World Health Organization – Cavities and tooth discolouration are among the most common dental issues seen in children in India. Doctors say many parents still approach dental care only when pain sets in, by which time the damage is often advanced and difficult to treat Doctors emphasise that this is preventable, with early intervention and correcting daily habits.

Disease burden Estimates from the World Health Organization (WHO) indicate that 43. 3% of children in India between one and nine years of age have untreated cavities in their milk teeth.

An analysis covering more than 69,000 children across the country reported that around 46. 9% had early childhood caries.

In several regions, particularly among preschoolers, prevalence crossed 60%, highlighting how common dental decay has become during the formative years. Explaining the underlying causes, K.

Arunkumar, associate professor of oral and maxillofacial surgery at SIMS Hospital, Chennai, said cavities usually develop due to a combination of frequent sugar intake and inadequate oral hygiene. “Children are exposed to sugar almost constantly — chocolates, biscuits, packaged juices and even sweetened milk. When this is combined with irregular brushing, cavities are almost unavoidable,” he said.

When food particles remain on the teeth, bacteria in the mouth break down sugars and release acids that slowly wear away the enamel. “If brushing is skipped or done poorly, this process continues unchecked.

Cavities often begin very early and progress faster than parents realise,” Dr. Arunkumar said. He added that the idea that milk teeth do not need care is both common and incorrect.

J. K.

Reddy, senior consultant in paediatrics at Apollo Children’s Hospitals, Chennai, said certain everyday habits increase risk significantly. “Frequent snacking, sipping sweet drinks through the day, or drinking milk before bedtime without brushing afterwards are major contributors to dental decay.

” He stressed that choice of toothpaste also matters. “Many children are either not using toothpaste regularly or are using products that are not age-appropriate. This results in inadequate fluoride exposure, which weakens the enamel and makes teeth more vulnerable to infections.

” Risk factors and warning signs Not all tooth discolouration in children is abnormal. Dr. Arunkumar explained that permanent teeth often appear more yellow than milk teeth when they first erupt.

“In many cases, this is just the natural colour of permanent teeth,” he said. There are cases when discolouration can signal underlying issues. Poor brushing, plaque buildup, certain medications, dental injuries and excessive fluoride exposure can be the causes.

Dr. Reddy highlighted fluorosis as a concern in parts of India where groundwater fluoride levels are high.

“As per BIS standards, the permissible fluoride level in drinking water is 1. 0 mg/L. Exposure above this during early childhood can lead to dental fluorosis, which is irreversible,” he said.

At the same time, fluoride levels that are too low can increase the risk of cavities. Doctors emphasised that diet and oral hygiene should work together.

Sugary and acidic foods feed plaque-forming bacteria, which produce acids that weaken enamel. Constant snacking or sipping sweetened beverages keeps the mouth acidic for long periods, preventing natural repair.

“Eating sweets occasionally is far less harmful than grazing on them all day,” Dr. Arunkumar said.

Dr. Reddy added that infrequent brushing allows plaque to accumulate. “Over time, this leads not just to cavities, but also staining and gum problems,” he said.

Colour changes should be checked along with other signs. “If a tooth is discoloured, feels rough or uneven, it could indicate early decay,” Dr. Arunkumar said.

Parents should seek dental checkups if discolouration affects only one or two teeth, appears brown or grey, or is accompanied by pain, sensitivity, foul odour or gum swelling. Dr. Reddy agreed, noting that localised yellowing with bleeding gums or visible cracks is more suggestive of disease than normal variation.

Prevention and care Experts emphasise brushing twice daily with fluoridated toothpaste in right quantities, better attention to night-time brushing, limiting the intake and frequency of sugary snacks and drinks, dental check-ups every six months, and encouraging parents to practise good oral hygiene themselves, as children tend to imitate adult behaviour. “Brushing at night is particularly important because food stays on the teeth for longer during sleep,” Dr.

Arunkumar said. Dr.

Reddy advised parents to supervise prolonged snacking with screen time and to include calcium-rich foods in children’s diets to support stronger enamel.