It's true! They're going to fall out! Sometimes, if a child has a small cavity on a tooth that's going to fall out within the year anyways, I'll be the first one to recommend against fixing it. Either it'll fall out before it's a problem or I'd sooner extract than fix the baby tooth with the permanent (adult) tooth so close to erupting anyways. But most of the time it's not this situation. Usually, it's a cavity on a tooth that the child still needs for another 2-10 years. In adult dentistry, a very real part of the oral healthcare goal is for everything to function, appear, and be both healthy and esthetic. While we worry about all of these things, sometimes with kids the cost-benefit ratio isn't there to make us want to consider doing veneers for baby teeth stained from years of tall extra whip hot chocolates. But it is of significant concern to me that we prevent in children the experience of pain, infection, swelling, as well as the experience of needing tooth extractions, the reason being to preserve speech and chewing function. The primary (baby) teeth are vitally important for maintaining proper growth and development of the jaw bones, and in coordinating proper eruption and alignment of the permanent (adult) teeth. At these ages, it's a very real worry to consider how hard extractions can be on kids (more on anesthesia and pain vs. pressure coming next month’s article!), and how hard it can be to prematurely be missing teeth psychologically.
When a tooth has a cavity that has broken from the hard outer enamel into the softer dentin core, the cavity progresses to the gooey center (nerve) in about 1 year, whereafter we are considering root canal therapies at best and, if certain pathologies develop and / or behavior preclude successful root canal therapies, extraction can be necessary. My goal is to fix teeth with cavities when they're small and easy for kids to tolerate having fixed. Ever since getting the Solea laser for cavity preparation, I haven't had a child who needed anesthetic, meaning no “shots” for fillings or crowns! However, shots are still needed for root canals and extractions.
The short game here is, again, to prevent pain, infection, swelling, and all the other harms in the departments of speech, feeding, orthodontic development, and psychological wellbeing. The goal is to fix problems when they're small and easier to manage and undergo for a child. The long game here is to learn from small cavities about how to prevent future cavities, and ultimately when the baby teeth DO all fall out, you have and will continue to maintain a mouth full of permanent teeth which do not have any fillings, cavities, crowns, root canals, etc. because we've learned good dietary and hygiene habits to be and stay healthy for a lifetime!
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