Cavities in primary teeth - a complete guide

Did you know that cavity causing bacteria can be transmitted from the mother to the child even before the teeth erupt?

Do you think your child is too young to need a dentist? Early childhood caries is a specific form of severe dental caries/decay that affects infants and children 6 years or younger. Severe early childhood caries begins soon after eruption of teeth. It progresses rapidly and has a lasting bad impact on the dentition.

What causes those nasty holes in the teeth?

The cavity causing bacteria can be transmitted from mothers to their babies even before teeth erupt. Cavities are caused by improper brushing and flossing. But they are not the only culprits.

Young kids can fall prey to tooth decay due to diet, shape of teeth, parents dental history, etc. Improper feeding patterns play their part too. Habits like the child going to bed holding the nursing bottle or breastfeeding the child repeatedly at night and not cleaning his/her teeth afterwards cause the milk to pool around the teeth providing an excellent environment for cavity forming bacteria. How often the child eats influences cavity formation more than what he/she eats.

How is a cavity formed?

The bacteria in the plaque ferment the food particles present on the surface of the tooth to produce acid. The acid causes demineralization of the tooth enamel. Conditions like heavy dental plaque, intake of sugary or sticky food, frequent snacking, etc. can cause the demineralisation. The outermost covering of tooth (enamel) progressively breaks down producing cavities or holes in the tooth.

How to recognise a cavity the signs and symptoms

Most cavities are completely painless. One of the first signs of decay is chalky or opaque spots on the teeth. Sensitivity to cold foods could be an indication of tooth decay. Since decay creates holes or cavities on the upper surface of the teeth or on the sides, the gap between the teeth is increased. The child may complain of food getting stuck between or on the teeth. The food getting stuck between the teeth if not removed properly can release putrid smells giving the child bad breath. There may be swelling in the gums around the decayed tooth too.

Detecting a cavity with radiograph is it safe?

Cavities, especially the ones wedged between two teeth, are detected by radiographic (x-ray) examinations. Dental x-rays also help find the extent of cavity. Worried about the child s X-ray exposure? Low dose X rays used in dental radiography usually pose no threat to the child. The collective radiation dose accumulated over time can have an effect though. According to a new study, frequent dental x-rays have been linked with higher risk of developing meningioma, the most commonly diagnosed primary brain tumour. But with good radiological practices like use of lead apron, high-speed film, etc. the child s exposure to radiation can me minimized.

Milk teeth are temporary - do they need to be fixed?

Contrary to popular belief, milk teeth need to be maintained well till they fall out of their own. They help in proper chewing. They also help in growth and development of the jaws, guide the permanent teeth during their eruption and aid in proper speech. Early extraction of milk teeth will cause crowding and eruption problems in the permanent teeth.

Failure to get the tooth filled will cause more damage to the tooth and the decay spreads to pulp, the innermost layer of the tooth with nerves and blood vessels. When bacteria enter the pulp it causes inflammation of the pulp. Untreated and infected teeth will cause repeated episodes of pain, tooth infection, difficulty in chewing, poor nutrition etc. A decayed front tooth may make the child self-conscious and low on self-esteem.

What are the treatment options?

The extent of decay and how long the milk tooth is expected to function in the mouth determines the kind of treatment. Dental fillings are used to fill the missing tooth structure due to decay But there are other reasons why the tooth needs to be filled - cracked or broken tooth and chipped or worn down tooth from improper brushing, nail-biting or tooth grinding.

• If the decay is caught early fillings can be done. The affected tooth is cleaned of its infection and filled with a suitable dental material. If the decay has destroyed much of the tooth structure not much is left to support a filling. In such instances a crown or cap is advisable
• If the infection reaches the innermost layer (pulp), the nerves are affected which can lead to a dental abscess and loss of the tooth. In such cases root canal treatment (pulpotomy and pulpectomy) is required to save the tooth. A root canal treated tooth is prone to breakage. To prevent this, crown or cap may be required to cover it.
• If the degree of infection is severe and condition of the tooth really bad the tooth may need to be extracted and a space maintainer placed. Space maintainers are appliances that help maintain space for the permanent teeth to erupt properly.

Is anaesthesia necessary?

The pedodontist, your child s dentist, will try a wide range of approaches to make him/her feel comfortable with the dental treatment. A local anaesthesia in the tooth to be treated will numb the tooth and make treatment pain free. If your child is still anxious nitrous oxide, commonly known as laughing gas, may be safely administered to help him/her relax. For very young and apprehensive children and for children with special health care needs, sedation is used to relax the child to reduce anxiety and increase cooperation. With adequate precautions and monitoring the risks of sedation are minimal.

General anaesthesia (GA) to perform the treatments may be recommended only if it is needed. GA comes with inherent risk of adverse events. When the anaesthesia is administered by highly qualified health professional with adequate monitoring and emergency equipment and trained support staff, dental treatment performed under GA is generally considered safe. It may be advised in the following conditions:

• Severe anxiety in the child
• Extensive dental needs needing lengthy, extensive dental work
• Child with a mental/physical disability

Tips to prevent tooth decay in your child:

• Practise good oral hygiene at home.
• Avoid unrestricted night-time feeding after the first primary tooth begins to erupt
• Wipe your child s teeth with a clean soft cloth made wet with boiled water after every feed.
• Wean your child from the bottle by 12 to 14 months of age and encourage him/her to drink from a cup.
• Visit a good pedodontist within six months of appearance of your child s first tooth.
• If your child is caries-prone, get fluoride varnishes and gels.

You may also like to read:

• You play a vital role in maintaining your child s oral hygiene
• Why you need to take your child s dental problems seriously
• 6 ways to fight dental caries while breastfeeding
• Top 10 foods to prevent dental cavities in children (and how to make them eat those!)
• Preventing dental decay in children the basics (Expert speak)

Photo source: Shutterstock.com

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