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What if my child has a cavity?
Do we really need to restore and save "baby" teeth?
Primary or baby teeth are the foundation of the permanent dentition. In other words, they are the key to healthy and well aligned permanent or adult teeth. Their position in the jaw maintains the proper place for the underlying permanent teeth. Primary teeth also help your child speak clearly and chew naturally.
If a primary tooth has a cavity, it is essential that an appropriate treatment be done before it breaks down, becomes infected and/or is lost early, since it can adversely affect the development and health of the permanent teeth. In other words, there is a great chance that the permanent (adult) teeth will not grow in their proper position and this can affect the way your child’s permanent teeth close together (occlusion or bite). Furthermore, your child might suffer a great deal of pain from a dental cavity or even develop a mouth or facial infection which can be very serious for his health. If your child develops pain or infection, it can influence his eating habits, his sleep, his concentration at school and therefore his general well being.
In summary, the preservation of “baby tooth” is far more important than the false myth that "...nothing needs to be done because they are going to fall out sooner or later."
How can I detect decay on my child’s teeth?
Decay can have many appearances. When you brush your child’s teeth, take a careful look at them. Large decay often presents itself as a cavity (a hole) but smaller decay can appear as either a chalky white, yellow or brown stain. It can be present close to the gum line, on the top surface or anywhere else on the tooth. One of the most common sites for decay on primary teeth is between the teeth. Unfortunately our eyes can not see there and that is why it is often important to take X-rays to make sure we can assess the whole situation. If you suspect that something you see on your child’s teeth might be decay, it is important to let us know so we can see your child as soon as possible. Don’t forget to visit us regularly so we can make a thorough examination of your child’s teeth because decay is not always obvious.
What types of treatment are possible for baby teeth?
The type of treatment chosen to repair a cavity will depend on your child’s age, his cavity risk, his dental hygiene, as well as the size and position of the cavity. In general, a lot of the procedures are similar to the ones for permanent teeth but adapted to primary teeth.
For anterior teeth, aesthetics is an important concern when we restore the teeth and we can discuss the different options for your child.
As for posterior (back) teeth, the three main types of restorations are amalgam fillings (silver), bonded fillings (white) and stainless steel crowns:
- Amalgam fillings are the least expensive option and are a strong and durable filling for small to medium cavity.
- Bonded fillings are more aesthetic since they are “tooth-coloured” but they are more expensive and work best in small restorations. However, they are more sensitive to plaque and poor oral hygiene. They are not usually as durable as amalgams and are not recommended for large decay.
- Stainless steel crowns are required When large decay is present on a primary tooth. If an amalgam filling or bonded filling is placed to restore a large decay, this can lead to the fracture of the filling, or even worse, the fracture and loss of the tooth. Therefore a stainless steel crown will preserve the primary tooth until it falls out.
For more information on types of fillings, visit the Canadian Dental Association website:
If the cavity has spread to the nerve of the tooth, a pulpotomy (partial root canal treatment on a baby tooth) will be necessary to save the tooth. This procedure involves removing part of the nerve tissue and placing special medication on the remaining tissue so it can heal.
If the tooth has developed infection or an abscess, a thorough evaluation of the conditions will be performed and we will discuss if it is preferable to perform a pulpectomy (partial root canal to remove infected nerve tissue of the baby tooth), a full root canal treatment, or a tooth extraction.
When a posterior tooth cannot be saved and must be extracted, a space maintainer might be required to prevent the adjacent tooth from moving into the empty space, keeping the space necessary for the eventual eruption of the corresponding adult tooth. Space maintainers are little appliances, usually made of metal, and are usually very well tolerated by children.
Will my child be cooperative?
Just like all children are different, they all react differently at the dentist. Many techniques exist to help your child have a good experience at the dentist. We will discuss and choose appropriate techniques for your child depending on his age, the dental procedures required for your child, his past experiences and his health status, and will continually adjust according to his level of cooperation during the examination visit.
We are trained in many methods to help children feel comfortable with dental treatment. We will almost always use a technique called “Tell-Show-Do” which consists in explaining to your child what is to be done, then demonstrating with instruments before the procedure is performed in your child’s mouth. We will also constantly reward desirable behaviors with compliments and praise. The office is also designed such that your child can watch a movie throughout his appointment thereby keeping them distracted during the treatment.
Sometimes, however, if your child is anxious, very young and/or uncooperative, he may need more support than a simple "Tell-Show-Do.” There are different management options available to help your child cope better with dental treatment:
- Nitrous Oxide/Oxygen is a blend of two gases that is administered to the child by a pleasantly scented (strawberry, orange…) nose mask. It is a very mild sedative inhaled by the child through nasal breathing and it makes them feel somewhat less anxious with a sense of well being. Nitrous Oxide/Oxygen is perhaps the safest sedative in dentistry. It is non addictive, easily taken and then quickly eliminated by the body through normal breathing. Your child remains fully conscious during treatment. For special instructions regarding the nitrous oxide technique please click here.
- Nitrous Oxide/Oxygen and Oral Sedation (also called "Conscious Sediation"): If a child is very anxious and/or fearful, nitrous oxide/oxygen will not be effective alone. An oral sedative (medication) will be administered prior to the treatment to make your child drowsy while he stays conscious throughout the procedure. For special instructions regarding the nitrous oxide/oral sedation technique please click here.
- General Anesthesia: If your child is very young, requires extensive work in his mouth or cannot cope with the above behaviour techniques, general anesthesia is recommended. While this procedure carries some risk, the technique renders your child deeply sedated and unaware of any treatment being performed. For special instructions regarding general anesthesia please click here.
In summary, during your visit, we will be able to discuss with you which behavior management option is the best for your child. We know that all children are not alike and therefore, every treatment is tailored to your child’s best need as an individual.
Kids & Teens Dentistry
Dr. M. Nikoui and Associates
3 Larkspur Drive, Ottawa, Ontario, K2H 6K8
Tel. (613) 820-8830
Fax (613) 820-8870