Treatment of deep caries of milk teeth. Treatment of caries of milk teeth in young children

Caries in milk teeth can cause unpleasant consequences for the health of the child. Therefore, parents should know the causes of the disease and its symptoms. And if there is a suspicion of caries, you should immediately consult a doctor

Unfortunately, children's milk teeth are no less prone to caries than adult teeth. Moreover, due to the structure of children's teeth, which have relatively thin and vulnerable enamel, caries at a young age is very destructive. Consider the causes and symptoms of caries in children, as well as the features of its treatment.

Causes of caries on milk teeth

Many parents are sure that if you limit the child to sweets, then the health of milk teeth is guaranteed. However, this is not the case, and, in addition to the abuse of sweets, there are other causes of caries:

1. Infection with pathogens from other children or even adults. For example, when a baby eats from one spoon with an adult who has teeth with carious cavities.
2. Insufficient care of the oral cavity of the child. Even recently erupted milk teeth need proper hygiene, but parents do not always understand this. As a result, plaque accumulates on the enamel of children's teeth, which can lead to the development of caries. Given the fact that the enamel on newly appeared teeth is still weak, caries can develop very rapidly.
3. Periodic intake of sugary drinks through the nipple is the most common cause of bottle caries, which is fraught with damage to the entire front row of teeth.
4. Early caries, which develops due to a lack of minerals (calcium and fluoride) in the child's food or due to the intake of certain medications.
5. Violation of the process of formation of the enamel of the child's teeth during fetal development, which may be due to the mother taking medications or smoking during pregnancy.

What are the symptoms of childhood caries?

Doctors distinguish several types of children's caries, depending on the depth of its spread, the intensity of development and localization of the process. In general, the disease has quite specific symptoms that parents should be aware of. The external signs of the manifestation of caries depend mainly on the degree of damage to the tissues of the teeth.

Symptoms of caries in milk teeth:

• initial caries. The formation of white spots on the surface of the tooth enamel that do not cause much discomfort. In the process of further development of the disease, the spots may change color to brown, dark brown or black;
• superficial caries. The carious cavity of white or dark color is still within the enamel. However, at this stage, eating sour or sweet foods can already cause pain;
• medium caries. It is characterized by the formation of a deeper cavity on the surface of the tooth. In addition to sensitivity to sweet and sour, there is sensitivity to cold and hot. Bad breath may also occur;
• deep caries. In this case, there are signs of pulpitis, the child complains of severe toothache, which becomes more intense during meals. The tooth is quickly destroyed, and the child's condition can be aggravated by fever, nausea and general weakness.

Parents should be aware that tooth decay in children develops somewhat differently than in adults. In particular, due to the weak degree of enamel mineralization, the disease in children progresses much faster than in adults. The same applies to the rate of spread of caries: if measures are not taken in a timely manner, then pathological processes can quickly spread to other milk teeth. Moreover, even one-year-old children who have recently erupted milk teeth are not immune from the appearance of caries.

Features of the treatment of children's caries

If a child has caries, then it is necessary to immediately begin a comprehensive treatment of children's teeth. At the same time, attention should be paid not only to the elimination of manifestations of caries, but also to the prevention of its reappearance. Simply put, it is desirable to supplement dental treatment with a doctor with home prevention using specialized tools. We are talking about the use of special anti-caries children's pastes and rinses for the oral cavity.

Traditional methods of caries treatment at an early age are as follows:

• silvering milk teeth. This technique is used in the early stages of the disease, when there are carious spots or enamel caries on the teeth. The essence of the treatment is that the dental tissues cleaned of plaque are treated with a solution of silver nitrate. A significant disadvantage of the method is the possible staining of the enamel in a dark color;
• fluoridation of teeth. After removing the affected dental tissues, the teeth are treated with a fluoride mixture, which helps restore the enamel. The disadvantage of the technique is the need to repeat the procedure many times, which is problematic in the case of a small child;
• filling. Carious cavities are cleaned, after which filling is carried out using composite materials. This technique is used not only for milk, but also for permanent children's teeth.

The main disadvantage of conservative methods is that many children are frightened by the sound of a working tool, which makes it difficult for the dentist to fully perform all the necessary manipulations. Modern dentistry for children can also offer a good alternative to traditional methods of caries treatment, which is the chemical preparation method. It consists in the fact that carious cavities are treated with special substances that soften the affected tissues. This is enough for the doctor to clean the tooth with hand tools, without a drill. Then the usual filling of the tooth is carried out.

Another issue that is very important for young patients is anesthesia. Most often, the treatment process is carried out with the use of modern local anesthetics. However, in some cases, when, for example, a child's tooth needs to be removed, full anesthesia can also be used.

Prevention of children's caries

Ideally, a full and proper prevention of caries in a child should begin even before his birth. To do this, the expectant mother's diet should contain a sufficient amount of calcium, protein and vitamin D, starting from the earliest stages of pregnancy. In the first year of life, the best prevention of caries of milk teeth can be called breastfeeding, which provides the baby with all the substances for the full formation of teeth.

Starting from the moment of eruption of milk teeth, it is necessary to begin hygienic procedures for cleaning the enamel from food debris and plaque. To do this, you need to use soft toothbrushes, as well as pastes that do not contain fluorine. Until the age of 3, it is advisable to refrain from giving the child sweets, especially sweets and sugary drinks. And make it a rule to visit a pediatric dentist at least twice a year.

It is important to understand that the conventional wisdom that caries in milk teeth does not need to be treated is fundamentally wrong. The fact is that progressive caries can provoke inflammation of the surrounding tissues (periodontitis), which can greatly slow down the appearance of a molar tooth. And the early loss of temporary teeth often leads to abnormal development of the maxillofacial apparatus, after which correction of the bite in children is required. Also, a long-term absence of milk teeth over time can cause problems with the digestive system.

