Oral Health›Life stages

Tooth Decay in Babies and Toddlers (Early Childhood Caries)

How tooth decay starts in babies and toddlers, the early signs to look for, how bottles, cups and night feeds play a part, and what dental teams can do, from fluoride varnish to treatment in hospital.

Updated September 2026·By the OHA editorial team·10 min read·How we write
Key takeaways
  • Decay can start as soon as a baby has teeth. The first sign is often a dull white band on the teeth next to the gums, most often on the top front teeth.
  • Found early, decay can be stopped. Lift your child's lip to check their teeth, and take them to a dentist by their first birthday.
  • Keep bottles for milk or water, never juice or sugary drinks. Several health bodies advise against letting your child fall asleep with a bottle.
  • UK and Australian guidance says to start using a cup from about 6 months; US bodies say by or around the first birthday.
  • Advanced decay may need fillings or teeth taken out, and some young children need this done under general anaesthetic in hospital.

The American Dental Association says tooth decay in babies and toddlers is often called baby bottle tooth decay or early childhood caries ("caries" is the medical word for decay). The Better Health Channel (Victoria) uses early childhood caries for a more severe type. For everyday brushing and toothpaste amounts by country, see children's teeth.

How common is it?

Each country measures this differently, so the figures cannot be compared directly.

  • England: in the 2024 national survey of 5-year-olds, 22.4% had decay that had reached the dentine (the layer under the enamel). Children in the most deprived areas were more than twice as likely to have it as those in the least deprived.
  • Australia: healthdirect says about 1 in 3 children under 5 have decay in their baby teeth.
  • US: the American Academy of Pediatrics (AAP) says 23% of children get cavities before their fifth birthday.

Why do baby teeth matter?

Baby teeth help children eat and speak and guide the adult teeth into position (Better Health Channel, healthdirect), and healthdirect says decay is the major reason children lose them early. The Raising Children Network says severe decay can affect nutrition, speech and jaw development, and untreated decay can mean pain, more decay in baby and adult teeth, and anxiety about the dentist. The AAP adds that gaps from lost baby teeth can let nearby teeth shift and stop adult teeth coming in correctly.

How does it happen?

Bacteria in the mouth feed on sugars and make acid, which damages the enamel, the hard outer layer of the tooth. The Better Health Channel says baby teeth have thinner, softer enamel, and the AAP notes that even the natural sugars in breast milk and formula can start the process.

  • Sleep: the Better Health Channel explains that when a baby is put to bed with a bottle, milk can pool in the mouth while saliva flow is low. The upper four front teeth are most often affected.
  • Frequency: the Raising Children Network says grazing and sipping over long periods is more likely to cause decay, and suggests 1½ to 2 hours between meals and snacks.
  • Shared germs: the American Dental Association and the AAP say decay-causing bacteria can pass to a baby through saliva, for example by cleaning a dummy in your mouth or sharing a spoon.

What are the early signs?

The Better Health Channel describes three stages:

  • a dull white band on the tooth next to the gum line, the first sign, which is hard for parents to spot
  • a yellow, brown or black band in the same place, as decay progresses
  • teeth that look like brownish-black stumps, which is advanced decay

The Raising Children Network says the gums may look red or purple and swollen, and infection can cause lumps or pimples on the gums or facial swelling.

Lift the lip. The Australian Dental Association suggests lifting your child's top lip and rolling down the bottom lip to look, and booking an appointment if you see white, brown or black spots that do not come off.

Not every mark is decay

The Better Health Channel says about 1 in 6 children have "chalky teeth", where the enamel did not harden properly, and these can be confused with decay. See white spots on teeth.

Bottles, cups and night feeds

The NHS says to use bottles only for breast milk, formula or cooled boiled water; the American Dental Association says formula, milk or breast milk, never juice, soft drinks or sugar water. The NHS explains that sweet drinks flow slowly through a teat and stay on the teeth longer, and England's survey links decay in the front teeth with long-term bottle use with sugary drinks, especially overnight.

