Tuesday, May 01, 2007

Cavities in Young Children Increasing

Recently, the incidence of tooth decay has been rising particularly in young children! How can this be? Over the years, we have seen the beneficial effects of fluoride and increased dental care cause a reduction the incidence of caries. New studies indicate this change may be due to increased use of sugary drinks and foods in young children. There are a lot of other factors that go into causing cavities, but looking at this recent news well, I think we all need to focus again on the obvious.

What can we do? 1. reduce the frequency of sugary drinks and foods. Don't let your child use a sippy cup like a pacifier, carrying it around taking one sip every 2 minutes for an hour. Don't put children over 1 year of age to bed with a bottle filled with juice or milk. Just put water in there unless it is meal time. 2. Get your child to the dentist by one year of age. That way we can detect problems early and create good habits from the beginning. 3. Larger issues surrounding access to care need to be addressed.


ADA News Article

MSNBC Article

AAPD News Release

AAPD Tips to Prevent Decay

38 comments:

misty said...

Do you think there could be a relationship between non-flouridated kids toothpaste and increase in decay? Any lit that addresses this? Especially without flouridated h2o.

Dr. Dean Brandon said...

Fluoride has been documented to reduce the rate of decay in many studies. Not taking advantage of fluoridated toothpaste may increases the risk of caries. Now, too much fluoride is not good either. In most cases I do not suggest my patients under two years of age use fluoridated paste. I also suggest very small amounts of paste for young children. The AAPD may have some good recommendations on all this.

Anonymous said...

Dr. Brandon when kids say mom my tooth hurts pretty much when it is very close for them to go see the dentist with the kids is that just fear some of the times when they say that or is it a cavity or is it half and half both.

Anonymous said...

why does a cavity hurt more after you have just brushed your teeth then when you have just eaten something?

cristina said...

My daughter just turned 7 a couple of days ago. She lost her two top front teeth early in the summer. Both were very loose and wiggly. Nothing has come in yet, though! Is this normal??

Dr. Dean Brandon said...

Permanent teeth tend to take a while to come in sometimes, still get it looked at if you are very concerned.

Anonymous said...

My three year old son has decay on two of his left molars. He was in a lot of pain this evening. What treatment is best? Will he need to have these teeth extracted?

Dr. Dean Brandon said...

If discomfort is from cavities, then the decay is pretty deep. Most of the time baby teeth can be restored if they are not abscessed. The dentist can diagnose this.

Anonymous said...

Many thanks for your speedy response. I took my three year old son to the dentist today - unfortunately he isn't a very compliant patient!! - but he let her see the cavities. She has referred him to the hospital where he may need a general anesthetic before treatment. The dentist gave me sensodyne to rub on his teeth before bed to help alleviate the pain short-term. This has certainly been a wake-up call and I am resolved to eradicate sweets and biscuits!!

Anonymous said...

All of the baby care books that we read before my daughter was born also recommended getting them in at 1 year and/or 6 months after the first tooth erupts. Unfortunately, our insurance company would not pay for a regular checkup until our daughter turned 3. Have you noticed many insurances do this? She's had a few issues that I think could have easily been caught much earlier had she had checkups earlier.

Also curious what your thoughts are on systemic flouride supplements for children whose tap water is not flouridated. Our pediatrician has strongly pushed for this since our daughter was 6 months old, but it is something we haven't felt comfortable with since it seems there are warnings about flouride consumption in young children

Dr. Dean Brandon said...

I should post some more on fluoride--young children may benefit from this if they do not have tap water fluoridated--I still am coutious about Rx for this until I review all flouride sources (grandmothers house, frequency of packaged drinks, shcool...many of these sources may have fluoride. We also test the natural tap water--some communities have fluoride naturally --like in the rocky mountains.

First visit by age 1 or six months after the first tooth erupts--that is our recommendation--do not let insurance companies dictate treatment. At one year of age-it's not a cleaning or x-rays--usually an quick examination.

Anonymous said...

I have a 3 year old son whom I took to the dentist a few days ago. His pedia dentist found 4 cavities. The 3 are very small but the 4th is the biggest and will require the shot to numb the gums and do some drilling. My son actually has a history of trauma when he was 2 years old and got his abscessed upper front tooth pulled out. The abscessed tooth resulted from physical trauma after he fell and hit the coffee table. The dentist pulled out his tooth using some numbing gel and then the shot on the gums. Now I'm sure my son really would hate going through this again. His pedia dentist gave us a few options regarding his filling for his 4 cavities. The first one is for my son to orally take Chloral Hydrate and he would be very groggy. According to his pedia dentist, he will not be asleep, just remain drowsy. However, the dentist said that this option is not so predictable since my son can still remain resistant throught the entire procedure. The second option is to sedate him using Ketamine administered IM route. The dentist said that this will be done at the dentist chair with an anesthesiologist present. The third option is general anesthesia. We personally asked the dentist which option she thinks is the best for my son and she said that the sedation using ketamine would be the most appropriate one for my son's case. I would just like to take your opinion on how safe Ketamine is when used on a 3 year old for dental fillings? Do you think this is really the best option for my child? Or should we try the oral Chlorate Hydrate plus nitrous oxide? I would really appreciate your response. Thank you.

