Tuesday, March 3, 2015

Why Baby Teeth Cavities Need Fillings

Kids Dental Care Cavities
Taking Care of Baby Teeth

Every week I have moms, dads, and grandparents bring in their kids and/or grandchildren in for their regular preventive visit that consists of a checkup/exam, dental cleanings, x-rays once a year, and fluoride treatment.  As part of kids dentistry children ranging from 1 year to 4 years old, up to 12 year old, will typically have primary dentition (baby teeth) remain in their jaw.  Even some adults will have the occasional baby tooth!

When kids come in for their 6 month checkup, after the dental assistant or the dental hygienists clean their teeth to be free of plaque, I (the dentist) will check their mouth for signs of cavity, or tooth decay, via a visual exam and digital x-rays.

If I do see a cavity, depending on the size of the decay, I may recommend either leaving the tooth as a "watch" or a tooth colored filling.   However every now and then, I'll get a question from the parents or grandparents, "it's just a baby tooth, can we just not fill the cavity and leave the tooth alone?"  My usual response would be "the tooth needs a filling and we do not want the cavity to continue to get bigger."  Here's why:


 A cavity can be ascertained visually and by x-rays.  If the cavity is contained within the enamel, the cavity can be left alone and treated with fluoride and proper oral hygiene (ie. daily brushing with a fluoridated tooth paste, daily flossing, and fluoride rinses).  If the cavity is small enough, proper oral hygiene and fluoride can arrest (stop the cavity from growing" and may even remineralize the cavity (ie. shrink the cavity).   This stage is when the cavity can be "watched" and left unteated.

If a cavity has progressed beyond the enamel and has extended into the dentin layer, depending on how big the cavity is, treatment is highly recommended.  If the cavity is relatively small, a tooth colored filling is recommended.  If the decay is deep enough to have hit the nerve/pulp of the tooth, a pulpotomy or "baby root canal" may be needed.  The reason a pulpotomy is needed in this case is because once decay/bacteria has reached the nerve, the nerve is at risk for infection.   Thus a baby root canal is needed to remove the nerve and decrease likelihood of infection.  After the pulpotomy is performed, a stainless crown is usually recommended to allow normal chewing.


If a cavity has extended beyond the dentinal layer, a filling is required to prevent the cavity from getting larger.  Left untreated the cavity has a chance to continue to get bigger and deeper, this may cause the child to have tooth pain.   The tooth may then require a pulpotomy and stainless crown as part of emergency dentistry treatment, increasingly likelihood of inconvenience, discomfort, and financial costs.


If the cavity is deep enough that restoration is not possible or has poor long term prognosis, the baby tooth may need to be extracted.  Once remove, the space once occupied by the baby tooth may need to be held by in place by a space maintainer until the permanent tooth erupts.

And as such, a baby tooth serves the following purpose:
  • Allows the child to chew properly and normally, thus permitting adequate nutrition.  Certain foods may be difficult to eat without teeth.
  • Allows the child to speak normally.  Without a baby tooth in place for a sustained period of time, normal speech and certain sounds may be difficult to pronounce.
  •  Holds space necessary for the adult teeth to erupt.  If a primary tooth is removed, adjacent teeth in front, back, and opposite may start to collapse into the space.  This may make it difficult for the adult tooth to coming in properly, and may cause malocclusion, prompting possible need for orthodontic treatment (braces).
  • Esthetics and self confidence.  A child may feel self conscious if he or she is missing a tooth for a sustained period of time, especially the front tooth.
Though in some cases baby teeth treatment may not be necessary or possible, hopefully this article will have shed some light as to why cavities on baby teeth need treatment and why baby teeth are important to a person's health.  If you have any questions on kids dentistry, please feel to contact your dentist or dental hygienist.

Your family Bellevue dentist,
Dr. Peter Chien