Extensive Dental Treatment for a Child

When a mother takes her 5 year old son to the dentist for the first time, the dentist tells her that the boy has several cavities. The dentist wants to take xrays of all of her son's teeth. The dentist says her son will need several fillings, crowns, maybe even root canal treatment or extractions. Is this unusual for such a young child?

Unfortunately, every dentist who treats children sees children with rampant caries - extensive tooth decay. Caries is the most common disease of childhood. Nearly half of all 4-year-old children have at least one cavity. Even some one-year-olds have cavities. This is part of the reason that dentists and physicians recommend early dental visits.

The following organizations recommend that children first see a before reaching their first birthday: American Dental Association, www.ada.org; The American Academy of Pediatrics, www.aap.org; The American Academy of Pediatric Dentistry, ww.aapd.org; and The American Academy of Family Physicians, http://www.aafp.org.

During the first dental appointment, the dentist will discuss what may cause tooth decay and how to prevent it. Tooth decay is most often caused by diet. Children should not be put to bed with a bottle filled with anything but water. Baby bottles filled with milk can cause rapid, extreme tooth decay. Chewy fruit snacks falsely advertised as a healthy substitute for fresh fruit and the rising use of soft drinks are another problem. You can help prevent decay by monitoring your child's diet, proper use of fluoride and thorough brushing.

Many children have GastroEsophageal Reflux Disease or GERD. The valve that prevents the stomache contents from going backwards up the esophagus is not tight. This can cause heart burn, sour taste, and other medical problems. Dental health suffers when the stomache acid contacts the teeth. Children with gastric reflux may have extensive decay or erosion of their teeth's enamel.

Children who have several cavities or a recent onslaught of decay may have an infection. Strep mutans bacteria cause tooth decay. Now, dentists can test for the presence of Strep mutans by scraping plaque from around the teeth and sending the sample to a lab. If Strep mutans is present, then the dentist can prescribe anti-bacterial rinses and other treatments to reduce the infection. Decreasing the concentration of strep mutans decreases future tooth decay.

Children commonly get tooth decay. Tooth decay is a bacterial infection. If decay becomes deep enough, it reaches the pulp or nerve and blood supply of the tooth causing an abcess. When the pulp is infected, the tooth cannot be repaired with a filling. First, the infected pulp must be removed. That is what root canal treatment is. Typically,
dentists restore root canal-treated deciduous teeth with a stainless steel crown. Many dentists find that a bonded tooth-colored filling or crown build up is better treatment than the crown for deciduous teeth.

Sometimes, deciduous teeth must be removed due to extensive decay. Early tooth loss may cause future problems with tooth alignment. When necessary, dentists recommend devices to hold the space of a missing tooth open. Space maintainers hold the other teeth in position until a second tooth fills the space of the missing tooth.

If your child has rampant caries, please do not wait to have it treated. A second opinion is always a good idea. Another general dentist who treats children or a pedodontist - a children's dental specialist - will either validate the first doctor's treatment plan or offer another way to treat your child that you may be more comfortable with. Dental disease may suddenly become painful or cause serious infections.

Dr. David Leader has practiced in Malden since 1989. He is a member of the department of general dentistry of Tufts University School of Dental Medicine, the chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs.