It’s often best health-wise to preserve even the most troubled tooth—including a child’s primary (“baby”) tooth. If that sounds like too much effort for a tooth that lasts only a few years, there’s a big reason why—if it’s lost prematurely, the incoming permanent tooth above it could erupt out of position.
Preserving a decayed primary tooth could include procedures similar to a root canal treatment, commonly used in adult permanent teeth with inner decay. However, we may need to modify this approach to protect the primary tooth’s pulp. This innermost layer plays a critical role in early dental development.
Because an adult tooth has reached maturity, removing diseased pulp tissue has little effect on its permanent health. But the pulp contributes to dentin growth (the layer between it and the outer enamel) in primary and young permanent teeth, so removing it could ultimately compromise the tooth’s long-term health.
Our goal then with a child’s tooth is to remove as much diseased tissue as possible while involving the pulp as little as possible. What techniques we use will depend on how much of the pulp has become infected.
For example, if decay has advanced to but hasn’t yet penetrated the pulp, we may remove all but a small amount of the decayed structure just next to the pulp to avoid its exposure. We may then apply an antibacterial agent to this remaining portion and seal the tooth to curb further infection.
If on the other hand the pulp has become infected, we may try to remove only the infected portion and leave the remaining pulp intact. We’ll only be able to do this, however, if we deem the remaining pulp healthy enough to remain infection-free after the procedure. If not, we may need to remove the entire pulp as with a traditional root canal. This option, though, is a last resort due to the possible effect on dentin growth and the tooth’s long-term health.
As you can see attempts to preserve a primary tooth can be quite involved. But if we can help it reach its full life span, it could mean better dental health for a lifetime.
If you would like more information on caring for primary teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Canal Treatment for Children’s Teeth.”
For most people, raising kids is an expensive proposition. (A recent estimate by the U.S. Department of Agriculture puts the average tab at almost a quarter of a million dollars before they turn 18.) But if you’ve been keeping up with parenting news lately, you may have come across an even more jaw-dropping fact: According to a survey by the Sunstar group, a maker of oral hygiene products, when the tooth fairy makes a pickup in New York City, she (or her parental surrogate) leaves an average of $13.25 per tooth!
That compares to $9.69 per tooth in Los Angeles, $5.85 in Chicago and $5.02 in Boston — and it’s a far higher rate than most other polls have shown. But it brings up a good question: What's a baby tooth really worth? Ask a dentist, and you may get an answer that surprises you: A lot more than that!
A child’s primary (baby) teeth usually begin coming in around the age of 6 to 9 months, and start making their exits about the time a child reaches six years; by the age of 10 – 13, they’re usually all gone. But even though they will not last forever, baby teeth are far from disposable — and they deserve the same conscientious care as adult teeth. Here’s why:
Primary teeth play the same important roles in kids’ mouths as permanent teeth do in the mouths of adults: they allow kids to bite and chew effectively, speak normally and smile brightly. Their proper functioning allows children to get good nutrition and develop positive social interactions as they grow toward adolescence — and those are things it’s difficult to put a price tag on.
But that’s not all baby teeth are good for. Each one of those little pearly-whites serves as a guide for the permanent tooth that will succeed it: It holds a space open in the jaw and doesn’t let go until the grown-up tooth is ready to erupt (emerge) from beneath the gums. If primary teeth are lost too soon, due to disease, decay or accidents, bite problems (malocclusions) can develop.
A malocclusion (“mal” – bad; “occlusion” – bite) can result when permanent teeth don’t erupt in their proper locations. “Crowding” is a common type of malocclusion that can occur when baby teeth have been lost prematurely. The new, permanent teeth may come in too close together because neighboring teeth have shifted into the gap left by the prematurely lost tooth, creating an obstruction for the incoming teeth. In other cases, the permanent teeth may emerge in rotated or misplaced positions.
Bite problems make teeth harder to clean and thus more prone to disease; they may also cause embarrassment and social difficulties. The good news is that it’s generally possible to fix malocclusion: orthodontists do it every day. The bad news: It will almost certainly cost more than $13.25 per tooth. Alternatively, baby teeth in danger of being lost too soon can often be saved via root canal treatment or other procedures.
We’re not advocating giving big money to toddlers — but we do want to make a point: The tooth fairy’s payout: a few dollars. A lifetime of good checkups and bright smiles: incalculable.
Even the sweetest children don’t always have sweet-smelling breath. If your child has persistent bad breath, it may be for one of the following reasons:
POOR ORAL HYGIENE HABITS. Bad breath often results from bacteria on the teeth and tongue that is not effectively removed during brushing and flossing.
- Tip: To encourage thorough cleaning as children are developing their oral hygiene habits, try handheld flossers that are colorful and easy to use, sing or play music to make brushing time fun, or try an electric toothbrush with a timer or a tooth-brushing app that keeps kids brushing for a full two minutes.
PLAQUE BUILDUP, TOOTH DECAY AND GUM DISEASE: Plaque, a sticky bacterial biofilm, can build up on tooth surfaces, between the teeth and under the gum line and can lead to tooth decay and gum disease. These conditions may result in bad breath.
- Tip: Stay on top of your child’s oral hygiene at home, and keep up with regular dental visits for professional cleanings and checkups.
