Dental caries (the term used for the cavity formation process) is the most common disease of childhood, five times more common than asthma. It is a largely preventable disease and was rarely seen in ancient civilizations. We strongly believe that dental caries is a preventable disease.
See our tips on how to keep your child cavity free.
Children should start seeing the dentist as early as 1 year old.
To begin, we will ask you and your child if you have any concerns or questions. These concerns will be addressed as we perform an oral exam. We will then proceed with cleaning his or her teeth to remove plaque and tartar.
We do feel x-rays are an important part of diagnosing problems that we can't visually see. Undiagnosed cavities in children can grow dramatically quickly, leading to more extensive problems and treatment needs. When we spot small cavities early on x-rays we are often times able to implement strategies to keep the cavities from going and requiring treatment.
We follow the Image Gently philosophy of limiting kids' exposure to x-rays. We do not take x-rays on children without first assessing the need for x-rays.
Routine dental cleanings and oral exams are the most important part of preventive care. With regular cleanings, you can prevent the buildup of plaque and tartar on your child’s teeth and reduce their risk of gum disease and cavities. By bringing your child to LPD for routine visits, we can provide you insights on their oral health, how to care for their teeth properly, and information about preventive treatments like dental sealants and fluoride, which can help protect their teeth from bacteria and decay.
Digital x-rays are the best choice for kids, since they are very fast, provide high-resolution images, and expose children to less radiation. X-rays will typically be recommended only if your child’s dentist thinks that your kid needs them, typically every few years, or more frequently if your child is at high risk for oral disease like tooth decay or gum disease.
Fluoride is a mineral that helps prevent cavities by hardening the
enamel (outer surface) of teeth. It can even reverse “soft spots” which are the first stage of tooth decay. Although we do support the use of small amounts of topical fluoride, we do not feel it is the primary way to prevent cavities.
Professional application of topical fluoride varnish is a valuable tool in cavity prevention. The benefits from fluoride varnish application has been seen to last up to four months in studies. For parents who are concerned about their child's exposure to fluoride, we would be happy to discuss alternative recommendations!
Silver diamine fluoride is a product that is painted on areas of active caries (cavities) for the purpose of stopping, or arresting the caries. Products like it have been used in Japan for 80 years and in parts of Europe for decades. We are excited to add this option in to our treatment for cavities and hope that it will lead to a significant reduction in the number of cavities requiring treatment.
IS TREATMENT WITH SDF PAINFUL?
Absolutely not! Since treatment with SDF is non-invasive there is not typically pain. If the liquid gets on the tongue or lips there can be a temporary tingling sensation. There is no need for local anesthesia (numbing) or removal of the decay (drilling.) Food debris, if present, is cleaned out, the teeth are gently dried with air, and the SDF solution is applied with a small brush for one minute.
HOW DOES SDF WORK?
SDF contains two active ingredients, silver and fluoride. The silver actually kills the bacteria present in caries (cavities.) In addition, the silver ions penetrate the weak part of the tooth and plug up the microscopic holes in the enamel or dentin surface. This residual silver continues to work at killing additional bacteria resulting in tooth structure that can be immune from further decay. The fluoride then helps to remineralize the weak areas of the tooth. One study showed that applying SDF once a year was more effective in stopping cavities than four applications of fluoride varnish four times a year.
WHAT ARE THE INDICATIONS FOR SDF?
For the very young child who has caries (cavities): In the past the only options for treating very young children with cavities was to treat them under duress as well as possible, to treat them under sedation or general anesthesia, or to leave the cavities alone which usually results in worsening of their condition. SDF can now be used to stabilize the cavities until the child is older and can receive treatment without sedation or general anesthesia.
*For the special needs child: Special needs children often have unmet dental needs. Parents are naturally nervous about how their child will “act” at the dentist so they avoid even taking their child to the dentist. Cavities in special needs kids can be stabilized with SDF, thus sometimes avoiding the need for sedation or general anesthesia.
*For children with cavities in primary (baby) teeth: We weigh many factors when deciding whether cavities in baby teeth need treatment or not. Usually baby molars are lost around the ages of 10-12. For kids with moderate sized cavities, SDF can be used to stabilize the cavities until the teeth are lost.
*For younger kids with cavities in baby molars. SDF can be used to stabilize cavities and hopefully prevent the need for any treatment at all.
*For children whose enamel did not form properly. Sometimes children have a condition in their enamel called hypoplasia or hypomineralization in which the enamel does not properly calcify. Causes for this condition can be high fevers or illness when younger, antibiotics, prematurity, genetic, and unknown causes. These teeth can decay quickly and are frequently very sensitive. Teeth with hypomineralization can be very painful to have treated even when proper local anesthetic has been provided. SDF can be used to stop the progression of the decay and to even stabilize the weak enamel. By stabilizing the enamel it also provides relief from what can be a very painful condition.
*For the adolescent with small cavities on the biting surfaces or between the teeth: although SDF is not as effective for treating cavities between the teeth as it is for treating exposed parts of the teeth, it can stabilize the cavities. Along with changes to diet and hygiene, it is hoped that cavities on the permanent teeth will not progress and will not require treatment. Our goal is to prevent the need for large fillings on kids at such a young age since large fillings can many times lead to larger fillings, crowns, root canal treatment and even tooth loss as a person gets older if the factors that led to the cavities are not addressed and modified.
