Common Childhood Dental Problems (& What to Do About Them)

Healthy Living

February 27, 2020

Brushing your kids’ teeth when they’re young — or worse, getting them to do it when they’re old enough — can feel like a pointless exercise. Those “baby teeth” are just going to fall out anyway, right? Well, that might be true, but it’s not the whole story. Permanent teeth do replace our starter set when we’re young, but we don’t get another set of gums. And teeth are just the figurative tip of the iceberg when it comes to dental health.

Children with dental problems miss more school and get lower grades than children who have healthy teeth according to the Centers for Disease Control and Prevention. The CDC also reports that 20% of children aged 5 to 11 and 13% of children aged 12 to 19 have at least one untreated decayed tooth.

Many of the most common dental problems in children can be prevented. Here’s what you need to know about your kiddos’ pearly whites.

Tooth Decay

Tooth decay is the number one problem that pediatric dentists see. The best way to prevent tooth decay is through regular brushing and flossing. Dental hygiene should begin very early in a child’s life to set the stage for good oral hygiene habits later:

  • Before teeth even appear, parents can (and should) wipe a baby’s gums with a soft cloth in the morning after the first meal and right before bed in the evening.
  • Once the first tooth pops up, start brushing it and any others that appear with a very soft toothbrush and plain water — no need for toothpaste yet.
  • By toddlerhood, kids can start brushing with a small amount of fluoride toothpaste. Parents should supervise brushing in children under 6, just to make sure kids are getting all the teeth and have mastered the skill of toothbrushing.

Experts disagree on this, but some kids may need a trip to the dentist by the time of their first birthday. Other pediatricians recommend waiting until around age 3 for a dental visit. If you have a history of dental problems (or your family does), you may want to start at the first-year mark because teeth problems can be genetic. Check with your pediatrician to see what she recommends.

As for fluoride, that’s still something of a controversy among some pediatricians and dental experts, but most seem to agree that fluoridated water is an effective public health measure in bolstering oral health. If your tap water doesn’t have fluoride, ask your child’s pediatrician or dentist whether he should be taking fluoride supplements to protect his teeth.


Thrush appears as a white, powdery film in the mouth. It’s common in small children and is actually a fungus known as Candida, a substance found naturally on the skin. Thrush typically isn’t a serious problem and can usually be treated with medication if needed. It’s common in kids who:

  • Are taking or have recently finished a round of antibiotics
  • Take medicine for asthma
  • Have a weak immune system
  • Use a pacifier regularly

Although it’s not a serious problem, thrush can be painful. Most cases won’t need to be treated since they’ll clear up on their own. But if thrush is causing significant discomfort or it doesn’t seem to be going away, check in with your pediatrician. An oral antifungal medication may be necessary.

Discolored or Darkened Teeth

Have you noticed darkened or discolored teeth in your children? This problem can have different causes. If it’s a baby tooth, discoloration can signal that it’s not being brushed evenly with other teeth. Uneven brushing may cause several teeth to become discolored, so make sure you’re brushing evenly for younger kids. Other causes for discolored teeth might be:

  • Certain medications, like tetracycline taken during pregnancy
  • Weak enamel, which some people are born with
  • Excessive amounts of fluoride
  • Injuries to the tooth

Color means different things here. Yellow and green teeth may indicate a genetic condition that causes too much bilirubin in the blood, for example. If careful brushing and better dental hygiene don’t help, talk to your child’s pediatrician or dentist. Damaged teeth may need to be removed, but there may be corrective procedures available to restore a tooth to its natural color.

Early Childhood Caries (ECC)

Early Childhood Caries (ECC) is an infectious disease that affects young children. Bacteria break down carbs in the body after eating, which creates an acid that can lead to mineral loss in teeth. Eventually, the teeth break down, leading to decay. ECC is painful and can significantly affect a child’s oral health — destroying her teeth and affecting her long-term health, too. You can reduce the risk of ECC by:

  • Keeping sugar to an absolute minimum. Breast milk naturally contains sugar, but drinks like fruit juice (even 100%) and other foods can contain huge amounts of sugar that a child doesn’t need. Reducing sugar intake in kids can also have other positive health benefits.
  • Starting good dental hygiene habits early, no later than when the first teeth appear. Make sure to wipe gums down after feedings, particularly right before sleeping, so the sugar can’t build up around the teeth.
  • Switching to a regular cup as soon as possible after a bottle. Dentists recommend only using a “sippy” cup as a short-term transition cup between bottle/breast and regular cup. Teaching children how to drink from a regular cup will help protect their teeth.
  • Only giving your child water between meals. Filling cups with milk or juice encourages a constant intake of sugar, which creates a perfect breeding ground for bacteria.

