Dear XXXXXXX

Thanks for your query.

I note that your daughter is 4 1/2 years old. I assume that she is not bottle feeding and thus the diagnosis will not be nursing caries. Nursing caries occurs in infants and young kids who bottle feed and often go to sleep with the bottle nipple in their mouths. The sugar in the milk stays in the oral cavity all the time the child is sleeping, and thus causes caries.

This is not to say that 7 cavities in a 4 1/2 year old is not worrisome!! It is indeed unfortunate that your daughter has so many cavities. Assuming that daughter is otherwise healthy, but her teeth have been eroded by the cavities, I would suggest that the diagnosis may be Rampant Caries. This is a rapidly progressive, burrowing type of cavity formation process, which can cause many teeth to be involved if not treated aggressively.

If a cavity has not damaged the tooth so much that its pulp is exposed, then filling can help. Filling does not merely mean filling the hole in the teeth, but it means, cleaning and removing all infection in/on the tooth; then restoring the tooth by using an appropriate material to give it shape and strength. Remember, the child needs to use her teeth not only to eat but also to learn to speak and pronounce words, develop the confidence to eat all foods (soft or hard), and have a beautiful smile. Filling will not cause any pain to the child.

Root canal treatment (RCT) is used when infection has reached the pulp of the tooth. If your daughter's teeth have been affected so much by cavities that the pulp is damaged then she will have pain and/or swelling with or without pus formation. Possibly, the swelling in the tooth with pus on the gum, which you mention appeared a month ago was a manifestation of the above process. Clove oil has helped to symptomatically treat it but will not remove infection from inside the tooth. Such teeth need to be preserved/restored not only for the above mentioned reasons but also because these teeth will, if left untreated, transmit infection to the underlying permanent teeth. Further, all the milk teeth act as natural space maintainers for their successor permanent teeth. If the milk tooth are allowed to fall off or are removed prematurely, then the permanent teeth will be crooked and not aligned properly. That in turn will necessitate orthodontic treatment when your daughter is 12 years old.

RCT is done under local anaesthesia which requires a very fine needle/injection to be used in the mouth transiently. Pedodontists are specially trained to deal with children and their heightened pain perception. In the rare case that a child is very uncooperative, it can be done under GA as well. As a parent, if you can reassure your daughter and be calm, controlled and firm during the procedures, your child will benefit by being able to undergo the above easily.

I hope I have answered your query satisfactorily. If you have any further questions, please do not hesitate to ask.

Thanks,

With best wishes,

Dr Ashu Gupta

---