do milk teeth cavities need to be filled

"It's only a milk tooth, it will fall out anyway" is one of the most common things we hear from parents, and from grandparents too. It sounds sensible, but it is often wrong, because of timing. The front milk teeth fall out at around six to eight years, yet the milk molars at the back usually stay until ten to twelve. A cavity in a four-year-old's back tooth may have six or more years of work left to do.

Why untreated decay in milk teeth matters

• Milk teeth decay faster. Their enamel (the hard outer layer) is thinner than adult enamel, so a small cavity can reach the pulp (the nerve and blood supply inside the tooth) within months.
• Pain and infection. Once the pulp is infected, the child can get toothache at night, a swollen face, or a pimple-like gum boil. Children with toothache eat poorly, sleep badly and miss school.
• Damage to the adult tooth. The permanent tooth develops just beneath the roots of the milk tooth. A long-standing abscess can stain or weaken the enamel of the adult tooth before it ever comes through.
• Lost space. If a badly decayed milk molar breaks down or has to be removed early, the teeth on either side can drift into the gap. The adult tooth may then come in crooked or get stuck, which can lead to braces later.
• Decay spreads. The bacteria causing the cavity are the same ones waiting for the first permanent molars, which arrive around age six.

What treatment can look like

Treatment depends on how deep the decay is, how old the child is and how long the tooth still needs to last:

• Early chalky white spots: often no drilling at all. Better brushing with the right amount of fluoride toothpaste, fewer sugary snacks, and professionally applied fluoride can stop or reverse them.
• A small to medium cavity: a tooth-coloured filling. For children, dentists often use glass ionomer, a filling material that releases fluoride, or composite resin.
• Decay that has reached the nerve: a pulpotomy or pulpectomy, the children's versions of root canal treatment, usually followed by a crown to protect the weakened tooth.
• A tooth that cannot be saved: extraction, sometimes followed by a space maintainer to hold the gap open.

When not filling is reasonable

Your dentist may advise leaving a cavity alone if the tooth is already loose and the adult tooth is close to coming through, or if the decay is shallow and has clearly stopped progressing (it looks dark, hard and shiny rather than soft and chalky). With a very young child, the plan may be to control the decay first with fluoride and diet changes, and treat it once the child can cooperate. This is a judgement made at an examination, ideally with an X-ray, not a rule of thumb.

How we handle it

For children under 10, we recommend our MDS Pedodontics department, who see children at Kharadi by prior appointment. Our current published fee for an MDS specialist consultation is ₹1,500. The treatment cost is confirmed only after the examination, because it depends entirely on what is found. You can book through our booking engine.

To understand how decay progresses in young children, see our page on decay in milk teeth.