Dentists gone wild! Cavities in baby teeth may not need fillings
© 2016 Roy Benaroch, MD
Clara wrote in:
“My six year old has being seeing a dentist for three years, and has never had any problems. At the last visit, his dentist identified three cavities on x-rays, and recommends capping the teeth with stainless steel caps. He’s not having any pain or problems. This seems like a lot of expense and a big deal for baby teeth. Is the dentist just trying to make more money?”
Well, I’m not a dentist, and I haven’t examined your child. But the story does sound fishy to me.
Some background: dental cavities (or “caries”) have become much less common in the developed world, from both improved hygiene and the widespread use of water fluoridation. Not only are cavities relatively rare, but small cavities can often reverse themselves, or at least stay small, with good oral hygiene. It wasn’t like that before fluoridation. Until the 1970’s, once a cavity started, it was going to get bigger and worse. Dentists had to be more aggressive back then.
There are some groups of children who are still at risk for extensive dental disease, and those kids really need more-aggressive care. These include children with poor oral habits (like sleeping with a bottle of milk or a sippy cup of juice), or children with serious developmental challenges that make good hygiene and exams difficult. Some of these kids may have a hard time communicating that their teeth hurt, so we need to be extra careful. Severe crowding or other oral health problems can also contribute to extensive tooth decay.
But most of our children have very few (if any) cavities, and the ones they do get remain small and don’t cause any problems. Small cavities can be safely monitored at dental visits, to make sure they don’t get worse. They don’t need to be filled, and the teeth that get them don’t need to be capped. Junior does need to make sure that she’s brushing well and staying away from soda and sticky candy.
Cavities that are more likely to need fillings or caps are those that continue to grow, especially if they erode near the center of the tooth. Pain or temperature sensitivity can be signs of a significant cavity or other oral problem that needs dental attention. Sometimes, cavities form in a way that weakens the tooth, or might allow decay to spread to other teeth. A dentist can help decide which cavities are the ones to worry about.
I suggest Clara (or any other parent who’s concerned about overly-aggressive recommendations for dental care in baby teeth) seek a second opinion from a qualified, experienced pediatric dentist. Most cavities in baby teeth don’t need intervention, but some do, and you need a good dentist to help figure that out.
Disclaimer: I’m not a dentist, I did write a chapter in a pediatric textbook on dental health, so I’m reasonably tooth-savvy. I also called my kids’ own pediatric dentist this morning to make sure I was giving reasonable advice here. Thanks Dr. Mac, you da best!