Galway Dentist – Tooth Decay in Children

Tooth decay is the most common chronic disease affecting children. It is often referred to as:

  • Cavities
  • Tooth Rot / Rotten Tooth / Bad Tooth etc.
  • Holes
  • Staining etc.

Tooth decay is caused by the sugars we eat mixing with bacterial plaque on teeth – this creates an acid which dissolves part of the tooth. If this happens often enough cavities will occur. There are specific bacteria in our plaque that cause this condition. Because it is a bacterial disease tooth decay can spread from one tooth to another through direct contact or by shedding into the saliva exposing all of the other teeth in the mouth.

Children who experience decay of the primary teeth are more likely to experience decay in the permanent teeth. By removing tooth decay and restoring the teeth, the numbers of decay-causing bacteria are significantly reduced.

Tooth decay can also significantly affect the quality of a child’s life. If a child has a toothache or pain with chewing, they will not be able to eat properly. Growth and weight gain, sleep patterns, behaviour and school performance may also be negatively influenced.

However, tooth decay is completely preventable by:

  • Effective tooth cleaning twice a day
  • Reducing sugar intake and frequency (including natural sugars e.g. fruit, honey and manufactured sugars e.g. jellies, sweets etc.)
  • Regular dental visits

Remember: your child can have tooth decay without any symptoms or obvious looking “cavities”.
Regular dental check-ups are very important for children.

Fixing Tooth Decay (“holes”) in Baby Teeth

Baby teeth should be retained until they fall out naturally because they serve a number of important functions. (see “why are baby teeth important“). Some children do not lose their last baby molar until 12-13 years of age. This is much later than many parents may realise.

  • If a baby tooth has a small cavity, it can be restored with a tooth coloured filling (composite).
  • If the cavity is very large or the enamel is poor quality, the tooth can be restored with a stainless steel crown. These are very successful restorations and can last many years. Children often refer to these crowns as “princess teeth” or “superman teeth”!
  • In some instances it is not possible to restore the damaged baby tooth so it will need to be extracted. However, this is a last resort as losing baby teeth early can cause loss of space for permanent teeth – this may require orthodontic treatment (braces) later.
Plaque
+
Sugar
=
Tooth Decay
Enamel
Dentine
Pulp
Tooth cavity

The earlier teeth are treated the better. This is more comfortable for your child and more affordable for you.

However, it is never too late to seek dental care!

How to Prevent Tooth Decay

Tooth decay can only occur if…
Plaque (source of bacteria) + Sugar – combine to create acid which then dissolves the outer part of the tooth (enamel). Once a cavity starts it can progress rapidly – especially if there is lots of plaque and sugar around!

The good news is that there is a lot we can do both at home and in the dental surgery to stop this happening.

Prevention AT HOME

1. Keep plaque low with good tooth cleaning twice a day
(brushing morning & night; flossing at night)

2. Keep sugar intake low.

  • Choose “healthy” foods and drinks. Water is the best and safest drink for teeth.
  • Choose “treats” that are tooth friendly; e.g. chocolate NOT sticky sweets like Skittles, Haribos, Polo-Mints etc.

Remember: the longer sugar contacts teeth (e.g. sticky toffee) and the more often sugar is taken – the higher the risk of tooth decay.

3. Strengthen teeth by using fluoridated toothpaste. Use
fluoride mouthwash if advised by dentist (usually from
6 years of age).

Prevention AT THE DENTIST

Regular dental visits greatly help to reduce the risk of tooth decay by…

  • Professional tooth cleaning – removing tartar / stains / plaque
  • Professional Fluoride – concentrated gels & varnish
  • Fissure sealants – as required
  • Periodic x-rays as needed to help detect problems early

Prevention AT HOME

  1. Keep plaque low with good tooth cleaning twice a day (brushing morning & night; flossing at night)
  2. Keep sugar intake low.
  • Choose “healthy” foods and drinks. Water is the best and safest drink for teeth.
  • Choose “treats” that are tooth friendly; e.g. chocolate NOT sticky sweets like Skittles, Haribos, Polo-Mints etc.

