Tooth decay in children: when does your child need to see a dentist?

If you can see a brown or black spot, a hole, or chalky white marks along the gum line of the upper front teeth, book an appointment now — none of those go away on their own. If your child has swelling of the face or gum, or pain that disturbs sleep, they should be seen the same day. Beyond that, children in Germany are entitled to regular dental check-ups from the first tooth onwards, paid for by statutory health insurance, and the whole point of those appointments is to find decay while it is still invisible to a parent. Baby teeth (Milchzähne) are worth treating even though they will fall out: they hold the space for the permanent teeth behind them. And decay in small children develops fastest through what is in the bottle or beaker between meals, not through what they eat at the table.

Every dentist hears the same reasonable objection: they are going to fall out anyway.

The last baby molars stay in place until around the age of twelve. A tooth lost at four therefore has eight years of work left to do, and it does four things during that time.

It holds the space. Baby molars keep a gap open for the permanent tooth forming underneath. Lose one early and the neighbours drift into the space, so the permanent tooth arrives with nowhere to go. A significant amount of childhood orthodontics traces back to a baby tooth lost too soon.

It shapes speech and chewing, and protects the tooth underneath. Front teeth are involved in forming several sounds, children who cannot chew comfortably change what they will eat, and the developing permanent tooth sits directly beneath the root of the baby tooth — untreated infection at that root is right next to it.

It sets the pattern. A child whose first difficult experience is a painful one learns something about dentists that takes years to unlearn. A child whose first visits involve counting teeth and a ride in the chair learns something else.

There is a further practical point specific to small children: decay travels faster in baby teeth. The enamel is thinner and the nerve sits closer to the surface, so the distance from a small brown mark to a tooth that hurts at night is measured in months rather than years.

The pattern in early childhood is different from the adult one, and it has very little to do with how much sugar is eaten in total.

It is about frequency, not quantity. Every time something sweet or starchy reaches the mouth, plaque bacteria produce acid and the teeth spend a stretch of time demineralising before saliva restores the balance. A biscuit eaten in one sitting is one acid episode; the same biscuit nibbled across an hour in the pushchair is a long one.

The bottle and the beaker are the classic culprits. Juice, sweetened tea, milk or formula sipped continuously — and above all overnight — bathes the upper front teeth in sugar precisely when saliva flow is at its lowest. The result has a name, early childhood caries (frühkindliche Karies), and its signature is chalky white bands along the gum line of the upper front teeth, later turning yellow-brown. The lower front teeth are often spared, because the tongue covers them during drinking.

Sugar hides in things that do not taste sweet. Fruit purée pouches, flavoured yoghurts, breakfast cereals, fruit teas, dried fruit that sticks to the chewing surfaces. Nothing here is forbidden; the useful change is keeping them to mealtimes rather than spreading them across the day.

Bacteria are transmitted. They are not present at birth, and usually arrive from the closest carers via a shared spoon or a dummy cleaned in an adult’s mouth. That is why dentists take the parents’ own dental health seriously in a child’s early years — it is not a reason for guilt.

Parents catch far more than they expect once they know where to look. Lift your child’s upper lip and look along the gum line — the spot most often missed, because it is hidden by the lip in a normal smile.

Two things cause confusion. Dark staining in the deep grooves of a molar is not automatically decay, and a thin dark line along the gum line in some children — black stain — is a harmless pigment deposit that comes off with a cleaning. The distinction is made in the chair rather than at home; Is it decay or just a stain? explains how the two are told apart.

This is the part newcomers most often miss, and it is generous.

Early check-ups from the first tooth. The funds cover a series of dental early-detection examinations (zahnärztliche Früherkennungsuntersuchungen, FU) through the toddler and pre-school years. These are separate from the paediatric U-examinations in the yellow booklet (gelbes Heft) and are booked with a dentist directly.

Individual prevention from school age. Cover then shifts to individual prophylaxis (Individualprophylaxe, IP): checking the teeth, showing the child how to clean them, and applying fluoride varnish to strengthen the enamel.

Sealing the permanent back molars. The first permanent molars arrive behind the baby teeth with deep grooves a toothbrush cannot clean. Sealing them (Fissurenversiegelung) is covered in the relevant age range — quick, no drilling, and as a rule well tolerated even by younger children.

Treatment itself. Fillings for children are covered as for adults: a tooth-coloured filling as standard care, at no charge, in back teeth too since the EU amalgam ban in 2025.

The entitlements are banded by age, so ask which apply to your child now. Nurseries and schools in NRW also run dental screenings, and a note home from one is a prompt to book rather than a diagnosis.

A first visit for a small child is usually undramatic: a ride up and down in the chair, counting teeth, a look with a mirror, and often nothing more. Where treatment is needed, it is usually cleaning out the decay and placing a tooth-coloured filling. Extensive decay in a very young child sometimes calls for a different approach, and we would discuss the options with you before anything is done.

Three things genuinely help beforehand. Bring them along to your own check-up first, so the room, the smell and the chair are familiar before anything is asked of them. Watch your vocabulary — avoid words the child had not thought of, including “it won’t hurt”, because children hear the noun rather than the negation; “the dentist is going to count your teeth” is enough. And do not promise that nothing will be done: if a filling turns out to be needed, a promise broken in the chair is expensive for years afterwards.

For genuinely anxious children we work in short steps, explain each instrument before using it, and can offer laughing gas (Lachgas) where it makes the difference between treatment happening calmly and not happening at all.

Your child was born prematurely, or has a chronic condition. Enamel defects are more common after a difficult start, and some long-term children’s medicines are sweetened or reduce saliva flow. Mention both — they change the prevention plan.

Braces or aligners. Fixed appliances make cleaning much harder, and white demineralisation marks around brackets are the classic consequence. This is the phase where fluoride and technique matter most.

A child who has already had a bad experience. Tell us beforehand rather than during the appointment. We start again from the beginning, at the child’s pace, with nothing done on the first visit if that is what it takes.

You are new to Germany. The dental system for children runs largely on appointments you have to book yourself, which is unfamiliar if you come from a country where school dentistry handles it. Nursery and school notes arrive in German, and they are worth acting on. We work in English with parents and children — English-Speaking Dentist in NRW sets out how the check-ups, entitlements and appointments fit together for families who have recently arrived in Wuppertal or nearby.