Wednesday, September 13, 2006

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?

42 comments:

Anonymous said...

I just saw an one year old girl with ECC; centrals did not look like they are fully in yet; One central with minimum clinical crown due to either decay or partial eruption..... parents are willing to go through GA to fix the cavities. Do you do primary tooth pulpectomy? what technique and obturation material do you use? is it possible to do post or core bulid-up? - thank u for your input! a newly graduated pediatric dentist.

Dr. Dean Brandon said...

If there's a lot of decay into the pulp, I may do a primary tooth pulpectomy . (assuming there's some root still there). I'll maybe post later about that, but I basically get the pulp out (barbed broach is great and files if necessary-nothing fancy), irrigate with hyopchlorite, and fill it with ZoE paste with a lentulo-spiral on a slow speed. (Forget the post and core). If there is enough tooth to get a crown on there, then fine, otherwise, extraction is the best option (with perhaps, a partial later on for looks?).....Just remember, kids are rough on their teeth , crowns included.

I always let the parent know treatment might change on a OR case once I get in there. I have to say I don't do many of these pulpectomies. Now, if it's definately abscessed, then I usually recommend Ext. I know some parents want to save them at all cost, just let them know what is realistic.

Sometimes I'll do a pulpotomy if the pulp seems still vital and in pretty good shape. -Formo and IRM like on posterior. Actually, pretty good luck with that.

Anonymous said...

Thank you very much for your input. You have a very wonderful website.

Anonymous said...

Hi. I was wondering if you could help me. My 13 month old has a white soft material coming down in between his 2 front teeth. Do you know what it could possibly be?

He also has a tooth on bottom that looks like 2 fused together.

Dr. Dean Brandon said...

Fusion is a common thing in young children. Your dentist can tell you if that is what it is.

White stuff? I have no idea.

IyaB said...

I'm worried about my daughter's teeth. She is 1 1/2 years old and she has developed white smudges on her teeth. I recently went to a pediatric dentist and she told me that out of the 16 teeth that my daughter has, 8 need work. This happened despite brushing regularly and the water-at-night routine. Anyway, the dentist told me that my daughter would need to be sedated and that she would have to have crowns on her two front teeth and the other teeth would have to be filled. I was just wondering if sedating children that young (less than 2 years old) is safe. Should I wait to get the procedure done until she's a bit older?

Dr. Dean Brandon said...

I do not do too many 1 year old sedations, but do them from time to time--very safely. Just be aware untreated decay gets worse with time. Consult with your dentist to express your concerns.

Anonymous said...

My child's dentist is removing my child's 2 front teeth due to them being broken in half in the root. My son is almost 4. I know you have mentioned that going without the front teeth will not impair his speech, but what if he already has speech problems. His speech is pretty bad. He goes to a speech therapist twice a week. He also has develpomental delay. The question I am trying to ask is...Since he already has speech problems would it be better to go ahead and get the pedo partials for the front 2 teeth? He has came along so much in the past year with his speech...Im afraid he will have more delays. Thanks

Dr. Dean Brandon said...

I cannot say if it is better for him on not. I will say I often see children with the combination of a sucking habits, "speech" problems, orthodontic crossbites or open bites, etc. In other words, things are multifaceted and have multiple causes. The speech pathologist we refer too the most cannot do too much with kids till they are about 8 years old although she does see the younger ones too. Sounds to me like you really want to get the partial...ask your dentist.

Anonymous said...

Do you know of any photos available online of the stainless steel crowns with the white fronts? We just learned that my 3-year old needs to have his 4 top front teeth crowned. My pediatric dentist uses the white front crowns and I am wondering what they will look like, if when placed the stainless steel will be obvious. I did not inquire (had too much to absorb at the appt. that I didn't even think to ask)about all white crowns.

Also...as my son grows, will the crowns look too small for his mouth? That probably sounds silly, but his teeth are so tiny right now. Do teeth grow as children grow? If so, won't the crowns seem small as he grows?