Night-time advice varies in wording. The NHS says that at bedtime or during the night, give only breast milk, formula or cooled boiled water. The Better Health Channel and the Raising Children Network advise against settling a baby to sleep with a bottle, the American Dental Association says bedtime bottles should be finished before bed, and the AAP says give only water or no sleep-time bottle.

Moving to a cup

  • UK: the NHS says introduce an open or free-flow cup (without a valve) from around 6 months, and discourage bottles from age 1.
  • Australia: the Better Health Channel says start a feeding cup from about 6 months, with only a cup by around 12 months.
  • US: the AAP suggests moving to a lidded cup around 12 months, and the American Dental Association says by the first birthday.

The Oral Health Foundation says training (sippy) cups should be used at meal and snack times rather than all day, hold only water between meals, and not be taken to bed.

Other things that help

  • Never dip a dummy in honey, jam or sugar (Better Health Channel, American Dental Association).
  • The Better Health Channel says fruit juice is not necessary or recommended for children, and the NHS warns that food sucked from a baby pouch can cause decay.
  • Ask for sugar-free medicines (Better Health Channel, NHS).

Fluoride varnish and other help, by country

Fluoride varnish is a high-strength fluoride coating painted onto the teeth (see fluoride explained).

  • UK: the NHS says children should be offered varnish at least twice a year from age 3, and younger children if their dentist thinks they need it. For children up to 6 whose decay risk is a concern, Delivering Better Oral Health, the UK guidance for dental teams, recommends varnish two or more times a year, a 1,350–1,500ppm fluoride toothpaste and more frequent check-ups. NHS dental care is free for children in England.
  • Australia: healthdirect says decay that has not yet made a hole can be treated by a dental professional with fluoride paste or varnish, and that toddlers at high risk may need a higher-strength toothpaste. Eligible children can get help with costs through the Child Dental Benefits Schedule.
  • US: the AAP says a paediatrician (children's doctor) may apply varnish once a child has a tooth, 2 to 4 times a year depending on risk, and recommends an oral health risk check by 6 months. It also describes silver diamine fluoride, a liquid painted onto a cavity to stop or slow it without injections, which permanently stains the decayed area black.

How is advanced decay treated?

The AAP says a cavity that keeps getting worse may need a filling, a crown (a cap over the tooth) or removal. A North Tees and Hartlepool NHS Foundation Trust leaflet says treatment can often be done with numbing injections, sometimes with sedation, but for some children a general anaesthetic (being fully asleep) is the only option, and the dentist decides.

In England there were 33,976 hospital episodes of tooth extraction for decay in 0 to 19 year olds in the year to 2025. The Office for Health Improvement and Disparities says most were likely under general anaesthetic, and that decay remains the most common reason for hospital admission in children aged 5 to 9. In Australia, the Australian Institute of Health and Welfare reports 13.9 hospital episodes for dental procedures needing general anaesthetic per 1,000 children aged 5 to 9 in 2024–25 (for all dental reasons).

The North Tees leaflet says most children recover quickly, though some feel sick or have a sore throat for a short time, and that pre-school children probably only need to be told the day before. The Wirral community trust advises following the hospital's fasting instructions exactly and having children's paracetamol and ibuprofen at home. See having a tooth out and dental anxiety.

When to see a dentist
  • You see a white band near the gums, or white, brown or black spots that do not brush off (Australian Dental Association, Better Health Channel).
  • Teeth have holes or are breaking, or the gums look red and swollen.
  • Your child is nearly 1 and has not yet seen a dentist.
  • The NHS says to see a dentist as soon as possible if you think your child has tooth decay.
Get help urgently
  • The AAP says to see a dental professional right away for tooth pain that wakes your child at night or lasts more than 60 seconds after eating or brushing, a swollen face or gums, or an infected tooth.
  • The Raising Children Network says if your child seems unwell, for example with a fever or facial swelling, and a tooth may be the cause, see a dentist or GP or go to an emergency department straight away.
  • Call 999 or go to A&E (or your local emergency number) if your child is finding it hard to breathe, speak or swallow, has a lot of swelling in the mouth, cannot open their mouth, or has a swollen eye (NHS).

