Why fill baby teeth? Q& A

Q.
It seems that filling baby teeth is a typical western scientific response that has little or no merit. I'm aware that there are always special circumstances where this procedure may be indicated. When is filling a baby tooth really a valid procedure?

A.

There is more than a little merit to treating primary teeth, and there are many factors involved in determining proper treatment. First of all, these "temporary" teeth are actually needed for several years. The incisors are typically present until six to eight years of age, while the canines and molars are present until 11 to 13 years of age. Primary teeth serve many different functions, such as chewing, phonetics, and space maintenance for permanent teeth.

If decay in primary teeth is left untreated, it will only progress. This progression can lead to pain and infection, which may eventually turn life- threatening. In addition, broken down, painful, infected teeth will lead to a decrease in nutrition, which will affect physical and mental growth and development of the child. In fact, parents or caregivers who do not provide proper access to dental care can be charged with child neglect.

Of course, dentists strive to prevent cavities from forming in the first place. Education is paramount. Parents and caregivers should be informed about proper oral hygiene. For example, parents should begin cleaning a baby's teeth as soon as they emerge. Children under six-years-old need to have adults help them with brushing and flossing. Even children in the six to ten age range should have parents check after brushing and flossing to ensure an adequate job was done. Disclosing tablets can also be helpful to show the areas where plaque still remains. Fluoride, properly used and in very small quantities, can be quite beneficial in reducing or eliminating tooth decay.

A child's diet should be carefully monitored. Children who are more susceptible to decay may need diet modification. Parents should remember that frequency of sugar intake is more important than overall intake. Keep in mind that frequent consumption of soft drinks can lead to a higher rate of decay, and many foods labeled with "no added sugar" may contain high levels of natural sugar. Regular dental visits are important for helping children keep their teeth clean, educating them about proper care, and catching problems early while they are more easily managed. Dental sealants also play an important role in preventative dentistry.

In addition to prevention, patients who are at risk for cavities should be screened. Several factors including family background, the individual, and the general oral environment should be considered. Patient background should include a family history of decay, water fluoride levels, epidemiology, ethnicity, and socioeconomic variables. Individual characteristics include age, orthodontics, diet, and medications that may lead to a decrease in saliva. Oral information includes past restorations and frequency of decay, eruption of teeth (newly erupted teeth are sometimes more at risk), oral hygiene, tooth morphology and salivary flow. Prevention can be designed individually to help combat some of these risk factors.

When decay is detected, several factors are considered. Two main considerations are the dental age of the child and the condition of the tooth in question. For example, if a radiograph, more commonly known as an x-ray, reveals that the cavity is small and the tooth is soon to be lost, treating the tooth would not be necessary. If, however, it appears that the tooth will remain in place for years longer, removing the decay and placing a filling would be most prudent. If the tooth is severely decayed and/or shows signs of infection, extraction or treatment of the tooth should be considered

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