Any information you can provide would be greatly appreciated.

Dr. Dean Brandon said...

Sometimes front baby teeth can have white crowns. There is a good post on this blog on white crowns for baby teeth. Although there are no clinical photos there there are some photos of the crowns themselves. You might try a search for the brands listed there.

Erin said...

My husband and I make a point to brush our two-year-old's teeth every evening. BUT, it is an awful fight of one of us holding her while the other brushes her teeth. Do you have a reccommended method for doing this effectivly?

Dr. Dean Brandon said...

You do the best you can. Some use the knee to knee method--lean the child back into your spouses lap. You hold the child's hands (so he won't reach up) and have him straddle your waist. Your spouse holds the head and brushes. It's hard to describe here, but if you ask your pediatric dentist, he will be knowledgeable of this.

Anonymous said...

Today was my childrens first dentist visit. My 3 year old has a couple of cavities and has to be sedated to be filled. However, my 19 month old daughter has a few cavities. She has cavities on her first four upper teeth and a couple in the back. The dentist said that they all need to be removed. Should I have them removed or should I just let them fall out on its own?

Dr. Dean Brandon said...

Well, I'd go with what your pediatric dentist recommends. Teeth need oto be removed sometimes if they are just too far gone to easily restore..Upper front teeth will not "fall out" till 7 top eight years of age...back teeth longer than that even to 12 years of age...Perhaps you can read more of my posts and get a general idea of how things are with kids and all thier teeth concerns and treatments.

worried mom said...

Hi. We just took our 2 1/2 yr old son to the pediatric dentist to find out what needed to be done about the visible decay on his front teeth. The dentist recommended $1300 worth of work which includes strip crowns for the front two teeth, and two composite fillings for small caries in the back teeth. My son was extremely cooperative throughout the visit (much to my relief!) The dentist would like to perform all the work in a single visit in his office and would like to use versed, administered nasally, and nitrous oxide in combination with local anesthetic. My son would be restrained using a papoose. He will not allow me to be present or visually monitor the procedures. I feel very anxious about leaving my two year old in the hands of a relative stranger for 45 minutes without being able to visually monitor his wellbeing. I can understand why parents wouldn't be allowed in the room during the procedure, but I don't understand why there isn't some way to monitor the procedure (either closed-circuit television or a two way mirror). What is it, exactly, that the dentist is so afraid that I'll see? I'd like to know if my kid is going to be screaming through this whole thing, because I'd strongly consider general anaesthesia if that's the case. I don't feel like I'm getting a straight answer out of my dentist, and I'm feeling very wary and concerned. I haven't seen you mention versed in your other posts and wonder if this is a standard method of conscious sedation or if this is strictly being used for it's amnesiac effect? Any feedback you could provide would be tremendously helpful...

Dr. Dean Brandon said...

You may want to read hee:

Sedative Drugs Used in Pediatric Dentistry

Parental Behavior in the Pediatric Dental Office

Plus there are a lot more here--I know-kind of hard to find. In our office there is a window parents can look through, but I tend to find if they want to be back thay end up in the room. Kids may be fussy (especially a 2 year old ) but not always. Some offices have different procedures, etc. May want to ask more questions--general anesthesia is a good option sometimes especially if you are anxious about his reaction.

Anonymous said...

my daughter was on antibiotics from the time she was 4 months old until she was almost 2 and she has had decay on the 2 teeth on either side of her front teeth and some small spotting on her front teeth. i was told that antibiotics could have been the cause but it wasn't listed as a side effect. she has never been bottle-fed and never used a pacifier. Could breastfeeding also have caused the decay? i was also curious because the 2 badly decayed teeth looked "chipped" right from the time they started growing in and we thought at the time it wasnt anything to worry about. now the dentist thinks they will have to be pulled. Will that affect her adult teeth coming in or is there any damage or problems that are caused by not having have teeth there for the few years it will take before her adult teeth to come in?

