Cavity Treatment

Hi Ellie,

My son and I saw the dentist today. He filled one of Brendan’s baby teeth and tried to fill another but ended up doing a pulp cap on the second tooth. If you remember, my son’s oral health was in pretty dire condition when we started your program. This is the first time we’ve seen a dentist since being told we needed to do $3,500 worth of work on his teeth under sedation. You’ll be happy to hear that Brendan did great with simple freezing.

We’re booked for a second (and final?) appointment to extract a tooth that we were told needed to be extracted over six months ago. It is really mostly a root now and quite loose. The dentist is also planning to fill another tooth that has a large hole (approx. 1/5 of the tooth on the tongue side).

As strange as it sounds this amount of work is much less than we were told he needed 6 months ago and I am quite comfortable with what the dentist is telling me.

I have one reservation. The hygienist warned me that the pulp cap could cause some pain and occasionally the tooth will require extraction anyway.

Before signing him up for a filling on the next tooth (which may or may not end up as a pulp cap), I would just like to know what is the danger of leaving a painless albeit compromised tooth alone. It has been explained to me many times as being the risk of the decay spreading from the baby tooth into the adult tooth and causing the adult teeth to come in with cavities requiring major work.

I’ve spent many hours researching baby teeth but have not found (could just be looking in the wrong place) anything that states definitively that this is the case. My question for you is how likely (or how many times in your practice have you seen) baby teeth cause cavities in emerging adult teeth in patients that are following your program.

Obviously, my concern is that a pulp cap (that may lead to pain and extraction anyway) would be worse than leaving a decayed (but not progressing) baby tooth alone.

Thanks for taking such good care of us. I consider it a huge victory that we’ve been able to buy so much dental time for his baby teeth and that his adult teeth require no work!

Kind regards,

CK

Hi CK,

Your story proves many points!!

Dentists are (in my opinion) trained to be far too scared of visibly seeing an old non-threatening cavity in the mouth.

This means that when they see a damaged tooth ( even if it is old damage and a cavity that has stopped) -most feel they have to do something about it!!

There are studies from Europe that show 60% of this work done is NOT necessary – especially this study cites pediatric teeth ( I will try to find this study for you).

This is not the study I was looking for, but it is an editorial that may be good reading:

http://www.guardian.co.uk/society/2000/apr/16/futureofthenhs.health

An actively rotten tooth (caries) is by definition, crawling with bacteria and this needs treatment.

Once the bacteria are gone – the process of decay stops.

Stopping a Cavity:

The ONLY way to get rid of the bacteria (and stop the cavity) is to get rid of all the germs in the mouth – by using xylitol.

( I guess we could add here that oxygen therapies and the use of Closys rinse can help remove these germs.

Oxygen therapies are done in dental offices and the use of a Closys rinse would need to be only for a child who is able to safely rinse and spit out.)

Daily use of xylitol will get rid of all cavity bacteria – in the cavity, plus germs on other teeth and in saliva.

Without tooth-destroying germs – the cavity will stop. In other words, enough xylitol can stop a cavity.

If a dentist is not used to the benefits of xylitol ( or not trained to think like this) they won’t believe that a cavity can STOP!!!

Without Germs?

The only damage that can happen now (with the germs are gone) will be if parts of the tooth break off over time.

Does this matter for a baby tooth? – not really – but it doesn’t “look” “cared-for” and therefore dentists don’t like to leave untreated bits of tooth in a mouth.

Food may get stuck in the “hole” and make it harder to keep clean, and I guess sharp bits can be uncomfortable to the tongue etc.

Apart from that – there should be no issues.

Using a fluoride rinse like ACT will help strengthen the remaining tooth and help prevent the breakage problems.

Pulp Infections:

On the other hand ( and this is what I think your dentist was talking about) if cavity bacteria continue to work their way into the center of the tooth – over time, it can get infected in the live part (in the middle of the tooth -the pulp area).

Infection in the pulp is like an abscess inside the tooth – with nasty pus and more and more liquids being produced – creating pressure. etc. When this happens it creates pain ( toothache).

The pressure is released by the dentist “opening up the tooth” to let the liquids / infection out.

Then the dentist cleans out the tooth by doing a “root canal” which means cleaning out the pulp area and then filling the empty space with clean filling materials.

Without any pain or X ray signs – this is unlikely to be the problem.

Untreated Pulp Infections:

If a pulp infection like the one I have graphically described above is allowed to develop untreated – more and more pressure will build up inside the tooth – (with no place to “go”).

Eventually the liquids have to go somewhere – so they burst into the jaw bone – and this may track out into the mouth through the jaw bone.

This sounds horrible, but in a child’s mouth it can happen easily because the roots of the tooth are short and the distance to the “outside” is not that far.

This allows this infection to show as little blister/pimple on the gum – with pus draining out of it.

THIS CONDITION – untreated over time – can cause the problems that your dentist mentioned for a new adult tooth.

The new adult tooth is growing beneath the roots of the baby tooth.

If the liquids and infection continue to spread into the jaw bone – it will have the chance to soak into the enamel of the newly forming tooth – and damage it.

This is why a dead baby tooth with a draining “fistula” should not stay draining through the gum.

It is better to deal with the infection by extracting the tooth or cleaning it up with some kind of treatment.

As you see there are a number of things that have to happen for this damage to occur – and it does not sound as if your son’s tooth is anywhere like at this stage.

Without cavity bacteria it would seem very unlikely for this scenario to happen – and at the toothache or gum pimple stage you could stop any damage.

Hope this information is useful in your decision making process.

Ellie



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