Children have twenty baby teeth. In my office occasionally a child comes in with advanced tooth decay. One has to decide whether to restore these teeth or not. If a decision is made not to restore teeth then the dentist has to make holding arches to keep the adult six year molars in there proper place to avoid severe orthodontic problems later. What criteria is used to decide whether or not to restore a baby tooth. The answer may be a little different than you expect. If more than half the baby tooth’s root is in place then our treatment procedures can have a good prognosis. If less than half the root is present then extraction and insertion of a holding arch to keep the teeth in place is more reliable course of treatment. Today we had such an instance. We had a 7 year old with advanced decay in her lower primary molars. No amount of treatment could save those baby teeth. We had an orthodontic laboratory make a holding arch for her. After administering local anesthesia I extracted the teeth and cemented the appliance on her adult six year molars. We will check the appliance at her six month appointments. She was the best patient and now without those abscessed teeth she will be out of pain.
Something else is very important to notice here. When you have decay in teeth you tend to get more decay. We call decay dental caries. When a dentist looks at a patient such as this we thing of the overall rate of decay. I take the time to discuss with my patients that all the decay or dental caries must be treated to arrest the growth of cavities. We address this by not only treating the decay but by using fluoride treatments and diet modification.