Summary

Obviously, the caries of milk teeth should not be treated with disdain. After all, this disease can cause serious problems in the present, problems with permanent teeth in the future. And parents should pay sufficient attention to the hygiene of the child's oral cavity, proper diet and prevention of childhood caries. And if signs of the disease still appear - immediately contact a pediatric dentist, without waiting for further progression and spread of the disease.

Dental caries continues to be a major problem for many children and the most common childhood infectious disease.

Decay in milk teeth has become an urgent problem for both parents and dentists. Children under the age of two years suffer from this pathological process more and more often. Currently 80% of preschool children have at least one affected tooth.

Eighty percent of dental caries is found in only 25 percent of children. Below we will look at what it is dental caries of milk teeth, its main causes, symptoms and treatment.

What is dental and early childhood caries

dental

This infection, which causes tooth decay by acid-forming bacteria found in dental plaque.

The most important information to remember is that caries is a dynamic disease process and not a static problem. Second, before a cavity forms, the caries infection can actually be reversed.

The progress of caries or its retreat is determined by the balance between protective and pathological factors in the mouth. Development of dental caries is a dynamic process: demineralization of hard dental tissue by acid products of bacterial metabolism - alternating with periods of remineralization.

sporadically, periods of demineralization alternate with periods of remineralization. Lactic acid, produced by cariogenic bacteria, dissolves the mineral calcium phosphate of tooth enamel in the process of demineralization.

A child's teeth have thinner enamel than permanent teeth, making them very susceptible to cavities. Dental caries in children was first observed clinically as a "white spot of the lesion". If the tooth surface remains intact and slightly hollow, then enamel remineralization possible. If the subsurface demineralization of the enamel is extensive, it eventually causes the surface of the overlying tooth to collapse, resulting in a "cavity".

Saliva plays an important role in preventing tooth decay. It provides calcium, phosphate, proteins, lipids, antibacterial agents and buffers. Salivation can reverse low pH levels in dental plaque, and at higher pH levels, calcium and phosphate can be brought back into tooth enamel.

One of the factors that reduce the risk of cavities is normal flow of saliva. Anything less than 0.7 ml/min increases the risk of developing a cavity.

early childhood

A dangerous form of dental caries that can destroy the teeth of preschool children and toddlers. Early childhood caries can also be defined as the appearance of any evidence of dental caries on any tooth surface during the first 3 years of a child's life.

Economically disadvantaged children are the most vulnerable to RDK.

Caries of milk teeth is progressive pathological process s, which leads to the gradual destruction of enamel and damage to internal tissues. Tooth decay begins as a superficial lesion of tooth enamel. However, if proper treatment is not carried out, decay can provoke the development of a deep cavity inside the tooth, penetrate into its tissues and cause an inflammatory process.

Early childhood caries is an infectious disease, and the bacteria Streptococcus mutans (Streptococcus mutans) is the main causative agent. Not only does S. mutans produce acid, this bacterium also thrives in acid. High sugar in the mouth increases the level of acid in the teeth. In children with RDC, the level of streptococci mutans usually exceeds 30% of the cultivated flora of dental plaque.

First, caries affects the primary upper anterior teeth, and then the upper primary molar teeth. The initial manifestation of early childhood caries are white areas of demineralization on the enamel surface along the gum line of the upper incisors. These white spots are affected so that they later become cavities that were discolored.

The mandibles are protected by saliva and the position of the tongue during feeding. The process of RDK can be so rapid that cavities appear in the teeth "as soon as they occur".

The first event in the natural history of RDC is the primary infection with S. mutans. The second event is the accumulation of S. mutans to pathological levels due to prolonged exposure to sugars. The third event is the demineralization of the enamel, which leads to the formation of cavities in the teeth.

Early S. mutans infection is an important risk factor for the future development of caries. Colonization of the baby's mouth with these bacteria is usually the result of transmission from the baby's mother. S. mutans can apparently colonize the mouths of infants even before their teeth begin to erupt and grow.

Children at high risk of developing early childhood caries may develop carious lesions on their upper front teeth soon after they erupt. As the disease progresses, decay appears on the surfaces of the primary upper first molars.

Causes

The process of caries should be considered as a dynamic change in the phases of demineralization and remineralization. This is a competition between pathological factors(such as bacteria and carbohydrates) and protective factors(such as saliva, calcium, phosphate and fluoride).

Streptococcus mutans bacteria

Streptococcus mutans is the main cause of tooth decay. An important risk factor associated with RDC is the early acquisition of cariogenic bacteria.

Streptococcus mutans is the main cariogenic bacterium.

Mutans Streptococci (Streptococcus mutans) are bacteria that adhere to enamel and produce acid by converting sucrose into lactic acid. Therefore, the acid produced by these bacteria lowers the pH of the oral cavity and promotes demineralization tooth structures.

Prolonged lowering of the pH level causes demineralization, which eventually leads to the formation of cavities. Although Streptococcus mutans is commonly found on enamel surfaces, these bacteria have the ability to colonize the oral cavity, and earlier acquisition of SM is associated with increased caries.

In infants, SM usually acquired from primary caregiver, most often from the mother, through contaminated saliva. While the mechanism of transmission is unclear, contributing factors may include close contact, sharing of utensils or food, and poor oral hygiene and/or open carious lesions in the primary caregiver.

Streptococcus mutans is strongly associated with caries. Its share in plaque associated with early childhood caries can be from 30% to 50% of the total number of viable bacteria. In contrast, S. mutans typically makes up less than 1% of the plaque flora in non-caries children.

The earlier a child's mouth is infected with mutant streptococci, the greater the risk of developing caries in the future.

Bad eating habits

Frequent use carbohydrate-rich or sugary foods allows cariogenic bacteria to maintain a low pH level on the surface of the teeth.

