Just Got an e-mail-Bad Decay on a Two Year Old's Teeth

I just received an e-mail from a concerned parent regarding extensive decay on a two year old. This is otherwise known as baby bottle tooth decay. Here is some of my reply:

1. Decay is caused by bacteria. Some kids pick it up and some don’t. We really don’t understand all the mechanisms. So, for one thing don’t blame yourself for the decay.

2. Yes, sometimes a bottle or sippy-cup (at night) can speed up the process, but most kids need milk, etc. during the day to get enough nutrition to grow healthy. The AAPD recommends getting them off the nighttime bottle (juice etc.) around one year of age. Of course that sometimes can be easier said than done. My own daughter loved the bottle, so I switched to just water. She wasn’t so keen on the water I must say, but it worked.

3. Don’t feel like you are the only one with this problem. I see it every day!

4. Now on cavities. How bad it is cannot be determined easily be appearance. I have to get in there and look around and feel of the area with little tools. If the decay “looks really bad”, like very black in color, that might actually be not so bad. I worry more about the decay that looks more light brown or yellow as it is growing so rapidly it has not yet picked up the stain the slower progressing “black’ decay has. In fact the brown or yellow decay may be much deeper than it looks on the surface.

5. Once decay starts, it usually does not stop. It only gets deeper and spreads.

6. A small cavity can be restored with a small White Filling, but remember the same predisposing factors that started the cavity in the first place are still there. So you can get recurrent decay later on. A medium cavity can be filled with a medium filling. A widespread cavity often needs a crown even if it’s not deep. A deep cavity may go very close to the pulp (nerve) or even infect the pulp. If that happens you are looking at some kind of pulpal therapy (like a Pulpotomy) or removal of the tooth if it’s actually abscessed. If the tooth has so much decay (and it can be deceptive how much decay there is in there) that you really can’t even hang a crown on there, I will recommend removal.

So where does that leave us. We as parents want the teeth “fixed”*, sometimes at all costs. That can be done in many cases. Sometimes it is better to remove the teeth to avoid the future complications of a “restored” tooth. If a back tooth is removed early, we usually recommend a space maintainer. If it is one of those front teeth on top, I know you really want to fix them, but if we have to remove them there is no need for a space maintainer. Speech will develop normally and only us parents care about the appearance. It also reduces the risk to the permanent teeth by having no “sick” tooth near it. Sometimes some kind of fake teeth (a Partial) can be placed for looks only. Not my first choice, but we do make tem from time to time. Usually that’s on a child that’s old enough to cooperate and has all their teeth (three or four years old). Remember, once he starts school, some kids are already loosing some teeth and it’s more normal. However, the upper front teeth don’t usually come in till age seven.

*They Are Just baby Teeth, Why Fix Them?