Risks of dental treatment on children

Despite all the latest technology, materials and techniques used – treatment on teeth (and anywhere else on the human body for that matter!) is never 100% guaranteed. This is because every human body has a host response which differs. Teeth are constantly soaked in saliva 24/7 and are affected by everything going into the mouth and what is being done outside the dental office.

Once dental treatment has been completed, factors that can not be determined by the dentists/specialist are related to how well the teeth are kept germ free (brushing and flossing), the child’s bite (occlusion), the child’s diet – what is eaten, how frequently, can contribute to decay around treated teeth; the child’s natural decay risk ie: the level of decay forming germs in their mouths and how quickly they develop decay; and compliance of preventive strategies as advised by the specialist.

Filling breaks, wears down, displaces – can occur from: difficulty initially placing filling due to difficult behaviour, active tongue, saliva contamination of the tooth surface makes the bond between tooth and filling weaker, bacteria growth around edges of fillings– brushing/flossing not consistently effective, decay around margins of fillings so the foundation filling is on, softens and weakens therefore retention is lost and filling comes out; child’s bite will change as baby teeth lost and new teeth erupt leading to some teeth and fillings receiving more biting force during eating; grinding during day or night can place extra stress on teeth and wear fillings down and weakening them

Infection of the pulp (nerve and blood vessels) can occur from decay starting around edges or under fillings which can cause inflammation of the pulp, in severe cases an abscess can form, a baby tooth would need to be extracted to avoid spread of the abscess to the underlying adult tooth. Infection under a stainless steel crown can occur due to variations in the host response and the degree of initial bacterial invasion into the pulp of the tooth – making the pulp not recover as we would hope even after treatment (pulpotomy and stainless steel crown). An abscess on an adult tooth would usually be treated by a root canal treatment.

Crown comes off – anterior crowns are weaker than natural teeth and can be damaged by trauma (falling over, biting hard things, eating sticky foods). Posterior crowns rarely come off, but can do in some situations (trauma, poor oral hygiene, crown loosens as the new adult tooth erupts under it etc). Depending on the age of the child, the crown may be re-cemented or replaced or may be left if the primary tooth is near natural exfoliation.

Hypomineralised teeth – these teeth already have weaker, more porous enamel which is even more difficult to bond fillings to. This enamel is very sensitive to work on with water, air and handpieces – hence, children are more anxious to have these teeth “touched” especially if they have already had a previous anxious experience. Restorations on these teeth need rigorous monitoring and maintenance. All the comments above also relate to these teeth.

Regular monitoring (clinical and radiographic) of your child’s teeth and fillings helps to pick up early signs of dental disease. If any of the above signs are detected, appropriate treatment can be advised. Any new areas of decay can be treated before needing complex treatment, as decay spreads more quickly in primary teeth due to the small surface area and thinner layer of overlying enamel compared to adult teeth.

© Kidz Teeth | Specialist Paediatric Dentists - Auckland, New Zealand