Late night bottle feeding or prolonged use of a sippy cup can lead to early childhood tooth decay. The flow of saliva decreases during sleep, so the clearance of sugary fluid from the mouth slows down.

Poor oral hygiene

Low fluoride on the surface of the teeth reduces the process of remineralization and increases the risk of developing caries. Children who already have one or more dental cavities have a higher risk of developing deciduous tooth decay.

When saliva flow is less than 0.7 ml/min, saliva cannot wash carbohydrates from the surface of the teeth. In addition, low salivation, low levels of IgA (secretory IgA or immunoglobulin A) in saliva, and low levels of calcium and phosphate in saliva reduce the chance of acid neutralization in plaque.

Finally, low socioeconomic status may reduce interest in oral hygiene and healthy eating.

At what age can appear

Tooth decay is common in very young children and adolescents.

There is a trend towards an increase in cases of caries of milk teeth in children. Very often it is found in children 2-3 years old or in children under 2 years old.

Adolescents are also exposed higher risk. Over time, teeth can wear down and gums can recede, making them more vulnerable to decay. Adults may also use more medications that reduce the flow of saliva, increasing the risk of tooth decay.

Kinds

Different types of dental caries are enamel caries, dentine caries, reversible caries, irreversible caries, pits and fissures, smooth surface, acute caries, early childhood caries, primary and secondary caries.

Caries of milk teeth begins with the fact that surface layers are destroyed, after which it penetrates deep into the dentin.

Circular caries is a specific type of tooth decay that is characterized by destruction of bone tissue at the cervical edge of the tooth.

This disease very quickly penetrates into the tissues of the teeth and affects the nerve channels. It is very difficult to detect this type of caries in the early stages and difficult to manage in later and advanced stages. Often, circular caries affects people over 30 years of age, but is often observed in children.

Caries that begins in a crack on the occlusal surfaces of the back teeth. Fissure caries is the name for a carious lesion in the area of ​​fissures(cracks). Such caries is usually caused by abnormal fissure anatomy. The teeth usually have a main crack that runs in the longitudinal direction.

Likewise, many small cracks that protrude from the side are called lateral cracks.

Retrograde

The development of a carious lesion starts from the side of the pulp. First, the dentin is damaged, then the enamel. Such caries can develop with purulent pulpitis, when the pathogen enters the pulp by the hematogenous route, with injuries and anomalies of odontogenesis.

Other types

Stages of tooth decay

The morphology of caries in various hard tissues of the tooth has its own characteristics. There are five key stages in tooth decay.

White spots

The first stage of tooth decay is associated with the appearance yellowish spots or chalky white area on the tooth surface due to calcium loss. This tooth decay is still reversible, with proper treatment.

enamel decay

At this stage, tooth enamel begins to damage below the surface layer without damaging the surface. If the decay persists, the tooth surface will be fractured and this damage will be irreversible.

At this point, the tooth must be cleaned and filled in by the dentist.

In the third stage, decay progresses beyond the enamel into the dentin. At this stage, the dentist can restore the damaged tooth with a filling. The level of pain also begins to increase, as with many stages of tooth decay.

Any toothache should be noted immediately so that the problem can be solved.

Cellulose involvement

The pulp of the tooth is involved and contaminated due to the action of bacteria. The result is the formation of pus, causing the blood vessels and nerves in the pulp to die.

At this stage, root canal therapy is the only treatment option.

abscess formation

Infection reaches the root of the tooth. The bones surrounding the tooth also become infected, causing severe pain.
This is the final stage of the infection. You may have visible swelling on your cheeks, along the affected side.

The dentist will prescribe antibiotics and painkillers. He may perform root canal therapy or remove the infected tooth at this stage.

Stages according to the degree of destruction

According to the degree of destruction, caries of milk teeth is classified into 4 stages.

Elementary

In place of the enamel appears white opaque spot, which resembles lime (chalk stain). The pathological process triggers demineralization and demineralization of enamel in the subsurface layer. The content of calcium, phosphorus, fluorine and other minerals decreases in the area of ​​the spot.

Enamel at the site of the stain loses its uniformity, shine, becomes soft, more penetrating. The small spot may become pigmented (yellow to dark brown). Cariousness can pass slowly, accompanied by remineralization. Then the spot acquires clear contours.

Surface

Shows demineralization and destruction of enamel within the dentinal-enamel junction. This is the first stage of dental disease, in which only the outer tooth enamel is destroyed. If left untreated, superficial caries will penetrate deeper into the tooth, affecting the dentin (and leading to moderate to deep caries).

Independently identifying superficial caries can be difficult: at this stage, pain from hot and cold foods can be mild and temporary, and patients are usually blamed for their tooth sensitivity.

If the decay is closest to the neck of the tooth, there may be occasional pain when brushing the teeth. Some try to see changes in the teeth in the mirror, but then the suspected tooth decay is only possible on the outside of the front teeth.

Explicit caries can be seen as dark gray or brown spots. The only way to accurately identify and evaluate superficial caries is with a regular oral examination by a dentist. To assess the depth of damage to the teeth, the doctor uses a dental probe or a diagnostic method. Initial and superficial caries should be distinguished from other pathologies of tooth enamel - fluorosis, hypoplasia and enamel erosion.

Intermediate degree

With medium caries, the destruction process affects not only the enamel, but also on the dentin layer of the tooth crown. Since there is enough dentin layer there, caries can affect the dental pulp (the neurovascular bundle in the coronal cavity).

Deep

Large cavities appear in softened dentin - carious cavity. Between the bottom of the carious cavity and the pulp, only the skin (a very thin layer) of dentin remains, or the carious cavity extends to the pulp.

signs

Early childhood caries develops over time and can be difficult to diagnose in the early stages.

