Keeping deciduous teeth (milk tooth: dens deciduus (from Latin : dens “tooth”, and decidere “to fall down”) healthy until physiological (natural) tooth change is the desired goal. The physiological tooth change is triggered by the permanent teeth following the deciduous teeth through the resorption of the deciduous tooth roots and the associated loosening. Unfortunately, this goal cannot always be achieved despite considerable success in prophylaxis during childhood. Excessive consumption of sugary foods and beverages, in combination with inadequate oral hygiene measures, leads to sometimes pronounced carious lesions and multiple caries (caries on many teeth). The causes of this are ultimately still to be found in the parents’ inadequate knowledge of correct nutrition and oral hygiene techniques; for they are required up to the age of 6 and, depending on the child’s manual dexterity and cooperation, often beyond, to carry out their child’s dental care consistently and regularly or to accompany it in a motivating manner. While the extraction (removal) of a deciduous incisor can promote speech problems and the development of dyskinesia (faulty movement of the tongue muscles in particular), in most cases it is not problematic for the further course of tooth change, it must be borne in mind with the molars that their early loss is very likely to cause a collapse of the support zone due to migration of the six-year molars of the 2nd dentition (the permanent teeth). Dentition (of the permanent teeth) and a more difficult eruption of the premolars (anterior molars of the permanent dentition) will result.
Causes of premature exfoliation (premature loss of deciduous teeth)
A deciduous tooth is considered to be lost prematurely if the permanent tooth that follows it still needs more than a year to erupt. The most common causes – besides a very low incidence of rare conditions – are:
- Trauma (accident); this particularly affects the anterior teeth (incisors and canines); this is accompanied by luxations (loosening) and possibly root fractures (root fractures);
- Deep carious infestation; as a result of deep caries comes to the pulp inflammation, which, unlike the permanent tooth, in many cases already represents the indication for extraction (surgical removal of the tooth);
- Orthodontic indications for extraction (removal) of one or more deciduous teeth, such as controlled extraction, eruption obstruction or compensatory extractions in the case of undercount of teeth in the 2nd dentition.
Deep caries may be caused by:
- Able-bodied children are presented too late for treatment,
- In children with poor compliance (cooperation), this must first be slowly worked out and thus the caries therapy begins too late or
- Parents refuse the in some cases inevitable treatment of carious lesions under intubation anesthesia (ITN).
Diagnostics
To assess the preservability of a deciduous tooth affected by caries, clinical assessment of the findings and, if cooperative and indicated under critical indication, supplementary radiographs are required.
Therapy
The therapy to be selected depends on the developmental status of the permanent tooth developing in the furcation (bifurcation) of the deciduous tooth. A clinically visible defect of the deciduous tooth is considered a guide for therapy planning; for example, if only a marginal ridge indentation is present, the possibility of pulp opening during excavation (removal of caries) must already be anticipated. After pulp opening, the procedure differs depending on development:
- Shows radiographically a still fully developed root, then opening the pulp (the pulp of the tooth), depending on its degree of inflammation, a pulpotomy (removal of the crown pulp) or the attempt of a very careful root canal treatment without over-instrumentation (working with root canal instruments beyond the tip of the root) is possible;
- If root resorption has already begun, but only less than one-third of the root is resorbed, then pulp opening only the possibility of a pulpotomy as a conservation attempt; if this fails, the tooth must be extracted (pulled).
- if root resorption has already progressed beyond the first third of the root, the treatment of choice for pulp opening is extraction of the deciduous tooth.
Furthermore, one will usually prefer extraction to a maintenance attempt at:
- Poor general condition,
- After an abscess in the apex or furcation area (root apex or fork area) that has already passed,
- In case of complications resulting from the problematic anatomy of the deciduous tooth root during root canal treatment,
- In any suspicion that the tooth germ may be damaged,
- In case of ankylosis (adhesion of the root of the deciduous tooth to the surrounding bone), which may become an obstacle to eruption of the successor.
