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Why Bother to Fix Baby Teeth?

From time to time, patients ask why we have an interest in repairing damaged baby teeth. The fancy name for baby teeth is Deciduous Teeth. Young people usually enter life without any teeth at all—which is a blessing to Mom.

After a few months, a few teeth make their way into the mouth, and within a couple of years, all 20 baby teeth are in place. Baby teeth will be in place until about 5 ½ or 6 years old when they then begin to be replaced with adult teeth. All of the baby teeth have been replaced by adult teeth by about 12 years old. The adult mouth is larger than the mouth of a young child of course, so although there are only 20 baby teeth, there are 32 adult teeth.

Baby teeth serve several purposes. The most obvious use for baby teeth is to chew food. However, there are also other uses. Speech is developing in the childhood years. The teeth play an important part in making the sounds that are necessary for proper speech. Baby teeth also play in essential role in guiding the adult teeth into the proper place in the mouth. As well, they are useful as space maintainers to make sure when the adult teeth are ready to erupt, there is room in the proper place in the mouth for them.

Consider for a minute what happens when a child gets a cavity in a baby tooth. The hard outer covering of the tooth (called enamel) is much thinner on a baby tooth than it is on an adult tooth. Since a cavity always starts on the outside of the tooth and works its way towards the inside, a tooth with thin enamel is destroyed much quicker than a tooth with a thick enamel covering. As well, baby teeth have pulps (nerves) that in proportion to the size of the teeth, are much larger than the pulps of adult teeth. Thin enamel on the outside of the baby teeth combined with large pulps on the inside of the baby teeth means that cavities progress into the pulp (nerve) of baby teeth much faster than with adult teeth. Abscesses (infections) of the baby teeth are painful just as they are on adult teeth. Often a baby tooth can get a very deep cavity in less than six months. Typically, infected baby teeth cannot be treated and have to be extracted.

When a baby tooth is extracted, if the root of the developing adult tooth is not mostly formed, the eruption of the adult tooth is delayed—often severely delayed. Baby teeth that are nearly ready to fall out when they are extracted (meaning the adult tooth has a root that is nearly fully formed at the time of extraction of the baby tooth) have an adult tooth erupt very quickly after they are taken out. But it is the baby teeth that are extracted quite early that cause the trouble. As well as delaying eruption, a baby tooth that is extracted very early is not in place long enough to provide a guide for the eruption of the adult tooth that is designed to replace it. This often causes an adult tooth to come into the mouth quite out of position. This can easily lead to orthodontic treatment being necessary in the adolescent period for both looks and for proper function. Leaving an infected tooth in place without treatment can cause unsightly discoloured patches on the adult tooth forming under the infected baby tooth. Additionally, leaving an infected baby tooth in place can cause chunks of the developing adult tooth not to form at all, as well as causing pain. When a child has a cavity, it has to be dealt with in a timely way.

Just for a moment, consider a problem that also comes up in the 6 or 7 year old period—although the problem concerns adult teeth. Sometimes parents don’t realize that first molars erupt at about the same time front teeth are coming in. Since a tooth doesn’t fall out at the back of Junior’s mouth at 6 years old, some people assume no adult molars are in place yet. However, by 6 years old, most children have four “6 year molars” that have erupted behind the last baby tooth—one in each half arch. These four teeth are the king pins in developing proper occlusion (bite). If one or more of them is lost, there will be fairly serious life-long effects. The bite will suffer on most of these people unless they get braces. The effects become more pronounced beyond 50 years old. Much increased incidence of tooth decay in the molars because of the improper positioning of the remaining molars, and periodontal disease (loss of bony and soft tissue support for the teeth), as well as much higher incidence of joint and muscle problems can be expected. In fact, poor positioning (tipping) of the molars because of loss of 6 year molars is the most common serious occlusal (bite) problem we encounter in adults.

Good health of the teeth and gums starts early. What is done in the period when the baby teeth are present (meaning up until about 12 years old) absolutely affects the mouth and the teeth for the entire duration of the patient’s life.

- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)

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