Tooth decay can manifest itself as:

• Toothache, spontaneous pain, or pain that comes on for no apparent reason
• Tooth sensitivity
• Mild and sharp pain when eating or when the child drinks something sweet, hot or cold
• Visible holes or pits in the teeth
• Brown, black or white coloring on any surface of the tooth. This may be a dull white band on the surface of the tooth closest to the gum line. This is the first sign and usually goes unnoticed by the parents, or it may be a yellow, brown or black band on the surface of the tooth closest to the gum line, which indicates the progression of carious decay.
• Pain when bitten
• Teeth that look like brownish-black stumps indicate that the child has developed cavities.

Methods of treatment and restoration

Treatment in most cases requires removal of decayed tooth and its replacement with stuffing.

Fillings (also called restorations) are materials placed in teeth to repair damage caused by caries (or cavities). Advances in dental materials and methods of restoration and treatment of teeth provide new effective ways to restore teeth.

There are several different types of restorations.

Direct restorations

They demand one-time filling directly into the prepared cavity or hole. Materials used for this include dental amalgam, also known as silver fillings; Glass ionomers; polymeric ionomers; And some composite (resin) fillers.

Amalgam fillers have been used for decades and have been tested for safety and durability. Dentists have found that amalgams are safe, reliable and effective for restorations.

glass Ionomers are tooth-coloured materials made from fine glass powders and acrylic acids. They are used in small fillings that cannot withstand the intense pressure of chewing. Resinous ionomers are made of glass with acrylic acids and acrylic resin.

Indirect

They require two or more visits and include inlays, onlays, veneers, crowns and bridges. They are made of gold, metal-based alloys, ceramics or composites.

At the first visit, the dentist will prepare the tooth and examine the area to be restored. During the second visit, the dentist will place the new restoration in the prepared area.

Some offices use newer CAD/CAM (computer-aided design or computer-aided manufacturing) technology, allowing them to do an in-office indirect restoration in 1 visit, saving the patient from having to come back again.

For indirect restoration, the dentist may use porcelain or ceramic materials.

• The first material looks like natural tooth enamel in color and translucency.
• Another type of indirect restoration may use porcelain fused to metal, which provides additional strength.
• Gold alloys are often used for crowns, inlays or onlays.
• Less expensive alternatives to gold are metal-based alloys that can be used in crowns and are resistant to corrosion and fracture.
• Indirect composites are similar to those used for fillings and are tooth-colored, but they are not as strong as ceramic or metal restorations.

Prevention of caries in children

Preventing tooth decay involves these simple steps:

1. Start brushing your child's teeth as soon as the first tooth appears. Brush your teeth, tongue, and gums twice a day with fluoridated toothpaste or supervise brushing.
2. For children under 3 years of age, use only a small amount of toothpaste, the size of a grain of rice
3. Starting at age 3, use a pea-sized toothpaste
4. Brush your child's teeth daily with a toothpick after age 2.
5. Make sure your child eats well-balanced meals and limits or eliminates sweets.
6. Check with your dentist about using supplemental fluoride if you live in an area without fluoridated water.
7. Also ask about dental sealants and fluoride varnish. Both apply to teeth.
8. Schedule (every 6 months) - dental cleanings and exams for your child.

By following preventive measures and not forgetting regular dental checkups of milk teeth, you can easily protect your child's milk teeth from caries. The main thing is monitor his oral cavity and not trigger the first signs and caries symptoms.

From this article you will learn:

• why teeth are affected by caries,
• what is the difference between the treatment of caries in children under 3 years old and older children,
• what is bottle caries in children: photos, causes.

Caries of milk teeth most often occurs in children starting from the age of two, which is associated, on the one hand, with weak mineralization of erupted milk teeth with calcium, on the other hand, with errors in caring for the baby's teeth on the part of the parents.

The treatment of caries in children under 3 years of age is different from the treatment of older children. In this article, we will analyze in detail the methods of treating children's caries. First of all, the choice of methodology will depend on −

• the age of the child and his behavior in the doctor's chair,
• depth of caries.

Children's caries of milk teeth: photo

Often on the teeth of a child it forms in the form of black spots, which can be mistaken for caries. The integrity of the enamel is not broken, and such pigmentation is a deposition of iron salts on the surface of the enamel - as a result of the vital activity of anaerobic bacteria (actinomycetes). This type of staining is called chromogenic.

Causes of caries in children -

Caries of milk teeth in children occurs due to several reasons, to a greater extent related to errors in the care of the baby's teeth by the parents, as well as due to the anatomy of the teeth of early childhood. Among the main reasons -

• Improper nutrition –
  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, even the special term "bottle caries" appeared (Fig. 9-11).

• Infection of a child with cariogenic microorganisms –
  the child is born with a sterile oral cavity. All the cariogenic microflora comes from his parents, when they kiss the child on the lips, try the child's food with his spoon and lick it.

• Weak calcium saturation of milk teeth –
  the enamel of erupting teeth contains little calcium, i.e. it is demineralised. Good hygiene, the use of toothpastes with calcium and fluorine, as well as the natural physiological gradual mineralization of tooth enamel by calcium contained in saliva - leads to a gradual saturation of the enamel with calcium and its hardening.

  However, in conditions of insufficient hygiene, malnutrition, accumulation of microbial plaque and food residues on the teeth, the physiological mechanism of enamel mineralization is no longer enough to maintain balance, and vice versa, enamel demineralization occurs, i.e. weak enamel begins to lose calcium. The result of this process is caries.

Treatment of caries of milk teeth -

As we have already said: treatment in children 2-3 years old will be very different from the treatment of older children. Below you can find the main methods, 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 dentist's chair), the following treatment methods can be used -

• remineralizing therapy,
• silvering (Fig. 13),
• deep fluoridation (Fig. 14),
• gentle filling of teeth (Fig. 15).

