Tooth decay syndromes.

How tooth decay can affect child and adult populations. | Baby-bottle tooth decay, Root caries, Gum-line cavities, Chronic dry mouth (xerostomia).

At different points in their life, a person may struggle with experiencing various tooth decay syndromes (a cavity rate or pattern that's shared with other members of their population group).

This page provides descriptions of some of the more common ones, and solutions for combating them.

cavities using:

A) Syndromes affecting children and adolescents.


B) Syndromes affecting adults (especially seniors).


Baby-bottle tooth decay.

Baby-bottle caries refers to a pattern of tooth decay that occurs with infants and preschoolers who are allowed to nurse from a bottle that contains a sugary beverage, either frequently, or else for prolonged periods of time (i.e. napping, sleeping), or both.

Other names for this syndrome are: Early Childhood Caries (ECC), nursing bottle caries, or just nursing caries.

Animation illustrating the tooth decay pattern usually displayed with baby-bottle caries syndrome.

The decay pattern typically displayed by baby-bottle caries syndrome.

a) Only specific teeth are affected.

In most cases, this condition displays a characteristic pattern of decayed teeth.
  • The upper front teeth are affected the most. These teeth may have very extensive decay.
  • The child's upper and lower molars are frequently affected too.
  • The lower front teeth are usually spared from cavity formation. That's because they are somewhat protected from exposure to the sugary drink by the nursing position of the child's tongue.
  • Sometimes the lower canines (eyeteeth) receive protection from the tongue's coverage. When not, they are at risk for decay formation too.


b) Why does the decay form?

There is nothing special or unique about nursing caries syndrome. It's simply a case of cause and effect.

  • A sugar supply (the drink) is available to the child's oral bacteria frequently, or else over extended time periods.
  • This excessive exposure simply tips the tug of war between demineralization and remineralization in favor of the former, and therefore a syndrome of cavity formation.


c) What can you do to prevent baby-bottle tooth decay?

Here are some of the things that you can do to reduce your child's risk of experiencing this problem:

  • Anticipate (unless you specifically know otherwise) that anything you place in a child's bottle could be a sugar source. Breast milk, bovine milk, formula, and fruit juices are all sources of dietary sugars.

    (Whether or not milk promotes an environment for tooth decay is debated.)

  • Never allow your child to nurse for long periods of time, or fall asleep with (napping or nighttime), a bottle that contains a sugary beverage.
  • Extended use of a sippy or no-spill cut can result in the same decay pattern.
  • Never give your child a pacifier that has been dipped in honey or any other type of sugary liquid.
  • Frequent breastfeeding (more than 7 times daily after 12 months of age) can be associated with nursing caries syndrome too.

Section references - Dean

Root caries / Gum-line tooth decay.

Root caries is a decay syndrome that takes place in situations where a person has a receded gum line (often involving many of their teeth), and thus exposed root surfaces on which dental plaque can accumulate.

The enamel-covered portion of a tooth is its "crown."

Animation showing that tooth crowns are covered with enamel. Tooth roots are made up of dentin.

Exposed root surfaces are composed of dentin.

a) Dental anatomy as it pertains to this problem.

You may not be aware of this fact but a tooth's enamel covering ends right at its gum line. The enamel-covered portion of a tooth is termed its "crown."
The remaining aspect of a tooth, the part that lies beyond its crown and usually below the gum line, is its root.

b) A tooth's root is "softer" than its crown.

The root portion of a tooth is not covered by enamel. Instead, it's primarily composed of another mineralized tissue called dentin.

Since dentin contains less mineral content than enamel (it's less "hard"), it's more easily and more quickly damaged by tooth demineralization (cavity formation).

c) How gum recession can increase your risk of decay.

When gum recession occurs, a tooth's root is referred to as being "exposed," meaning aspects of it are no longer covered over by gum tissue and bone.

The recession may occur as a result of several different scenarios:

  • Abrasion, such as toothbrush abrasion (caused by inappropriate brushing technique).
  • A result of periodontal (gum) disease, or a consequence of its treatment.
  • It's commonplace that with age a person will find that they've accumulated some degree of gum recession (due to assorted reasons and episodes).


Gum recession exposes root surfaces.

Animation illustrating how gum recession places a tooth's root at risk for cavities.

As a result, the roots are placed at greater risk for developing cavities.

Exposed root surfaces = A new set of cavity risks.
Due to gum recession and subsequent root surface exposure, a person may find that they're now at risk for a second set of cavity-prone years. (The first ones being during childhood and on into their teenage years.)
Here's why:
  • As mentioned above, root surfaces are relatively "soft," at least in comparison to tooth enamel, and therefore decay more readily.
  • Anatomical considerations associated with teeth that have a receded gum line can make them more challenging to thoroughly clean.

    As a result, dental plaque (a key factor in the formation of tooth decay) may remain on their surface for extended periods of time.


d) Seniors are especially at risk for this syndrome.

Gum recession frequently accompanies advanced age, which means that seniors are especially likely to experience root caries.

