Pediatric Dentist, Dr. Premila Naidu on causes and treatment of cavities

This is the second part of a series of Interview with her, where she talks about the importance of dental health in children. In this part, she addresses one of the most common concerns of early childhood caries, the causes and treatments that one must take.

Here is the transcript of our interview with Pediatric Dentist, Dr. Premila Naidu. Please note that the transcript has been edited for clarity and brevity and is not verbatim.

This interview is part of a series of interviews about ‘On early dental health in children’. You can see the first part of the interview here.

What are the common causes of cavities in children?

Nowadays we are seeing a rise in number of children suffering from early childhood caries. The most common cause for it is breast feeding or bottle feeding the children at night especially after one year of age. WHO does recommend that you breastfeed your child up to the age of 2 years, but this type of cavity is mainly seen in children who suckle purely out of habit than hunger. The sugar in the milk remains in contact with the teeth for a longer period of time and at frequent intervals causing demineralisation or weakening of the teeth. This type of cavity usually affects the upper teeth but at later stages even the lower teeth get affected. If a mother wants to breast feed the baby till 2 years then it is very important that she wipes the child’s teeth after every feed.

The second common cause is snacking. It is a common misconception that only chocolates or sweets can cause cavities. WRONG! Any sticky carbohydrate can cause cavities. Frequent snacking with biscuits, chocos, jellies, candies etc can also cause cavities. These food items can stick around the teeth for a long time, allowing the decay-causing bacteria to produce acids, making the teeth weak and finally causing a cavity. It is better to carry healthy snacks like fruits when going out and these sticky snacks can be given at home once in a while as long as their teeth are cleaned immediately.

Other causes for the cavity would be the shape of the tooth itself. The molars especially may have deep grooves, making them prone to cavities. In very rare cases the teeth may be developmentally weak.

At what age is it safe for the child to undergo dental treatment?

Sometimes as parents, we see a cavity and wonder whether it is safe for a child so young to undergo dental treatment? Will the child cooperate? Will it be too painful for my child? What we need to understand here is that dental caries is a progressive disease. It is not going to stop with proper brushing or medication.

So as soon as a parent suspects a cavity,irrespective of the age, it is better to treat it than to wait till the child complains of pain. We encourage the parents to bring the child for regular check-ups so that we can identify a cavity at the early stages and make sure we treat it. We can also identify teeth that are prone for cavities and take preventive measures. One more thing that is important to understand is the nerves of a milk tooth are not as sensitive as the adult teeth, hence no pain does not mean no problem in deciduous teeth.

What are the different treatments for cavities?

The treatment for cavities would mainly depend on how deep the cavity is.

Early sign of a cavity is known as a White spot lesion, where you will see white spots in the upper front teeth, or even in the molars at times. For this stage there is no need for any extensive treatment; there is a paste that is available, which can be applied regularly that will help in strengthening the teeth.

A tooth has 3 layers: enamel, dentin and pulp.

As long as cavity is in the enamel we can clean it up and fill it or what we call ‘restorations’. Usually a glass ionomer cement is used. But sometimes other materials like miracle mix, composers and different types of crowns can also be used to restore the cavity.

Even the cavities which have reached the initial stages of dentin can go in for a restoration treatment.

As the cavity moves closer to the pulp there is a higher chance of the pulp being infected. In such a situation an x-ray is taken to check the extent of the infection. If the x-ray shows that the pulp is involved then a procedure called pulpectomy needs to be done, where the infected pulp is removed and an antibiotic paste is filled into the roots. To restore the strength  a crown may be placed on the child’s tooth.

Sometimes when the infection is very extensive the root may be damaged. In those situations the tooth may have to be removed and replaced with a space maintainer.

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