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Cavities (dental caries) are the most common oral disease that affects children from infancy through adolescence. Cavities are decayed areas on teeth that develop into tiny holes. They can form on the smooth sides of teeth, in the grooves of teeth, or on the surfaces of tooth roots.
According to the 2012 National Health and Nutrition Examination Survey (NHANES), 56 percent of children between 6 and 8 years of age had cavities in their primary teeth.
About 20 percent of children have untreated tooth decay in their baby teeth. 21 percent of children between 6 and 11 years of age have cavities in their adult teeth.
Early childhood caries (ECC) are light brown in color and turn black over time. Cavities most commonly appear on the biting surfaces of primary molars.
This is because baby tooth enamel is more fragile than permanent teeth, which makes them prone to “caries attacks.” The pits and fissures (deep grooves) on primary teeth are also very thin, which creates an environment for plaque retention, bacteria proliferation, and demineralization.
Common causes of early childhood caries include:
High levels of bacteria and plaque on teeth result in cavities. Scheduling professional teeth cleanings at least twice a year prevents plaque buildup. During the cleanings, pediatric dentists remove plaque that cannot be reached with a regular toothbrush.
Refined carbohydrates and sugary foods can cause cavities in baby teeth. Drinking fruit juice out of a sippy cup or bottle is also bad for your child's dental health. This is known as baby bottle tooth decay or bottle rot.
Some tap water has fluoride in it that keeps primary and permanent teeth healthy. However, it is important to check your community’s water report to find out if you have fluoride in your tap water. Inadequate amounts of fluoride can result in weaker enamel, predisposing you to cavities.
Brushing, flossing, and using fluoride toothpaste regularly reduces the chance of childhood cavities. Before teeth grow in, parents should routinely clean their baby’s gums to prevent the spread of cavity-causing bacteria.
Reduced salivary flow, or dry mouth, can result in cavities or decay.
Cavity-causing bacteria can be transferred from mother to baby. You should pay close attention to oral hygiene during pregnancy because it is a key factor in preventing gum disease, cavities, or tooth loss. If a mother has untreated cavities, sharing utensils or kissing her baby on the lips can cause cavities in her child's teeth.
A child also has a higher risk of cavity development if they were born prematurely, had a low birth weight, or if there were any complications during birth.
A child’s baby teeth develop cavities more often than adult teeth because they have thin enamel.
If a child was excessively bottle-fed, used a pacifier, or sucked on their thumb frequently, they are more susceptible to tooth decay. Also, do not dip pacifiers in honey because cavities can form.
Untreated cavities in baby teeth can lead to other oral health conditions, such as gum disease or tooth loss.
Even though baby teeth fall out, it is still crucial to take care of them. More specifically, if one tooth becomes infected and isn’t treated quickly, the cavity-causing bacteria can spread to other teeth.
Multiple cavities in baby teeth can lead to severe pain, hospitalizations, or emergency room visits. It is also more expensive and invasive to treat multiple cavities and may warrant the use of general anesthesia or sedation.
Tooth decay in baby teeth can affect developing permanent teeth in two ways:
Tooth decay can be prevented naturally with lifestyle changes or through the use of preventive dental techniques, such as tooth sealants and fluoride therapy.
When an adolescent patient understands the importance of good oral hygiene, a pediatric dentist can assist him or her in developing a routine at home that can be easily maintained throughout life.
Cavity prevention tips include:
Once an adolescent is old enough to take care of their own oral cavity, they should floss their teeth daily with traditional floss or by using a floss holder.
Adolescents should brush their teeth with fluoridated toothpaste at least twice a day, ideally in the morning and before bedtime. After meals, rinsing the mouth with water is encouraged. If braces are present, it is also necessary to remove any debris caught around the wires and brackets.
Many adolescents are successful in carrying out effective oral hygiene practices at home. Although, some neglect to perform these activities consistently. Topical fluoride and occlusal sealants are the primary preventive treatments of choice.
Topical treatments prevent dental decay and are completed during a pediatric dental exam or teeth cleaning.
Fluoride treatment is only recommended for young children between 3 and 16 years of age. This includes brushing with a fluoride toothpaste at home, receiving professional fluoride treatment twice a year, and drinking fluoridated tap water.
For almost five decades, pit and fissure sealants have been effective in preventing cavities on the biting surfaces of primary teeth. Sealants create a “physical barrier” on teeth. They also release small amounts of fluoride over time to prevent decay long-term.
The sooner a pediatric dentist places dental sealants, the more effective they are, especially in adolescents with deep grooves in their teeth.
A child’s first molars grow in at around age 6, and the second molars grow in around age 12. As soon as the teeth grow in completely, they can be sealed immediately and are cavity-free from the start.
There are three types of treatment options that are used to fill cavities in primary teeth:
In the past, amalgam was the material of choice for minor dental restorations in children. Today, it continues to be an effective cavity treatment method. Dental amalgam consists of an alloy mixture of tin, copper, silver, zinc, and mercury.
The material is extremely strong, durable, and lasts up to 10 years longer than composite fillings. Amalgam dental fillings are also the cheapest restoration available.
Over the past 30 years, resin-based composite fillings have been one of the most widely used restorative materials. Resin composite is currently used for sealants and cavity fillings in primary and permanent teeth.
The material is tooth-colored, so it blends seamlessly with natural teeth. Composite fillings are also relatively strong, durable, and the most aesthetically pleasing direct dental filling available.
Since the 1950s, stainless steel crowns (SSCs) have become a valuable restorative material and treatment of choice for severely broken down primary teeth. They cover and protect a child’s primary molars that are severely decayed or damaged.
SSCs are extremely durable restorations that may be placed after a pulpotomy/pulpectomy or in teeth with large carious lesions (cavities) where amalgam fillings are likely to fail. They also fix fractured or chipped teeth.
Depending on your needs, there are two types of SSCs available, including pre-contoured and pre-trimmed crowns.
The cost of a cavity restoration depends on the type and the dentist’s location. Although, dental restorations are medically necessary.
Part or most of the procedures are covered by a good insurance policy. The prices below reflect procedure costs without insurance:
Amalgam (Silver) Filling
$50-$200 (per tooth)
$90-$300 (per tooth)
Stainless Steel Crowns
$300-$500 (per baby tooth)
$30-$75 (per tooth)
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“Dental Caries (Tooth Decay) in Children Age 2 to 11.” National Institute of Dental and Craniofacial Research, U.S. Department of Health and Human Services, www.nidcr.nih.gov/research/data-statistics/dental-caries/children.
“Fluoride and Healthy Teeth.” Paediatrics & Child Health, Pulsus Group Inc, Oct. 2002, www.ncbi.nlm.nih.gov/pmc/articles/PMC2798600/.
Koch Göran, et al. Pediatric Dentistry: a Clinical Approach. John Wiley & Sons Inc., 2017.
Nowak, Arthur J. Pediatric Dentistry: Infancy through Adolescence. Elsevier, 2019.