When a parent sees a dark spot on a milk tooth, the first question is almost always the same: «Does it need to be treated even if it will eventually fall out?» The answer is yes. deciduous tooth Caries can cause pain, infections and difficulty in chewing, but its removal can also compromise the space necessary for proper eruption of the tooth. permanent teeth.
La caries in children, Furthermore, it can develop more rapidly than that of adults. For this reason, it is important to recognize the first signs and intervene without waiting for the child to start complaining of pain. When the diagnosis is early, we can apply more simple and conservative solutions, This protects the tooth and makes the dental care experience much more comfortable.
What is tooth decay and how does it develop in milk teeth?
La caries It is a pathology caused by the action of the acids produced by bacteria present in the plaque. These microorganisms use the sugars introduced with food and, over time, can weaken the enamel, creating a real cavity.
In the milk teeth The process can progress quickly because the enamel and dentin are thinner than those of permanent teeth. The lesion, therefore, It can reach plus quickly the inner part of the tooth, where it is located the dental pulp.
This does not mean that every small spot is necessarily a cavity. Color changes can also be caused by pigmentation, enamel defects, or difficult-to-remove residues. diagnosis It must be performed by the dentist, through clinical observation and, only when truly necessary, with targeted radiographic examinations.
How to recognize a tooth decay in children
In the early stages, tooth decay may not cause any discomfort. The first sign is often a opaque white stain, This is especially noticeable near the gum margin: it indicates that the enamel is losing minerals, but a cavity is not necessarily present yet.
As the lesion progresses, the tooth may take on a yellowish, brown, or black color. The surface may appear irregular or have a small indentation.
When the caries Reaches the deeper layers, They may appear:
- sensitivity to cold, hot or sweet foods;
- pain during chewing;
- spontaneous discomfort, especially in the evening or at night;
- difficulty eating from one side;
- persistent bad breath;
- Swelling of the gums near the tooth.
In younger children, pain is not always described in precise terms. Sometimes it manifests itself through irritability, disturbed sleep, a refusal to eat certain foods, or a tendency to frequently put their hand to their mouth. swelling of the face or the gums, the presence of pus, one severe pain or fever They require timely dental evaluation because they may indicate that the infection has spread beyond the tooth.
Why do decayed milk teeth need to be treated?
Defining the milk teeth as “temporary” can lead to underestimating their importance. In reality, they remain in the child’s mouth for several years and perform essential functions. They allow to Chew correctly, they participate in language development and they lead the Growth of the arches. Above all, they maintain the space reserved for permanent teeth. If a deciduous tooth is lost too early, those nearby may shift and reduce the space available for the permanent tooth.
One premature loss It can therefore favor crowding and alterations in alignment. In these cases, it becomes important to evaluate the development of the arches through a path of Pediatric orthodontics, To understand whether it is necessary to maintain the space or intervene on the growth.
Treating a cavity also means preventing the child from experiencing pain, difficulty eating, or recurring infections. Our goal it is not to intervene more than necessary, but keep the tooth when the conditions exist to do so.
What are the most common causes of tooth decay in children?
Tooth decay is not only dependent on the total amount of sugar consumed. It is particularly important the frequency with which teeth are exposed to sugars and fermentable carbohydrates during the day.
Fruit juices, sweetened teas, biscuits, candies, sweets and snacks consumed repeatedly keep a person feeling full for a long time. acidic environment in the mouth. Even drinks considered harmless can become problematic if they are sipped frequently or held in the mouth.
Particular attention should be paid to’use of the bottle’ during the night. Sleeping with milk, sweetened teas or juices exposes the teeth to sugars just when the production of saliva decreases. This can lead to the development of what is known as bottle tooth decay, or early childhood caries, which often affects the upper incisors and can progress rapidly.
Other factors that can increase the risk are:’oral hygiene not adequate, the’absence of fluoride, Previous cavities, certain characteristics of the enamel and a tooth arrangement that makes cleaning difficult. When very close or crowded teeth are present, plaque can accumulate in spaces that the toothbrush cannot reach well.
Therefore, there is no one-size-fits-all prevention. During the visit, I consider the child’s diet, hygiene, oral anatomy, and medical history to determine their individual risk.
DENTIST FOR CHILDREN: FIND OUT THE IMPORTANCE OF THE FIRST VISIT
How to treat a cavity in milk teeth
The therapy depends on the depth of the lesion, the child’s age, the tooth involved, and the time remaining before its natural fall out. Not all cavities require the same treatment.
When the lesion is still initial and no cavity has formed, we can try to stop the process through more accurate control of the plaque and the correct use of the dental floss. fluoridated toothpaste e Applications professional of fluorine. This phase requires regular checksA white active spot should not simply be observed without a precise preventive program.
If caries has already created a cavity, the compromised tissue must be treated and the tooth reconstructed. At City Life Institute we apply, when indicated, the Selective Carious Tissue Removal (SCTR), This is a conservative procedure that involves the selective removal of the cancerous tissue.
In the peripheral areas of the cavity we remove the altered tissue It is necessary to obtain a stable closure. Near the pulp, however, we can preserve a part of the affected dentine that is still treatable; removing it completely would unnecessarily increase the risk of exposing the vital part of the tooth. The tooth is then sealed with an appropriate restoration. The goal is to stop the activity of the caries, protect the pulp, and Keep the milk tooth until the physiological moment of its replacement, avoiding more invasive procedures when they are not necessary.
How to treat tooth decay without turning the visit into a negative experience
A frightened child is not a “difficult” child. He or she is communicating a fear that must be recognized and managed in a way that respects his or her own time. For this reason, especially when medical care is needed, I do not only consider the tooth but also the willingness of the young patient to cooperate.
At City Life Institute, during the first visit to the dentist dedicated to children, The setting is an integral part of the process: first we build familiarity with the studio and the tools; then we introduce care, avoiding any forced approaches that could leave a negative impression.
We use a psycho-attitudinal approach, We involve the parents and we resort to positive reinforcement to help the child gain confidence. In selected cases, when anxiety and agitation make it difficult to undergo treatment, we can also consider conscious inhalational sedation.
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City Life Institute Milan: preventing today means treating less tomorrow!
Waiting for pain can make treatment less simple and invasive: a cavity diagnosed at an early stage can usually be managed with conservative procedures; a deep lesion requires a more complex intervention and can expose the child to a less serene experience.
At City Life Institute, my goal is to intervene in a proportionate way, preserving as much as possible the healthy dental tissue and explaining every choice to parents. Prevention does not only consist of checking if there are cavities: it means knowing the specific risk of the child, correcting the habits that increase it and accompanying the growth of the mouth over time.
Information note: This article is for informational purposes and does not replace a direct clinical evaluation. Indications, frequency of check-ups and treatment methods must be determined by a doctor on a case-by-case basis.
Dentist and Aesthetic Doctor, Postgraduate in Implantology, Oral Rehabilitation NYU, Master in Oral Surgery and Implantology UNIBO, European Master in Aesthetic Medicine ICAMP – Milan, Order of Physicians Milan Dental Practitioners Register 5921, Register of Medicine with an Aesthetic focus