Four year-old with severe decay

My four-year-old son has severe decay (bottle mouth) to the point that it looks has if he doesn't have any front teeth, and the rest of his teeth are decaying also. What will the dentist do to help him?


This is an extremely important issue. I am seeing nursing caries more often in my own dental practice. Nursing caries or baby bottle tooth decay is a condition which involves rampant caries (i.e. many teeth are decayed, possibly severely) and affects approximately 2.5-15% of children. It is due to long periods of exposure to certain beverages. For example, a child nurses either from the breast or a bottle containing milk or fruit juices for up to eight hours. The teeth usually affected by this condition are the upper anterior teeth and the upper and lower posterior teeth. Generally, the lower anterior teeth are not affected.

A dentist needs to evaluate the condition of the teeth and develop a treatment plan. All findings and treatment should be discussed with you prior to beginning treatment. If the plan changes during the course of treatment, you should be informed. Treatment may include extraction of severely affected teeth and restoration of others. Restorations may include pulpotomies or pulpectomies (removal of the nerve tissue inside the tooth) and crowns or fillings. If posterior teeth need to be extracted, space maintainers should be placed. Otherwise, space loss for eruption of the permanent teeth can occur. If only anterior teeth are extracted, a space maintainer may not be necessary. Application of fluoride and fluoride supplements may help stall or decrease the growth of the decay. All of this treatment is important to avoid or alleviate any pain or infection. Infection may be dangerous and may also affect the development of the permanent teeth.

Important factors to consider are the severity of the case, the age of the child, and the level of cooperation. If your son is pretty cooperative, he may be able to have the work done slowly over several appointments with local anesthetic. This can be accompanied by some type of sedation if necessary. It is important to take this slowly and not overwhelm the patient as this can create a bad experience. If your son's cooperation and/or tolerance is low, you may wish to consider having all the treatment done with general anesthetic.

I strongly urge you to take your son to either a general dentist or a pedodontist for a thorough evaluation as soon as possible. You and the dentist will be able to devise a plan which will bring your son back to good oral health. Good oral health is necessary for good general health.

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