A question we can expect to be asked everyday at Green Apple Pediatric Dentistry. I have continuously been asked this questions since I first treated a child, my junior year of dental school. Everyday we see children that present with decay on their primary (baby) teeth, sometimes not just one but multiple teeth are involved. Sometimes the cavities are obvious and visible to the parents, and therefore the primary reason the parents made an appointment at our office, in other situations they are not, even to the doctor, especially if located in between the teeth with tight contacts. These such areas are only visible for inspection with radiographs. Sometimes in families with multiple children in which the older children never had any cavities and the younger one(s) has cavities, parents are perplexed at how this is possible.
It is also common to hear a parent say:
“Billy never eats any sugar, how can he have 6 cavities?”
“My dad had bad teeth and I have bad teeth, Billy must have inherited the same problem”.
Sometimes baby teeth suffer traumatic events that caused them to discolor, form an infection, and even cause swelling (abscess) and pain.
All of the above scenarios essentially lead to the same question when treatment is recommended: But aren’t they just baby teeth?
Yes, however the decision to treat or not is a multi-factorial one.
Reasons to move ahead with treatment are:
- Primary teeth provide chewing function during a child’s years of greatest body growth
- Esthetically, they provide an attractive appearance and smile
- They play a role in speech
- Permanent tooth guidance is greatly affected by primary teeth. For example, premature loss of baby teeth may cause shifting and drifting of other teeth which may increase the chance for orthodontics
Longevity of primary teeth can be expected to be as follows:
- Permanent incisors (upper and lower four front teeth) and first molars (erupt behind the 2nd baby molars) usually erupt between 6-9 years of age
- Permanent cuspids (replace baby canines) and bicuspids (replace 1st and 2nd baby molars) usually erupt between 10-13 years of age
*Usually meaning “on average” this is the pattern children follow; there are the outliers that will either get their baby teeth earlier or much later. This is the reason why treatment of baby teeth is multi-factorial and individualized. The size of the cavity, the daily diet (acidic vs basic), oral hygiene, tooth structure, enamel quality, salivary flow, and the number of years the tooth is to remain in the mouth, are among the factors used in determining if the tooth needs to be treated or left alone to exfoliate on its own.
“My other children never had cavities, how can Billy have four?”
It is common; in fact we see that happen quite frequently. There is variation in oral bacterial populations in every child’s oral cavity. Every child has a different set of bacteria and different levels of each; and every child has different salivary flow and quality. Every child may not always eat exactly the same thing even in the same family. In addition, we often hear about one of the children having a “sweet tooth” meaning that child may be eating more sweets not only in the form of candy or chocolate but also starchy snacks and sweet drinks. Some non-dental factors to consider are that brushing habits may be different, vigilance of children may decrease as the number of children in a family increases, at times the older children may have the task of monitoring their younger sibling’s brushing, or children may be under the care of grandparents for the major part of the day and getting treated to more snacks than usual. Some children in a family were cared for at home while another child may have been cared for in a childcare center or pre-K school, causing a change in the diet and oral care of that child, in comparison to the other siblings. Some children may be ill frequently for long periods of time requiring them to take medication that is sweetened for better taste and also medications that may cause dry mouth as a side effect. The above are just examples and although they may not apply to every family they shine light on dental, non-dental, medical, family structure, and social factors which may influence dental caries risk on baby teeth.
“Billy never eats any sugar, how can he have six cavities?”
It is common; this may have to do with the nature of the snack foods. Cariogenic, meaning the ability of a food or substance to induce dental decay can help recognize which foods are more cariogenic and which are less cariogenic. Sugar content is generally well known, frequency is not as often understood, and physical properties such as stickiness are rarely known. Generally, when the teeth are exposed to a liquid carrying sugar and/or acid whether in high or low amounts, it usually takes the mouth 25-30 minutes to return back to a neutral pH. As seen in the graph below, a pH at 5.5 or lower causes tooth demineralization or decay. A pH higher than 5.5 is required to prevent tooth decay. Therefore frequent snacks whether solids or liquids, including some brands of water, can cause the pH to remain low and lead to higher risk for decay.
The lower the pH the higher the risk for tooth decay (demineralization).
Even certain brands of water can have a low pH.
The physical properties such as stickiness of foods will influence their effect on tooth decay. For example: fruit rollups, raisings, gummy bears, sticky chips, sticky crackers, sticky cereal, will have a more significant effect on tooth decay than will foods that are less sticky, more fibrous, and higher textured such as fruits and vegetables. Stickiness of liquids can certainly be a factor. I was recently recommended to start drinking coconut juice to increase hydration. I thought all coconut juices are the same but they’re not. Some are made from concentrate and others are non-concentrated straight from the coconut fruit. I chose to drink non-concentrated juice not just because it sounds more “natural” and healthy but also because the taste is better. I quickly discovered how sticky my teeth felt after drinking it even though the juice is clear. I also noticed how much easier is for other foods to stick to my teeth after drinking coconut juice and how desperate I was to brush my teeth after sipping on it for a couple of times in a 2 hr period. I’m using this as an example to show how different foods and liquids behave when they come in direct contact with the teeth.
“My dad had bad teeth and I have bad teeth, Billy must have inherited the same problem, right?”
Although it is possible, it is rare. In my five years of practice (seven if you count residency) I have not seen a child who had inherited a dental problem or inherited soft teeth. It is true that certain hereditary traits, related to the oral cavity and the teeth can be inherited; however, a true inherited enamel defect (soft enamel) on all teeth is not common. When it is observed it is usually in correlation to a syndrome or medical condition.
Localized enamel hypoplasia or enamel hypocalcification (soft spots) are possible and are more commonly seen but only limited to one or a few teeth in most cases. It is important to emphasize that decay is primarily due to sugar and/or acid exposures from solid foods and liquids, bacterial composition in the mouth, and oral hygiene practices.
At Green Apple Pediatric Dentistry we look forward to help you identify the factors that may be causing an acidic environment in your child’s oral cavity and help you restore it to a healthier less-cavity-prone environment. After all, they aren’t just baby teeth, they are valuable primary teeth needed for proper function including chewing and speech development; they are irreplaceable primary teeth needed for proper guidance of permanent teeth as they erupt; they are cute white little pearly teeth making up the attractive smile on your child’s sweet face!