Gentle dental filling in children up to 3 years –
in fact, this is the only method if your child already has medium caries. Don't worry, filling teeth in children of this age is quite possible, and many dentists treat even 1.5-year-old children this way. The most important thing here is the approach, and that the child is not scared from the very beginning.

It is very important not to cause discomfort to the child during the first visit to the dentist, limiting himself only to cleaning the teeth affected by caries with a polishing brush and paste, as well as treating the teeth with special remineralizing gels or fluoride varnishes. On the second visit, you can already start gentle filling.

First, it is necessary to remove enamel and dentin 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 are 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 painlessly.

Important points that parents need to know before filling -

• The presence of the drug "caries-marker" at the dentist –
  it is very important that a pediatric dentist has a “caries-marker” preparation, which helps the dentist determine whether he has completely removed the dentin affected by caries. In children of this age, it can be very difficult to determine. If the dentist leaves at least a little bit of carious dentin, caries will occur under the filling, which will very quickly turn into pulpitis and acute pain. Those. if the doctor does not have such a drug initially, I would not even sign up for treatment if I were you.

• The choice of material for filling –
  after removal of all tissues affected by caries and appropriate antiseptic treatment, they proceed to the actual filling. The second important point is the choice of filling material. Children of this age can and should be filled with teeth only with “light-curing glass-ionomer cements”. Under such a filling with medium and deep caries in children, you should always put a medical pad made of calcium-containing material.
If your child has initial caries in the form of white chalky spots (without violating the integrity of the enamel), then the treatment will be the same as in children under 3 years old - remineralizing therapy, deep fluoridation, and in the worst case - silvering. A link to these methods was given by us a little higher. With superficial, medium and deep caries in children of this age, the method of filling teeth with light-curing glass-ionomer cements should be unequivocally applied.

Carious tissues should preferably be drilled out with a drill, and only in the most extreme case can removal of carious tissues with curettage spoons or trowels be used. Under the glass ionomer filling (if the caries is medium or deep), a gasket made of calcium-containing material is also required. We hope that our article: Caries of milk teeth in children turned out to be useful to you!

Sources:

1. Higher professional education of the author in dentistry,
2. Based on personal experience of 20 years as a dentist,
3. The European Academy of Pediatric Dentistry (EU),
4. National Library of Medicine (USA),
5. “Pediatric therapeutic dentistry. National leadership” (Leontiev V.K.).

Caries of milk teeth in young children is a common problem that needs timely treatment, because not only the beauty of the baby's smile, but also the state of health depends on it.

This disease of hard tissues of the tooth affects adults and children, milk teeth and permanent ones. Every year, the spread of carious lesions becomes more and more widespread. More than 80% of children under three years of age have carious cavities in milk teeth.

The distinctive features of the course and treatment of childhood caries lead to the need to search for new methods of treatment and improve old ones.

Psychological trauma inflicted in early childhood and associated with toothache is deposited in the subconscious for life and leads to fear of dental treatment. That is why the approach to the treatment of caries in young patients should be gentle and painless.

Causes

Factors that influence the development of the carious process:

• insufficient hygiene - this procedure falls entirely on the shoulders of parents whose children have not reached another 2-3 years. With the appearance of the first tooth, they should have a rule of daily brushing with gauze or finger brushes without the use of paste;
• sweet mixtures and drinking - in medicine there is the concept of "bottle caries", which occurs from the frequent feeding of a child at night with sweet mixtures or sweet drinks. Less saliva is produced at night, it does not wash the teeth well enough, and carbohydrates provoke the growth of cariogenic microflora;
• excessive consumption of sugars (sweets) is one of the main reasons why caries is formed;
• soft food - teeth are conceived by nature in order to tear off and grind food. When a child eats predominantly soft foods and neglects hard foods such as fruits and vegetables, there is no mechanical self-cleaning of the teeth;
• low mineral content - insufficient intake of substances such as calcium, fluorine and phosphorus with food leads to the fact that the structural components of the enamel do not receive “building” material for strengthening;
• heredity - the genetic prerequisites for the occurrence of childhood caries cannot be denied, because such a relationship can be traced through the example of many families.

Caries of milk teeth in young children can be prevented by preventive methods. For example, our site already has an article about games and a coloring calendar.

Symptoms

The appearance of these signs signals that it is time to take the child to the dentist:

• change in the uniformity of the color of the enamel and the appearance of white spots (as with);
• discomfort from temperature and chemical irritants;
• pain when eating;
• bad breath.

The initial signs in the enamel structure are hardly noticeable, so parents should be attentive to their baby's smile and take them to the dentist's office 2-3 times a year, because caries spreads much faster (!) in children than in adults.

The nature of the child's complaints depends on the stage of the disease.

1. With the initial manifestations of carious disease, with the exception of a change in the appearance of the teeth, nothing is noticeable and nothing hurts.
2. When the process enters the next stage - the superficial one, then most often the child will also not be bothered by anything. At this stage, caries can be cured with no drill.
3. The appearance of crater-shaped cavities, pain sensitivity when eating, especially those with a sharp difference in temperature, discomfort from food getting stuck, indicates a deepening of caries to an average level.
4. At the last stage, pain during chewing joins all the previous symptoms.

Photo

Diagnostics

There are four stages in the development of caries:

• elementary;
• surface;
• average;

The initial form looks like whitish spots and stripes on the surface of the enamel, and this surface becomes rough, loses its natural luster, acquiring chalky spots. Loss of tooth tissue at this stage does not yet occur.

The superficial form is characterized by the destruction of the tooth to the enamel border. Depending on the individual sensitivity of the child, complaints of pain may be absent. The enamel acquires a hue that varies from light brown to black.

The average is considered to be the form to which parents already independently pay attention and understand that the time has come for treatment. Here there are complaints of pain from irritating substances and temperature effects, and a hole appears that affects the enamel and dentin. The color of the cavity depends on whether the disease is acute or chronic.

