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DECAYED BABY TEETH — SAVE THEM OR PULL THEM?

Your child's dentist has had the same conversation many times:

Dentist: "Your son, John, has a very large cavity in his second primary molar. To save the tooth, I will have to do a root canal and place a crown."

Parent: "Doc, it's a just baby tooth. Why don't you pull it?"

The reaction is a common one because most people don't realize the important role that primary (baby) teeth play in a child's life. By the time most children are 3 years old, they will have 20 baby teeth. These teeth help the child chew and speak. They also maintain the spaces for the permanent teeth. Tooth decay is caused by an infection. This infection in a baby tooth can also harm the permanent tooth that is growing under the baby tooth. Therefore, the dentist wants to treat John's diseased primary tooth.

If a child loses a baby molar (back tooth) too soon, the molar can no longer maintain the space for the permanent tooth that is growing between its roots. The tooth behind the lost molar will start to drift forward into the space. If this occurs, the permanent tooth may not have enough room to come into the mouth in a normal position. The child also will not be able to chew as well without this molar.

For these reasons, dentists advise trying hard to save baby teeth. But sometimes a baby tooth may be so diseased that it can't be saved. If this is the case, the dentist will extract (pull) the tooth. The dentist may recommend a space maintainer. This device preserves the space of the missing primary tooth until the permanent tooth is ready to come in.

Of course, the best way to maintain baby teeth is to practice prevention. Proper brushing, flossing and regular visits to the dentist will help preserve your child's baby teeth until the permanent teeth are ready to replace them.

A child who experiences cavities on the baby teeth is considered to be at high risk for dental decay and should receive counseling (along with the caregiver) to reduce their risk level. The dentist and dental hygienist should take a diet history for the child. Food that contributes to cavities should be avoided. Eating habits will also need to be modified or reduced to enable a reduction in cavity risk. This is very important, because children who experience cavities in the baby teeth also tend to be the ones who experience cavities in the permanent teeth.

A child who has cavities or the beginning of cavities on their primary teeth can be treated with a topical fluoride called fluoride varnish. This will turn the tooth dark or black but will stop the cavity from growing. In addition, the dentist will prescribe fluoridate supplements such as tablets, drops or lozenges, for children who have experience cavities in their primary teeth, especially if they live in communities without fluoridated water.

The treatment of cavities in primary teeth has recently been examined in a landmark study in Great Britain called the FiCTION (Filling Children's Teeth: Indicated Or Not?) trial. Your dentist will assess the tooth to determine if traditional dental care is warranted, such as removal of the entire cavity and placement of a filling, or removal of most or some of the cavity and the placement of a restoration, or even in some instances no treatment with a filling, only observation and prevention, including diet modification and fluorides.

 

Last updated June 30, 2021

 

References:

  • Ahmad AJ, Parekh S, Ashley PF. Methods of space maintenance for premature loss of a primary molar: a review. Eur Arch Paediatr Dent. 2018 Oct;19(5):311-320. doi: 10.1007/s40368-018-0357-5. Epub 2018 Sep 5. PMID: 30187262; PMCID: PMC6208772.
  • Contreras V, Toro MJ, Elías-Boneta AR, Encarnación-Burgos A. Effectiveness of silver diamine fluoride in caries prevention and arrest: a systematic literature review. Gen Dent. 2017 May-Jun;65(3):22-29. PMID: 28475081; PMCID: PMC5535266.
  • Bonetti D, Clarkson JE. Fluoride Varnish for Caries Prevention: Efficacy and Implementation. Caries Res. 2016;50 Suppl 1:45-9. doi: 10.1159/000444268. Epub 2016 Apr 22. PMID: 27100219.
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  • Marshman Z, Kettle JE, Holmes RD, Cunningham KB, Freeman R, Gibson BJ, McColl E, Maguire A, Douglas GVA, Clarkson JE, Innes NPT. Dental professionals' experiences of managing children with carious lesions in their primary teeth - a qualitative study within the FiCTION randomised controlled trial. BMC Oral Health. 2020 Mar 4;20(1):64. doi: 10.1186/s12903-020-1051-7. PMID: 32131801; PMCID: PMC7057668.