Milk teeth caries most often occur in children from the age of two, which is connected on the one hand with weak mineralization of the cut teeth of milk with calcium, on the other hand, with errors in the care of the baby’s teeth by the parents.
Treatment of caries in children under 3 years of age differs from the treatment of older children. In this article we will examine in detail the methods of treatment of children's caries. First of all, the choice of methodology will depend on -
- the child’s age and behavior in the doctor’s chair,
- depths of carious lesions.
Children's caries of milk teeth: photos
Often, a dark pigment is formed on the teeth of a child in the form of black spots, which can be mistaken for caries. The integrity of the enamel is not impaired, and this pigmentation is a deposit of iron salts on the enamel surface due to the vital activity of anaerobic bacteria (actinomycetes). This type of staining is called chromogenic.
This dark plaque is formed as a result of the interaction of hydrogen sulfite (the product of vital activity of actinomycetes) - with iron contained in saliva, or with iron of red blood cells that fall into the oral cavity during gingivitis in a child (inflammation of the gums).
Milk teeth caries can be -
- In the form of white spots on the enamel surface (Fig.1-2) -
This is the initial form of caries, in which there are pockets of demineralization in the enamel (they have little calcium). Such foci look like white chalky spots, while there are no signs of enamel destruction. If this form of caries does not begin to heal, then enamel continues to lose calcium,
- Black spot caries -
Enamel in the area of white chalky spots, before it starts to break down, may turn black. This is due to the fact that the enamel becomes so porous that cariogenic microbes penetrate into it, although outside such enamel has no signs of destruction, and remains smooth and shiny.
This stage of caries is not mandatory, and most often white spots immediately turn into surface carious defects. It is necessary to distinguish caries in the black spot stage - from the black pigment on the teeth, which we described a little higher.
- Surface caries (Fig.2-3) -
surface caries is considered to be superficial, in which only tooth enamel is destroyed. Those. the carious process still does not penetrate the dentin under the enamel. If such caries is not treated, then over time it turns into ...
- Average caries (Fig.4-5) -
in this form, not only the enamel, but also the dentin of the tooth is destroyed. As soon as cariogenic microorganisms penetrate dentin, the speed of tooth decay increases with lightning speed, since Dentin (unlike enamel) is very soft and porous.
- Deep caries (Fig.6) -
This is the next step in the development of the carious process. In this form of caries, only a very thin layer of healthy dentin is kept separating the carious cavity from the tooth pulp (24stoma.ru).
Bottle caries -
The term bottle caries is often used to name caries in children, the cause of which is a bottle with a sweet drink that is always available to the child (especially at night). Such caries, as a rule, affects the four upper incisors (Fig.9-11).
Complications of caries in children -
the lack of timely treatment of average caries leads to the rapid penetration of microorganisms into the tooth pulp and the development of first pulpitis, and then periodontitis. If the main symptom of pulpitis is acute pain in the tooth, then with periodontitis (against the background of purulent inflammation in the apex), the main symptoms will be
- bumps on the gum with pus inside (Figure 7),
- periodic appearance of fistulas on the gums with purulent discharge (Fig. 8).
Causes of caries in children -
Caries of primary teeth in children occurs due to several reasons, mostly related to errors in the care of the baby’s teeth on the part of the parents, as well as due to the anatomy of the teeth of early childhood. Among the main reasons -
- Malnutrition -
very often parents, instead of feeding the child according to the schedule recommended by pediatricians, feed the baby on demand, or even put a bottle of sweet liquid next to the child, from which he himself can drink whenever he wants. In the latter case, the special term “bottle caries” even appeared (Fig.9-11).
Such frequent intake of carbohydrates, especially in the absence of regular hygienic processing of teeth and gums, leads to the fact that cariogenic microorganisms receive constant raw materials (carbohydrates) for the production of acid, which destroys the teeth.
Bottle caries: photo
- Poor baby's oral hygiene -
the lack of regular hygienic dental treatment (at least two, and preferably three times a day) leads to an increase in the number of bacterial plaque consisting of cariogenic microorganisms. The abundance of plaque is one of the main conditions for the development of caries.