ECC isn’t just an occasional cavity. It’s a serious disease that not only destroys early teeth but also costs a lot to treat and manage. Children with ECC typically need surgery to repair the damage, which can range from $1,500 to $2,000. It’s also a painful condition that can impact communication, eating, sleeping, learning and playing.

Weakened Enamel

Another common dental problem in children is weakened enamel. Healthy teeth are covered with a hard substance called enamel that protects the tooth from bacteria and acids. Enamel does not regenerate if it’s damaged or eroded over time.

Children with weak enamel may complain about their teeth hurting when they eat hot, cold or acidic foods. Their teeth may also appear discolored, with white sports or yellowish-brown stains, or they might have tiny grooves and pits in the surface. Without proper treatment, weakened enamel could lead to discoloration of the teeth as well as cavities and ECC.

Fluoride treatments are the best way to protect the enamel in a child’s teeth. A naturally occurring element, fluoride helps harden teeth in children who have not developed their adult teeth and also hardens adult teeth when they emerge. Fluoride is included in toothpaste, mouth rinses and professional dental treatments. Some municipalities also fluoridate the water system as a public health measure. If yours doesn’t and you’re concerned about your children’s enamel, talk to your pediatrician or dentist about fluoride supplements.

Pits and Fissures

Adult teeth contain pits and fissures when they first break through the gum surface. These pits can collect bacteria. In most children, the fissures are small enough that regular brushing prevents any problems from forming. But since many children struggle with proper dental hygiene, these fissures and pits can lead to cavities.

Your child’s dentist may recommend dental sealants as a protective measure if she’s concerned about bacterial growth. Dental sealants are plastic-like coverings that fit the chewing surfaces of the teeth. They’re usually placed on molars because of the large chewing surface. Resistant to saliva, bacteria and food particles, sealants last up to 10 years. This makes them ideal for younger children as they learn to take care of their teeth properly.

Sealants eventually wear down, but you can get them reapplied if necessary. While most children who need sealants have them applied between ages 6 and 7, some kids might need them in the early teen years. The sooner they’re applied, the less chance there is for tooth decay.

Misaligned Bite

The official name for a misaligned bite — when the teeth are crowded or don’t line up as they should — is malocclusion. There’s no specific cause of malocclusion. Your child may have been born with a mouth that’s too small for his teeth, or it could be caused by accidents, injuries, genetic components or any combination thereof. One common contributing factor is thumb-sucking. Children who suck their thumbs after age 5 have a higher chance of developing malocclusion.

Misaligned bite can develop over time, especially as the adult teeth start to come in and need more room to grow. If there’s no room, they may become more crowded in the mouth. You might think of this as a cosmetic issue, but misaligned teeth can actually cause a host of long-term problems if left untreated. These include:

  • Trouble eating or speaking
  • Teeth grinding
  • Mouth breathing
  • Tooth decay and gum disease
  • Loss of baby teeth too soon or too late
  • Problems with the jaw joints

Malocclusion can cause serious problems, but it may also be treatable with the right interventions early in life. These might include removal of problem teeth, orthodontic devices (like braces or retainers) or jaw surgery. If you notice an underbite, overbite, gaps in your child’s front teeth that don’t close over time or other bite issues, mention them to your pediatrician or child’s dentist.

Children’s teeth aren’t just for chewing food. Teeth assist in speech development and play a critical part in how a child feels about himself. Children who have problems with their teeth may have difficulty eating, and research indicates poor teeth can lead to self-esteem issues. The earlier you address dental problems in children, the better. Practice and model good dental hygiene habits at home, and talk to a pediatric dentist for more specific tips on caring for your child’s teeth.