Year: 2020

As a dental office that works with children, we often get asked the question of why we fix cavities in baby teeth. This is a good question and worth looking into further. First, it helps to address what a cavity is.

What is a Cavity?

A cavity, or dental caries, is a progressive disease that is caused when certain bacteria in the mouth produce acid which destroys the tooth structure creating a hole, or cavity.  A cavity can be a small lesion in the enamel (outermost layer) of the tooth, or a very large lesion progressing into the nerve and blood supply of the tooth causing an abscess.

Is it Necessary to Fill Cavities in Baby Teeth?

Usually. Your child’s dentist will be able to tell you if these are cavities that need to be fixed or if they can be left alone.  If the lesion is still very small and only in the outer enamel layer of the tooth they can be left alone. For these lesions we will put a note in your child’s chart to closely monitor them to see if they are progressing at future visits. Often when the lesion is still in the enamel, minerals from your child’s saliva or fluoride from their toothpaste or drinking water can remineralize them and keep them from progressing.

Another case where your child’s dentist may recommend not treating the decay is if the tooth is close to coming out.  We will weigh how quickly the cavity is progressing versus how long the tooth will be in the mouth to determine if it needs to be treated. If we don’t believe it will cause pain or infection before it comes out, we will recommend not treating it. However, if the decay is through the outer enamel layer of the tooth and the tooth will still be in your child’s mouth for a significant period of time, we will recommend repairing the tooth to prevent pain and abscess.

How Long Do You Keep Your Baby Teeth?

On average, children start loosing teeth around six years old and lose their last baby tooth around twelve. Everyone is different, and some will have earlier ranges or later ranges, but this would be considered average.

Pulling Baby Teeth with Cavities

Baby teeth perform lots of functions. They chew food, help with the esthetics of your child’s smile, are used in speech, and among the most important, they hold space open and help guide the permanent teeth into place.  If a posterior baby tooth is lost early, it will allow the other teeth to shift and will often crowd out the space needed for the permanent tooth to come in when your child is older.

How Do You Fix Cavities in Baby Teeth?

Overall, the process of repairing cavities in baby teeth is similar to their permanent counterparts. This involves numbing the tooth, removing the decay, and repairing it with the most conservative restoration. White fillings are used for smaller cavities. White or silver crowns are used for larger cavities.  Depending on the proximity of the decay to the pulp (the nerve and blood supply of the tooth), a pulpotomy may be recommended.  A pulpotomy is a procedure used to treat and soothe the pulp of the tooth when it has been affected by tooth decay. It removes the affected part in order that the roots of the tooth may remain healthy and progress normally for the remainder of the tooth’s life.

What if the Baby Tooth has an Abscess?

If the decay and bacteria have progressed far enough into the tooth to cause an abscess, your child’s dentist will recommend extracting the tooth. This will alleviate the infection and pain that can go with it.  Depending on the spacing in your child’s mouth, his or her dentist may recommend a space maintainer to prevent space loss. A space maintainer prevents shifting of teeth from the early loss of a baby tooth that could cause crowding or impaction of the permanent tooth.

What if my Child Cannot Cooperate During Dental Treatment?

This is a very common concern for parents whose child needs dental treatment.  We have a number of ways to address it.  First, our office is geared toward children.  Our dentists and assistants only work with children and teenagers so we are very comfortable in helping with dental anxiety. Secondly, we have many options for helping with dental fear and anxiety including nitrous oxide or laughing gas, oral sedation, in-office IV sedation, and general anesthesia

Nitrous Oxide

We offer nitrous oxide or laughing gas with all treatment visits.  Nitrous oxide helps with dental anxiety. For a lot of our patients, especially older patients, it is all they need.

Oral Sedation

We also offer oral sedation.  This is used when your child is a little more nervous and anxious for dental treatment.  They come in before the appointment to take a small amount of medicine that offers a mild sedative effect.

In-Office IV Sedation

Sometimes oral sedation is not enough to break through a more intense fear of the dentist. A new option we provide is in-office IV sedation. This is a deeper sedation than our oral sedation option and is provided by a pediatric anesthesiologist. This allows a very young or very fearful patient to have all of their dental work done while they are asleep.

General Anesthesia

For patients with a lot of dental needs and a severe dental phobia, we partner with LeBonheur Children’s Hospital and Outpatient Surgery Center to provide dental care under general anesthesia.  This allows us to take care of all your child’s dental needs while asleep under the care of LeBonheur’s anesthesiologists. This is also a great option for delivering dental care for our patients with dental fear and a health history that precludes them from some of our other options.