Do Cavities in Baby Teeth Really Need to Be Filled? (Updated for 2018)

when to fill cavities in baby teeth
Alpharetta, GA – You’ve just taken your child to a pediatric dentist, only to find that he or she has a cavity in a baby tooth. A common question we get from parents is,  “Since that tooth is just going to fall out anyway, can’t you just let the cavity go, instead of going through all the trouble associated with filling it?”

“As I’ve discussed in other blogs, baby teeth are extremely important and should be cared for just like the permanent teeth,” says Alpharetta children’s dentist Dr. Nanna Ariaban. “They help your child eat and speak properly, and ensure the permanent teeth are healthy and can erupt properly.”

So, is it necessary to have a cavity filled? Dr. Nanna says yes, with certain exceptions.

For small cavities, there is a possibility that they can repair themselves through remineralization. If your pediatric dentist catches the cavity when it has just started, your dentist can give you tips to help better care for your child’s teeth and hopefully prevent the cavity from growing larger. This will include proper dental friendly diet and oral hygiene habits.

Next, if the pediatric dentist determines that the tooth is close to falling out, it may not be necessary to fill it. If your child won’t have the tooth for very much longer, the dentist may recommend just allowing the tooth to fall out without repairing it.

“But it’s important that parents follow the advice of a well-trained pediatric dentist, who has the unique knowledge of treating children,” says Dr. Nanna. “Our opinions are informed by years of careful study and treatment, and we know what can happen when decay is left untreated.”

Related Article: What are Cavities? 

A 2014 report from the American Academy of Pediatric Dentists revealed that by age 5, nearly 60% of children in the U.S. will have experienced some level of tooth decay. The same report stated that when left untreated, this decay can lead to infection, difficulty in chewing and even malnutrition. Other studies show that children who have dental decay often experience difficulty in school due to pain associated with the problem.

“It wasn’t that long ago that children didn’t come for their first dental visit until the late toddler or early preschool years, when they had a mouthful of teeth,” says Dr. Nanna. “But, we saw the rate of childhood dental caries continue to increase, so now it is recommended that children see a pediatric dentist for the first time by the first birthday. This way, we can work with parents to develop good oral hygiene habits, help with dietary tips, and monitor the teeth so we can intervene before an issue becomes a big problem.”

But why do parents need to take the time, and spend the money, to fix teeth that will just fall out eventually anyway? Tooth decay is a disease, plain and simple. It’s caused by specific germs, and can be spread easily, and it can last a lifetime. And if the baby teeth have serious decay, the permanent teeth can become damaged even before the erupt.

Dental Cavity in Baby Teeth

Do cavities in baby teeth affect permanent teeth?

There may be some considerations that getting a cavity filled or treated would be a waste of money because baby teeth aren’t even the permanent teeth, but it’s important to understand the long term problems that come from lack of treatment.

Primary, or baby teeth, are of a different consistency and thinner than adult teeth. Therefore, they require more attention when it comes to brushing, flossing and oral care. Cavities can quickly progress into very large cavities and can cause the need of baby root canals and crowns. If untreated this can form into dental infections causing pain and swelling.

It’s also important to help children keep their baby teeth as long as they can because they help guide the development and positioning of your adult teeth. Primary teeth that must be pulled or are so infected they fall out, this can create orthodontic problems which will accentuate the need for braces or other orthodontic procedures. This can make your child need longer orthodontic treatment or even make children who didn’t need braces to be forced to get braces to correct their smile.

Other Problems that Cavities can Cause when Untreated

Besides the impact that baby teeth can have on the placement of permanent teeth, there are other consequences of leaving cavities untreated in baby teeth. These include:

Impede strong nutrition: Not treating cavities can cause eating to be painful and uncomfortable. For children that experience pain when eating will avoid wanting to eat and will start to affect their overall nutrition. Some healthy foods can naturally be hard, including apples, carrots and celery. However, if a child is unable to eat these hard foods because of pain in the mouth they will start to loose essential nutrients that are important for their overall health.

Affected Speech: Untreated cavities can also lead to problem with speech. Teeth are a part of speaking and can affect the sounds that children can make when speaking. However, if they have cavities and have teeth rot and fall out, it can begin to cause speech impediments that will affect the child’s ability to speak properly and can have lasting effects on their confidence in public speaking and communicating with others.

Self Confidence and Appearance: Discolored or missing teeth can lead to children developing a poor self image of themselves. If they feel that their smile or teeth don’t look healthy or white, they may begin to refrain from smiling and wanting to show their teeth. This lack of confidence in their appearance will have a lasting affect on the belief in themselves and their social lives.

Spreading Infections Across Other Teeth: Cavities can and will spread to other teeth if untreated. It is commonly thought that cavities are unlike other diseases or infections, that they cannot be spread. Cavities surely can and will spread to other teeth in the mouth if untreated. Cavities can also be spread to other people! It is important to treat cavities so they not only destroy a tooth, but that they do not set off other cavities in the mouth.

Spotting the Early Signs of Cavities

How do I spot the early signs of cavities for my child?

Its always harder spotting cavities early when its not your own mouth. However, if your child is complaining about sensitivity or pain in their mouth, it may be caused by the formation of a cavity. If your child complains about sensitivity or pain when they eat foods that are cold or hard, it can signal cavities.

The mayo clinic lists the following signs of cavity formations:

  • Toothache, spontaneous pain or pain that occurs without any apparent cause
  • Tooth sensitivity
  • Mild to sharp pain when eating or drinking something sweet, hot or cold
  • Visible holes or pits in your teeth
  • Brown, black or white staining on any surface of a tooth
  • Pain when you bite down

You will want to check the tooth to see if there is plaque build up or any discoloring. If so, then it would be good to schedule an appointment for a cleaning and check up so that the dentist can treat it earlier.

