Cavities

Believe it or not, dental caries is the most common childhood disease. This is the disease that causes cavities (which are basically holes) to form in teeth. Luckily, it is preventable with proper oral hygiene and some help from the parents (that means you!)

• Caries are caused by various types of bacteria (mainly Streptococcus Mutans) which live right on the tooth structure. This bacteria secretes acid after eating and digesting carbohydrates (e.g. sugar). The acid then slowly destroys tooth structure (forming a cavity in the tooth). As if this weren't bad enough, plaque (the white stuff you feel on your teeth when you get up in the morning) helps the acid stay close to the teeth, instead of getting washed out by saliva.

• Cavities may be within enamel, they may penetrate through to the dentin, or they can extend all the way to the pulp of the tooth. Refer to the post here regarding the structure of teeth.
  

• There are various treatments for different types of cavities. However, the best policy is always prevention.

• One rather disturbing phenomenon that occurs in some children is referred to Early Childhood Caries. This used to be referred to Baby Bottle Caries because the cavities, which form on the anterior (incisors and canines) upper teeth are a result of the child being put to sleep with a bottle (usually of milk or juice, which both contain sugar) in their mouth.

Primary (baby) teeth

Below are some basics parents need to know about primary teeth with regards eruption (coming in) times, exfoliation (shedding) times and about the structure of teeth.

• There are 20 primary teeth
• 8 Molars (chewing teeth)
  
• 4 Canines (vampire teeth)
• 8 Incisors (front teeth)
• They are named A through T
  

• The sequence of eruption is more important than the timing. Sometimes this order is different, but this does not necessarily mean that anything is wrong. It may just be a sign that you should check in with your child's dentist. Here is the normal sequence (keep in mind that it does vary from child to child) beginning with the teeth that should erupt first to the teeth that should erupt last:
• Lower central incisors
• Lower lateral incisors
• Upper central incisors
• Upper lateral incisors
• Lower first molars
• Upper first molars
• Lower canines
• Upper canines
• Lower second molars
• Upper second molars

• There are 4 main tissues that make up all teeth
• Enamel - The outermost, hardest, and most caries/cavity resistant tissue in teeth
  
• Dentin - The tissue directly under the enamel (or cementum when speaking of the roots.) This tissue is not as hard as enamel, it is still however harder than bone.
  
• Pulp - Consists completely of soft tissue. This is where all the nerves and blood vessels are.
  
• Cementum - The outermost part of the roots of the tooth. This tissue is responsible for connecting your teeth to the bone supporting them.
  

An introduction to your child's mouth

Having had the parents of many of my own pediatric patients ask me similar dental related questions, I decided writing a blog to answer some dental basics that all parents should know would be helpful. This is the first post and will therefore touch on just a few concepts. If you are interested in expanding your knowledge of any particular concept, my other posts may be helpful and of course, you are always welcomed to ask any questions, or request for me to write a post on a dental topic you are interested in learning more about.

• Primary (baby) teeth are important (even though they will fall out anyway)
  

They will fall out, but they serve very important functions while they are there. Other than the obvious reason (chewing) they maintain the space needed for the permanent (adult) teeth to erupt into proper position, without getting crowded. Primary teeth are also involved in the proper development of the facial muscles and jaw bones.

• Keeping primary teeth healthy

The proper methods of keeping those pearly whites happy will be discussed in a future post

• Brushing properly
• Flossing properly
  
• Sealants
• Mouthwash
• Diet
• Dental follow-ups

• Things can go wrong
  

Cavities may start to form and slowly destroy the tooth structure. Sometimes these cavities become large enough to reach all the way to the "living" part of the tooth (pulp), where all the nerves and blood vessels are. There are even times when the tooth must be taken out due to a size and location of the cavity.

• How are cavities treated?

After the infected tissue has been taken out, different types of fillings can be placed to restore the tooth. If a cavity gets too close to the pulp, two different procedures can be performed to fix the problem. The most common one is a pulpotomy, where some of the living tissue is taken out. A pulpectomy is a similar procedure to a pulpotomy, except that all living tissue must be taken out during a pulpectomy. After a pulpotomy or a pulpectomy, the most common treatment is to cover the tooth with a stainless steel crown (cap). If the tooth is lost prematurely, space maintainers must be used until a permanent tooth erupts into the position. I will write a post about each of these treatments in future posts