As dental caregivers one of the most common questions we get asked is, “Why do we fix cavities on baby teeth when they are not permanent and the cost to fix can sometimes be very expensive?” Baby teeth are important for many reason. Not only do they serve their purpose in chewing to maintain good nutrition, but also in speech development, maintain proper position of all the teeth in the area, and most importantly, esthetics promoting a healthy smile that helps children feel good about the way they look. According to the American Academy of Pediatric Dentists (AAPD), it is very important to keep primary or “baby” teeth in place until they are lost naturally because they stand as place holders for the permanent ones to come in its place. Premature loss will cause crowding, resulting in misalignment of permanent teeth.
Most babies will get their first tooth around 6 or 7 months of age, and it usually starts off with the bottom front two teeth. Then additional baby teeth will continue to come in until almost three years of age. Baby teeth begin falling out at around 5-6 years of age, but the back molars do not fall out until around 12 years of age. A child’s permanent teeth begin to erupt at around age 5 years of age with the first molars and continue to erupt until around age 21 with their 3rd molars being last. So, if a 3yo child comes in with 2 cavities on her baby molars, we definitely need to restore them because those teeth need to last approximately another 9 years!
If your child develops a cavity in a baby tooth the decay will slowly and sometimes rapidly get bigger and deeper. One thing we have to remember is that cavities are not unchanging and will not just go away. They will continue to get bigger. A tooth is formed in layers. The outer layer is called enamel which is very hard. The next layer is softer called dentin. If the tooth is really close to falling out, one option is just leaving it alone. If it looks like it may be a while until it would normally fall out, we need to treat it, otherwise you are in for toothaches, infection and more extensive dental work. When the cavity is small and just in the enamel ( the outer part of tooth), sometimes the cavity can stay the same size or even heal itself. But once it’s into the dentin layer, it will continue to grow and get bigger and bigger. Sometimes the decay grows rapidly, but depends on oral hygiene, size of the tooth, and frequent sugar exposure. What may look like a small brown spot on the tooth this year may very often turn into a big hole the following year.
A small or medium size cavity can be filled with a white filling, but a deep or large cavity may need a crown to cover the whole tooth. If the tooth is in the back, the crown may be silver in color since it will fall out. If the cavity is not caught in time and is really deep and has gotten close to the nerve in the middle of the tooth, it may even need a Pulpotomy or “nerve treatment”. Therefore, get in a habit of making regular dental appointments for your children so decay can be caught in early stage. As we always say prevention is the key but early detection is the next best thing. Remember, if decay is discovered and treated early it will be less invasive and less expensive!