The deep form is rarely found in children, as it quickly turns into pulpitis, because the chamber where the nerve is located is wide and occupies a large area in the crown of the tooth. The child often says that it hurts him to eat, and when eating, he tries not to chew on the sore side.

Video: about children's teeth at Dr. Komarovsky's school.

Caries of milk teeth in children and its treatment

Parents should understand that the carious process in milk teeth is subject to mandatory treatment, because it affects the health of not only permanent teeth, but also the body. Caries is an infectious process, and the earlier the stage, the less painful the preparation will be.

Choosing a dentist for your child's first visit to the clinic is very important. It depends on the professionalism and communication skills of the doctor how the child will treat this process in the future.

A good specialist when working with a child is guided by the following rules to stop the spread of caries:

1. 30 minutes is the time that a child is able to sit quietly in a chair.
2. Anesthesia is carried out in two stages: first, an anesthetic gel is applied to the mucous membrane where the intended injection site is located, after which the drug is injected.
3. Drilling a carious cavity is necessary only in cases where it is impossible to remove the altered tissues in another way.

Each stage of a carious lesion has its own methods of treatment.

Remineralizing therapy and silvering are used to restore the enamel structure during initial changes.

• silvering is a method that was popular among parents and doctors during the Soviet era, and is now being used to treat children under three years old. Silver has a strong antibacterial effect and does not allow the enamel to collapse further. The procedure is very simple: a solution of silver nitrate is applied to a cotton ball, after which the surface of the tooth is treated with it. Due to the persistent black staining of teeth, this method is less and less in demand;
• remineralization - the action of the technique is based on the property of trace elements of fluorine and calcium to penetrate into the enamel structure and restore its crystal lattice. The range of drugs is wide, so the dentist selects the necessary remedy individually, depending on age, the level of intensity of caries and its form, acute or chronic. The disadvantage is that the treatment is carried out in a course, in order to achieve the effect, you will have to visit the dentist almost daily if office treatment is prescribed. In the case of home use, parental supervision should be carried out, since fluoride preparations in large quantities can cause poisoning.

• drill preparation - used quite often. Typically, the doctor drills with a handpiece that runs at low speed and also uses water cooling. Children who previously had a negative experience of treatment are afraid of such equipment, so parents should conduct appropriate psychological preparation, and the dentist should use a drill in cases where it is indispensable;
• ART technique - the principle of operation is based on the use of hand tools to remove softened dental tissues. The use of enamel knives and excavators is completely painless and does not cause such stress for the baby as the previous method. However, it is not always possible to completely remove a carious lesion only with hand tools;
• laser preparation - every year the use of laser in medicine increases. It has a strictly directed action, removes only the affected tissue and does not cause pain. However, not every clinic has such tips in its arsenal, and it will take more time to remove caries than when using a drill;
• ozonation - this painless procedure saturates the tooth tissues with ozone and helps in the fight against microbes;
• depophoresis - based on the penetration of active substances into the tissues of the tooth under the influence of an electric current.

For filling, glass ionomer cements, sealants, composites and compomers are used. The last group of materials includes colored fillings loved by parents. The child enthusiastically chooses the color of the material, and then proudly demonstrates his unusual fillings.

Video: caries in children, its treatment under general anesthesia - the experience of a young mother.

What to do if the child is afraid of dental treatment?

To reduce a child's fear:

• have a conversation about the upcoming procedure, while not scaring the baby and not lying;
• the first visit is desirable to do in order to get acquainted with the doctor and a simple examination of the oral cavity;
• ask the dentist to show the child the tools, introduce the drill and let the baby touch it, because, as you know, the unknown breeds fear;
• the day before, do not disturb the baby, let him spend the evening in a calm atmosphere;
• as a thank you for good behavior at the dentist, you can give a toy or take you to an amusement park.

The first impression of dental procedures should not cause moral harm and discourage the desire for treatment.

Prevention

Teaching your baby to brush their teeth is an important action to keep them healthy, which should become a habit.

Caries of milk teeth in young children and its occurrence can be reduced by adhering to the following rules:

1. Brush your teeth in the morning and evening, and after each meal, teach your child to rinse his mouth with water.
2. Limit your intake of carbohydrate foods.
3. Enrich your child's diet with meat and dairy products, as well as fruits and vegetables.
4. Offer your child solid food - this mechanically cleans the teeth from plaque, and also puts a load on the periodontium, thereby increasing the blood supply to the gums.
5. Visit the dentist at least 2-3 times a year.

It is easier to provide a sufficient level of prevention than to treat the child later, because the condition of the milk bite affects the health of permanent teeth.

Consequences

A neglected condition and untimely dental treatment has the following consequences:

• with a weak immunity of a child, each carious tooth increases the likelihood that infectious diseases will occur in the oral cavity, such as thrush, etc. Pathogenic microflora with saliva enters the gastrointestinal tract and can cause general diseases;
• in case of severe destruction, milk teeth will have to be removed. This negatively affects the formation of a permanent bite;
• bad breath creates a barrier in communication with peers.

Video: how to avoid caries of milk teeth?

Additional questions

Is it necessary to treat caries of milk teeth in children?

Yes, it is subject to mandatory treatment, because it is a source of infection of the whole organism. Timely treatment of carious cavities and keeping the child's mouth in good condition is important for the formation of permanent teeth.

Caries is a pathological process, which is characterized by damage to the hard tissues of the tooth and the further formation of a cavity in it. In recent years, caries of milk teeth is a fairly common problem. By the age of 6-7 years, until permanent teeth begin to appear, more than 70% of children have lesions in milk teeth, and most of them go to the dentist with complications or a running process. Most often, caries of milk teeth is detected at 2-3 years old, but sometimes it can also occur in children who are not yet two years old. In different regions of the country, the prevalence of this form of caries by the age of four is 20-80%. How can such problems be avoided and what parents need to know?