Dr. Dean Brandon said...

You are asking good questions--but there are no easy answers. I can say that in our office consicious sedation is used often. Your dentist is correct that some children are still fussy even with medications. Every child is different. That is why no one answer is absolutely the best one. We do not use Ketamine in the office as it is technically a general anesthetic and we do not have an anesthesiologist in the office--but I know some pediatric dentists that do this method in the office (with an anesthesiologist).. Mostly if we feel a procedure cannot be done in the normal way or with consicious sedation, we go to the hospital and use general anesthesia like you would for getting ear tubes put in or tonsils taken out.--we do this all the time.

As far as medications, please read more about sedation and sedative medications here on this blog. Ketamine is a unique medication in that they are totally out (unconscious) but they retain the ability to control their airway-that is a good thing. No answer for you from me, but seems like you are thinking about all options here--just remember, kids are pretty resilient. Many kids who were very resistant and fussy for treatment as young children are great patients as they get older. Good Luck.

Anonymous said...

How long does it take for a cavity to form?

Dr. Dean Brandon said...

How long? well, it does not for overnight. It takes time, but things can change fast especially in children. That's why we see kids usually every six months for recall examinations.

Anonymous said...

my 7 yr old has 3 huge cavities in her baby molars, one dentist said we should try save them, it looks like 50% of the tooth is eroded, another wants to extract all 3, he wnats to do it all at once, shold he do it, should an oral surgeon do it or should i get a 3rd opinion.

Dr. Dean Brandon said...

Some teeth are "savable" wiht proper restorations, some are not due to extent of decay, and are best to be removed. See my posts on baby teeth why fow them and others. Many baby molars should remain till age 12. For a 7 year old, I would let a Pediatric dentist give the best advice possible as to proper treatment and the method of that treatment.

Anonymous said...

I am looking for clinical studies of outcomes of treatment options for caries in baby teeth, and a full description of diagnostic criteria of caries using X-ray films.

I want some evidence that drilling out small cavities is more effective than fluoride and remineralization for baby teeth with minor erosion of the enamel.

Dr. Dean Brandon said...

Here is a good resource link on x-rays:

Article from ADA on x-rays

Every dentist is differen and every patient is different. These are only guidelines. Sometimes you want extra e-xrays to check something out, other times, you don't need to. That is why you rely on the dentist and his experience and expertise.

I don't have anything redily available specifically on the fluoride thing. I have cases where I will disk (enamel only lseions) on smooth surfaces of the teeth apply fluoride and observe--it works often, but mainly because I know which lesions will work and which need restoration. Decay is an agressive thing, fluoride helps, but once decay starts, it is impossible to stop it if it is through the enamel layer. It can help with inbetween the teeth lesions so long as they are not through the out layer of enamel--in kids it doesn't take much to go through that thin enamel. What it sopunds like you are talking about is say a small cavity on the front of a baby tooth that is very small or chalky. If once the defective structure is removed there is not a hole or any restoration needed and the surface can be cleaned, and it is in the enamel layer only, then maybe---maybe you can get away with watching it for a while and applying fluoride--it might buy you a little time. Most of the time (like 98% of the time) if there is decay, we are "filling" the tooth.

Dr. Dean Brandon said...

Sorry about the misspellings I am typing in a hurry, got to go...

Dr. Dean Brandon said...

Oh, one more note on x-rays. Digital x-rays have reduced exposure even more than the chemical processing E-speed film etc, they reference in the guldelines. Whatever is done is based on scientific research and experienced clinical application.

Anonymous said...

my almost four year old went to the dentist yesterday he happens to have decay on his top front four teeth and a little on one tooth on the bottom they are just decay spots not half of the tooth or all of it just a little as we can visibly see do you think a pediatric dentist is going to cap them or just drill and fill i dont want my child to have the silvwer caps all over his mouth i would prefer the white ones so that people dont make comments is the silver ones any more effective than the white ones

Dr. Dean Brandon said...

