Why can’t you wait for a new tooth to treat decayed deciduous teeth?
"Some children can see more than a dozen small cavities in their mouths." Liu Xinyi, a 2025 master's student in stomatology at Zhejiang University, went to a free clinic in Shengsi County, Zhoushan City, Zhejiang Province this summer and was deeply impressed by the dental caries situation among children.
When it comes to dental health, many people may directly think of protecting permanent teeth, but ignore the health of deciduous teeth during childhood. "Caries can cause toothache. When children have toothache, it will affect eating, which in turn affects nutrient absorption. Some children have toothache on one side and chew on one side for a long time, resulting in a big face." Wu Zhifang, head and chief physician of the Department of Pediatric Dentistry at the Affiliated Stomatological Hospital of Zhejiang University School of Medicine (hereinafter referred to as "Zhejiang University Dental"), called on everyone to pay attention to the problem of dental caries in children's deciduous teeth.
In addition, children’s deciduous teeth have permanent tooth germs underneath them, and apical periodontitis caused by severe deciduous tooth caries can lead to permanent tooth development problems. Wu Zhifang said: "When children's permanent teeth erupt, if there are yellow plaques on the surface, it may be caused by periapical inflammation of deciduous teeth. Severe deciduous tooth caries may even have systemic effects, and local infection may cause nephritis, rheumatoid arthritis or infection of other organs."
Shengsi County in Zhoushan City and Jingning She Autonomous County in Lishui City are the dental support areas of Zhejiang University. This summer, Zhejiang University Dental School, relying on the "Mu Guang Smile" ideological and political education brand, organized five "Sunshine Pioneers" summer social practice groups to go to free clinics.
Lu Kejie, a 2023 doctoral candidate in dental medicine at Zhejiang University who went to the free clinic in Jingning, said: “There is a relative lack of popular science resources on campus here. During the exchanges with local children and parents, I found that they do not know much about basic oral health care knowledge such as brushing teeth, applying fluoride, and pit and fissure sealing.”
This situation is consistent with Wu Zhifang’s diagnosis and treatment experience: “The oral hygiene status of children in remote areas is worse than that of children in cities. Parents’ awareness (of this aspect) is also relatively weak. The medical level is different between regions, resulting in differences in the prevalence of dental caries.”
The parents of many local children in Jingning have gone out to work for a long time, and their grandparents take care of their children. Zhou Yinhuan, director of the Department of Dentistry at the People's Hospital of Jingning She Autonomous County, said: "These children's bad oral habits will greatly increase the risk of dental caries."
Shengsi is an island county with special geographical conditions. Liu Xinyi is the captain of the student team of Shengsi Free Clinic. She said: "The free clinic is held in a summer care class in Shengsi. There are more than 30 children, with an average of 6 cavities per capita, and the caries rate is relatively high." Liu Xinyi explained that because the sample size is small and the polarization is very large, the data will be somewhat biased. "Some children have more than a dozen small cavities in one mouth."
During free clinics in Jingning County and Shengsi County, the student team collected many misunderstandings about the protection of deciduous teeth, and Dr. Wu Zhifang explained and corrected them one by one.
"Snacks eaten by children, such as cakes and biscuits, easily adhere to the surface of the teeth, but the children do not notice it and do not rinse their mouth or brush their teeth after eating. In clinical practice, we often encounter cavities between two adjacent teeth of young patients, with food residue embedded in them." Wu Zhifang said that children's perception is weaker than that of adults, and some children with very deep cavities may not feel much pain. "The caries rate in deciduous teeth of 3-year-old children in my country is about 50%, and 5-year-old children reach 70.9%. Many children have 8 or even 20 cavities in a mouth."
In more than 20 years of clinical experience, Wu Zhifang has seen that dental caries brings not only pain but also psychological pressure to children. "Children with a mouth full of tooth decay are very obvious when they open their mouth. They may be criticized by others in daily life, which brings psychological pressure to the child. Some children will develop an inferiority complex and do not like to smile. They are afraid that others will see their dark teeth."
At present, tooth fluoride coating and pit and fissure sealing are recognized as effective and cost-effective means of preventing caries in children. The free clinic teams in Jingning and Shengsi provided dental fluoride coating services for children.
"Fissure sealing can reduce the risk of dental caries by 60% to 70%, and tooth fluoride application can reduce the risk of dental caries by 30% to 40%, and also reduces the cost of later treatment. If small holes are not repaired, large holes will suffer, and the deeper the degree of dental caries, the higher the cost of treatment." Wu Zhifang explained, "These two methods are very convenient and can be carried out on a large scale in communities and schools. They have been popularized in big cities. Pit and fissure sealing and tooth fluoride application in remote areas can be brought to campus soon."
Wu Zhifang said that pit and fissure sealing and tooth fluoride coating are effective, but they are not "specific drugs" and cannot 100% prevent the occurrence of dental caries in children. Genetic factors and personal constitution are also causes of dental caries. More importantly, parents should set an example for their children. While developing good tooth brushing habits themselves, they should also frequently observe their children's oral conditions and treat small cavities as soon as possible.
Wu Zhifang found that as long as the children do not complain about toothache, many parents will not take them for treatment even if the caries has occurred for a long time. "They think that children's teeth will change and do not need treatment. This is a very bad view. If you find dental caries, you should treat it as soon as possible. Even if there is no dental caries, you should have regular oral examinations."
"Many of my patients have developed the habit of regular oral examinations every 3 to 6 months. For children with a high incidence of dental caries, it is recommended to review them every 3 months. Regular examinations can also alleviate children's fear of dental visits to a certain extent," Wu Zhifang said.
Liu Xinyi said that as a student majoring in dental medicine, her free clinic experience made her want to participate in more charity activities such as free clinics in rural areas when she was a student and when she became a dentist in the future.
Wu Zhifang said, "During the next free clinic, we can compare the incidence of dental caries among children in these remote areas to see if there has been any change after the oral health knowledge promotion by medical students. This work needs to be followed up for a long time."
"The significance of free clinic activities goes far beyond on-site diagnosis and treatment. More importantly, it helps everyone establish good oral hygiene habits. Good habits can be used for life." Wu Zhifang said.
Intern Qiu Beicen China Youth Daily·China Youth Daily reporter Liu Changrong Source: China Youth Daily
