Dental decay is the disease of the hard tooth tissue, namely enamel and dentin, that affects children and adults, alike. It is called a cavity because it manifests as a hole in a tooth.
The trend of this disease in children has been changing from the period of the mid-1900s, before which there was a decrease in the incidence of the disease, to a steady increase during current times. Tooth decay is more prevalent in kids who are from families with lower socioeconomic status.
Dental plaque is the causative agent of both cavities and periodontal disease. This thin film of bacteria and food substances forms within 20 minutes of eating, hardens in 24-48 hours and becomes a substance known as calculus. Twice-daily brushing and flossing are essential and important, especially for children. Neglect leads to cavity formation and progressive destruction of the tooth and supporting structures. Acidic oral environments have a cumulative effect on the progress of the cavities, as well. Consumption of candy, soda pop, health drinks, etc., is deleterious to oral health, as their breakdown is acidic.
Initially, decay appears on tooth surfaces as white spots that are mostly seen in the grooves of the teeth which when neglected, become a brownish-black crumbling of the enamel. What is essentially happening in an acidic oral environment is that the organic and inorganic materials are destroyed and eroded by bacteria and sugars. These sugars are often the remains of a meal of high-calorie food and beverages.
It is imperative that a child’s food consumption is supervised and that good oral hygiene is adhered to on a daily basis. A particularly deleterious habit causes what is called “Baby Bottle Syndrome.” This is commonly seen in children who sleep with a bottle in their mouth allowing milk (or other sugary drink) to pool in the mouth before and during sleep. This produces rampant tooth decay with effects that last into adulthood.
It is imperative that a child’s food consumption is supervised
and that good oral hygiene is adhered to on a daily basis.
The best time to start professional oral health evaluation is when a child reaches 2-2.5 years of age. At this time, children have a full complement of baby (deciduous) teeth. The child is also evaluated for normal development of the jaw and for possible sleep apnea. Earlier examinations may be essential due to early destruction of teeth, as with Baby Bottle Syndrome.
Neglected, diseased teeth can become abscessed and lead to more complications such as septicemia, meningitis, cardiac infections and even death. The abscessed baby teeth also infect the adult teeth lying directly below them.
Traditionally, the treatment has been largely preventive, such as using low-dose fluoride toothpaste in children ages 2-11, fluoride applications at the dentist, drinking fluoridated water, and sealants. Specific teeth are treated with fillings, commonly known as the “silver fillings” and “white fillings.” Silver (amalgam) fillings were placed after removing substantial tooth structure, thus compensating with strength of the material. With the advent of the white (composite) filling materials, only the diseased tooth structure is removed and replaced. The composite materials, in addition, bond with the enamel and dentin for a seal that prevents leakage around the filling. Colorful composites are also available to be placed in baby teeth. Abscessed baby teeth can be treated with a “baby root canal” (pulpotomy), and then restored with stainless steel crowns. If the baby tooth is not restorable, it is extracted and a space-maintainer is placed to hold space for the adult teeth below it. In the event the space is not maintained at this stage, the child may need extensive orthodontic treatment. If multiple teeth are involved and the child is not cooperative, treatment will need to be rendered with sedation therapy.
The future looks very promising with the invention of growth hormone gels and proteins containing amelogenin derivatives, which rebuild the decayed part of the tooth! Also, nanoparticle technology has evolved with the creation of a substance that will disrupt biofilm, the causative agent of tooth decay.