You may want to read more here on the blog about crowns. "Silver" crowns are usually only indicated on badly decayed posterior (back) teeth where fillings would not be a good idea. White crowns don't work so well most of the time. In the front most of us pediatric dentists do white crowns, but they are not as robust as the porcelain crowns adults have. They are basically large white fillings or plastic like coverings that look ok, but kids are pretty rough on those so they break down at times. Again, it's kind of hard to explain in one or two sentences, so browse the blog, there is more info there.

Anonymous said...

Have you ever heard of or used a metal "band" to cover a cavity in a very young child. Our dentist offered this as an option rather than putting our three year old through the trauma of fillings or crowns.
It seems like a great idea to me, but I was wondering if there were any out there that were white or clear, rather than the shiny "silver". His cavities are between his top front tooth and the incisor next to it.

Dr. Dean Brandon said...

I do not do that--that is place a band over known decay--you never know quite what it might do under there. all orthodontic bands are silver. I suppose there are some who do that and it might slow down the decay a little, but it it not a typical thing to do. Proper restoration is the best idea.

Megan Lawrence said...

Dr. Brandon why is it that cavities seem to occure in the front of the mouth more then in the back, were the molars are? Because isn't it around the molars that food is more likly to get caught, like salad,candy,taffy ext.I think they are the ones that grinds the food. Aren't they?

Dr. Dean Brandon said...

Megan, cavities can form on any tooth. Although any one person's experience can differ, I generally see more cavities on back teeth.

alaskafan said...

HI, I took my 4 year old to pediatric dentist for the first time 3 days back. She said he has weak enamel on back molars upper and lower on one side(she said may be that's how those teeth came in or it could be the early start of decay), and asked us to scrub his teeth with ACT fluoride rinse before bed. We have been doing that every night. My kid did allow the dentist to check his teeth but he did not allow cleaning and x-ray.
Now I see a brown spot on his upper molar, could that be a cavity? could the dentist have missed that when she examined his teeth? I am going to take my kid back again in three months to try the cleaning again. Should i have the dentist look at his teeth before that?

Dr. Dean Brandon said...

Of course, if you have concerns I am sure they would be happy to address those concerns, either with another exam or not. If they said there was no problem and they got a good look, I would trust that.

Now, I have kids that are pretty wiggly or hard to examine and I do my best to see as good as they will let me, but I am not perfect and sure I miss small stuff from time to time. --but that's usually with disruptive kids. If a mom called and needed my to take a second look at something that they (the parent) saw, I'd be ok to take a look just to be sure.

tgrabs said...

If there is swelling on the cheeks near a tooth with cavity, does this mean the tooth is abscessed?

Dr. Dean Brandon said...

Perhaps. A proper dental exam will tell for sure. Can be other things too.

Pooja Shetty said...

Doctor, pls answer my question, am so worried. My 4 year old had two pulpotomies on april 8. A month later, he complained of pain in his cheek while eating. It is on and off. It disappeared for a week, and yesterday when he ate something hard it came again. He does not appear to me in discomfort when it happens seems to be quite mild. Dentist said to give it some time. Please let me know your thoughts. Please help!

Dr. Dean Brandon said...

Crowns can become loose and cause some minor discomfort, but it is pretty rare and they can be recemented. More often inflammation from a badly decayed tooth, even after a pulpotomy can be so bad, that it can abscess or continue to cause trouble. Although, most of those kinds of cases, it's much less severe if the tooth had a previous pulpotomy--sort of low grade. Make sure your dentist follows it, as it appears you are doing...

Pooja Shetty said...

Okay doctor but there is no redness or swelling, could it still be possible? Also why is he saying cheek hurts? Shows the cheek and not teeth. Do you think it will go on its own as its not severe? Do you think it is a nerve issue? I am praying it is not ��

Dr. Dean Brandon said...

Of all the baby teeth that need pulpotomies and crowns, very few have problems. Some do, but it is usually not too severe. Observation of these cases is sometimes warranted, till something is more obvious. Let your pediatric dentist follow this, take indicated x-rays, etc. Things tend to get more evident as to the cause with time, or they tend get better. Things like ear infections, etc that need to be ruled out as well.

Pooja Shetty said...

I mean doctor, i hope it is not trigeminal nueralgia ? As i read some scary things on the net and that it can result from root canal treatments. The question is .. Why is the cheek paining ( though mild) and not teeth ��

Dr. Dean Brandon said...

First of all, true root canals are not done on children (on baby teeth), not like on adults. A pulpotomy is not a root canal. The best thing to do is check with her pediatric dentist. If problems persist or are something other than tooth related, that can be determined. I know you are worried, but rare weird things that you read on the Internet, are most likely that--rare and unusual. Best of luck. Until an examination by someone there (I can't diagnose over the Internet), --well, just make sure a professional takes a look.

Pooja Shetty said...

Sure doctor, thank you so much!! Really appreciate it