Good oral hygiene (+ proper nutrition) is the best prevention of caries in children. How to properly brush your child's teeth, at what age, what hygiene products are best to choose - read our article: "Features of oral hygiene in young children"
- Infection of a child with cariogenic microorganisms -
A baby is born with a sterile oral cavity. All the cariogenic microflora comes from him just from the parents when they kiss the child on the lips, try the baby’s food with his spoon and lick it.
- Low calcium saturation of milk teeth -
enamel teething contains little calcium, i.e. it is demineralized. Good hygiene, the use of toothpastes with calcium and fluorine, as well as the natural physiological gradual mineralization of tooth enamel with calcium contained in saliva - leads to a gradual saturation of the enamel with calcium and its hardening.
However, in conditions of inadequate hygiene, improper nutrition, accumulation of microbial plaque and food debris on the teeth - the physiological mechanism of enamel mineralization is not enough to maintain balance, and enamel demineralization occurs on the contrary, i.e. weak enamel also begins to lose calcium. The result of this process is caries.AdvertisingDental implantation with immediate loading permanent prosthesis all-on-4 all-on-6 Implantation in 3 days
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Treatment of caries of primary teeth -
As we have already said: treatment in children of 2-3 years old will be very different from the treatment of older children. Below you can familiarize yourself with the basic techniques, their advantages and disadvantages.
1. Treatment of caries in children under 3 years old -
In children of this age (depending on the depth of damage to the tissues of the tooth by caries, as well as on its behavior in the stomalotog chair), the following methods of treatment
- remineralizing therapy
- silver plating (Fig. 13),
- deep fluoridation (fig.14),
- sparing tooth filling (fig.15).
Remineralization, deep fluoridation and silvering are actively used in children under 3 years of age in the treatment of initial caries in the form of a white spot or surface caries that does not extend beyond the enamel layer. Our separate article is devoted to these methods of treatment:
→ "Application of silvering and teeth remineralization in children"
Gentle dental filling in children under 3 years old -
in fact, this is the only method if your child already has an average caries. Do not worry, tooth filling in children of this age is quite possible, and many dentists treat even 1.5-year-old children in this way. The most important thing here is the approach, and the child should not be frightened from the very beginning.
It is very important during the first visit to the dentist not to cause discomfort to the child, limited only to brushing the teeth affected by caries with a polishing brush and paste, as well as processing the teeth with special remineralizing gels or fluoride varnishes. In the second visit, you can already start a gentle filling.
First, it is necessary to remove the enamel and dentine softened by caries. This can be done not only with a drill, but also with a sharp trowel or curettage spoon. The fact is that enamel and dentin in children of this age is much softer than in adults. It is also very important that in children pain sensitivity in the teeth is reduced, and as a rule, all this proceeds without serious consequences.
Important points that parents need to know before sealing -
- The presence of the dentist drug "caries-marker" -
It is very important that a pediatric dentist necessarily have a caries-marker preparation that helps the dentist determine if he completely removed dentin caries. In children of this age, it is very difficult to determine. If the dentist leaves at least a little carious dentin, there will be caries under the filling, which will very quickly turn into pulpitis and sharp pains. Those. if the doctor does not have such a drug initially, I would not even be registered for treatment in your place.
- The choice of material for sealing -
after the removal of all caries-affected tissues and the corresponding antiseptic treatment, they proceed to the actual filling. The second important point is the choice of filling material. To fill the teeth of children of this age can and should be only "glass ionomer cements light-cured." Under such a filling, with an average and deep caries in children, it is always necessary to put a medical gasket made of calcium-containing material.
2. Treatment of caries in children 4-6 years old -
If your child has an initial caries in the form of white cretaceous spots (without damaging the integrity of the enamel), the treatment will be the same as in children under 3 years old - remineralizing therapy, deep fluoridation, and in the worst case, silver plating. Reference to these techniques was given by us a little higher. For surface, medium and deep caries in children of this age, the method of filling teeth with glass-ionomer light-cured cements should be unambiguously applied.
Carious tissues should preferably be drilled with a drill, and only in the most extreme case can the removal of carious tissues be used with curettage spoons or ironers. Under the glass ionomer seal (if the caries is medium or deep), a strip of calcium-containing material must also be put. We hope that our article: Children’s Dental Caries - proved to be useful to you!
Author: dentist Kamensky K.V., 19 years experience.