Options for treating caries in baby teeth

TOOTH decay is not limited to adult teeth. In fact, just under half of the world’s children between two and 11 years old have some form of tooth decay in their primary (baby teeth), with a large number of them being left untreated because it is expected that they will soon fall out and new teeth will appear. But it is important to prevent and seek early treatment for caries in baby teeth, dentists say, as they set the stage for the permanent ones to follow.

“Caries occur when harmful bacteria in the mouth start to erode the enamel of the teeth. If left untreated, these develop into holes in the teeth called cavities,” said dental surgeon Dr Kevané Francis. “Not only can this affect the way in which the permanent teeth grow when it’s time, but it can also negatively impact a child’s physical and emotional well-being immediately.”

The dentist explained that pain and sensitivity caused by damaged teeth can ultimately affect the way, and how much a child eats, and in turn can cause poor nutrition and development.

“Also, a decaying tooth can infect another tooth and lead to multiple cavities in the mouth,” she said. “This can negatively affect the child’s speech and self-esteem, and the pain can be excruciating.”

But what options are there for treating dental caries? Dr Francis shared the most common routes taken by oral health experts to treat decay in temporary teeth.

Good oral hygiene

“The importance of brushing twice per day for at least two minutes a day cannot be overemphasised,” she said. “Even before your baby starts growing teeth you can start cleaning the gums to reduce bacteria in the mouth. As the child grows older, you introduce brushing with a small-headed, soft-bristled toothbrush and a pea-sized amount of fluoride toothpaste.”

She also highlighted that cutting back on sugary drinks and sweets, especially close to bedtime, can help protect teeth. “Make a habit of giving children water instead. It’s better for them and it helps to clean the teeth throughout the day.”

Protective treatment

Dr Francis pointed out that regular dental cleanings can help to protect the baby teeth from caries, and other protective measures can be applied if your child is at an increased risk for developing caries.

“Your dentist may recommend a sealant,” she said. “This is an additional layer of protection that is placed over the enamel of healthy teeth to prevent decay from happening in the first place. You can ask your child’s dentist more about the procedure.”

Fillings

“The exact treatment will depend on the extent of the damage to the tooth,” the dentist said. “But dental fillings are one of the most common treatments done when there is a cavity, because it prevents the decay from worsening and reaching the pulp of the tooth, when it can affect the developing permanent tooth.”

She explained that with dental fillings, the decayed part of the tooth is removed completely and a tooth-coloured substance is used to fill the hole that is created.

Pulpectomy

“This is similar to a root canal in adults, and it is done when the decay has reached the tooth pulp but there is still enough of the healthy tooth to restore with a filling,” she noted. “The damaged pulp is removed and packed, and then the tooth is filled.”

Pulpotomy

“This is similar to a pulpectomy, but slightly less invasive,” she clarified. “Only the coronal (top) part of the pulp is removed in this procedure, so it is done when the pulp is not as inflamed.”

She added that a crown (cap) may be placed over the filling after these procedures are done, to provide strength, as the filling alone may not be strong enough to withstand occlusal forces (chewing).

Extractions

Dr Francis explained that extractions are a last resort, because missing teeth can affect the direction in which nearby teeth grow, and cause speech impediments and orthodontic problems later in life for the child.

“This is only done when the decay is so bad that the tooth cannot be saved,” she said. “If this needs to be done at an early age, when the replacement won’t come in for a while, then we try to put a space maintainer to hold the space until the permanent tooth comes in.”