Dr,
A recent discovery of cavities in my children prompts my asking:
Would a root canal be necessary in a seven year old child?
Should all cavities be filled, even small cavities in primary teeth?
Is mercury in fillings acceptable for primary teeth which will be falling out within five years or so?
What can I do specifically so that we don’t have cavities like this again?

Thanks for any time you may be able to spend in addressing these questions.
–Laura

Dear Laura,
Let me try to answer your questions as listed.

1. Should root canals be appropriate for a 7 year old?
Root canals are use when the nerve of the tooth is damaged or dead. This will cause the leakage of toxins into the body. Usually an abscess is the result with a variety of consequences. Root canals for children fall into two categories: for permanent teeth or baby teeth. if it is for a permanent tooth it is usually a very good idea. If it for a baby tooth, it depends on how much longer the tooth is needed before its eventual loss. Baby teeth serve many purposes: they are important in helping jaws develop and holding the place for the soon to be present permanent teeth. So whether the baby teeth should be root canaled the answer is maybe. Your dentist will be able to answer the pros and cons for treatment.

2. Should all cavities be filled?
Again, the answer is usually. If the tooth is not in hopeless condition and there is continued need for the tooth then the answer is yes. With a baby tooth I usually try to gauge the size of the cavity with the expected time for the loss of the tooth. If the cavity will not grow to big and cause nerve damage or affect the tooth next to it I will not repair it. I always inform the parent so they can be in on the decisions.

3. Should Mercury fillings be used?
Mercury fillings are also known as Amalgam fillings. The material is approximately 50% mercury and 50% silver. I do not believe it should be used for any reason. Mercury is very dangerous for children and women in the child bearing years. Once mercury enters and is absorbed in the body it is very difficult to remove, not to mention the expenses for removal. There are other materials that will restore the teeth as well without the possibility of risk.

4. How to prevent cavities?
This is a great question. Prevention is where the battle should be fought. So your areas to concentrate on are:
A. Control diet. Everything that can cause cavities should be controlled. The list is numerous but the management is doable.
B. Good oral hygiene with toothbrush and floss. These are very inexpensive and have a huge bang for your buck.
C. The use of sealants. This wonderful tool is very under utilized.
D. Oral hygiene instruction from your dentist. Always ask the dentist or the hygienist for an evaluation at each visit because each hygiene appointment should be a learning time. Patients should clean their own teeth and the professionals should instruct.
E. Frequent hygiene appointments with a dental checkups each visit. This is the standard in our office. This allows for the aforementioned instruction and for the prompt discovery of problems early in the game.
F. X-rays routinly taken. The are invaluable to help in prevention of serious problems. If you can, have digital x-rays taken. Digital x-rays have a significant reduction in the exposure of the x-ray.

I hope this helps.

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