Tuesday, November 14, 2006

Can a Tooth get a Cavity Before it Erupts?

Can a tooth get a cavity before it even erupts into the mouth? Well, in a bacteriological sense, no, but I occassionally see an odd occurance where there is evidently a large radioluscency(dark area) in the coronal (top) part of a unerupted tooth that indicates loss of tooth structure like a cavity would appear. What is it? Technically it cannot be a cavity as that is caused by a bacteriological process. There are no cavity causing bacteria associated with an unerupted tooth. This is due to some kind of abnormal internal resorptive process. The cells in the developing tooth dissolve the tooth from the inside out in a pattern similar to a cavity. When the tooth actually erupts, bacteria go right to the area and starts an actual decay process. So, basically you end up with a really big cavity rapidly. It is necessary to treat these teeth early and agressively. Sometimes they even need a root canal or removal. It's a pretty odd thing to see on an x-ray if you understand the normal decay process. This is not to be confused with developmental defects in the enamel like Enamel Hypoplasia, which is quite common. It is probably more similar to Internal Resorption , which starts in the pulpal tissue rather than the coronal area, but I have to say I don't really know for sure what causes it.

19 comments:

ails-26 said...

Dr dean,
I am writing to you from Ireland as I am really concerned about my 8 year old son's dental heath, in the past three years he has had alot of work done on his teeth, they seem to be decaying right in front of my eye's, we have cut out sweets totally from his diet which in the first place were only occasional treats, and he even brushes he's teeth after every meal, but noting seems to stop the decay. its really worrying now at this stage because he's permanent teeth are coming through, and are been affected by this ongoing decay as well, within a matter of months one tooth was so badly decayed he had to have a filling put in.
From reading your blog's I have noticed many things that my son could have from tooth internal resorption to enamel hypoplasia. There is also a factor to be taken into account that I had a bad accident while pregnant and was taken to hospital and but on steroids and other medication as well, I wonder if all this could have affected the development of he's teeth that they have become weakened in some way. when he's first baby tooth came down it had a yellow stain on it, I brought him to a dentist and was told it was because of a trauma while pregnant he also has white stains like in your blog about enamel hypoplasia.
I am so worried and concerned at this stage that I feel he will be spending the rest of he's years with nonstop dental problems already at the age of 8 I can't count the amount of time's he has been to the dentist, could he even have a calcium deficiency? as you can see i am very worried about it and any information you could give me would be most welcome.
yours sincerely
Aileen Bell.

Dr. Dean Brandon said...

Sorry to hear your situation. Remember, once decay starts it will continue getting worse no matter how much you brush, etc. (although it does slow it down a little) until it is restored/fixed.

A lot of young kids I see that have lots of problems with decay seem to have fewer problems as they get older into the permanent dentition (thicker enamel/better brushing technique/sealants helping to prevent occlusal decay). Still, if you think he has decay, it needs to be addressed/fixed. Don't worry too much, with a caring parent like you, I think he will be fine.

Anonymous said...

I think my son has a cavity in his front tooth.As a baby it seemed his tooth came in with a small hole.Now it seems to be getting darker.I brush and floss everyday.I dont see how this is happening.

gretchen from Ohio said...

Is there anything you would recommend for a patient to do after having one of these before. My son has 4 new teeth, 3 of which needed fillings almost immediately. Would extra calcium help? Any other vitamin or mineral that we should supplement?

Dr. Dean Brandon said...

Generally, good nutrition should help--adequate levels of fluoride in the drinking water during the development of the teeth. Sometimes, it just happens due to a developmental anomaly.

Anonymous said...

My 6 year old daughter had extensive decay to one of her front teeth, I had trouble getting a dentist, in England it is very difficult. I took her to the emergency nhs dental centre, the only told me to put fluoride on it and put some kind of sealant on which looked like putty, it came off the same day. When I eventually got her a dentist we asked if he would extract the tooth as we were worried about her permanent tooth, he said he wouldnt remove it as it could affect her speech, he then filled it but the filling came off after 6 months and he said it was pointless to put it on again, nor would he remove the tooth, we asked several times, her permanent tooth has now came in and I was very upset when a saw a small cavity in it. I have now found another dentist after months of trying, and wonder what this dentist should do with the permanent tooth, obviously her old dentist did the wrong thing by leaving the baby tooth in and my confidence in dentists has fallen I just want the best for my daughter

Dr. Dean Brandon said...

Hopefully your confidence in dentistry can be restored, but I suspect it will take some time. I cannot judge what was done or not done. There are times I will not fix a tooth for instance, if it is naturally going to fall out in a few months on it's own and is not causing problems. The fluoride things sounds like a stop-gap thing-helpful, but very temporary.

