Milk tooth caries

Milk tooth caries, a common and recurring issue in children, requires special attention. Despite being temporary, milk teeth must still be treated by a pediatric dentist to prevent the complete destruction of the affected tooth, which could lead to misalignment of the permanent teeth. Additionally, untreated caries can pave the way for painful infections such as abscesses or fistulas.  

What is milk tooth caries?

Milk tooth caries is a widespread infection in children, primarily due to the poor mineralization of enamel and the brittleness of dentin—the material that forms each tooth. According to a recent study by the Ministry of Health, 21% of pediatric patients suffer from this infectious condition, a figure that rises to 43% in pre-adolescents (ages 10 to 14).  

Caries are classified based on the type of damage caused and the specific area of the tooth that is affected.

• Class 1: The infection affects the outermost surfaces of premolars and molars, as well as the areas of incisors closest to the tongue.

• Class 2: The infection targets the interdental spaces between premolars and molars.

• Class 3: The damage impacts the spaces between incisors and canines.

• Class 4: The infection spreads to the areas between canines and incisors, also affecting the gum margins.

• Class 5: The infection involves the dental collar (the area near the gum line).

• Class 6: The pathology affects the edges of anterior teeth or the cusps of posterior teeth.

  
  

Another particularly dangerous type of infection in infants is bottle caries, caused by poor oral habits such as dipping a pacifier or bottle in honey or other sugary substances to soothe the baby or help them fall asleep. Frequent use of these methods damages all elements of the oral cavity, starting with the upper incisors and eventually affecting the posterior teeth.

Caries is not caused by sugar, but by certain bacteria such as streptococcus mutans.

Symptoms of milk tooth caries

In its initial stages, caries in milk teeth are almost asymptomatic. The first signs include dull white spots or halos appearing on the enamel, often accompanied by a gradual roughness of the tooth's surface.  

At this stage, the child may experience mild sensitivity to certain foods and drinks. However, as the lesion progresses deeper, more noticeable symptoms arise. These include the appearance of the characteristic cavity and intense pain during chewing or breathing in cold or warm air, caused by inflammation of the tooth pulp.  

If left untreated, the condition can lead to tooth necrosis and abscess formation. This is characterized by noticeable gum swelling and the presence of bubbles on the affected tissue.  

For young children aged 12–18 months, early caries often first appears as small white spots on the upper incisors (less commonly on the canines). Without intervention, the decay rapidly worsens, leading to the destruction of the milk teeth. This can result in frequent crying episodes and may impact the proper development and alignment of the permanent teeth.

Risk factors

Caries develops more rapidly in milk teeth than in permanent teeth as the enamel is less mineralised, thinner and the dentine is much more fragile. The acids produced by the bacterial plaque reach the pulp (the innermost part of the tooth) causing pain, abscesses and, consequently, nerve death. The risk factors that promote this condition are many and often act simultaneously.

They include:

- an imbalance in the mouth's microbiota, caused by cariogenic bacteria that transform sugars into acids and attack enamel and dentine

- a poor diet

- poor oral hygiene

- environmental factors of a socio-economic nature

- individual susceptibility factors such as medication use, insufficient saliva, congenital enamel defects, congenital diseases.

Deciduous decayed teeth, even if prone to decay, must still be cared for because before being replaced by permanent teeth they allow proper chewing, allow adequate phonation (the pronunciation of words), maintain the space necessary for good eruption of the permanent teeth, and increase self-esteem in the child because they provide a beautiful smile. The treatment of milk tooth caries is determined by the dentist depending on the severity of the problem and the type of lesion:

- traditional methods. The damaged part of dentine and enamel is removed and the filling is performed. In order to encourage the cooperation of the child patient and avoid fear, the paediatric dentist may decide to intervene with relative analgesia, i.e. conscious sedation with Nitrous Oxide. If the filling should not be sufficient, due to severe pulp impairment, the definitive extraction of the tooth is carried out.

- ART (Atraumatic Restorative Treatment) technique. The approach tends to preserve the healthy part of the tooth through treatment with ozone therapy that sterilises the carious cavity and then proceeds to closure with bioactive materials. Solution indicated for uncooperative children

- ozone therapy. The treatment is indicated for children between 18-30 months with the aim of blocking the progression of inflammation and stimulating the teeth to strengthen themselves.

It is also important to act early on the causes of caries, which is why it is necessary to improve oral hygiene, change eating habits, lifestyle and follow proper fluoroprophylaxis. Prevention is, in any case, the best cure to avoid caries in milk teeth.

How to prevent it

Prevention is the best way to reduce the risk of developing milk tooth caries. It is therefore necessary to

- pay attention to oral hygiene from early childhood. Since it is not yet possible to use a toothbrush and toothpaste, it is necessary to pass a moistened sterile gauze over the gums and first teeth every day, massaging them well

- avoid putting the baby to sleep with a bottle full of milk or sugary teas. do not get him/her used to the dummy dipped in honey

- teach older children the regular use of a toothbrush, floss and mouthwash

- correct bad eating habits, supporting a healthy diet low in sugar and sweets

- not feeding the fear of the dentist, but rather getting the child used to regular visits starting from the first one, recommended from the age of 3-4.

Some scientific research has shown that caries can also be hereditary and therefore transmitted from mother to child during gestation. Therefore, pregnant women who experience even a trivial toothache or develop more or less serious caries should book a check-up at the dentist.