Should decay in baby teeth be treated?

Every day I encounter the answer to that vital question as more and more children arrive at our practice in pain, with huge abscesses, so forming their first visit to the dentist, or even more sadly, their second visit (where at the first visit the dentist chose to not treat the small cavity he encountered in the child’s mouth).

The purpose of milk teeth can be summarized as follows: Aesthetics, Function and Space Maintenance, in preparation for the succeeding permanent teeth.

When teeth become compromised by decay, one or more of the above will be affected by varying degrees unless the teeth are treated. Especially when decay is diagnosed with decay in the baby molars at an early age of 4-6 years old, the child still has another 6-7 years of the teeth in the mouth before their natural exfoliation.

Unfortunately once tooth decay begins in a tooth, it won’t just disappear – but in fact, will usually (and generally fairly rapidly) increase in size and depth, causing the child moderate to severe pain.

In addition, at around the age of 6, the permanent molars erupt and are slowly followed over the next 6-7 years by the rest of the permanent teeth. This means that as new permanent teeth enter the mouth, they are already at a ‘disadvantage’ with reduced prognosis as they are exposed to the barrage  of bacteria present in the adjacent rotting teeth and thus in the mouth as a whole. Thus the decaying teeth serve as a breeding ground for bacteria compromising the health of the new permanent teeth.

According to Dr Patel, Head of Pediatrics and Preventative Dentistry, www.timeswellness.com:

“Milk teeth and their good function are paramount in the growing years to establish a good foundation of health. Further the first permanent molars and anterior teeth come into the mouth at six years of age. This means, an untreated milk tooth can co-exist with a permanent tooth for about six years and pass on the dental decay to it resulting in future dental problems. Hence even treating a milk tooth has a preventive role as it attempts to make the child caries (decay) free and minimise their dental problems as an adult.”

In addition, as cavities become larger and deeper, bacterial infiltration usually penetrates the nerve, resulting in tooth abscesses which are often accompanied by severe pain, swollen faces, fever and a compromised immune system – requiring antibiotics and extraction of the tooth.

More and more research is proving a link between oral health and the bacteria in the mouth to diseases that affect the body and plague our societies such as heart disease and strokes and even cancers.

Thus leaving decay untreated and so allowing for the chronic habitation of excess bacteria in the mouth, compromises your child’s immune system and makes the more prone to getting sick.

In addition, sooner or later these teeth will need to be treated and by then, the only treatment option is extraction. Depending on the number and position of teeth, this will then have variable consequences. As verified by the South African Dental Association and the Paedodontic Society of South Africa, Dr Tony Widmonte BDS(Wits) , “Why do we need baby teeth?”, www.ourchildren’steeth.co.za

Losing baby/deciduous teeth can cause problems for the jawbones, muscles and permanent teeth.

How can this happen?

You see, deciduous teeth actually encourage normal development of the jawbones and muscles.
When a child chews, the pressure on the teeth encourages bone growth around the roots.
The muscles that open and close the bottom jaw are joined to the upper jaw as well. Here also during chewing and talking the muscles continually pull and put pressure on the bones and encourage normal growth.
Deciduous teeth are designed to fit into a small jaw. As the jaw grows, the small teeth no longer fit the growing jaw, so we lose these teeth for larger adult ones.
However if a deciduous back tooth is extracted due to decay, the tooth next to it may tilt or drift into the now empty space. In addition, the teeth in the other jaw may move up or down to fill the space left by the missing tooth.
When adjacent teeth shift or move up or down into an empty space left by a lost tooth, the space becomes smaller than it originally was, so a lack of space is created in that jaw for the permanent teeth to grow into.
So we often find that when the permanent teeth erupt they are crowded or cramped together in a smaller space and they may also come out rotated or in the wrong place or even remain permanently buried beneath the gum.
If left untreated, expensive and extensive orthodontic treatment may be needed to make the smile acceptable and give the child a confidant self image.”

I have explained why I and most knowledgeable dental professionals choose to treat milk teeth, but it is your child, so you can make the decision to treat or not to treat.