Dr. Dean Brandon said...

As you can read here and in other posts, cavities are caused by a bacteria and aggravated or accelerated by things like diet (bottle or breast ad at night after one year of age) and brushing issues, etc. Decay can progress rapidly often leading to the removal of teeth. If you treat the decay, and institute proper preventive strategies and orthodontic guidance, the permanent teeth should be ok in most cases. Please read more on this here ont he blog.

Anonymous said...

My 5 yr old son has had a stainless steel crown (made by 3M - anatomically shaped) placed on one of his lower first primary molars by a pediatric dentist. Soon after it was placed, we had a therapist express concern over the metal in his mouth. Are you aware of any studies that examine the leaching of the various metals that are part of the stainless steel alloy once the crown is in the environment of the mouth? We understand that this type of crown is very durable, but now we are worried about it's impact on his overall health. Is this metal completely "inert"? We are very upset about this and feel that we made a mistake by letting the crown be placed - especially since a second opinion from a general dentist indicated that the cavity could simply have been filled. Any insights you have would be appreciated.

Dr. Dean Brandon said...

You can read much more here on the blog about stainless steel crowns. Simply put they are safe and effective. They are no different than the spoon you put in your mouth every day. They contain no mercury (if that is your concern).

If a cavity is small, I do white fillings. Often however, (especially in baby molars), a crown is a better option when the cavity is larger. A large filling may "work" on a permanent molar, but will not hold up in a baby molar. I wonder, would you feel the same if the crown "looked" white, like a regular tooth? Why do you feel that a crown would be a health concern and a white filling would not? Your concerns are not unreasonable, but I use these crowns almost every day. They are safe.

Anonymous said...

Thank you for your prompt reply, Dr. Brandon. In particular, it is the nickel that is part of the stainless steel alloy that is of concern - I do know that no mercury is involved. We recognize that stainless steel is a part of our daily lives (cookware, etc.), but those things are not in our body all of the time exposed to saliva and other food and bodily chemicals. That is the concern. We would certainly appreciate a more aesthetic look, but are willing to look past the appearance as long as we are sure this is a safe material. The resin used for the fillings may also be a health hazard for all we know, but it does not seem to contain the heavy metals in it. We are also wondering why a porcelein, ceramic, or resin crown cannot be used with a child. It only needs to last 5 yrs or so - they last that long (and longer) in adults. And, if it broke, could it not be replaced? It is definitely more expensive, but it was not even offered as an option. Thank you for referring me to your stainless steel crown section on your website - I had read that prior to posting and would have posted my questions there if you had not disabled that function. I have appreciated the information you provide at this site. One additional question - in your experience (or through your knowledge of the research base), have you noticed a relationship between early antibiotic use (particularly amoxicillan) and enamel formation/susceptibility to tooth decay in children's primary teeth? Our son had chronic ear infections from infancy and antibiotics were used to treat the infections - we wonder if this has been a contributing factor in his dental problems.

Dr. Dean Brandon said...

Stainless Steel Crowns(3M)=safe.

Porcelain crowns and porcelain fused to metal (the most common permanent tooth crown), etc. are impractical in baby teeth--porcelain (or white filling material/resin) is fragile-In baby teeth you cannot make it thick enough to withstand biting forces. You'd have to wipe out the whole tooth to get it thick enough.

Cavities are caused by a bacteria. Fevers at certain ages can cause hypoplasia (not cavities), but even that "link" is debatable.

Anonymous said...

