Doctors are calling for greater awareness on kids’ oral health amid the rise in tooth decay cases. They say there is a misconception among parents that decay and cavities in milk teeth is not a serious concern as it will eventually fall and be replaced by permanent teeth. However, if the cavities are not treated on time, it can affect mastication (chewing) and development of new teeth.
Take the case of Aadhav (name changed), a baby less than two years old, who was brought to a dental clinic with early childhood dental caries (multiple tooth decay). One of the reasons for tooth decay is frequent and on demand breastfeeding at night (during the nap) and not maintaining oral hygiene. “Frequent exposure to liquids with sugars such as fruit juice and milk with sugar, followed by improper oral hygiene appropriate for that age, can cause tooth decay,” said Dr Ponnudurai Arangannal, paediatric dentist. In the case of Aadhav, the baby boy required a full mouth rehabilitation including a pulpectomy (tooth root canal procedure for babies).
Early childhood caries or “baby bottle tooth decay” is not caused by a single factor but is typically the result of combination of dietary, behaviour and biological influences. “Though bottle-feeding and breastfeeding can cause cavities, bottle feeding is considered more destructive. In modern day kids we see reasons like prolonged eating duration (more than 30 min) and increased screen time during meal time as attributing factors for caries,” says Dr Hariharan, joint director, Kidznteenz Exclusive Pediatric Dental centre, Chennai.
There are 20 milk teeth and they begin erupting around six to 24 months, and start shedding from six to 11 years. They are important as they play a role in jaw growth and development. Milk teeth are natural space maintainers for permanent teeth and if they are removed early, especially the teeth at the back, the adjacent teeth will migrate and the space will be lost and also cause misalignment of teeth.
“There is a misconception among parents that if baby teeth fall before 12 years, then permanent teeth will replace them. The fact is there are only 20 baby teeth, but there are 32 permanent teeth. The 20 baby teeth will be replaced by the permanent teeth apart from the three permanent molars on each side. If these fall, then they will not be replaced. They are lost for life,” said Dr Girish Karandikar, former chairman of Indian Board of Orthodontics. Pronunciation of certain words also requires the teeth in the front especially when kids are learning new words, added Dr Hariharan.
“White, chalky, or opaque lines that often appear near the gumline are one of the earliest signs of demineralisation. As the decay progresses, these white spots may turn brown or black, signalling a cavity. Irritability, difficulty sleeping or avoiding chewing on one side of the mouth can sometimes indicate dental pain or sensitivity,” said Dr Ponnudurai.
Prevention better than cure
As the saying goes – prevention is better than cure – never put a child to bed with a bottle containing milk, juice or formula. Only water should be used for overnight bottles.
Prevention includes correction of bad food habits, inclusions of good brushing habits/cleaning habits (especially in very young children), periodic paediatric dental visits right from the first tooth eruption (6-8 months of age). “Based on the observations, paediatric dentists recommend periodic fluoride application and preventive fissure sealants. Remineralising agents are quite helpful in pre-cavity stages, said Dr Hariharan.
The mouth is full of several types of microorganisms which will act on any food remnants to produce acid. If proper dental hygiene is not maintained, it slowly eat away the different layers of the teeth. “The tooth is made up of three layers – enamel (protective hard outer layer), dentin (sensitive, supportive inner layer) and pulp (innermost core with nerves and blood vessels). The acid produced will eat away the dentin. When this happens, organisms can reach the pulp which is considered as the heart of the tooth, and destroy it,” said Dr Girish Karandikar.
If the decay is at the initial level, filling alone is required. If there is a deep cavity, pulp therapy is performed. “Pulp therapy (baby tooth root canal) is a treatment to save badly infected or decayed tooth. First a hole is drilled into the tooth and the infected pulp (centre part of tooth) is removed. After cleaning and disinfecting of the inner canals, the space is filled with biocompatible substances to prevent future infections. A crown or a cap is placed over it to restore the strength and function. his final step, and allows it to function normally,” said Dr Hariharan.
“Root canal in kids, especially in very young children (less than 3 years), is always challenging as their cooperative ability is less. In such kids we require some pharmacological assistance like nitrous oxide sedation, oral sedation and general anaesthesia. Providing safe sedation and anaesthesia is another challenge when compared to adults,” added Dr Hariharan.