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Why is it important to treat milk teeth affected by tooth decay?
Milk teeth, also called temporary teeth, play an important role in providing an effective mastication, absolutely necessary in the dento-maxillary and body development. Lateral teeth (temporary canines and molars) maintain the eruption space for their permanent successors. Milk teeth from the lateral area of the arcade are wider than their permanent successors, so, when they are replaced, an extra space will be obtained, which will advantage the alignment of permanent front teeth, if they are slightly crammed.
If milk teeth are affected by tooth decay, they lose their morphology, reduce in size due to the distraction of the contact areas between the teeth and sometimes require premature extraction, long before the normal replacement period. Thus, the excess space, naturally present, is lost, through the forward migration of the first permanent molar, which erupts behind the milk teeth, at the age of 5-6. Forward migration is a phenomenon which occurs immediately after the extraction of the milk tooth and will cause a significant narrowing of the space needed for the eruption of permanent premolars and canines, which will be crowded or even completely outside the arcade, requiring orthodontic treatment.
Cavities contain numerous species of bacteria, and their presence in high number in the child’s mouth causes frequent infections (of the throat, respiratory tract, general) and permanent teeth may be affected by tooth decay due to the contact with this bacteria. A healthy tooth, in contact with a decayed tooth, will lead to the transfer of destructive microbes and the start of tooth decay into the enamel of the healthy tooth.
The prophylaxis of cavities and dental crowding requires the treatment of milk teeth, with the restoration of the correct crown morphology, maintaining of the contact points between the teeth, avoiding premature extractions. The treatment involves cavity removal and tooth filling. If the cavity is very deep, the tooth nerve is affected, which requires treatment for removing the infected nerve and then root canal obturation and dental filling. If the tooth is badly damaged and fails to respond to treatment, frequent abscesses (pus) occur and extracting it could be necessary. If this is the case, the execution of space maintainers is required. They maintain the position of the teeth next to the extraction, prevent the forward migration of the teeth and provide space for the arcade alignment of future permanent teeth. Space maintainers can be fastened on the teeth next to the edentulous space, as a ring, cemented on the tooth behind the edentulous space, and a wire loop advancing forward, to the tooth before the extraction. This type is only recommended for one missing tooth. It is easy to wear and does not depend on the child’s meticulousness. It is removed when the permanent tooth erupts.
The lingual arch and the Nance appliance are used as space maintainers when several back teeth are missing and the permanent incisors have erupted.
The decision to apply a space maintainer must consider the dental age and the evolution stage of the permanent teeth. If there are more than 6 months until the tooth is changed, a space maintainer is recommended. A full mouth X-ray is required, in order to see if the permanent tooth buds are present and the time when they will erupt on the arcade.