Children’s caries

The Spanish Society of Paediatric Dentistry (SEOP) responds to 10 common queries about children’s dental caries that we discuss here.

Caries affects 80% of the world’s population and, of these, 10% are boys (about 600 million children). 

1. What is caries and what causes it?

As indicated by the SEOP: “Tooth decay is a chronic disease caused by a sugar-dependent imbalance that is exploited by the microbes that live in the mouth to make acid that will destroy the teeth.”

Acid-forming germs lower intraoral pH when ingested sugars remain in the mouth and metabolized. This drop in pH affects the enamel structure by demineralizing and weakening it.

2. From what age can caries appear?

Caries can appear when the first teeth appear. It is known as “childhood caries“. Therefore, it is very important to provide good oral hygiene from an early age, provide fluoride and eliminate sugar from the diet.

3. Why does caries occur? What habits lead to caries?

Caries is caused by the combination of 5 factors that facilitate the spread of bacteria that melt enamel with acid: the bacteria themselves, the condition of the teeth, the fermented carbohydrates we ingest, the frequency with which the teeth are exposed to sugar acids and the lack of proper oral hygiene.

Poor oral hygiene and ingested sugars are the allied habits of caries. Sweets, sugary drinks, fruit juices with added sugars, etc., but also pasta and pastries (which, when contained in flour, when metabolized, damage acid is produced), alter the oral pH and make it acidic. It is recommended that children have a healthy and balanced diet and follow good oral hygiene from an early age.

4. How is it detected?

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Paediatric dentists diagnose caries in regular check-ups. If caries is detected at home, it means that caries is advanced and the tooth is more damaged. That is why it is so important that children go to the dentist from the moment the first tooth comes out to ensure that the child’s oral health is correct, prevent problems and detect them in time.

A first sign is a whiter color change without brightness in the form of a white spot. The second phase is already the appearance of a yellow, brown or black color, and finally in the third phase (the most visible) is when the hole is in the enamel. This destruction of the tooth indicates that caries is at an advanced stage.

5. Does caries hurt?

If caries is not treated and progresses, it can cause an infection that generates pain and discomfort.

6. Is it contagious?

Microbes that cause caries can be transmitted orally. The most common form of transmission is to clean the teat from the bottle or pacifier with saliva. Even if parents do not have caries, the exchange of saliva can transmit germs to the baby’s mouth (which is sterile at birth). So it is advisable to clean them with water.

7. How are caries treated in milk teeth?

Milk teeth (or primary dentition) are the teeth that come out first and fall out to make way for the permanent teeth.

• Fillings are the most common treatments.
• If the caries has caused a large hole in the workpiece, a metal crown is usually placed that allows chewing and prevents the extraction of the part.
• If caries has caused an infection, the infection can be treated with a pulpotomy or pulpectomy in which the nerve of the tooth is removed and cleaned. In the case of pulpotomy, part of the nerve is removed and in the case of pulpectomy, the entire nerve is removed.
• If the infection caused by caries determines it or the tooth is too destroyed, then this is when the milk tooth is extracted. To prevent the final tooth from running out of space and not being able to erupt properly, a space maintainer is placed where the milk tooth used to be until the final one comes out.

Remember that each case is different and it is the pediatric dentist who must diagnose and determine the appropriate treatment for each child.

8. Can a caries in a milk tooth affect the final tooth?

If the infection in the milk tooth reaches the bone between the temporary tooth and the definitive tooth and affects the permanent germ, it can create a pus bag that affects the definitive tooth: malformations, spots or secondary injuries… It is detected with X-ray.

You need to stop thinking that milk teeth, as they fall out, do not need to take care of them.

9. Can caries affect other organs?

According to the SEOP, “any infection in the body can cause heart conditions in patients who have suffered from vascular problems, congenital heart disease or rheumatic fevers as children. These are extreme cases controlled by the cardiologist, but which the pediatric dentist must know.”

10. What advice could we follow to prevent childhood caries?

• Follow good oral hygiene from babies.
• Go to regular paediatric dentist check-ups.
• Do the fluoridations determined by the pediatric dentist. Fluoridations are used to reduce the incidence of caries since fluoride reacts with the hydroxyapatite crystals in the enamel and converts them into fluorapatite crystals (much more resistant to the action of acids).
• Do not sleep with the bottle with juices or sugars. Only with water.
• Do not grease the pacifier with honey, sugar, fruit juice…
• Do not clean the pacifier or teat from the bottle with saliva. Better with water.

The SEOP recommends that children go to the pediatric dentist every 6 months for prevention.

“Milk teeth, as they end up falling, you don’t have to take care of them so much.” Error!