How to treat children with dental caries?

Written by Li Bao Hua
Dentistry
Updated on March 07, 2025
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To treat cavities in children, first, the extent of tooth decay needs to be assessed. If the decay is mild, the decayed part can be removed and directly filled. If the decay is severe enough to inflame the dental nerve, an X-ray of the tooth is required. If it is a deciduous tooth that is about to fall out soon and is not worth saving, treatment might be unnecessary. However, if the tooth root has not been absorbed and the permanent tooth will take a long time to erupt, root canal treatment can be considered. In cases where a young permanent molar is decayed and the nerve is infected, a vital pulpotomy should be performed to preserve the living pulp and promote further development of the tooth root.

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How to deal with toothache from cavities?

Cavity toothache occurs when bacteria infect the hard tissue of the tooth, approaching or reaching the dental nerve, causing a pain response from the nerve, which is also a self-protective reaction. Initial treatment for cavity toothache involves using a drill to remove the decayed hard tissue of the tooth. If the decay is completely removed and the dental nerve is not exposed, this condition can be directly treated by filling or using a pulp-capping agent to protect the nerve before filling. If, after removing the decay, the dental nerve is exposed or reached, the situation cannot be resolved with a direct and immediate filling. Instead, nerve-killing procedures are necessary, which involve root canal treatment of the tooth.

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Is tooth sensitivity caused by exposed nerves?

When a patient has dental caries, it can cause some damage to the gum tissue, resulting in the gums being in a state of acute inflammation. At this time, the gums may be particularly sensitive, especially to hot and cold stimuli, but this does not necessarily mean that the nerves in the gums are exposed. It is recommended that patients pay attention to a light diet and avoid overly hot or spicy foods, as well as hard foods that may irritate the sensitive gum tissue, leading to discomfort. Therefore, patients are advised to maintain a light diet, avoid spicy and irritating foods, and drink plenty of water. Additionally, it is crucial for patients to develop healthy oral hygiene habits. It is recommended that patients visit the hospital in a timely manner for consultation, and receive specific treatment plans based on the extent of the damage caused by the caries.

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Dentistry
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Can cavities be detected in an X-ray?

In clinical practice, not all cavities require X-rays, nor can all cavities be detected through X-rays. The purpose of taking X-rays is to understand the depth of the cavity and the distance between the cavity and the dental nerve. Some cavities occur on the surfaces between teeth which cannot be seen with the naked eye; in these cases, X-rays can provide a clear diagnosis. However, early-stage cavities only involve changes in the enamel, showing as chalky changes or small black dots and lines on the tooth surface. For these superficial changes, X-rays will not show any abnormalities. Therefore, it is important to maintain oral hygiene by brushing teeth morning and evening, and rinsing after meals to detect and treat cavities early, to prevent other complications.

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If a cavity doesn't hurt, is it better not to treat it?

Cavities are primarily caused by poor oral hygiene and the effects of bacteria in the mouth, among other factors, leading to chronic progressive destruction of the hard tissues of the teeth. Generally, the progression is slow, initially appearing as yellowish-brown spots or defects on the tooth surface without causing any pain symptoms, making the treatment fairly straightforward—simply removing the decay and filling it can often be completed in one session. However, many cavities are not treated during this optimal period and progress to the dentin, causing sensitivity to hot and cold and leading to toothache. If not treated promptly, the cavity will enlarge, and in severe cases, lead to pulp infection, causing spontaneous pain, episodic pain, and pain from temperature stimuli. At this stage, the treatment becomes more complex and painful, requiring root canal therapy, typically needing three to four follow-up visits, and thus, costing more than a simple one-time treatment. If the condition is not controlled, it may develop into apical periodontitis or apical abscess, leading to space infections. The treatment then becomes even more complicated and painful, requiring incision and drainage, along with systemic anti-inflammatory treatment. If the tooth is severely damaged, the remaining roots and crowns can become a focal point for bacterial infection, potentially inducing other diseases. Therefore, it is crucial to detect and treat cavities early—the smaller the cavity, the better the treatment outcome, also saving time and money.

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What should I do about bad breath caused by dental caries?

If a patient is suffering from dental caries that have already caused bad breath, the situation requires active treatment targeting the dental caries. Due to the ease with which food residue and bacteria can accumulate in cavities, this will cause an odor in the mouth. Initially, it is essential to clear out food debris, bacteria, and any decayed material from the cavity. If the cavity is shallow, it can be directly filled with light-cured resin material. After the cavity is filled, the patient's bad breath symptoms should be alleviated. However, if the cavity is deep, it should first be treated with a pulp-protecting base before filling. If the dental nerve is affected, causing pulpitis, root canal treatment must be conducted first.