Fillings for baby teeth

Maybe you have just found out that your child has one or more cavities in their baby teeth?

It is normal for parents to have concerns and questions. 

In this blog, we hope to give some answers and reassurance about fillings for baby teeth.


Children can develop tooth decay soon after their baby teeth come through. Prolonged bottle feeding with sweetened drinks, or frequently falling asleep with a bottle of milk or whilst nursing are the most common causes of decay in babies. Cavities usually do not cause pain in the early stages and young children may be reluctant to open wide to let their parents see or brush their teeth. So, it can come as a surprise to find out that your child has a cavity at a young age. 

Why should we fill baby teeth, won't they fall out later anyway?




Baby teeth are important for normal eating and speech development. A healthy smile is also beneficial for a child's self-esteem once they reach school age. 





Once a cavity has formed it usually progresses resulting in pain and infection. If an abscess on a baby tooth is not properly treated the infection can spread to and affect the developing adult tooth underneath.



Baby teeth also maintain the spaces for permanent teeth to erupt into. Although front baby teeth can start to fall out from around 6 years old, the back teeth need to last until around 12 years old. If baby teeth are lost too early other teeth may tilt or drift into the vacant space, forcing the adult teeth to come through crooked. 

If my child has a cavity what are the treatment options?

Fillings

If the decay is in the enamel or dentine layer only (not close to the nerve of the tooth) the decay can be removed and a filling placed in the cavity. 

Basic procedure:

• Smaller cavities in baby teeth can often be cleaned without using local anaesthetic. If the cavity is deep or the tooth is particularly sensitive, a small injection may be required to numb the tooth. For more information, see this blog post: Questions about local anaesthetic
• The decay is removed and the cavity is washed. There will be some mild vibrations and noise at this stage. A suction tip is used to remove water from the mouth, or your child may spit out when required. 
• The clean cavity is dried by blowing air onto it and then the filling is placed.

At Small Bites, we keep up to date with the latest filling materials and techniques. The two most commonly used filling materials for children’s teeth are:

Glass Ionomer Cement  

• Bonds directly to the tooth surface and so helps prevents leakage around the edge of the filling.
• Releases fluoride which can help prevent further decay.
• It is relatively quick and easy to place and is therefore popular for use with young children where cooperation for treatment is sometimes difficult.
• It  is quite brittle and prone to wear and so it is usually used in areas which are not under a lot of pressure from chewing.
• Reinforced Glass Ionomers have recently been developed which can be used in higher stress areas, such as the biting surfaces of the teeth.
• Glass Ionomer is white in colour but, unlike composite, it does not come in various shades to match the teeth more accurately. It also available in other bright colours for use in back teeth, if children prefer this.

Composite filling

• Composite fillings come in many shades which match and blend in well with the tooth. Therefore, it may be advised for front teeth where appearance is important.
• Composite is stronger and more wear resistant then glass ionomer.

• A blue etching gel, used to prepare the cavity surface, is painted onto the cavity surface and washed off after about 30 seconds. 
• A bonding agent painted onto the cavity surfaces. This adheres the filling material to the tooth.
• Next, the filling is placed in the cavity.
• A blue light is often used to give faster setting of the filling.
• The filling procedure takes a bit longer than for glass ionomer.

Your dentist will check the filling, and polish it, if required. Please follow instructions for looking after your teeth following treatment. It is usually advisable to wait half an hour before eating and drinking and to avoid hard, sticky and chewy foods on the same day. 

Pulpectomy

If the decay has started to affect the area containing the nerve of the tooth (the pulp), a pulpectomy is often required. For more information, see this link: Pulpectomy - Root canal treatment for baby teeth

Crowns

Teeth which are too broken down to adequately hold a filling or which have undergone pulpectomy usually require a crown to strengthen the tooth. This will be covered in a future post.

At Small Bites, the exclusive dental care centre for children in Bangalore, we have plenty of experience with young children and work to put them (and their parents!) at ease. If you have any questions or concerns, please contact us.



Don't forget to read our other posts for advice on preventing dental decay:

It's Never to Early to Start Preventing Tooth Decay
What Causes Dental Cavities?
Top Toothbrushing Tips

Stem Cell Banking from Teeth

Many people are familiar with stem-cell banking from the umbilical cord at birth. Did you know that it is also possible to bank stem-cells bank from baby teeth and young, healthy adult teeth? This recent technology has great potential to enable treatment of diseases and aid healing and repair using an individual’s own stem cells in future years.

What are Stem Cells?

Stem Cells are the “master cells” of the body which have the potential to differentiate into various types of cell, depending on the part of the body. They are also able to self-regenerate or multiply.

There are two main types of human stem cells:

Embryonic Stem Cells are obtained from early embryos. They have the potential to become any type of cell in body. The embryos are usually donated as extra embryos following IVF treatment. However, their use is controversial as collection of the stem cells results in the destruction of the embryo.

Adult Stem Cells are found in various parts of the body. They have the potential to become various types of cells. Bone marrow, umbilical cord blood and dental pulp tissue are good sources of adult stem cells.

