Early childhood caries, often known as cavities in young children, is a common infectious disease affecting primary (deciduous) teeth. Although these temporary teeth eventually fall out to make way for adult teeth, the answer to whether cavities should be filled is generally yes. Professional treatment is necessary to manage the decay and prevent complications.
The Essential Roles of Baby Teeth
Primary teeth serve multiple functions beyond simply chewing food. They maintain proper nutrition by allowing a child to chew a variety of foods effectively, supporting healthy growth and development. The presence of these teeth also influences the formation of speech patterns, as the tongue and lips use them to form certain sounds.
The most recognized function of a primary tooth is its role as a natural space maintainer. Each baby tooth holds the space in the jaw for the permanent tooth that will replace it. If a primary tooth is lost prematurely due to decay, adjacent teeth can shift into the vacant area, reducing the space needed for the adult tooth. This movement can lead to crowding, misalignment, or impaction of permanent teeth, often necessitating orthodontic treatment later in life.
Consequences of Leaving Cavities Untreated
Ignoring decay in a baby tooth carries a risk of pain and discomfort. As decay progresses deeper into the tooth structure, it can reach the pulp, where nerves and blood vessels reside, causing sensitivity and pain. This discomfort can interfere with a child’s ability to eat, affecting nutritional intake, and can also disrupt sleep patterns.
Untreated decay can quickly spread, leading to a dental abscess, which is a pus-filled pocket of infection at the tooth’s root. If this infection is not managed, it may spread into the surrounding jawbone or soft tissues of the face, a condition known as cellulitis. Severe infections can even impact the underlying permanent tooth bud, potentially causing developmental defects in the enamel of the adult tooth, such as hypoplasia or discoloration. The presence of a high number of decayed primary teeth is also a strong predictor of future decay in the permanent dentition.
Modern Treatment Approaches for Pediatric Cavities
The treatment chosen for a cavity depends on the extent of the decay and the child’s age. For mild to moderate decay, traditional restorative procedures, such as a dental filling, are used to remove the decayed portion and seal the tooth. Fillings are commonly made from tooth-colored composite resin or glass ionomer material, which releases small amounts of fluoride.
When decay has advanced deep into the pulp chamber, but the tooth is still restorable, a pulpotomy may be performed. This involves removing the infected tissue from the crown, applying medication to the remaining nerve tissue, and then covering the tooth with a crown. Stainless steel crowns are durable restorations often used on back teeth after a pulpotomy, ensuring the tooth remains functional until natural exfoliation.
For very young or anxious children, or those with small, non-painful lesions, a non-invasive option like Silver Diamine Fluoride (SDF) may be used. SDF is a liquid solution applied directly to the decayed area; the silver acts as an antimicrobial agent and the fluoride promotes remineralization. This treatment arrests the decay and prevents progression, though it causes the decayed area to stain black. Extraction remains the last option, reserved for teeth too severely damaged or infected to be saved, and often requires a space maintainer to prevent adjacent teeth from drifting.
Strategies for Preventing Early Childhood Caries
The most effective approach to managing early childhood caries focuses on prevention through consistent daily habits. Proper oral hygiene should begin before the first tooth erupts by gently wiping the infant’s gums with a soft cloth after feedings. Once the first tooth appears, brushing twice daily should begin using a soft-bristled toothbrush and fluoride toothpaste.
The recommended amount of toothpaste varies by age: a smear the size of a rice grain for children under three, increasing to a pea-sized amount for children aged three to six. Parental supervision is necessary until the child develops the dexterity to brush effectively, generally around age six or seven.
Dietary habits are also important; limit frequent consumption of sugary foods and drinks, including fruit juices. Avoiding bottle-propping at night with anything other than water is necessary, as sugars in milk or juice can pool around the teeth while the child sleeps. The first dental visit should be scheduled by a child’s first birthday to establish a dental home and receive personalized preventive guidance.