My 2 1/1 year old son has baby bottle decay on his 3 front teeth (E,F & G). He has been breast fed since birth. He also has severe asthma and takes pulmacort daily, and also food allergies and eczema. The dentist says that he has very little, if any, enamal on his teeth. One of the teeth has the decay close - or on - the nerve. Dentist has recommended pulpotomy on at least two teeth. Given his previous hospitalizations, ER visists and somewhat poor health, I am not comofortable with GA and restoration. I am concerned about the trauma of "putting him under". Dentist says that this procedure is no guarantee that it will truly fix the teeth or prevent further decay. My gut is telling me to extract all three teeth with an oral surgeon under the gas mask (not sure what this really is, but it is supposed to sedate him). I feel that it is safer and will get rid of the unhealthy teeth, thus, prevent further problems and then we're hopefully done with tormenting him at this very young age. Dentist says that decay is not severe enough to demand ext, but not healthy enough to demand restoration and it is my choice. I am wondering what will be the best for his long term health (permanent and current teeth, self image, speech, sedation, etc.). Thanks for all of your time and any assistance. This is obviously a very important decision.

Dr. Dean Brandon said...

As you can read on my posts, it is often a good choice to remove baby front teeth. Back teeth are more important for space maintenance, etc. Each case is different. If restoration is the decision, then GA is often necessary due to the age of the patient. If teeth are removed there is no further threat to the permanent teeth from infection of the baby teeth , etc. Either way, it is good you are attempting to get him back in good dental health.

Luna Maia said...

My 20 month old has cavitiy on D ling, and the front of the other. They want to do Deep sedation, for fillings. Aparently ts not bad enough for a crown. The one on D is just to the dentin but apparently not in it. The one on the front o the other tooth is mild. The dentist felt the sedation with versed was unsafe bc of hs age, i'm feeling deep sedation seems crazy for what were trying to accomplish. Is there any other methods that we could try first? I was given the wait and see or deep sedation choices.
thank you

Dr. Dean Brandon said...

Luna,

See my posts on sedation and behavior management (under General Topics). I do not like to sedate one year-olds, but Versed is a fairly safe drug. Read my posts on all this as I think I cover much of what I could say here. I do not do "deep" sedation in the office. If that is needed, I go to the OR at the hospital. Options run the gammut, from general anesthesia to "hold and go" to no treatment at all (waiting).

Jutinut said...

My 2 year old daughter just did a metal crown on her 4 front teeth. The Dentist said she needs to do more crown on the upper teeth, and some filling at the bottom within the next 2 appointment. After the first treatment was done,my daughter kept saying it's hurt, and cried a lot. I started to worry If I made a bad decision for her. I read through your answers, and sounds like it was a good idea to do crown if the cavity got worse. The next 2 appointment going to be within the same month. I don't know if she can stand it. The reason that we need to do the treatment within the same month because the referral letter from the insurance will expire within this month, and the dentist said we should do it right away. if we wait for another referral letter to be made, teh cavity will get worse. I'm really worry after the first treatment because it looks like she's in pain. Do you think doing 3 treatments within the same months will be to much for her to handle?

Dr. Dean Brandon said...

Other than minor discomfort the day after extensive treatment, generally children do quite well after treatment. In fact, it is my observation that they do much better than us adults. Pain long after treatment is not the usual occurance. It's a little hard to tell with a 2 year old of course. If there is pain, I would consult with the dentist.

It is unfortunate about insurance coverage, but the dentist is correct--decay does get worse with time. For extensive treatment most often with 2 year olds, we do treatment under general anesthesia, or sedation and do most if not all teeth at one appointment. I cannot say on that.

Anonymous said...

Dear Dr. Brandon,
My 6.y.o. son has had his 2 upper right molars filled by a pediatric dentist(1 small and one medium filling) and both fillings look as flat as tabletops to me. I asked him how those 2 teeth felt and he said that they were "too long". Is it normal to fill baby molars in such a way? My son hated the visit and, although I know that filing a filling is painless, I do not want to put him through the ordeal if it's unnecessary. On the other hand, I am affraid that improper fillings will affect the bottom teeth and occlusion. As it stands now, he already has lost 4 bottom and 2 upper incisors and has 2 first permanent molars out.
Thank you for your help!
Sincerely,
V.

Dr. Dean Brandon said...

Occasionally a filling is a little high. It can be adjusted fairly easily by the dentist. New fillings also may feel a little different immediately right after treatment. If it's still bothering after a few days, I'd get them to check.