      What are the advantages of Dental Pulp Stem Cells?

    Stem cells from teeth are mesenchymal stem cells which have the potential to become many different types of cells in the body.

Dental stem cells are easily collected by extracting the tooth and are found in high concentrations within the tooth pulp.

There are no ethical issues, since the stem cells are harvested from teeth that would fall out naturally or are to be extracted for other reasons.

I have already banked stem cells from my child’s cord blood. Why should I also consider banking dental stem cells?

Banking dental stem cells is complimentary to cord blood banking. The stem cells obtained from the umbilical cord are hematopoietic stem cells which are able to differentiate into all types of blood cells to treat blood diseases. The stem cells from the dental pulp have a much wider range of potential therapeutic uses.

In what treatments are stem cells already being used?

The use of haematopoietic stem cells to treat diseases and conditions of the blood system, such as leukaemia and anaemia, is well established. This demonstrates how powerful stem cell therapies can be. Scientists all over the world are currently researching ways to harness other types of stem cells and use them to learn more about, to diagnose, and to treat various diseases and conditions.

What diseases can potentially be treated using stem cell therapy?

Research has shown that adult stem cells can be taken from one area of the body, transplanted into another area and reprogrammed to grow into a completely different type of tissue. 

Stem cell science is continually moving forward. 

Many potential treatments are currently being tested in animal models and some have already been brought to clinical trials:

•  Type 1 (insulin dependent) diabetes
•  Treatment of spinal cord injuries
•   Neurological diseases e.g. Parkinson’s disease
• Heart disease
• Regeneration of bone, cartilage and other tissues
• Treatment of Autoimmune diseases

Which teeth can be used for stem cell banking?

Baby (milk) teeth

These should be extracted and sent for stem cell banking soon before they are due to fall out.

Healthy adult teeth

When extraction is planned to make space before orthodontic treatment.

Wisdom teeth

These are often extracted due to lack of space.


Teeth with decay are not suitable for stem cell banking.

Teeth from children and young adults usually give a better quality and quantity of stem cells than older teeth.

At Small Bites -  the exclusive dental care centre for children in Indiranagar, Bangalore - we have partnered with Stemade to offer stem-cell banking from baby teeth and young, healthy adult teeth. 

If you have any further questions please contact the practice. (Click Small Bites link above).

Further information is also available on Stemade’s website (click for link).

Fluoride: What parents need to know - Part 2

In Part 1 we discussed the benefits of fluoride and the risks of over-exposure to fluoride.

Fluoride can be useful in strengthening teeth and protecting them from decay, if used in the right way. 

As we discussed in the previous section, there is a risk of dental fluorosis, or mottling of teeth, if children swallow too much fluoride.

In this second part we will look at the uses of fluoride and safety guidelines.

Products which contain fluoride

Fluoride Toothpaste 

This is the most common application of fluoride as it can easily be used regularly at home. Regular use of fluoridated toothpastes has been shown to reduce tooth decay by up to 50%. 

Safety guidelines for using fluoride toothpaste:

• Young children who cannot spit out should use either plain drinking water or a training toothpaste which does not contain fluoride for brushing.
• Children generally learn to spit out from around 5 or 6 years old. At this stage fluoride toothpaste can be introduced with adult supervision.
• It is best to use a lower fluoride toothpaste up to 7 or 8 years old, when children still tend to swallow some paste and their developing teeth could still be at risk of fluorosis.
• The amount of fluoride is usually shown on the toothpaste packet in parts per million (ppm). In India, most adult toothpastes contain 1000 ppm and toothpastes designed for children often contain 500 ppm or less of fluoride. 
• No more than a small pea-sized amount of toothpaste should be used. Instruct your child to spit out after brushing and not to swallow it. 

• Keep toothpaste out of the reach of young children. Swallowing large amounts can cause stomach problems and other health issues. Seek immediate medical attention if a child swallows a large amount of toothpaste. 

Fluoride Mouthwash or Rinses

Mouthwashes are not recommended for children. If a teenager or young adult is at a high risk of cavities, or wearing braces which make their teeth more difficult to clean, their dentist may recommend a fluoride mouth rinse to be used at a different time from brushing. This should of course not be swallowed. Avoid mouthwashes that contain alcohol.

Fluoride Varnish

Fluoride varnishes are useful for children who are at a higher risk of tooth decay. As they contain a very high level of fluoride they can only be used by dentists and applied no more than twice a year. 

The varnish is painted onto teeth and sets quickly, sticking to the tooth surface to minimize swallowing and maximize its effect. If a tooth has very early dental caries in enamel, it can help to stop the decay and prevent it becoming a cavity. Fluoride varnish is also beneficial for sensitive teeth.

Glass Ionomer Fillings

Glass Ionomer is commonly used for fillings and sealants in baby teeth. In addition to being able to adhere directly to tooth surfaces it also releases small amounts of fluoride over an long period of time. The level of fluoride released is too low to cause any health problems but helps to prevent decay and the need for future fillings.

