What to know about dental cavities in children

Scott Balzer, DDS

Dentistry

Dental cavities are the most common chronic disease of childhood, according to the Centers for Disease Control and Prevention (CDC). Left untreated, they can cause pain and infections that can lead to problems with eating, speaking and even learning. Scott Balzer, DMD, explained what parents need to know about cavities in children and how to prevent them.

What causes a cavity?

Plaque builds up on the teeth, and in that plaque is bacteria. The bacteria then eat the sugars you eat, creating acid as a byproduct. That acid is what forms a cavity.

The CDC notes that a child’s chances of getting a cavity are higher if:

• Family members have cavities.
• They consume a lot of sugary foods and drinks.
• They have special health care needs.
• They wear braces or oral appliances.

How serious are cavities in a baby tooth? Isn’t it going to fall out anyway?

Cavities can be very serious, causing pain and swelling and putting the child at risk for even more serious health problems.

“This is very extreme, but there are reported cases of children with dental abscesses where these infections spread and become fatal,” Dr. Balzer said. “Getting it treated before it becomes serious is super important.”

But he said the question about whether it’s necessary to fill the tooth is a fair one.

“There are times when it does make sense to leave the cavity be and let the tooth fall out without treatment,” Dr. Balzer said. “It depends on how deep the cavity is and how close it is to potentially causing pain to your child. I’ll tell patients, we can wait, but the second your child notices some type of pain, or you notice any type of swelling, come in and we’ll handle it.”

How is a severe cavity treated?

The options that exist depend on how much of the tooth is left after removing the cavity and all the bacteria that was in the tooth. If there’s a solid foundational tooth structure that remains, it might be treated with a filling or a crown.

“There are cavities that are so severe there’s not much left to put a crown on top of, and so we have no choice but to pull it,” Dr. Balzer said. “A root canal is also an option, depending on how long the tooth is expected to remain in the mouth.”

Is anesthesia or sedation during a dental procedure safe for children?

Dr. Balzer said multiple options are available to provide a safe, pain-free experience for children during their dental procedure.

Nitrous oxide, commonly known as “laughing gas,” can help a child feel less anxious. Nitrous oxide is provided with a little oxygen, causing them to feel more relaxed, but it doesn’t make them fall asleep.

A local anesthetic, such as lidocaine, is then used to numb the mouth.

“Pairing lidocaine with nitrous oxide makes the child ultra-relaxed and they’ll let you do the work that needs to be done,” Dr. Balzer said. “Nitrous oxide is super safe.”

Mild and moderate sedation may be offered, depending on the dental facility. In some cases, general anesthesia in an operating room setting may be needed.

“General anesthesia is more reserved for extreme anxiety cases and for children who require a lot of work, such as multiple fillings or crowns,” Dr. Balzer said. “But not everyone’s a candidate. There are some things that would prevent you from being able to have sedation in an operating room setting, and there are always risks with general anesthesia. So, while I say it’s very safe and monitored, there are risks that go along with it and should be discussed with your dentist.”

Bottom line, Dr. Balzer said the goal is to provide a good experience for the child.

“As a child, if your first experience at the dentist is traumatic and miserable, that can really scar you for future dental appointments into adulthood, and we don’t want that.”

What’s the best way to prevent children from needing extensive dental work?

Dr. Balzer said good oral hygiene is the key. Here are some quick tips:

• Brush twice a day and floss. Be sure to use a fluoride toothpaste in children 2 years and older. If younger than 2, talk to your dentist.
• Limit drinks and food with sugar. Eat fruits and vegetables for snacks rather than sweets.
• Visit your dentist regularly. Make your dental exams a priority and a routine.

When should children start having dental care?

Children should start seeing the dentist when they begin getting teeth.

“As early as six months is okay, but certainly by the time they turn one year old,” Dr. Balzer said. “Some parents may think it’s a waste of time if their child has one or two teeth, but it helps to get the child sensitized to the dental clinic – the smells, the sights and the noises. Making sure they feel comfortable from a young age is important so that children continue their dental care and good oral health down the road.”