Even with regular brushing, children can develop cavities due to several factors related to diet, habits, and the physical structure of their teeth.

According to the guide, the primary reasons children experience persistent decay include:

• Dietary Habits: Frequent consumption of sugary or starchy foods fuels the bacteria that cause cavities. "Frequent grazing" on items like crackers, dried fruit, or sugary drinks creates a constant acid bath on tooth enamel.
• Prolonged Sugar Exposure: A common cause of early childhood caries is prolonged exposure to liquids like milk, formula, or juice. This often happens when a child falls asleep with a bottle or uses a sippy cup throughout the day.
• Deep Grooves in Molars: Back teeth often have deep grooves that trap food and bacteria. These areas are difficult to clean thoroughly with a toothbrush alone, which is why treatments like dental sealants are recommended to create a protective shield.
• Inadequate Technique or Supervision: For children aged 6 to 12, independent brushing is encouraged, but adult supervision is still needed to check for thoroughness and ensure they are flossing daily as soon as teeth begin to touch.
• Poor Oral Hygiene Consistency: Plaque buildup from inconsistent brushing or failing to brush for the full recommended two minutes can lead to both decay and childhood gingivitis.