POST-NASAL DRIP: This common cause of foul-smelling breath in children results when excessive mucus is produced and drips down the back of the throat.
- Tip: Schedule an appointment with your child’s pediatrician to determine and treat the cause.
MOUTH BREATHING. Breathing through the mouth instead of the nose can cause a dry mouth. This can lead to increased oral bacteria, which can cause bad breath. If children breathe through the mouth all the time, not just because of a temporary cold or allergies, your child is at greater risk for tooth decay and gum disease.
- Tip: If your child is a chronic mouth breather, schedule a dental visit so we can check for any adverse effects on dental health. Note that over time, habitual mouth breathing may lead to poor alignment of the teeth. An ear, nose and throat (ENT) specialist can treat problems with tonsils, adenoids and sinuses — common causes of mouth breathing.
FOREIGN OBJECT IN THE NOSE. It wouldn’t be the first time a child has stuck a pea or other small object up their nose â?? or their sibling’s nose — only to find that it won’t come back out. A foreign body in the nasal passage can cause infection and lead to bad breath.
- Tip: Don’t try to remove the object at home, as part of it may remain in the nasal passage. A medical professional will have the right equipment to dislodge the object more comfortably.
MEDICATION. Children who take antibiotics for a long time may develop a fungal infection (thrush) in the mouth. Other medications can cause bad breath due to the way they break down in the body.
- Tip: Call your pharmacist if you have a question about medications and bad breath.
MEDICAL CONDITION. Infections of the throat, sinus or tonsils can cause bad breath, as can more serious health conditions.
- Tip: If your child’s breath is unpleasant for an extended period of time, get it checked out by a health professional.
If you are concerned about your child’s breath, schedule a visit. We are happy to remind your child of proper brushing techniques and check for other problems that need to be addressed.
For more on young children’s oral health, read “How to Help Your Child Develop the Best Habits for Oral Health” and “Why See a Pediatric Dentist?”
Question: What oral health issue do teenagers who wear orthodontic retainers and older folks who wear dentures have in common?
Answer: Both need to pay particular attention to cleaning their oral appliances.
The same goes for anyone who wears a nightguard to control tooth grinding, a mouthguard to protect teeth while playing sports, or a clear aligner for orthodontic treatment. Yet many people aren’t sure how to properly clean their appliances — so here are a few handy tips:
- Use toothpaste on your appliance — the ingredients in toothpaste, which are designed to polish the hard enamel of your teeth, are too abrasive for the soft plastic of oral appliances, and will cause scratches.
- Boil your appliance, or use bleach to clean it — both will end up breaking down and destroying the appliance. Don’t even use very hot water, as it can deform the plastic and make the appliance useless.
- Leave your appliance out on the nightstand, or anywhere else — pets and small children have been known to find (and destroy) oral appliances left lying around. Instead, store it properly in its special case.
- Use liquid dish detergent or hand soap to clean your appliance. A little mild soap plus warm water will do a great cleaning job. While you’re at it, get a brush just for the appliance — because, while it’s fine for plastic, you don’t want to brush your teeth with soap!
- Put a towel in the sink basin when you clean your appliance. Soapy appliances (especially dentures) can be slippery, and can be damaged by dropping — and that’s an expensive mishap.
- Consider investing in an ultrasonic cleaner. These inexpensive countertop devices are an excellent way to get the tiny ridges and crevices of your appliance really clean.
Whether you rely on dentures for everyday use, or just need to wear a retainer for a period of time, your oral appliance serves an important function. It may also represent a significant investment. That’s why it’s worthwhile to spend a few minutes each day giving these important items the care they need.
Your child’s dental care wouldn’t be the same without x-ray imaging. It’s one of our best tools for finding and treating tooth decay.
But since x-rays emit radiation, is your child in any danger when they’re exposed?
X-rays, an invisible form of electromagnetic energy, will form images on exposed film after passing through the body. Because it takes longer for x-rays to pass through dense tissue like teeth and bones, the corresponding areas appear lighter on the film than less dense tissue like the gums. We can detect decay because the diseased tooth structure is less dense and thus appears darker against healthier tooth structure.
The downside of x-rays, though, is the radiation they emit could potentially alter cell structure and increase the risk of future cancer, especially with children. That’s why we follow a principle known as ALARA when using x-ray imaging. ALARA is an acronym for “as low as reasonably achievable,” meaning the doses for an x-ray session will be as low as possible while still gaining the most benefit.
Advances in technology, particularly the development of digital processing, has helped reduce the amount of radiation exposure. We’re also careful with what types of x-rays we use. The most common type is the bitewing, a device with the film attached to a long piece of plastic that the child holds in their mouth while biting down.
Depending on the number of our patient’s teeth, we can usually get a comprehensive view with two to four bitewings. A typical bitewing session exposes them to less radiation than what they’re receiving from natural environmental background sources each day.
Keeping the exposure as low and as less frequent as possible greatly reduces health risks while still getting the full benefit of early decay detection. Still, if you have concerns about your child’s x-ray exposure, we’ll be happy to discuss our approach and all the precautions we take using x-ray imaging.
If you would like more information on x-ray diagnostics and your child, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “X-Ray Safety for Children.”
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