Tooth decay in children: what baby bottle tooth decay looks like, how to prevent it and how milk teeth are treated

How common is tooth decay in children in Poland?

Tooth decay in children in Poland is common even before preschool: according to the most recent national survey (2016 to 2019), it affects 41.1% of three-year-olds, 76.8% of five-year-olds and 85.1% of seven-year-olds. Severe early childhood caries was found in 20.9% of three-year-olds and 48.5% of five-year-olds.

In Podlaskie province, the region around Białystok, the proportion of children with decay rises from 32.0% at age 3 to 98.0% at age 18, and decay in milk teeth increases 2.4 times between the ages of 3 and 6. Children from rural areas are affected more often than children from towns in every age group except three-year-olds.

These are the latest data available: the Supreme Audit Office (NIK) found that the Ministry of Health did not continue national monitoring after 2020. The table shows the proportion of children with decay and the average number of teeth that are decayed, filled or extracted because of it (the dmft index for milk teeth, DMFT for permanent teeth).

What is baby bottle tooth decay and what does it look like?

Baby bottle tooth decay is the everyday name for early childhood caries, meaning any carious change, even without a cavity, in a milk tooth of a child under 6. The American Academy of Pediatric Dentistry (AAPD) classes any decay on a smooth tooth surface before the age of 3 as severe.

The first sign is often dull, chalk-white spots along the gum line on the upper incisors, which are easy to miss. Later the spots turn brown, the enamel crumbles, and the tooth starts to hurt when the child eats something sweet or cold.

The AAPD lists frequent on-demand night feeding, by bottle or breast, after 12 months of age as a behaviour that increases the risk of decay. This is not an argument against breastfeeding. The point is that the teeth should not stay in contact with milk or a sweet drink for many hours without brushing, and that it is worth raising this with the dentist when a child often feeds at night.

Which fluoride toothpaste for a child, and how many ppm?

A child's fluoride toothpaste should contain 1000 ppm fluoride from the first tooth until the age of 6 and 1450 ppm after that, and what differs above all is the amount put on the brush. This is the recommendation of the European Academy of Paediatric Dentistry (EAPD, 2019), with brushing twice a day.

Polish experts (2019 recommendations) allow 1450 ppm toothpaste for children aged 3 to 6 at high risk of decay and recommend that a parent supervise brushing until the age of 8; the EAPD says at least 7 years. Toothpastes with 5000 ppm are used only on a dentist's recommendation, in people over 16.

What protects a child's teeth from decay most at home?

A child's teeth are protected from decay above all by everyday habits, and only after that by treatments in the surgery. Decay develops when plaque bacteria have access to sugar for long periods, so what matters is both brushing and how often the child eats or drinks something sweet.

• Brushing twice a day with fluoride toothpaste, the last time before bed, and nothing to eat or drink except water after the evening brush.
• A parent going over the teeth again, even when the child wants to brush on their own.
• Water to drink between meals instead of juices, sweetened drinks and flavoured milk.
• Regular mealtimes instead of constant snacking, especially on sweets and sugary snacks.
• No milk or juice in the bottle at bedtime, and with frequent night feeds a conversation with the dentist about hygiene.
• Check-ups from the first year of life, at which the dentist assesses the risk of decay and chooses preventive measures.

Fissure sealing in children: when, and is it funded by the NFZ?

Fissure sealing in children is funded by the NFZ (Poland's National Health Fund): the first permanent molars can be sealed once up to the age of 8, and the second permanent molars once up to the age of 14. The procedure closes the grooves on the chewing surface that a toothbrush cannot reach, and it is done soon after the tooth erupts, before decay has had time to develop in it.

A 2017 Cochrane review reports that after 24 months teeth sealed with resin have 11 to 51% fewer decayed surfaces than unsealed teeth. Sealing (in Polish, lakowanie) is sometimes confused with varnishing (lakierowanie), but these are two different procedures.

• Sealing: closing the fissures of the molars with a liquid material that hardens and stays on the tooth.
• Varnishing (fluoride varnish): coating the teeth with a fluoride varnish that strengthens the enamel; on the NFZ no more often than once a quarter.
• A 2013 Cochrane review reports about 43% fewer decayed, filled or missing surfaces with fluoride varnishes in permanent teeth, and 37% in milk teeth.

How is decay in milk teeth treated?

Treatment of decay in milk teeth depends on how far it has progressed: early changes without a cavity can be stopped, a cavity has to be filled, and decay that has reached the pulp is treated with root canal treatment or by extracting the tooth. Milk teeth hold the space for the permanent ones, which is why they are treated just as seriously.

For children and young people up to the age of 18, the NFZ funds, among other things, dentine impregnation in milk teeth, fillings, pulp amputation (pulpotomy), light-cured composite in incisors and canines, and root canal treatment of any tooth.

• Early change without a cavity (a white spot): fluoride, better brushing and diet, a check after a few months.
• Dentine impregnation (silver nitrate treatment): stopping decay in a milk tooth with an agent that stains the lesion dark.
• A cavity in the tooth: removing the affected tissue and filling it, under local anaesthesia if needed.
• Decay in the pulp: root canal treatment of the milk tooth, or its extraction and keeping the space for the permanent tooth.

When are milk teeth treated under general anaesthesia?

Treating milk teeth under general anaesthesia (in Polish often called narkoza) is an option when a child is unable to cooperate in the chair and many teeth need treatment. It is a medical decision made after a joint dental and anaesthesiology qualification, not a replacement for prevention.

Since 1 January 2026 the NFZ has funded general anaesthesia for, among others, children up to the age of 3 who do not cooperate despite adaptation visits and pharmacological sedation, and who have at least 8 carious cavities or need root canal treatment or extraction of at least 4 teeth, a surgical procedure or treatment of an injury. The other criteria, including those for older children and children with disabilities, are described in a separate article on treatment under general anaesthesia funded by the NFZ.

When should the first visit be, and what does the NFZ provide for prevention?

The first visit to the dentist should take place within 6 months of the first milk tooth erupting, and no later than 12 months of age. This is the recommendation of the AAPD and the Polish Society of Paediatric Dentistry.

For the youngest children, the NFZ provides preventive visits at 6, 9 and 12 months of age and in the second year of life, with hygiene instruction for the mother and fluoride prevention. A child under 6 is also entitled to an adaptation visit, which is for getting used to the surgery, not for treatment.

How it works at DentalBlue

DentalBlue in Białystok provides paediatric dentistry and prevention: adaptation visits, professional cleaning, fissure sealing and fluoride treatment. In the clinic's price list an adaptation visit costs 250 zł, sealing one tooth 220 zł, extended fissure sealing 260 zł, silver nitrate treatment of one arch 250 zł and tooth cleaning with fluoride 250 zł. The final scope and cost are set at the visit, and prices may change.

When a child is unable to cooperate in the chair, treatment can take place under general anaesthesia in the clinic's own anaesthesiology department, after a joint qualification consultation. Eligibility for NFZ funding is checked at this qualification.