Ling said...

Dr. Brandon, I can't describe how thankfulness I am to read all these posts! Thank you! As to the decay, friends recommended to me 'ozone dentistry' recently. I did a research online, and found it is a relatively new technique. It uses the ozone gas to kill the bacteria in the decay and with proper diet, the teeth will re-mineralize. I have a 2.5 year old son who has extensive decays and I am thinking of giving it a try. What is your view on this technology?

Dr. Dean Brandon said...

If there is a lot of decay on a two year old, that is usually early childhood caries, a rapidly and pervasive amount of decay in young children. "Ozone" is not something for large cavities. It looks like something really for incipient areas, sort of like the very beginnings of decay in the outer layers of enemel. Other things like lasers, air abrasion have been touted over the years as "no drill" dentistry and have some, but very limited use. If a cavity is visible in a young child, it is usually larger, you still have to get the decay out and restore the tooth. Go to a pediatric denitist and they will be able to help you out with proper and appropriate care. "Ozone" is not a generally used or accepted treatment at this time.

Anonymous said...

My son who is 2 yrs old and has caries in his four front teeth. We have been advised to either extract or use GA to restore teeth with stainless steel crowns. We were told that during the procedure they will decide if a root canal is necessary. I am also noticing some white chalk spots on the adjacent teeth with one or two pit marks. Currently we are brushing his teeth after meals, avoiding juice and providing lots of water to help keep his mouth clean. What would you recommend? Your website has given me great confidence in your recommendation. Thank you.

Dr. Dean Brandon said...

Sounds like you are getting good advice. Once decay starts it must be dealt with or it will spread and grow worse.

Anonymous said...

I have a question I recently took my 1yr to the dentist due to 2 chipped teeth. Was told his two upper l teeth have some decay and I also noticed that his two upper front teeth have little to no enamel left. I'm brushing after every meal now and was told to put 1/2 a pea size of fluriod tooth paste on his teeth after ever brush. He now has an appt til 4 months from now put I want to take him to a pediatric dentist to get the work done I think he should be seen sooner and work done to save his teeth. My question is if there is little to no enamel on his teeth what treatments or work be done on him since he is so young?

Dr. Dean Brandon said...

I usually suggest if you see something suspicious, it's best to get a pediatric dentist to take a look now even if the regular checkup might be a few months. Decay progresses with time. You can read here on the blog about fillings crowns, etc. It all depends on the amount of decay present.

Anonymous said...

What do you know about Ozone Treatment also known as heal ozone treatment? Many natural path post and forums referring to these treatments as close to miracle treatments and a great alternative to conventional treatment being crowns and fillings. Do you have any insight or experience with reversing decay with this treatment or hardening heath or enamel with this treatment? Thanks.

Anonymous said...

Hello, i have a 2 year old and about 6months ago she had to get 2 of her teeth capped with silver caps from grinding her enamel off and from decaying..she still grinds her teeth and I clean her teeth twice a day she also eats very healthy.. i have notice that shes starting 2 get dacay on her 2 bottom teeth and in the middle as well..as a young parent it frustrates me because i take care of her teeth so well..My daughter loves her teeth and i want her to have healthy teeth..do you have any kind advice for me?? * a concerned Mother

Dr. Dean Brandon said...

Ozone treatment--I am not familiar with any effective treatments in this regard.

Shilpi Prasad said...

Hello, My daughter is 5 yrs old, she recently went for her 1st dentist appointment, the dentist told us she had a small cavity in her 2 of her bottom moral teeth, it's not big but our dentist is forcing us to do the filling. She do not have any infection, no swelling, no pain, nothing, So what do you advise us?

Dr. Dean Brandon said...

Well, I would think a dentist is not really forcing you to do anything. We try and advise what is the best course of action. You can read here the importance of stopping the decay process. If you do not, it will get worse and worse. Some back molars need to stay till about 12 years of age.