Whatever the case, I do hope for the best. I think there are private pay dentists in the UK? If you can find a specialist in pediatric dentistry, that would be best of course.

As an asside, I fear we may be going down a similar path the in the USA. I think most dentists would be wise to fight to stay out of any nationalized plan.

Anonymous said...

Thank you for your advice Dr Brandon. Pediatric dentists are more rare in England although there seems to be a couple in London. I am thinking of giving these a try if I don't like what the new dentist has to say. The nhs system in England is failing, many people do not have a dentist and when places become available people are waiting in the street for hours outside the dentist to get a place, it takes ages to get an appointment when you have one! As for my daugthers old dentist he had over 2 years to do something about that tooth but he chose to leave it, I wish I'd got another dentist sooner I feel terrible. I trusted he was making the right choice. I just wondered as the cavity is on the front tooth would a filling be sufficient or would this fall off as you use these teeth to bite into food all the time or would she need a crown, at this stage the cavity is very small, only visible when you look closely.

Jack said...

Dr. Dean, My 11 year old son just visited his pediatric dentist and the x-ray shows that the 2nd molar seems to be decayed but it is still under the bone. Our dentist has never seen this and as I look on the internet it is not very common. I can email the x-rays for you to look at. We and the dentist are looking for some other opinions before they just cut into his jaw to look at it. Would you please take a moment and reply. Thank you, Jack

Dr. Dean Brandon said...

I cannot comment on your particular case since he is not my patient but, as you can see here, I have seen similar things before. Again, in the cases I have seen, I do not think it is really "decay" or a cavity in the unerupted tooth. It is simply some sort of malformation/hypolasia of the developing tooth. Could also be similar to internal resorption. It only becomes actual "decay" when the tooth is exposed to the oral cavity. In other words, when it erupts.

What to do depends on the case. Often, I just watch the developing tooth for any change (usually there is none). Then when it erupts, make a decision as to fill it, crown it, or remove it--or nothing.

Jack said...

Thank you for your reply, but I am still cautious about what to do. His appt is this Thursday and I am not sure that cutting into his jaw to examine the tooth is the best thing to do. Where can I forward the x-rays so you can see it for yourself? Or I can post them on my FB page...I think.

Thanks,
Jack

Dr. Dean Brandon said...

I do not give out my e-mail here on the blog, but you can always send me anything by mail to our office. I cannot give a professional opinion unless you are my patient. There are too many ethical and liability issues. That is, a doctor cannot give an opinion on a specific case unless he has the entire history, information, any x-rays he deems necessary AND accepts the consequences of that opinion and how it may affect the patient. The binding contract a patient has with their doctor.

Jack said...

After talking with the dentist again, her concern is primarily saving the tooth if possible BECAUSE the wisdom tooth will need something to push against to come in correctly. She said, if it were an upper molar she wouldn't have any issues, but since it is the lower she has concerns. In your opinion, would it be just as good to wait for it to expose itself or cut into his jaw to see what it is? And it may just have to be extracted if they find it needs to be removed (in that case...what does the wisdom tooth use to come in???) I don't see the difference in waiting as opposed to cutting in now (but I am not a dentist that has studied for years).

Mousumi said...

Dr. Dean,

Thank you for your wonderful informative blog. My nearly 17 month old daughter just had her 1st molar (lower right side). Though I am not a dentist, but I think tooth is still coming out. This morning I noticed that, she has a dark spot (not black but grayish I would say) right at the top and center part of the tooth. I really have no idea what is it. She had been really fussy in eating and cranky during this teething phase, she also had a diarrhea last weekend. Other than the molar she has 6 upper tooth and 4 bottom ones.
Please advise.

Dr. Dean Brandon said...

Well it's likely nothing serious. Still I'd advise seeing a pediatric dentist. A dental light can get a better view.

Anonymous said...

My 11 month old son has, what looks like, some black spots on his gums! Is this an early sign of tooth decay? The teeth have not erupted yet.

Dr. Dean Brandon said...

Black spots on the gums may be nothing other than natural gingival pigmentation (which is more common in dark skinned individuals), however I'd get it checked out by a pediatric dentist.

Anonymous said...

Hi my 11 month old has cavity on his 4 front teeth should I take him to the doctors is it serious and what can be done I'm very concerned for his teeth

Dr. Dean Brandon said...

Yes, I'd have it looked at by a pediatric dentist. You'd think 11 months is pretty young, but if they have teeth, they can get tooth decay.