Causes of caries

Most often, caries of milk teeth can be formed under the influence of several factors at the same time. Its most common causes are:

• The defeat of the tooth germs in the prenatal period.
  In the embryo, tooth germs begin to form in the first trimester of pregnancy. That is why any illnesses of the expectant mother that she suffered during this period, as well as the use of medications, can contribute to the fact that the fetus is disturbed by the proper development of teeth.
• Insufficient oral hygiene or its absolute absence.
  In this case, food particles remain on the teeth, and this is an excellent environment for the life and reproduction of bacteria.
• Wrong eating habits - use of teats for a long time.
  Those children who are not able to switch from drinking from a bottle to a sippy or cup for a long time, and especially those who have learned to fall asleep every night with a bottle or pacifier in their mouth, are at risk of bottle caries. With this pathology, through prolonged contact with the teeth of the liquid from the bottle (especially if it is sweet), the front teeth are affected by caries, while the process spreads along the circumference of the crown part of the tooth (along the perimeter of its visible part).
• Insufficient amount of food in the daily diet, which requires intensive chewing and leads to increased salivation, due to which the teeth are cleaned naturally.
  This factor is present in children under two years of age, it is one of the causes of early caries.
• Lack of calcium in food and water - the main building material of the tooth and fluorides, which strengthen tooth enamel and protect against caries, preventing the possibility of its development.
• Rickets - with this pathology in children, tooth tissues are easily destroyed.
• Physiologically determined low resistance in children of dental tissue to agents that cause caries.
• Anomalies of the dentition and bite.
• hereditary predisposition.
• Chronic diseases, as well as frequent respiratory diseases, due to which the overall resistance of the body decreases.
• An excessive amount of carbohydrates in the child's food, which contribute to the development of caries in two directions at the same time: they feed the bacteria, and in the process of their decay, organic acids are formed that damage tooth enamel. For the formation of caries, it is not so much the total amount of carbohydrates consumed that matters, but the frequency of their intake.

Without a doubt, a child who is not yet three years old should not snack between meals, especially foods containing a high amount of carbohydrates (sweets, chocolate, etc.). Instead, it is better for the baby to offer fruits, marshmallows, marmalade, pastries, drying. It is better to eat sweets after breakfast or dinner, and then brush your teeth after a while. Almost all children do not grow up without sweets, but their use should be limited and reasonable.

The Forbidden fruit is sweet…

In order not to tempt the baby with "forbidden fruits", simply do not buy them and do not use them yourself. Undoubtedly, your friends and relatives all bring sweets to the child solely from the best of intentions. Try to talk to them and explain that instead of sweets, you can bring a child, for example, a toy or an interesting book. Due to poor or no oral hygiene, the plaque that remains on the teeth after eating food turns into plaque containing bacteria that produce lactic acid, which damages enamel and promotes cavities. As soon as the child has the first teeth, he should immediately have toothpaste and a brush that are age appropriate. Developing the habit of brushing your teeth at an early age twice a day (in the morning and also in the evening, after meals) will prevent many problems.

Signs of caries

Caries of milk teeth according to the depth of the lesion can be divided into the following types:

In children, multiple damage to the teeth is possible (immediately 20 milk teeth may be affected). In addition, in childhood, several carious cavities may occur in one tooth. Due to the physiological and anatomical features of the structure of the teeth, some children have a thinner layer of dentin and enamel, so hard tissues have a higher permeability, which is why the carious process quickly spreads over the surface of the tooth and deep into it. This contributes to the spread of the process to deeper tissues and the development of periodontitis and pulpitis.

Stay vigilant

In the event that you find the formation of plaque on the child’s teeth that you are not able to remove on your own, as well as brown or white spots, this indicates that the child needs to be urgently shown to a pediatric dentist. If the baby complains about the discomfort that occurs when eating hot or cold food, this indicates the spread of caries into the deeper layers of the tooth. In no case should parents ignore such complaints. It happens that a small child is not able to clearly communicate what is bothering him, so if he refuses food or a certain type of food, and also chews on one side, this may indicate a toothache.

Complications of caries

The most typical complications of caries are pulpitis and periodontitis.

Pulpitis is a pathological process in which the inflammatory process affects the soft dental tissue (pulp). Symptoms of pulpitis can develop in a few hours. This is preceded by minor pain, then acute pain occurs, more often at night or as a result of exposure to thermal stimuli. Such signs indicate that the carious cavity is most likely very deep and the pulp of the tooth is affected. In this case, urgent dental intervention is necessary.

In the event that toothache has been observed repeatedly, the child has swelling of the gums or cheeks, and a fistula with purulent discharge is visible near the tooth on the mucous membrane, pain occurs as a result of biting on the tooth, this indicates the spread of the pathological process beyond the tooth and inflammatory the process has developed in the tissues that surround the tooth and a pathology such as periodontitis has arisen. When treating it, the doctor will choose the treatment tactics individually, but such a milk tooth is unlikely to be cured, but it will need to be removed.

Ways to treat caries

With caries in children at the initial stage of its development, enamel silvering can be used. At the same time, a special solution is applied to the carious cavity (untreated), which contains silver ions. This is usually a temporary measure that is used to fight tooth decay. When using silver preparations, the areas of the tooth affected by caries, that is, the carious stain itself, are permanently stained black, and this does not look very aesthetically pleasing. However, one should not think that the entire tooth will become black. Only the part affected by caries will darken, while the healthy area will remain unchanged white.

