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Dealing with tooth decay in very young children (Expert interview)

Written by Admin |Updated : February 26, 2014 4:58 PM IST

dentist kidTooth decay leading to pain, swelling and sleepless nights is a very agonizing experience for the child and parents alike. Dr Meenakshi Kher, a renowned Paediatric Dentist practicing in Mumbai for the last 17 years tells us how to prevent, treat and manage Early Childhood Caries (or tooth decay in children 71 months or younger). Excerpts from her interview:

Q: What is Early Childhood Caries? Why is it important for us to take it more seriously and nip it in the bud?

Dr Meenakshi Kher: Early Childhood Caries is a specific form of severe dental caries/decay that affects infants and children 71 months or younger. If there is any sign of a cavity in a child younger than 3 years, it is deemed severe, and it is only prudent that you consult a good pedodontist immediately.

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Severe early childhood caries begins soon after eruption of teeth. It progresses rapidly and has a lasting bad impact on the teeth. Some young children with Early Childhood Caries may be severely underweight because of associated pain and disinclination to eat.

Q. How do such young children end up having tooth decay?

Dr Meenakshi Kher: One of the main reasons why such young kids fall prey to tooth decay is due to improper feeding patterns. Perhaps your child goes to bed holding the nursing bottle or is repeatedly using a sipper especially at sleep times. You may also be breastfeeding him/her repeatedly at night and not cleaning his/her teeth afterwards.

All these habits cause the milk/juice to pool around the teeth while the child sleeps. This in turn provides an excellent environment for cavity forming bacteria.

Q. How can one prevent severe early childhood caries/decay?

Dr Meenakshi Kher: In the case of Breast-fed infants, if your baby falls asleep while nursing, he/she should be burped to make sure milk is swallowed before placing the child in bed. Unrestricted night-time feeding should be avoided after the first primary tooth begins to erupt. However, in cases where night feeds cannot be avoided, especially in infants who get their milk teeth as early as three to six months, wiping the teeth with a clean soft cloth made wet with boiled water after every feed is recommended. Though cumbersome, this can prevent a lot of heartache (not to mention toothache) later.

If your child is bottle fed, make sure he/she does not go to sleep with a bottle in the mouth. Try and wean your child from the bottle by 12 to 14 months of age. Encourage him/her to drink from a cup as they approach their first birthday. Make sure the sipper is not used very often.

Ensure that your child by one year of age, learns to enjoy a whole family meal. Avoid introducing your baby to any refined carbohydrate and junk food at this age. Go visit a good pedodontist within six months of appearance of your child's first tooth. Get the child's teeth examined and discuss more about how you can maintain the health of your child's teeth better.

I recommend application of fluoride varnishes and gels for caries-prone children. But equally important is good oral hygiene at home.

Q. Why do milk teeth need to be treated? Won't they fall anyway?

Dr Meenakshi Kher: Milk teeth shed (fall) when the permanent teeth below them are ready to erupt. Only the lower two front teeth fall at approx 6yrs of age. Every year thereafter, the child will lose roughly 2 milk teeth. The milk molars shed between 10 and 13 yrs and require to be healthy until then. Untreated and infected teeth will cause recurrent episodes of pain, tooth infection, difficulty in chewing, poor nutrition etc. Decayed front teeth may lead to a self conscious child with poor self esteem. Early extraction of milk teeth will cause crowding and eruption problems in the permanent teeth. These will eventually take a toll on the child's general health. Therefore it is imperative that you seek treatment for them.

Contrary to popular belief, milk teeth are very important and need to be maintained well till they fall out of their own accord. They not only help in proper chewing (thus the nutrition and health of the child), but also help in growth and development of the jaws. They guide the permanent teeth during their eruption and aid in proper speech. A properly maintained set of milk teeth ensures that there is enough space for the permanent teeth to erupt thus maintaining aesthetics of the child as he/she grows up.

Untreated and infected teeth will cause repeated episodes of pain, swelling, difficulty in chewing, poor nutrition etc. If the front teeth are affected, they may lead to a self-conscious child with poor esteem. Early extraction of milk teeth will cause crowding and eruption problems in the permanent teeth. These will eventually take a toll on the child's general health.

Q. What kind of treatment options are available for a child with early childhood caries /decay?

Dr Meenakshi Kher: Treatment for the decayed teeth would depend on the extent of decay and how long the milk tooth is expected to function in the mouth.

Catch the decay early and get fillings done, before the infection reaches the pulp or nerve in the roots. In case it does, root canal treatment is required for the tooth. The affected tooth/teeth are cleaned of its infections and filled with a dental material.

The infection and the subsequent root canal treatment may make the tooth/teeth prone to breakage. To prevent this, paediatric crowns or caps may be required to cover them.

If a tooth/teeth cannot be saved and extraction or removal is the only option, space maintainers may be required. These appliances maintain space for the permanent teeth to erupt properly.

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