Baby tooth decay: treat it, or wait until the teeth fall out

The short answer: treat it. «They'll fall out anyway» is the most common reason children reach us already in pain and with a swollen face. The last baby teeth are replaced at 11–13, so a tooth that goes bad at four has to last through half of childhood.

Why waiting is risky

A baby tooth is built differently from a permanent one, and that is the main thing to understand.

The enamel and dentine are thinner

The layer of hard tissue over the nerve in a baby tooth is roughly half as thick. What would stay a surface cavity for a year or two in an adult tooth reaches the pulp in a few months in a child. That is why a «tiny hole» spotted in summer can become night-time pain by winter.

Under every baby tooth lies the bud of a permanent one

When infection passes beyond the root tip, the inflammation develops right against the bud of the permanent tooth. The result can be enamel hypoplasia — the permanent tooth erupts with white or yellow-brown patches, and in severe cases with a deformed crown. That is irreversible: such a tooth can be restored later, but it will never be pristine.

Losing a tooth early is not something you can «let slide»

Baby teeth hold the space for the permanent ones. If a molar is removed at five, the neighbours tilt into the gap within months and the permanent tooth no longer has room — it erupts crooked or stays in the bone altogether. Orthodontic treatment later costs far more than a timely filling.

When it is genuinely fine not to treat

Honestly: such cases exist. A tooth is not restored if:

• it is already visibly loose;
• the X-ray shows the root has resorbed by more than half;
• the permanent tooth beneath it is ready to erupt.

The dentist then explains this to the parents and schedules a check-up. The catch is that none of it is visible from outside: a tooth can wobble because of inflammation rather than natural replacement. So the decision «we are not treating this» is made after an X-ray — and it is a decision, not inaction.

What decay looks like in a child

It almost never starts with pain. Signs worth noticing at home:

• White chalky patches along the gum line, especially on the upper front teeth. This is the earliest stage — the tissue is not yet destroyed and can be restored without a drill.
• Dark grooves on the chewing surface that a brush will not clean off.
• The child chews on one side or refuses cold and sweet food.
• Food getting stuck between particular teeth — often the first sign of decay on the contact surface, which is invisible from outside.

A word on bottle decay

If a child falls asleep with a bottle of juice, milk or sweet tea, the upper front teeth break down fast — at night saliva is barely produced and does not wash the sugar away. It starts with the same white patches, and within months only stumps are left of the crowns. The simplest prevention: water only in the night bottle.

How baby teeth are treated

• Remineralisation and deep fluoridation — from UAH 500. Works at the white-spot stage, before a cavity forms. The best possible scenario.
• Fissure sealing — the grooves of the chewing teeth are filled with a protective material so plaque cannot pack into them. Prevention rather than treatment.
• Filling — once a cavity has formed. For adults that is from UAH 1,750; for a child the figure is given after an examination, because the amount of work varies.
• Nerve treatment of a baby tooth — if decay has reached the pulp. The techniques differ from adult ones, because the tooth is meant to be replaced naturally.
• Extraction with a space maintainer — when the tooth cannot be saved and natural replacement is still a long way off.

For children who absolutely will not sit through treatment, or when a very young child needs a great deal of work, treatment under sleep is considered. That decision is made together with the parents after an examination, not by default.

How to lower the risk

• Brush from the very first tooth, and until the age of 7–8 brush with the child or after them. A child cannot clean their teeth properly alone: the motor skills are not there yet.
• Count the number of times, not the amount of sugar. One sweet after dessert does less harm than the same sweet spread across five moments in a day: each time the enamel takes an acid attack lasting 20–40 minutes.
• Floss between tightly spaced teeth. Contact decay is the most common and the least visible.
• A check-up every six months. In a child, six months is enough for a white spot to become a cavity.

If the child is frightened

The best thing you can do is bring them for the first time when nothing hurts. Then the first experience is an introduction rather than treatment through tears. We described how such a visit goes in the article about a first visit without fear.

On the anaesthesia we use for children and adults alike — in the article does dental treatment hurt. The adult general-dentistry side is on the page restorative dentistry.

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