The most traditional way to treat caries in milk teeth is to remove the affected dental tissue with a drill using local anesthesia.
The dentist decides on the need to use local or general anesthesia (anesthesia) individually in each case. Sometimes neither the parents nor the doctor can persuade the child to open his mouth to treat or show his teeth. Most often, such a problem is faced by children under the age of three or suffering from concomitant pathologies. Then there is a need to treat the teeth under general anesthesia. The child should not have a fear of the dentist. It is desirable that he makes friends with him and understands that it is necessary to treat his teeth. After all, he will have to deal with this for the rest of his life. The psychological mood of the baby largely depends on his parents and relatives, who can convey to him their fear of visiting the dentist. Try to explain to the baby about the importance of a visit to the dentist and set him up to the fact that such a procedure does not need to be afraid.

Caries Prevention Methods

Since caries can develop in babies from an early age, the prevention of this problem should be dealt with as soon as the first teeth appear. Caries can be prevented by constantly removing microbial plaque and food debris from the oral cavity with hygiene products, which primarily include toothpaste and a brush.

How to brush your teeth?

Each specialist has his own opinion on when you need to brush your child's teeth using toothpaste. According to its composition, toothpaste must necessarily correspond to the age of the baby - all information about this can be found on the packaging. Pastes for children under the age of three should not contain fluoride. Children at this age, not having rinsing skills, swallow pasta. If a large amount of paste containing fluoride enters the child's body, serious health problems can occur, so in this case you should immediately consult a doctor. Babies from about 4 years of age can partially spit out the remnants of the paste after brushing their teeth. That is why toothpastes for this age contain fluoride. The maturation of tooth enamel is accelerated if hygiene products containing active fluoride are used regularly. This has been shown to help reduce the risk of caries.

Children's toothbrushes are diverse. For very small ones, you can use special fingertip brushes, with which the mother can easily remove plaque from the tooth of her child. By the age of 2.5-3 years, you should gradually give the child a toothbrush in his hand and teach him to brush his teeth on his own.

Choose a toothbrush with soft bristles that is 2-3 teeth wide. It is recommended to change it every month, because disheveled bristles can injure the gums, and besides, it is a source of bacteria. The child should have an individual toothbrush, it should be stored separately, without a case, with the bristles up. Before brushing your teeth, as well as after the procedure, the brush should be rinsed well with running water.
Oral care with additional hygiene products

• You can use dental floss or floss when all 20 milk teeth erupt (most often this is the age of 2-2.5 years). Dental floss should be used if the teeth fit snugly together. This must be done very carefully so as not to accidentally injure the gum.
• Tooth rinses (elixirs) can be used as an additional means of hygiene in babies with a high risk of caries. In special children's elixirs, the content of fluorine is in the amount that a child of one age or another needs. You can use it twice a day after brushing your teeth or eating foods that contain a lot of sugar. And chewing gum should be given to children no earlier than after 3 years. The sweeteners contained in them (sorbitol, xylitol, etc.) have a beneficial effect on tooth enamel and prevent the occurrence of caries. Chewing gum also promotes increased salivation and self-cleaning of the oral cavity. You can give them to children, regardless of the presence or absence of fillings in the mouth. Duration of chewing - no more than 10-15 minutes.

How to brush your teeth properly?

It happens that an attempt to brush your teeth can sometimes cause a negative reaction. But you don't need to get upset about it. Better be patient and play. Remember that a child under the age of three, and even older kids, also learn the world through the game. Therefore, do not insist on brushing your teeth, it is unlikely that the baby will understand that this is important. Just play. For such games, a battery-powered brush and a toy on the handle are perfect. The movements made by the brush for different groups of teeth should differ from each other. Cleaning of the front teeth should be carried out from the gums with unidirectional vertical movements. The movements of the brush behind the cheeks are circular, while the teeth should be closed. Cleaning of the chewing tooth surface is carried out with horizontal movements from the inside (from the side of the palate and tongue), back and forth, sweeping upwards like a “panicle”. But not only the movements that are made are important, but also how much time is devoted to this. There are two ways to check the sufficiency of brushing your teeth:

1. - by time (it takes about 7-10 minutes to clean all the teeth), for this you can use an hourglass or any other clock
2. - by the number of movements (for each area occupied by the bristles of the brush, 5-6 movements are necessary).

Proper nutrition

One of the preventive measures of dental diseases is a balanced diet - one in which the daily diet contains proteins, carbohydrates, fats, minerals and vitamins that are needed for the formation and proper growth of dental tissues. In infants, this is breastfeeding. Older children in the diet should include all the necessary types of complementary foods that are recommended for this age. Water and fluorinated salt can also be additional sources of fluoride, and no special indications are needed for their use. The main sources of calcium are fermented milk products (cottage cheese, milk, cheese, etc.), buckwheat, gooseberries, potatoes, peas, oats, mineral water (some of its types).

First visit to the dentist

The first visit of the child to the dentist is necessary, most often, for the following reasons: for a preventive examination upon admission to a preschool institution or in case of complaints. Don't put off your first visit to the dentist past the age of four. Subsequently, the child needs such visits twice a year. If the baby has already begun a carious process, then during such a time it will not be able to spread deeply, such complications of caries as periodontitis and pulpitis will not arise, and the tooth can be saved. The sooner the doctor can detect caries, the more successful and painless the treatment will be. Sometimes, in the initial stages of the superficial form of caries, treatment can be carried out without instrumental intervention with the help of mineralizing agents. At the same time, therapeutic solutions of calcium and phosphorus are applied to the damaged areas of the enamel. The task of the dentist is not only to carry out dental treatment, but also preventive measures that will help maintain healthy teeth and gums:

• professional oral hygiene (dental plaque removal);
• treatment of teeth with calcium and fluoride preparations
• appointment of general treatment if necessary (internal intake of vitamin-mineral complexes);
• Teaching your child how to properly brush their teeth
• correction of the composition and diet, identification of bad habits together with parents;
• Fissure sealing (grooves that are on the chewing surface of the tooth) is a preventive method that is aimed at preventing caries damage to permanent teeth.