Remember: the longer sugar contacts teeth (e.g. sticky toffee) and the more often sugar is taken – the higher the risk of tooth decay.

  1. Strengthen teeth by using fluoridated toothpaste. Use fluoride mouthwash if advised by dentist (usually from 6 years of age).

Prevention AT THE DENTIST

Regular dental visits greatly help to reduce the risk of tooth decay by…

  • Professional tooth cleaning – removing tartar / stains / plaque
  • Professional Fluoride – concentrated gels & varnish
  • Fissure sealants – as required
  • Periodic x-rays as needed to help detect problems early
Baby boy

What is Bottle Decay?

One serious form of rampant tooth decay in young children is what we used to call “baby bottle tooth decay” or “nursing caries”. We now use the term “Early Childhood Caries” (E.C.C.) for this condition. The cause of this disease is a sugar-containing liquid pooling around children’s teeth for a prolonged period. Remember – all milk (human and animal) contains some sugar.

The children affected by this disease are those who typically take a bottle (containing juice, milk, formula etc.) to bed; or a child who is breast-fed on demand at night. Salivary flow and swallowing are reduced at night so teeth can be immersed in the liquid for hours! If this happens over a prolonged period (and the child’s teeth are not cleaned properly) – it is highly likely they will develop tooth decay. Top front teeth are usually the first affected – but the tooth decay can rapidly spread to other teeth.

Progression of Untreated Dental Disease in Young Children – Early Childhood Caries (E.C.C)

Losing baby teeth early can adversely affect speech / eating / appearance and the self-esteem of your child. Front baby teeth do not fall out naturally until approx. 6½ – 7½ years of age. Back baby teeth are retained much longer; early loss of these teeth can cause space loss, resulting in crowding of adult teeth – requiring orthodontic (braces) treatment later.

All this can be prevented by ensuring your child only takes PLAIN WATER to bed at night.

Progression of Untreated Dental Disease in Young Children
Progression of Untreated Dental Disease in Young Children
3 year old child who took a bottle of milk / formula / juice to bed at night. Tooth decay (cavities) visible on two top front teeth.
If child continues to take a bottle at night they will develop cavities on all top teeth and many other cavities on back teeth.
Progression of Untreated Dental Disease in Young Children
Progression of Untreated Dental Disease in Young Children
Left untreated, there is now further breakdown of teeth. Extensive dental treatment required.
Bottle continued – 4 top teeth now need to be removed. Treatment also required on many other decayed back teeth. If not treated there is a high risk of abscess/pain/swelling and damage to the developing permanent teeth!

Tooth decay is completely preventable. Untreated tooth decay in baby teeth can also damage permanent teeth.

How to Prevent Tooth Decay in Young Children

  • After each feeding, wipe your baby’s mouth / teeth with a damp facecloth or gauze even if baby falls asleep – this also helps get them used to tooth brushing later.
  • The only safe drink at night is water. If your child will not fall asleep without the bottle and its usual beverage, gradually dilute the bottle’s contents with water over a period of two to three weeks.
  • Stop bottles / wean breast-fed children by 1 year.

Note: Contact us if you notice any changes e.g. staining, “chipping”, or white marks on your child’s teeth. These could be signs of tooth decay; we can help you to deal with this.

3 Year Old Twins

Decay in primary (baby) molars
Healthy primary (baby) molars
Decay in primary (baby) molars
Healthy primary (baby) molars
This child took a bottle of milk to bed – extensive tooth decay on all molars …
… Her twin only took plain water to bed and all teeth are healthy

Use of bottles with milk, juice or formula and prolonged breast feeding are the main causes of decay in baby teeth.
If your child takes a bottle to bed – the ONLY safe drink is PLAIN WATER

In a nutshell…

Hazelnut

It comes down to basics

  1. Keep your children’s teeth clean – brushing twice a day, flossing daily
  2. Keep their total sugar intake low (Including “Natural” sugars e.g. Honey, Raisins etc.)
  3. Bring your child to the dentist regularly – approx. every 6 months or as advised by the dentist.