In Summary

When used in a controlled way, the benefits of fluoride outweigh the risks. 

Parents and dentists need to take into account the overall fluoride exposure from all sources when making decisions about the use of products or treatments which contain fluoride. 

In areas with high levels of fluoride in drinking water, fluorosis  (mottling and staining of the teeth) is common. In these areas it is wise to minimise fluoride exposure as much as possible. 

Dental Fluorosis

In areas where the is no significant fluoride in water the appropriate use of some fluoride therapies will be important in preventing decay.

If you need more information and advice, please speak to your dentist.

If you live in Bangalore, you can contact us at Small Bites, Exclusive Dental Care Centre for Children (click for link) where we will be happy to help.

Fluoride: What parents need to know - Part 1

Many parents are confused about fluoride.

Is it good or bad for children?

What are the risks and benefits of fluoride?

In this blog post we will answer these and other questions.

What is fluoride?

Fluoride is the 13th most abundant element on the earth's crust. It is found naturally in rocks, soil, water and some foods. The level of fluoride in water varies greatly between different geographical areas. Fluoride can also be emitted into air and water as a waste product of some industries.

Is fluoride good or bad?

In low levels, fluoride is beneficial in protecting teeth from decay. 

If the right level of fluoride is available while teeth are forming it is incorporated into the developing enamel, making it more resistant to acid attack, which is the cause of tooth decay. Teeth that have developed under the influence of fluoride also tend to have shallower grooves, making them less prone to decay. Tooth enamel formation starts from 3 months after conception (in the womb) and is completed by around 8 years old, with the exception of the wisdom teeth.

Studies in both the USA and the UK have demonstrated the ability of an optimum level of fluoride in drinking water (either naturally occurring or added) to significantly reduce dental decay in both children and adults.

Fluoride is also beneficial after teeth come through. The surface enamel of teeth is weakened and dissolved by acid attacks which occur after consuming sugary or acidic food and drinks. However, enamel can remineralise, or repair, itself by taking in minerals from sailva. Low levels of fluoride present in saliva and dental plaque encourage remineralisation and therefore make it less likely that a cavity will be formed. The fluoride also becomes incorporated into the enamel surface making it stronger and more resistant to acid attack.

Recent scientific studies have also shown that fluoride is able to reduce the ability of plaque bacteria to produce acid.

Scientists now believe that the effect of fluoride after teeth erupt into the mouth is more important than during tooth development. These effects explain why the incidence of decay has generally decreased with the introduction of fluoride toothpastes.

So what's the problem with fluoride?

Like many other minerals, fluoride is toxic at very high concentrations, but it is very rare to be exposed to these levels. The problem with fluoride is when you swallow more than the recommended level over a long period of time. The most common problem that is seen with consuming moderate levels of excess fluoride is dental fluorosis.

Dental Fluorosis 

Individuals who are exposed to too high a level of fluoride in early childhood (up to 7 years old) are prone to dental fluorosis, or mottling of the teeth.

In its mildest form, the only sign of fluorosis may be white specks on the enamel surface. Teeth more severely affected show discolouration, often in bands or lines, and pitting. Although they are more resistant to decay, teeth with severe fluorosis have structurally weaker enamel. 

The amount of fluoride in drinking water varies greatly. The level of fluoride in freshwater, for example rivers and lakes, is usually low. However as water seeps through soil and rocks it becomes contaminated with various naturally occurring substances or pollutants. These contaminants also become more concentrated where the groundwater level dips. 

India has become increasingly dependent on groundwater, from wells or bore-wells, to meet demands for drinking water and in some areas, this contains much higher than the recommended level of fluoride.

The optimum level of fluoride in drinking water - to provide dental health benefits and minimise side effects - is 1mg per litre. In India, the permissible level is up to 1.5 mg/l. 

The Indian Department of Drinking Water Supply reported that 203 out of 593 districts have higher than permissible levels of fluoride in water.

As this map shows,almost all states in India have districts where groundwater contains excessive levels of fluoride. Even in Bangalore, the level of fluoride varies between different areas and during different seasons. As water quality is not well regulated, it is not always easy to know the levels of fluoride in a particular area.

In some areas, the level of fluoride in water is excessively high. In these areas skeletal fluorosis may also occur. This causes pain and stiffness in the joints and, in more severe cases, bone deformities.

It is recommended to drink bottled or filtered water and, in high fluoride areas, to avoid food and products containing fluoride. Not all water filters remove fluoride, those which work by reverse osmosis and ion exchange resin are able to remove about 90% of the fluoride. Bone char filters have been found to be even more effective in removing fluoride. It is difficult and expensive to remove fluoride from the ground water supply and, in rural areas, other sources of drinking water are not always easily available. Recharging groundwater using harvested rainwater can be useful in reducing levels of contamination.  

Slides used from: http://www.schools.indiawaterportal.org/wq-test/fluoride-factsheet


In the second part we will look at how fluoride can be used safely to benefit dental health.