking on sweets, sipping juice or sweetened milk throughout the day and, above all, falling asleep with a bottle or while breastfeeding keep teeth in contact with sugar for hours. At night, saliva decreases and protects less. The article tooth decay: what it is and how it starts explains this process.
Early signs: the first sign is usually a dull, chalky white spot on the part of the tooth near the gum, usually on the upper front teeth. At this stage there is no hole yet and the lesion can be stopped. Later, the spot may turn yellowish or brown, the enamel breaks down and holes appear, with teeth that chip easily.
Signs of advanced decay: a dark or broken tooth, food stuck in the tooth, bad breath, a child who avoids chewing on one side, complains when eating sweets or cold foods, or wakes up in pain. A small bump on the gum near the tooth, with or without pus, may indicate an infection at the root. Facial swelling, fever, a child who seems very unwell or has difficulty swallowing or breathing are emergency signs: go to the emergency room.
Why treat it if the tooth will fall out? Because decay in baby teeth can hurt, become infected and disturb eating and sleep, and early loss of the tooth can disrupt the space for the permanent tooth. In addition, a mouth with many cavities keeps bacterial levels high, which raises the risk for the permanent teeth coming in.
| What you see | What it may be | What to do |
|---|---|---|
| Dull white spot near the gum | Early decay, no hole yet | Visit for hygiene, fluoride and habit changes |
| Yellowish or brown spot with rough enamel | Progressing decay | Assessment to treat as soon as possible |
| Hole or broken tooth, food getting stuck | Decay with a cavity | Assessment; filling when indicated |
| Pain when eating, crying at night | Deep decay near the nerve | Prompt assessment; may require referral |
| Bump on the gum, with or without pus | Root infection (abscess) | Assessment the same or next day |
| Facial swelling, fever, difficulty swallowing or breathing | Spreading infection | Emergency room immediately |
Prevention, children's toothpaste and when to see a dentist
Protective habits: clean your baby's mouth from the first teeth; avoid letting your child fall asleep with a bottle of milk, juice or any sweetened drink; offer water between meals; keep sweets to mealtimes instead of spreading them through the day; and brush your child's teeth at least twice a day, always with an adult's help, paying special attention to brushing before bed. Until children have the coordination to brush alone, the adult does the brushing.
Children's toothpaste: what protects against decay is fluoride. A toothpaste without fluoride, or with very little, does not offer the same protection, so check the label and ask your dentist about the right concentration. The amount is small: the size of a grain of uncooked rice for younger children who cannot spit yet, and the size of a pea once the child can spit, as advised by the dentist. Keep the tube out of the child's reach. The article fluoride and dental sealants explains other forms of protection.
What the dentist does in simple cases: examines the mouth, advises on hygiene and diet, performs cleaning and fluoride application, may recommend sealants and treats small cavities with fillings. The first visit is recommended when the first tooth comes in or by the first birthday. When decay is extensive, there is pain, an abscess, many teeth are affected or the child needs a different approach, the dentist assesses the case and, when needed, refers to a pediatric dentist, as explained in the article on pediatric dentistry.
This content is for information only and does not replace an exam. Consult a dentist if you notice white spots, holes or darkened teeth in your child's mouth. In Mooca, Dr. Cléo Salustiano sees patients every day, from 8 a.m. to 10 p.m., including Sundays and holidays, and sees children for simple cases of preventive dentistry, cleaning, fluoride and early decay. If there is pain, see also the page on dental emergencies in Mooca.
Does a decayed baby tooth need treatment?
+
Yes. Even though it will fall out, a baby tooth helps the child chew and speak and holds the space for the permanent tooth. Untreated decay can cause pain, infection and early tooth loss. At the white-spot stage, decay can often be controlled with hygiene, fluoride and habit changes.
What is baby bottle tooth decay?
+
It is decay that appears early in babies and toddlers, usually on the upper front teeth, linked to frequent contact with sweetened milk, juice or other sugary drinks, especially when the child falls asleep with a bottle. It starts as a white spot near the gum and can progress quickly.
My child has rotten teeth. What should I do?
+
Book an assessment as soon as possible. The dentist checks how many teeth are affected, whether there is pain or infection and plans the care. Simple cases are treated at the office; extensive decay, an abscess or many affected teeth may require referral to a pediatric dentist. Facial swelling or fever call for the emergency room.
Which children's toothpaste should I use?
+
What protects against decay is fluoride, so choose a fluoride toothpaste and confirm the right concentration for your child's age with the dentist. The amount is small: a grain of uncooked rice for younger children and a pea-sized amount once the child can spit. An adult should supervise brushing.
When should my child first see a dentist?
+
The general recommendation is when the first tooth comes in or by the first birthday. At that visit, the dentist examines the mouth, advises on hygiene and diet and spots early signs of decay, such as white spots.
Is a white spot on a baby tooth decay?
+
Often, yes: a dull, chalky white spot near the gum is usually the first sign of decay. But it can also be an enamel development defect. Only an exam can tell the difference. At the early stage, decay can be stopped with fluoride and better hygiene.
Does the Mooca office see children?
+
Yes, for simple cases: prevention, cleaning, fluoride, sealants, early decay and guidance for parents. Complex cases are assessed and, when needed, referred to a pediatric dentist. Dr. Cléo Salustiano (CRO-SP 170844) sees patients at Rua Hipódromo, 1141, Mooca, Monday to Sunday, from 8 a.m. to 10 p.m. Appointments via WhatsApp (11) 97409-7834, in Portuguese, English or Spanish.
