Why Baby Teeth Cavities Need Fillings

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:

WHEN DOES A CAVITY ON BABY TEETH NEED TO BE TREATED?

 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.

SO WHY DOES A BABY TOOTH NEED A FILLING?

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.

WHY IS A BABY TOOTH NECESSARY?  CAN YOU JUST REMOVE IT?

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
425-614-1600
info@bellevuefamilydentistry.com

Oral Ecology of Mouth and Bacteria

Ferocious Teeth!

You may have gone to dentist and had fillings on your teeth done due to cavities.  You may also have had root canals and crowns because a tooth broke.  Why did they happen?  How did I get a cavity?   Why did my tooth break?  And over time they may need new replacement fillings or crowns, and you may be thinking why needed to be replaced.

IS MY MOUTH REALLY DIRTY AND HARSH?

When dentistry first started, dentists needed materials that could withstand the harsh environment in the mouth.  The mouth is truly an inhospitable environment!

1.  Consistently moist due to saliva.  Moisture, much like that of rain causing wood rot, can cause wear and tear on the teeth and promote bacterial growth.
2.  Oral temperature is approximately 98.2 degrees Farenheight.  This temperature is favorable to bacteria growth.
3.  As such due to constant moisture and heat, the mouth contains 500-1000 types of bacteria,  with Streptococcus Mutans as the predominant bacterial strain.
4.  Constant exposure to foods and drinks that are acidic.  A low pH wreaks havoc on teeth  and may make it prone to wear and tear.
5.  Exposure to foods that are hard and crunchy.  Carrots, celery, nuts, hard sugar candies, chips, cookies, and ice.  These foods can cause quite a bit of trauma to our teeth, and have been known to crack a few teeth!
6.  Bruxism, grinding, and clenching.  These "parafunctional habits" cause a tremendous amount of pressure on our teeth.  Molars generate well over 200 pounds per square inch, stronger than that of a gorilla and chimpanzee!  Imagine having this force subjected on your teeth on a consistent night time basis.  Due to life stress, this may even occur during the daytime.

WHAT HAPPENS INSIDE THE MOUTH?

With a moist and warm environment, bacteria favors the tooth's smooth enamel surface, and is a place for bacteria to reside.  Exposure to food and plaque permits bacteria to feed off plaque that unleashes enzymes that promote tooth decay.  Add on daily exposure to hard foods and potential grinding and clenching, the mouth can be a combat zone.

CAN FILLINGS AND CROWNS REALLY WITHSTAND THE MOUTH?

With tooth decay or cavities, dentists require materials that can mimic tooth structure and with stand natural tooth flex and stress.  Tooth colored fillings, when small and moderately sized, has been shown to hold up well within the mouth.  If teeth break or if a cavity is excessively large, porcelain crowns due to its monolithic porcelain layering, can mimic natural tooth in terms of esthetics and withstand harsh chewing forces.

Much like a natural tooth and our bones, they can weaken, break, and crack.  No dental material can last forever, but studies have shown with proper care, fillings and crowns can last anywhere from two to ten years or longer before needing replacement.

FOR OPTIMAL DENTAL CARE, WHAT CAN I DO TO PROTECT MY TEETH?

Daily brushing and flossing are two of the most effective ways to decrease bacterial levels.   Changing the toothbrush head every 3 months to ensure the bristles stay effective and to avoid exposure to growing bacteria.  Going to the dentist twice a year for checkups and dental cleanings will help remove excessive bacteria and plaque.  Using a nightguard if you grind your teeth at night will help prevent tooth fracture that may require extraction or emergency dentistry.  And getting a filling when the cavity is small will help avoid more expensive treatments down the line.

If you have any questions about your mouth and its oral environment, be sure to consult with your family dentist or hygienist.

From your friendly dental office,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Dental handpieces

You may be wondering what type of equipment your dentist uses when he/she works on your tooth.  The "drill" is actually called a hand piece, and there are two types of "drills" or dental handpieces your dentist typically uses, the high speed and the low speed.

The high speed handpiece is controlled by a sensitive amount of air pressure placed on the foot control.  The maximum speed of the high speed handpiece is 350,000 rpm and requires 32 psi of air.

The high speed is typically used for:

•  Initial cavity removal and preparation
•  Preparation of a tooth for a crown.  
•  It also used sometimes during a surgical preparation for a tooth during a surgical extraction.

The low speed handpiece is used for other operations, and has a speed range of 0 to 8,000 rpm and requires 40 pis of air.  The actual speed is also controlled by pressure on the foot control.  Unlike the high speed, the low speed handpiece can change direction of rotation (forward and reverse).  Such uses of the low speed include:

• Cavity refinement/removal
• Removal of decay
• Finishing and polishing of an amalgam and resin restoration
• Drilling pins and posts to assist in retention of a large filling
• Prophylaxis (dental cleaning)
• Laboratory grinding, finishing, and polishing

If you have any questions on the dental handpiece, be sure to ask your family or cosmetic dentist.

From your dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Pregnancy and Dental Visits

As I see more and more pregnant women in the Bellevue, WA and Redmond area, I have found that pregnant women sometimes tend to neglect their own dental health.   They may delay or ignore their dental cleanings or treatment due to their pregnancy.   It is important to not only the mom-to-be, but also to the unborn baby, to continue with routine cleanings and careful management of dental decay and infection. Long term studies have shown pregnant women who do not take care of their dental health are at an increase risk for having an early premature delivery, which in turn increases the risk of having a low-birthweight baby. 

By working very closely with your primary care physician and obstetrician/gynecologists your dentist will work to ensure your oral health is at satisfactory so that mom and baby will be healthy and happy!   

From your family Bellevue dentist, 

Dr. Peter Chien

If you have any questions, feel free to contact us at 425-614-1600 or through our website:
www.bellevuefamilydentistry.com