Regular dental check-ups save you money – problems are spotted earlier or even prevented – more comfortable for your child and easier on your wallet!

“Prevention is better than cure”

Silver Diamine Fluoride

What is Silver Diamine Fluoride?

Silver Diamine Fluoride SDF is an FDA-approved topical solution that treats and prevents dental caries (tooth decay) and reduces tooth sensitivity.

It is made with two active ingredients:

  • The SILVER is anti-microbial which kills bacteria and prevents the formation of new biofilm.
  • The FLUORIDE prevents further demineralisation (softening) of the tooth structure.

SDF helps to harden the tooth structure that has been softened by tooth decay.

Treatment with SDF does not eliminate the need for restorative dentistry (ie fillings, crowns etc) but it is effective at preventing further tooth decay.

Who should have SDF?

We recommend using SDF in several situations including:

  • Children who have extensive tooth decay (severe early childhood caries)
  • Young children who have difficulty sitting still for treatment
  • Special needs patients
  • Children with carious lesions (cavities) that need to be treated over several visits

Advantages of SDF

  • Provides immediate relief of tooth sensitivity
  • Kills the microorganisms that cause cavities
  • Hardens softened dentine making it more acid- and abrasion-resistant
  • Does not stain healthy dentine or enamel
  • Fast, easy and comfortable treatment

How is SDF applied?

  • Teeth are gently cleaned
  • Carious teeth are isolated, kept dry and all excess debris removed.
  • A microbrush is dipped into a drop of SDF and applied for 1 minute.
  • Any decayed area will stain black. Healthy tooth tissue will NOT stain.
  • For best results repeat application is recommended. Your dentist will advise of this.
  • Depending on the location and extent of the tooth decay as well as the child’s cooperation, other treatment may include placement of Fluoride varnish at the same visit.
  • At a later date, fillings, crowns, extractions – with or without sedation or General Anaesthetic (GA) may be required.

Are there Risks or Side Effects to SDF?

One of the greatest benefits of SDF is that it carries very little risk and is generally free of side effects. The most prominent risk is a completely aesthetic one – blackening of the treated tooth. Stained tooth structure can be replaced with a filling or crown in the future- depending on child cooperation and parental wishes.

SDF can also temporarily stain any tissue surfaces it contacts: for example lips and gums; this staining is temporary and fades in a week or so as the skin cells shed naturally.

SDF will stain clothing, toys and work surfaces – all efforts will be made to avoid touching anything except the carious teeth, but this can be challenging especially with younger patients who are very giddy and unable to cooperate.

What does the tooth look like after SDF?

The area with tooth decay stains black – this can happen in a day or may take longer. The blackening is a sign that the SDF treatment is working.

Back baby (primary) molars with tooth decay - BEFORE application of SDF
Back baby (primary) molars with tooth decay - AFTER application of SDF
Back baby (primary) molars with tooth decay
BEFORE application of SDF
Back baby (primary) molars with tooth decay
AFTER application of SDF
Front (primary) teeth with tooth decay - BEFORE application of SDF
Front (primary) teeth with tooth decay - AFTER application of SDF
Front (primary) teeth with tooth decay
BEFORE application of SDF
Front (primary) teeth with tooth decay
AFTER application of SDF

Should some children not get SDF?

Children with allergies to Silver should not receive SDF.

Children who have sores or ulcers in their mouth are not good candidates for SDF.

If the tooth decay is into the nerve of the tooth, SDF should not be applied. If parents are unhappy with Black discoloration on their child’s decayed teeth, SDF will not be applied.

Benefits of Receiving SDF

  • Relieves dental sensitivity
  • Helps to stop tooth decay
  • Helps to buy time for patients who are very young, fearful, or have special needs that may otherwise require Sedation or General Anaesthesia (GA) for traditional dental treatment.

Alternatives to SDF

No treatment: usually tooth decay progresses eventually causing pain or abscess formation.

Conventional dental treatment: fillings, crowns extractions etc- with or with out Sedation or General Anaesthetic.