By Concern

Black Spots or Holes in Your Child's Teeth? Here's Everything You Need to Know.

Tooth decay is the most common chronic childhood disease in India — and the most preventable. Finding a cavity in your child's tooth is not a sign of failure as a parent. It is a signal to act.

Mother comforting child with toothache

Understanding Cavities in Children

A cavity (dental caries) forms when bacteria in the mouth feed on sugars and produce acid that erodes tooth enamel. The process can begin as soon as the first tooth erupts.

  • Sugary drinks and snacksFrequent consumption of juice, flavoured milk, biscuits, chocolates, and dried fruits that cling to tooth surfaces.
  • Inadequate brushingNot enough time, wrong technique, or missing back teeth and between teeth.
  • Night-time bottle feedingMilk or juice pooling around teeth during sleep — a leading cause of early childhood decay.
  • Deep grooves in back teethNatural pits that trap food and bacteria even with good brushing.
  • Shared utensilsCavity-causing bacteria can transfer from parent to child through spoons, cups, or by tasting food before giving it.
Do baby teeth really need treatment?

Yes — absolutely. Baby teeth hold space for permanent teeth, support chewing and nutrition, and protect the developing tooth underneath. Untreated decay causes pain, infection, and abscess that can damage the permanent tooth. A painless cavity at stage 2 is a far better outcome than a painful abscess at stage 4.

Treatment Matched to Severity

We match treatment to the exact stage of decay — from a paint-on liquid to a crown, and every option in between.

Stage 1 — White Spot Lesion

A chalky white area indicates early mineral loss. No drilling needed. We apply fluoride varnish or Silver Diamine Fluoride (SDF) to remineralise the enamel and arrest decay.

Stage 2 — Enamel Cavity

Decay has broken through the enamel surface. A small filling is required. We use minimally invasive techniques — removing only decayed tissue — and restore with tooth-coloured composite or glass ionomer cement. Most procedures at this stage require no injection.

Stage 3 — Dentine Cavity

Decay reaching the softer dentine layer progresses faster and may cause sensitivity. For deeper lesions close to the nerve, an Indirect Pulp Cap (IPC) procedure protects the nerve and allows healing.

Stage 4 — Pulp Involvement

When decay reaches the nerve, a Pulpotomy (partial nerve treatment) or Pulpectomy (full root canal for baby teeth) is required, followed by a crown to protect the tooth.

Stage 5 — Abscess or Advanced Infection

An abscess is a bacterial infection at the root. It requires immediate treatment — drainage, pulpectomy, and in some cases antibiotic therapy. Please call us the same day.

Stage 6 — Extraction

If a tooth is too severely damaged to save, extraction may be the only option. We strongly recommend placing a space maintainer to prevent drifting and crowding of permanent teeth.

No-drill options available

At the earliest stages, Silver Diamine Fluoride (SDF) can arrest and remineralise decay without any drilling — ideal for young or anxious children. For small enamel cavities, LASER dentistry removes decay without the drilling vibration and sound children find most frightening.

Prevention Plan After Treatment

  • Six-monthly checkupsProfessional fluoride varnish applied at every visit to strengthen enamel between appointments.
  • Pit and fissure sealantsApplied to newly erupted back teeth to seal grooves before decay begins.
  • Supervised brushingTwice daily with age-appropriate fluoride toothpaste — technique matters more than duration.
  • Eliminate night bottlesReplace sugary drinks with water, especially before sleep.
  • Diet counsellingA targeted, practical session for the whole family — non-judgemental, focused on frequency of sugar exposure rather than total sugar quantity.
Most Common Age
2–8 years
Peak cavity risk period
Treatment Time
20–45 min
Per tooth, depending on stage
Pain Level
Minimal
Topical anaesthesia always used first
Baby Teeth Until
Age 10–12
They matter longer than you think

What Families Say

★★★★★

"My 4-year-old had six cavities. Dr. Mittal treated four with SDF — no needles, no drilling. My daughter sat completely still and kept asking to come back."

Anitha K. · Mum of Kavya, 4 · Vijayanagar
★★★★★

"Our son walked out telling his sister the dentist is 'actually fun.' He had never been without crying before."

Suresh & Lakshmi V. · Parents of Rohan, 6 · Peenya

Frequently Asked Questions

Yes, in almost all cases. Leaving a cavity untreated allows decay to progress rapidly into deeper layers — reaching the nerve and causing pain, abscess, and potential infection of the underlying permanent tooth. The only exception is a very small lesion in a tooth about to fall out naturally within weeks.
At the earliest stage (white spot lesion), yes — fluoride varnish or Silver Diamine Fluoride can arrest and remineralise without any drilling. For small enamel cavities, LASER dentistry removes decay without vibration and sound. For larger cavities, some preparation is always required, but we minimise it using our minimally invasive approach.
Brushing alone is not sufficient if the diet contains frequent sugary or starchy snacks. Frequency of sugar exposure matters more than total quantity — ten small snacks cause far more damage than one dessert at dinner. Other factors include brushing technique, fluoride concentration in toothpaste, deep grooves in teeth, and the specific bacterial strain in your child's mouth. A Prevention Assessment visit can identify the cause.
No. Cavity pain only begins when decay reaches the nerve — which is stage 3, not stage 1 or 2. Many significant cavities requiring pulpectomy are discovered in children who had no pain at all. A painless cavity detected at stage 2 and treated with a filling is a far better outcome than a painful abscess at stage 4. The check-up exists precisely to catch what the child cannot feel.
Silver Diamine Fluoride is a clinically validated topical liquid approved for children, used in Japan since the 1960s and supported by substantial peer-reviewed evidence. It contains silver (antimicrobial), fluoride (remineralising), and ammonia (penetration aid). The main known effect is darkening of the treated tooth surface, which is always discussed before application. SDF is safe, effective, and particularly well-suited to young or anxious children.
Related Treatments

Ready to Help Your Child?

Book a consultation with Dr. Sugandh Mittal — specialist paediatric dentist, Bengaluru.

Book Appointment →
Appointment Chandra
Layout
Banasha-
nkari