Frequently asked questions

Does breastfeeding cause tooth decay?

Delivering Better Oral Health says breastfed babies experience less tooth decay, and the AAP says studies suggest breastfeeding in the first year may halve the risk. The AAP also says milk left in the mouth when a baby falls asleep at the breast can be a risk once teeth appear, and suggests gently removing the breast once your baby is asleep. If you are unsure about night feeds, ask your child's dentist or child health nurse.

Can early decay in baby teeth be reversed?

Sometimes. The Better Health Channel says very early decay can be reversed with advice and possibly treatment, but it is often not noticed until later. The US National Institute of Dental and Craniofacial Research says that at the white-spot stage, enamel can repair itself using minerals from saliva and fluoride.

Does fluoride varnish stain teeth?

The AAP says some varnishes make teeth look yellow or dull until the varnish is brushed off, 4 to 12 hours later. Silver diamine fluoride is different: it permanently stains the decayed area black, though the adult tooth that replaces a baby tooth is not stained.

Sources

  1. Baby and toddler tooth care (Best Start in Life), NHS, accessed September 2026
  2. Children's teeth, NHS, accessed September 2026
  3. Looking after your baby's teeth, NHS, accessed September 2026
  4. Drinks and cups for babies and young children, NHS, accessed September 2026
  5. Dental abscess, NHS, accessed September 2026
  6. Tooth decay, NHS, accessed September 2026
  7. Delivering better oral health, chapter 2: summary guidance tables for dental teams, Department of Health and Social Care and NHS England, accessed September 2026
  8. Oral health survey of 5 year old schoolchildren 2024, Office for Health Improvement and Disparities (GOV.UK), accessed September 2026
  9. Hospital tooth extractions in 0 to 19 year olds 2025, Office for Health Improvement and Disparities (GOV.UK), accessed September 2026
  10. Children's dental treatment under general anaesthetic, North Tees and Hartlepool NHS Foundation Trust, accessed September 2026
  11. Preparing my child for their dental general anaesthetic, Wirral Community Health and Care NHS Foundation Trust, accessed September 2026
  12. Training cups (sippy cups), Oral Health Foundation, accessed September 2026
  13. Tooth decay: young children, Better Health Channel (Victoria), accessed September 2026
  14. Looking after your baby or child's teeth, healthdirect Australia, accessed September 2026
  15. Tooth decay, healthdirect Australia, accessed September 2026
  16. Tooth decay: babies, children and teenagers, Raising Children Network, accessed September 2026
  17. Baby and toddler oral health, Australian Dental Association, accessed September 2026
  18. Oral health and dental care in Australia: dental procedures requiring general anaesthetic, Australian Institute of Health and Welfare, accessed September 2026
  19. Tooth decay with baby bottles, American Dental Association (MouthHealthy), accessed September 2026
  20. Why it's important to take care of baby teeth, American Academy of Pediatrics (HealthyChildren.org), accessed September 2026
  21. Breastfeeding after your baby gets teeth, American Academy of Pediatrics (HealthyChildren.org), accessed September 2026
  22. Bottlemouth syndrome, American Academy of Pediatrics (HealthyChildren.org), accessed September 2026
  23. Fluoride varnish: what parents need to know, American Academy of Pediatrics (HealthyChildren.org), accessed September 2026
  24. Silver diamine fluoride to stop tooth decay, American Academy of Pediatrics (HealthyChildren.org), accessed September 2026
  25. Tooth decay, NIH National Institute of Dental and Craniofacial Research, accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

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