WILL MY CHILD NOT NEED TRADITIONAL TREATMENT FOR THE CAVITIES?
Possibly but there is no guarantee. SDF has been shown to have about an 80% success rate when applied twice per year. 20% of cavities will continue to grow. SDF has been shown to be a little less effective for cavities between the teeth compared to cavities on other surfaces. Along with changes to dietary habits, hygiene, and the use of other “anti-cavity” products, we are hopeful our success rate will exceed 80%!
HOW SAFE IS SDF?
SDF has been approved for use by the FDA. Silver nitrate has been successfully used by dentists since the 1800’s without reported incidence. The advent of local anesthesia possibly caused a shift away from the use of silver nitrate since teeth with cavities could be treated without pain. SDF has been used in Australia and parts of Europe for decades, and in Japan for over 80 years without any reported adverse effects. One drop of SDF is usually sufficient to treat up to five teeth. Within that one drop of SDF there is roughly the same amount of fluoride as a properly fluoridated liter of water. Another comparison is that the amount of fluoride is approximately 1/10th of the fluoride found in the topical fluoride varnish we use. The amount of silver is also well within safe limits. While we are not qualified to discuss silver used in other products, it is considered safe by the NIH for some indications. From the NIH website, “Topical silver (used on the skin) has some appropriate medical uses, such as in bandages and dressings to treat burns, skin wounds, or skin infections. It’s also in medicines to prevent conjunctivitis (an eye condition) in newborns.”
IS SDF TREATMENT COVERED BY INSURANCE?
Yes and no, depending on the individual policy. Hopefully companies that do not currently cover it will find that this is a more cost effective treatment than traditional dental treatment. To find out if your insurance company covers SDF you can provide them with code D1354 to see if it is a benefit.
THIS SOUNDS TOO GOOD TO BE TRUE. WHAT ARE THE DOWNSIDES?
There are some downsides. SDF does permanently turn the part of the tooth with decay or weak enamel black. Therefore it is not indicated for front teeth except in the very young child when we want to try to avoid the need for sedation or general anesthesia. It can also discolor weak or hypomineralized enamel. SDF does not always work and will likely need to be reapplied annually. SDF does not fill in any open cavities and may not prevent the need for treatment. Additionally, not all insurance plans cover the treatment. Although it is not a “silver bullet” that works all the time, we are excited that SDF does give us a conservative method to treat cavities.
Sealants are a protective coating that is applied to the deep crevices and grooves on the biting surface of the permanent back teeth. Due to the depth of the grooves, difficulty keeping these areas clean, and the modern diet, these grooves are at a high risk for developing cavities. Sealants fill in the grooves, decreasing the chances for the formation of cavities in these areas.
While they do not protect teeth on the flat surfaces and in between, sealants have a long track record of helping to reduce cavities. Since the placement of sealants requires a fairly high level of cooperation in order to be successful, they are usually not placed on the baby molars, especially when children are younger. Additionally, the grooves on baby molars are not typically as deep as the grooves on permanent teeth.
Kids laugh around 400 times per day.
The first and most important thing you can do to help your child stay cavity-free is to limit snacking, especially on foods that have added sugar or are mainly carbohydrates like crackers, cereal, pretzels, and chips. Additionally:
You should brush your child’s teeth twice a day for two minutes until they’re 6 years old, or are able to tie their shoes on their own. After this, we recommend making brushing a family activity. You can demonstrate proper technique to your children, and make sure they’re brushing regularly.
You will need to floss your child’s teeth for them until they’re about 10, since it’s a lot harder to learn proper flossing technique than it is to learn proper brushing technique.
Flossing your child’s teeth will not be dissimilar to flossing your own. Depending on their age, you may need to find a toy or distraction to keep them entertained while you floss their teeth. Floss holders may be helpful for toddlers so they don’t bite your fingers. Just make sure you’re flossing between every two teeth that make contact.
Sometimes we hear parents question why it's important to take care of their children's baby teeth. It's a question that makes sense since all the baby teeth will eventually fall out. Healthy baby teeth are essential for your child to eat and chew properly, and damaged or decayed baby teeth can cause them pain and discomfort. Most children start to lose baby teeth around the age of six, however it's important to understand that baby molars, where the vast majority of cavities are found, are usually kept until the ages of 10 to 12. Additionally, the baby teeth are important for proper nutrition, the development of speech, self esteem, and to hold space for the permanent teeth.
The prevention of dental decay is not as simple as avoiding candy and routine brushing. Dental decay is on the rise in young children. Today's hectic lifestyle and conveniences have created the perfect storm for the development of cavities in young children. Sugar is added to many products such as yogurt, squeeze pouch snacks, and snack bars. Additionally the convenience of snack foods that are primarily carbohydrates such as crackers, pretzels, popcorn, and chips greatly increase a child's risk for cavities since these foods stick to the teeth and break down into sugars in the mouth.
Around 85% of children see the dentist regularly.