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Section Questions and Answers

Tooth Decay in Children

"Tooth decay is the single most common chronic childhood disease - 5 times more common than asthma, and 7 times more common than hayfever. Over 50% of 5-9 year olds have at least one cavity. This increases to 78% among 17 year olds."
"The role of sugars and other carbohydrates is critical. Nearly all carbohydrates have caries-promoting properties..." U.S. Surgeon General's Report

  1. What is tooth decay?
  2. What causes tooth decay?
  3. What is dental plaque?
  4. How does decay progress through the tooth substance?
  5. What are the symptoms of tooth decay?
  6. What is "baby bottle tooth decay"?
  7. How does the dentist discover decay?
  8. Which tooth surfaces are most likely to decay?
  9. Can decay be prevented?
  10. Why are regular brushing and flossing necessary?
  11. Can decayed teeth be saved?
  12. What measures should be taken to prevent decay?
  13. The toothache/pain chart. Visit the chart to find out what is causing your pain.

 
1. What is tooth decay?

  • Tooth decay is a disease that destroys teeth.
  • It can result in loss of teeth if it is not treated.

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2. What causes tooth decay?

  • Tooth decay is caused by bacteria which are in dental plaque.
  • The bacteria feed on dietary sugars, and release acids that dissolve the enamel and dentine of teeth. This is the decay process.

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3. What is dental plaque?

  • Dental plaque is a thin coating of bacteria and food particles that sticks to teeth.
    • It cannot be rinsed off, but it can be removed by brushing, flossing and a dental scaling.
    • It causes tooth decay and gum disease.
  • Diets rich in soft, sticky, carbohydrate foods (refined sugars) assist plaque formation.

See Diet and Decay

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4. How does decay progress though the tooth substance?

  • The first layer affected is the outermost, the enamel.
  • It then spreads to underlying dentine.
  • The decay can eventually reach the nerves and blood vessels of the tooth.

Click to enlarge
Spread of decay
and abscess on root

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5. What are the symptoms of tooth decay?

  • In its early stages decay is quite painless.
  • Later stages are associated with pain caused by sweet foods such as chocolate, sugary snacks and drinks.
  • When the decay spreads deeper, sensitivity can be felt with hot and cold drinks.
  • Severe lasting pain especially with hot food and drinks, indicates that the nerves and blood vessels in the tooth have been affected by the decay.

Visit the Pain Chart to learn more about the causes of pain.

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6. What is "baby bottle tooth decay"?

  • Baby bottle tooth decay
    Babies that are put to bed and left with a bottle of juice or milk can develop what dentists are now calling "baby bottle tooth decay" or "nursing bottle syndrome".
    The decay can be very severe.
  • When baby teeth have prolonged exposure to milk or fruit juice, the following sequence of events can take place:
    • The bacteria in plaque are able to convert dietary sugars into acid.
    • Plaque is normally present in all mouths.
    • It sticks to teeth and produces acid which can dissolve tooth structure. This is how the decay process starts and progresses.
    • Baby teeth can become decayed from their lengthy exposure to the sugar and acid contents of the bottle.
    • Plain water is the safest drink to give the baby between meals.

Click to enlarge
Baby bottle tooth decay

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7. How does the dentist discover decay?

  • Regular check ups by the dentist that include x-rays, will ensure that decay will be detected soon after it has started.
  • A dull white patch on a tooth could be a sign of early decay.
  • The dentist can discover cavities that have developed, by using a special fine explorer instrument.
  • X-rays can reveal cavities that cannot be seen by visual dental examination.

Click to enlarge
Illustration of x-ray
showing decay

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8. Which tooth surfaces are most likely to decay?

  • The chewing surface with its grooves and pits is usually the first to decay.
    • This is because dental plaque and bacteria accumulate in these areas.
    • The areas between teeth are also common places for decay to start.
    • Tooth decay can start around and under old fillings that have cracked, chipped or broken down.
    • Decay can also occur at the necks of teeth, at the gum line.

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9. Can decay be prevented?

  • Getting rid of dental plaque by regular brushing, and reducing the amounts of refined sugars in the diet, can prevent decay.
  • Fluoride in the water, toothpaste, and mouthrinses can prevent and reduce decay.

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10. Why are regular brushing and flossing necessary?

  • Plaque formation is an ongoing process, commencing soon after brushing. This is why regular brushing is necessary to keep it off the teeth.
  • Tooth brushing cleans mainly the surfaces of the teeth that can be seen.
  • Floss removes dental plaque from between the teeth, where the toothbrush cannot reach.

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11. Can decayed teeth be saved?

  • In most instances decayed teeth can be treated and saved.
  • Early decay is easily managed by removing the decay and replacing the lost tooth substance with a filling.
  • Larger areas can be repaired by placing a stainless steel cap or crown over the baby tooth to protect it until it is replaced by a permanent tooth.
  • Even when decay has reached the nerves and blood vessels of a tooth, the tooth can be saved. A pulpotomy can be performed on the baby tooth to save it. Root canal treatments are not usually an option for baby teeth.

See Restoration of Teeth

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12. What measures should be taken to prevent decay?

  • Diet control
    • Your child should eat less mushy refined carbohydrate (sugar).
    • Natural sugar in fruit, vegetables and juices is preferable to the refined sugar in biscuits (cookies), cakes, chocolates, sweets, confectionery and fizzy soft drinks.
    • The acid in carbonated drinks, including diet drinks, can also be harmful to teeth.
  • Home care or oral hygiene
    • Regular brushing and flossing is essential.
    • From the age of two, children should be encouraged to brush their teeth with their parents' help.
    • Parents should carry out the brushing and flossing until the child is capable of doing so alone. Flossing is difficult for young children, but they should be encouraged to do it as soon as they are able to.
    • Teeth should be brushed after eating and before bedtime.
  • Surface application of fluoride
    • Fluoride is a chemical that hardens the enamel of a tooth and increases the resistance to decay.
    • It can also assist in stopping the early stages of the decay process.
    • Toothpaste containing fluoride helps to prevent tooth decay.
    • Fluoride mouthwashes can be used, but only for children over the age of 6 years, when they are able to rinse out and not swallow the mouthwash.
  • Dietary supplements of fluoride
    • In areas where the concentration of natural fluoride in the water is very low, dietary supplements for children are available.
    • Fluoride supplements should only be taken if prescribed by a dentist or doctor.
  • Professional dental care
    • Visits to the dentist should begin at two to three years of age. In this way fear of dental care can be avoided.
    • Regular visits to the dentist are essential for ongoing prevention and the early detection of decay.

    • Fissure sealants:
      These are special filling materials that are bonded to the teeth, and will keep away the decay-causing bacteria.
      They are fused or bonded to grooves and pits on the chewing surfaces of the back teeth.

    • Fluoride can be applied to the teeth by the dentist to prevent decay.

Click to enlarge
Before sealants
Click to enlarge
After sealants

See Fissure Sealants, Oral Hygiene, Diet And Decay, Fluoride, Pain and Anxiety

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13. The toothache/pain chart

Pain chart

Pain severity
+ = Small degree
++ = Medium degree
+++ = High degree
Glossary
Acute = Fast developing
Apical = End of root
Chronic = Slow forming
Periodontal = Around the tooth
Pulp = Nerves and blood vessels of tooth

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