  • It's been estimated that roughly half of all people over the age of 50 have had at least one root surface cavity, two for those age 70, and three for ages 75 and beyond. (Leake)


As an added factors:
  • Seniors often experience a decrease in oral moisture. A factor that increases their risk for decay. (See next section.)
  • They also frequently have diminished manual dexterity, which makes brushing and flossing effectively more difficult. (The use of an electric toothbrush may be beneficial.)

Section references - Leake

e) The treatment of root caries can be difficult.

Successfully treating this syndrome can be a challenge.

  • Just as cleaning a tooth's nooks and crannies that have become exposed when its gum tissue recedes, your dentist will have difficulty in identifying, accessing and treating the cavities that have formed on these surfaces too.
  • To make matters worse, the decay involves comparatively softer tooth dentin, as opposed to enamel. That means the rate at which cavities start and advance is accelerated.

All of these factors combined lead to an outcome where experiencing this syndrome frequently results in tooth loss.

f) What can you do to minimize your potential for gum recession?

  • Brushing incorrectly (like too forcefully or brushing back and forth in a "sawing" motion) can cause gum tissue to recede. So can brushing with a toothbrush whose bristles are too stiff.
  • Gum disease (periodontal disease), as well as those procedures required for its treatment, typically result in some amount of gum recession. Be diligent with your oral home care so you don't develop this condition.
  • Bruxism (a habit of tooth clenching and grinding) can create changes with teeth that result in gum-line recession.


g) What can you do to help prevent root caries?

  • If dental plaque doesn't accumulate on your root surfaces, cavities can't form. And towards this goal, the use of an electric toothbrush may help to make your brushing efforts more effective.

    Our page "The best power toothbrushes for senior citizens" discusses this issue.

  • Ask your dentist about the use of fluoride tooth varnish. This type of product is painted onto your teeth and root surfaces (twice-a-year application is common). It helps to ensure that fluoride, and therefore the anticavity benefit it provides, is available precisely where it's needed.

Section references - Hilton

Xerostomia / Chronic dry mouth.

Hyposalivation refers to the situation where a person has diminished salivary flow (a reduced amount of saliva in their mouth). In situations where this condition is a chronic (long-standing) one, the term xerostomia is used.

One problem associated with this condition is that a lack of saliva can tip the balance between demineralization and remineralization in favor of the former, and therefore create a syndrome of cavity formation.

a) What role does saliva play in cavity prevention?

Saliva plays a very important role in fighting tooth decay. Here is a list of some of the benefits that it provides:

  • It contains buffering agents that help to neutralize the acids that cause tooth demineralization.
  • It contains the minerals that must be present for the tooth remineralization process to occur.
  • It contains antibacterial agents that can help to inhibit the growth of oral bacteria.
  • Its presence and flow aids in the clearance of sugars from the mouth (the food source for bacteria that cause cavities).

As these protections are lost, the decay rate of the person can be expected to rise, possibly significantly.

b) What can cause xerostomia?

Advanced age.

A person's salivary glands tend to work less effectively as they age. And as a result, the quantity (and composition) of their saliva may change.

Health status.

Both a person's medical condition and/or the consequences of its treatment can inhibit their production of saliva.

Problematic treatments can include: radiation therapy of the head and neck, radioactive iodine therapy, immunosuppressive therapy.

Problematic conditions can include: autoimmune diseases (Sjogren's syndrome especially), HIV infection.


Oral dryness is a side effect of some types of medications. In fact, hundreds of drugs are known to have an inhibitory effect on salivary flow.

This includes items such as: Antihistamines (allergy and cold medications), blood pressure agents, diuretics, urinary incontinence drugs, narcotics as well as antidepressant, antipsychotic and anti-anxiety drugs.

This cause of xerostomia can be especially likely for seniors since it's so common for them to be taking a regimen of multiple medications.

Tips for preventing tooth decay -

Fact - Having a chronically dry mouth can increase a person's risk for cavities.

Cavity prevention suggestions :

  • Since salivary flow decreases when we sleep, be certain to brush and floss thoroughly before going to bed so to ensure that your mouth is as plaque-free as possible.
  • Drink and rinse with water frequently throughout the day, or when up at night.
  • Salivary flow increases when we chew food, so chewing sugarless gum can be a good way to boost a person's output of saliva.

    The sugar substitutes found in sugarless gum are not readily fermented by the bacteria that cause cavities and therefore will not promote the formation of acids that cause decay. Xylitol-sweetened products (gum, lozenges, etc...) have the advantage that it provides an anti-cavity effect on its own (see button link above).

  • Consult with your doctor about your condition. The medications pilocarpine or cevimeline are sometimes prescribed as salivary gland stimulants.

    In cases where salivary gland stimulation isn't an option, the regular use of an oral moisturizer may provide a solution. (Some of these products have been found to demineralize tooth dentin, so ask your dentist for guidance when making a selection.)

Section references - Hilton


 Page references sources: 

Dean JA, et al. McDonald and Avery's Dentistry for the Child and Adolescent.

Leake JL. Clinical decision-making for caries management in root surfaces.

Hilton TJ, et al. Summitt's Fundamentals of Operative Dentistry: A contemporary approach.

All reference sources for topic Tooth Decay.