If your child is visiting a pediatric dentist every 6 months then the dental staff should be able to catch any formations of cavities and stop any further growth.

The best advice for those who are worried about cavities forming is to double down on strong oral habits. Make sure your children are brushing and flossing regularly. Monitor their diet and see if there were any areas that may have changed. For example, some kids can be receiving treats at school or from a friendly neighbor that can be full of sugars.

What are my options if my child has cavities?

If your child has developed cavities, there are a number of different options that can be taken. Common options include:

Remineralization: Like we mentioned above, if the cavity is small enough, the pediatric dentist may elect to allow the tooth to repair itself. This occurs because saliva can actually speed up healing processes. Saliva contains proteins, enzymes and compounds that help harden the enamel of teeth and can even “remineralize” your tooth’s enamel. If a cavity is small enough, a tooth can go through remineralization (or self repair) if the oral hygiene and diet promotes the saliva. If diet is poor and filled with sugar and starch, it can and will overpower the saliva causing the cavity to grow larger. Your pediatric dentist will discuss proper care and course of action if they feel that remineralization is possible.

White Fillings and Restoration: If remineralization is not a viable option, a filling will need to placed onto the teeth. This process is a commonly known one to both adults and children. Your pediatric dentist will drill away at the cavity and decay. Once everything has been taken away, the tooth will be filled with a filling. At Polkadot we use white fillings, which harden in seconds and mimic the color and appearance of natural teeth. For those who are worried, Dr. Nanna will walk through the procedure with the child, going over each tool that the would use.

Crowns: If the tooth decay or cavity is large, a filling will not be able to do the job of restoring the tooth. A crown will create a protective structure around the afflicted tooth and will minimize the risk of developing a new cavity or further tooth decay on the tooth. To place a crown on a tooth, the tooth is shaved down and then the prefabricated crown is fitted on the tooth and then it is cemented on the tooth using dental cement. It’s important to make sure to use the right size for the crown as it will affect the child’s bite if the crown is too large or small.

Extractions or Baby Root Canals: Once a cavity is so large that it starts to reach the nerve of a tooth, it will cause intense pain. The cavity can cause an infection and inflammation of the nerve and when this occurs, the only option is to conduct a baby root canal. This involves removal of the infected pulp (nerve and blood vessels). After removal, medication will be placed on top of the affected area. Unlike adult root canals, baby root canals are much different, they take only a few minutes to complete and additional visits are not necessary!

Laughing Gas or Nitrous Oxide: Depending on the number of procedures or the comfort level of the child, laughing gas or nitrous oxide can be used. It is a safe sedative and extremely effective in helping children reduce anxiety. The laughing gas creates feelings of happiness and relaxation and has a rapid onset while non-allergic. The laughing gas is given by placing a fitted mask over the nose. Once the patient starts breathing through the mask, they will begin to feel the nitrous oxide. Laughing gas has no lingering effects and is perfectly safe. The use of this option will be at the recommendation of your pediatric dentist.

Sedation Dentistry: In some extreme cases, the number or severity of dental treatments may be high. When it comes to dentistry for children, we have to balance the effectiveness of the procedure, but also their overall comfort with dentists. Children can sometimes need extensive work, but due to the stress and discomfort of all the work, it creates an anxious relationship where getting them to the dentist can be extremely difficult. Sedation dentistry is used to help balance the need for dental treatment while also ensuring a healthy relationship with the pediatric dentist on a long term basis.

Your pediatric dentist will discuss with you the options of using sedation dentistry and if it is a good option for you child. At Polkadot we have two options including conscious oral sedation and general anesthesia. Factors that can lead to the need for sedation dentistry include your child’s anxiety level, ability to cooperate and required amount of treatment.

“Have you ever heard a dentist tell you not to clean your child’s pacifier off in your own mouth?” says Dr. Nanna.

“This is because the bacteria that live in your mouth can be introduced into your child’s. It’s also why we say never share toothbrushes or even store toothbrushes where they can touch each other. Introducing new bacteria can lead to decay, especially in a child who has a diet high in sugar and who doesn’t have proper oral care habits.”

If your child complains of dental pain, or even headaches, schedule a dental appointment right away. This can be a sign that there is decay, and the issue should be addressed by a dentist before it progresses too far. Whether your dentist recommends filling the cavity, or taking a more precautionary wait and see approach, you’ll know you are making an effort to save your child more pain and other problems.

Even though baby teeth will eventually fall out, it’s important that you care for them just as you do permanent teeth. Baby teeth play an important role in a child’s health and well-being. Brush twice a day, floss daily, and maintain regular check-ups with a pediatric dentist, starting around age one.

© 2018 Polkadot Pediatric Dentistry.  Authorization to post is granted, with the stipulation that Polkadot Pediatric Dentistry in Alpharetta and Johns Creek, GA, is credited as sole source. 

Dr. Nanna Ariaban

Dr. Nanna Ariaban

Pediatric Dentist at Polkadot Pediatric Dentistry
Dr. Nanna Ariaban is a board certified pediatric dentist and owner of Polkadot Pediatric Dentistry located in Alpharetta GA. She is a member of the American Academy of Pediatric Dentistry, Georgia Academy of Pediatric Dentistry, the Southeastern Society of Pediatric Dentistry, and the American Dental Association. Dr. Nanna provides highest quality pediatric dental care in Alpharetta, Milton, Johns Creek and Roswell, GA for infants, children, and teens. She was recently voted as America's top pediatric dentist for two years in a row.
Dr. Nanna Ariaban

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