The treatment of children’s teeth is essentially the same as for adult teeth, but there are some differences. Primary teeth have a different anatomy, besides being much smaller, with larger pulps and thinner enamel than permanent teeth .
There is therefore less room and a smaller margin of error for the dentist drilling in primary teeth. The other important consideration is that the primary teeth will all fall out by around twelve years of age.
It doesn’t make sense to construct a major restoration for a tooth that will come out naturally in a short time, nor is it cost effective to fill a primary tooth that will soon be lost. The rule of thumb is not to fill a cavity if the tooth will be lost before the cavity starts to hurt.
This saves time and money. The dentist is able to judge, from the X rays and the clinical appearance of the tooth, if the tooth should be treated or left alone until it falls out by itself. Aside from these considerations, the treatment of baby teeth and permanent teeth is about the same.
We believe that it is actually more difficult to fill a primary tooth than a similar cavity in a permanent tooth. A general dentist’s fees for children’s dentistry, therefore, should be comparable to the fees for adult dentistry.
Time, as we have stressed elsewhere in this book, is the indispensable key to success in all phases of dentistry, and children’s dentistry is no exception. In areas which do not have fluoride in the drinking water the use of fluoride supplements for very young children is essential .
If your child is prone to cavities, stricter attention to diet and home care (less sugar and more brushing) is in order, and the use of an over the counter fluoride rinse could be helpful. Parents often are concerned because of thumb sucking or the use of a pacifier.
Sucking is a normal instinct. Many infants start sucking their thumbs or using a pacifier within three months of birth. Thumb sucking and pacifiers can cause the permanent teeth to grow in out of position if the child continues these habits past the age of five or six.
Fortunately, most children discontinue these habits well before this age. If your child hasn’t stopped, we recommend a program of positive reinforcement, with gold stars being given for every day that the child doesn’t suck his thumb and a big prize being given if forty or fifty stars are earned.
Sometimes peer pressure can help. (Do you want to be the only kid in class with your thumb in your mouth?) Appliances that have sharp spokes that stick into the thumb and torture kids aren’t effective, nor is yelling at and punishing them. If worse comes to worst, the teeth are easier to fix than your child’s psyche.
It’s not surprising that in a country as affluent as the United States, the care and maintenance of children’s teeth have a high priority. In many families, parents neglect their own needs in order to ensure that their children have a healthy and pain free mouth. Even with all the widespread interest in children, we see a deplorable lack of knowledge and scandalous lack of quality care in the treatment of children’s oral problems.
As an example, every year or so we hear the news that a child died in a dentist’s office while undergoing routine dentistry such as a few fillings, under general anesthesia. Children have this kind of dangerous anesthesia due to the parents’ fears of dental pain and the dentist’s assurances of safety. Often the child had been un-cooperative in another dentist’s chair, and the parents, being embarrassed, found a dentist, usually through an ad that says the dentist “caters to cowards,” who will put their child “to sleep.”
They do this rather than finding a dentist who would take the time to relax the child’s fears and convert the child to a cooperative patient We believe that general anesthesia for filling teeth is absolutely unnecessary and should not be done, except in the case of a child with a medical problem that makes it impossible to do dentistry any other way, such as a child with seizures.