Cavities in Baby Teeth: Treat Now or Wait?

By Dr. Mohsen Alozaibi, Tiny Teeth Dental Center, Abu Dhabi

"It doesn't hurt him, and it's going to fall out anyway. Can't we just wait?" It's a fair question, and sometimes the answer really is to watch carefully. But often, leaving a cavity in a baby tooth lets a small, simple problem grow into a painful one.

Why waiting can backfire

Decay in baby teeth tends to spread faster than in adult teeth, because the enamel is thinner. A cavity that is small today can reach the nerve within months. When that happens:

• Pain can appear suddenly, often at night or while eating.
• Infection can develop, sometimes with a gum boil (abscess) or facial swelling.
• An infection around a baby tooth can occasionally affect the adult tooth developing underneath, leaving marks or weak spots on it.
• If the tooth has to be removed early, the teeth beside it can drift into the gap, causing space problems for the adult teeth.

Many baby back teeth stay until age 10 to 12, so "it will fall out soon" may mean several more years.

The treatment options, simply explained

There is no single answer for every cavity. Depending on the size of the decay and your child, the dentist may suggest:

• Monitoring and fluoride: very early decay, seen as white chalky spots, can sometimes be stopped or even reversed with fluoride varnish, better brushing and fewer sugary snacks. The dentist checks again at follow-up visits.
• Silver diamine fluoride (SDF): a liquid painted onto the cavity that can stop decay from progressing, without drilling or injections. The trade-off is that it stains the decayed area black permanently. It is often useful for very young children, or to buy time, and it may need repeat applications.
• Fillings: the decay is removed and the tooth is filled with a tooth-coloured or other material, for small to medium cavities.
• Pulp treatment: when decay reaches the nerve of a baby tooth, the infected part of the nerve can be treated so the tooth can be kept. This is sometimes called a "baby root canal."
• Crowns: a cap that covers the whole tooth, used when a tooth is badly broken down or after pulp treatment. Crowns for baby back teeth are often stainless steel, and tooth-coloured options exist for front teeth.
• Extraction with a space maintainer: if a tooth can't be saved, it may be removed. For some back teeth, a small space maintainer holds the gap open so the adult tooth has room to come in.

How the dentist decides

The right choice depends on which tooth it is, how deep the decay is, how long the tooth still needs to stay, your child's age and cooperation, and their overall cavity risk. A good plan is one you understand, so ask questions: what happens if we wait, and what are the alternatives?

Keeping your child comfortable

Treatment today is very different from what many parents remember. Depending on the child and the procedure, comfort options may include numbing gel before a gentle local anaesthetic, a calm step-by-step approach with "tell, show, do," and, for some children, sedation or general anaesthesia for more extensive treatment. Your dentist will discuss what suits your child.

Whatever the treatment, the best protection afterwards is the same: twice-daily fluoride brushing, fewer sugary snacks and drinks between meals, and regular check-ups.