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Dentistry/Child's caries

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Question
My 5 yr old son has several cavities, 8 in all. He is our last child and brushing was lax. Older siblings have had a few, each in their primary teeth, so per se, they are not overly cavity prone. Cavities include deep ones in his lower back molars and besides multiple fillings under general anesthesia, pediatric root canals have been recommended for the molars.

One of the molars is beginning to hurt so action is necessary. Is a root canal under general anesthesia at 5 a reasonable treatment of a deep cavity. Would a safer option be to extract the rear molars since they should be falling out naturally in a few years? What bothers me more than fillings or root canals or the monetary cost, is the thought of inducing general anesthesia in my 5 yr old son to perform this work.

Answer
Treatment of a deep cavity in a primary molar is an important measure in preserving the health and integrity of the developing dentition.  Your son needs to keep the primary molars until age 10-12, another 5 to 7 years, until such time that those teeth will be replaced by permanent teeth.  Loss of the primary molars at age 5 will result in significant problems with the emergence of the permanent teeth later on so it is important to take every possible measure to keep those primary molars until they are ready to be replaced by permanent teeth.  Once the permanent first molars, also called the 6 year molars, have completely erupted it may be possible to remove one or more of the primary molars if necessary and place a space maintainer to help prevent these unwanted problems but at age 5 the permanent first molars are usually not erupted yet so treatment must be done.

Sometimes a primary molar is so deeply infected that a root canal needs to be done.  This often requires placement of a crown if the decay has undermined the structure and integrity of the tooth.  In many cases these procedures can be done in the office over a period of several visits using oral sedation in order to avoid the need for general anesthesia.  While some pediatric dentists prefer to complete all treatment in one visit using general anesthesia, there are some pediatric dentists who will consider, under certain circumstances, completing treatment in the office with oral sedation over a course of several visits.

I hope these general comments provide you with the information you seek.

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Dr. Randolph Myerson

Expertise

Please limit your inquiry to questions about orthodontics (braces) and children's dentistry. I am both an Orthodontist and a Pediatric Dentist, having been trained in both of these dental specialty fields. Orthodontics is the dental specialty that treats problems of tooth, bite and jaw alignment using braces and removable appliances. Pediatric Dentistry is the dental specialty also known as dentistry for children, which deals specifically with the dental problems of this special age group from infants to adolescents. I am also experienced in Forensic Dentistry, the application of dentistry to law enforcement and identification using dental records.

Experience

I have been in the private practice of orthodontics and pediatric dentistry for over 20 years. Prior to that I served for three years on the Cleft Palate and Cranio-facial Reconstruction team at Children''s Hospital of Philadelphia and was an Assistant Professor of Dentistry at University of Pennsylvania School of Dental Medicine. I also served as a dentist in the U.S.Air Force, stationed at Andrews AFB in Washington, DC.

Organizations
I am a Fellow in the American Academy of Pediatric Dentistry, and a member of the American Association of Orthodontics, as well as a member of the American Dental Association and the Dental Society of the State of New York.

Education/Credentials
I received my BA in Biology from Frankin & Marshall College in 1969, and my dental degree from University of Pennsylvania School of Dental Medicine in 1973. In 1978 I received both my Certificate in Orthodontics from University of Pennsylvania School of Dental Medicine, and my Certificate in Pediatric Dentistry from Children''s Hospital of Philadelphia after completing a three year Teaching Fellowship in Orthodontics and Pediatric Dentistry in 1978.

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