A three-year-and-seven-month-old girl arrived at the Prof. Soedomo Dental Hospital of Universitas Gadjah Mada accompanied by her mother. Nearly all of her upper front teeth were severely damaged. This was her first visit to a dentist, and she cried as soon as she saw the examination room.
This case is more than a clinical report. It illustrates how Early Childhood Caries (ECC), a dental disease affecting children under six years of age, is still often underestimated. Yet its impact extends far beyond tooth damage itself.
When Baby Teeth Decay Too Early
ECC is defined as the presence of one or more carious lesions, teeth lost due to caries, or restored tooth surfaces in the primary teeth of children aged 71 months or younger. The disease is not merely an aesthetic problem. It can cause chronic pain, abscesses, fever, lip swelling, and reduced appetite, which may ultimately interfere with growth and development.
In the patient reported by drg. Finsa Tisna Sari, M.Biomed., Ph.D., together with her colleagues Shoimah Alfa Makmur and Putri Kusuma Wardhani in the July 2024 issue of the Journal of Oral Health Care, clinical examination revealed dentinal caries in ten teeth: teeth 52, 54, 62, 63, 64, 71, 74, 75, 81, and 85. Two additional teeth, 51 and 61, had already developed pulp necrosis, a condition in which the tissue inside the tooth has died.
The cause of this condition often stems from seemingly harmless everyday habits. Allowing children to fall asleep while drinking milk or sugary beverages causes the liquid to pool around the upper teeth. During sleep, saliva production decreases significantly, preventing the remaining liquid from being adequately cleared. Cariogenic bacteria can then multiply unchecked, attacking the still-thin and vulnerable enamel.
From Tears to the Dental Chair: A Psychological Approach as the Key
The first challenge was not technical treatment, but building trust.
During the first visit, no dental treatment was performed. The dentist used the Tell-Show-Do method: explaining the procedure in age-appropriate language, showing the instruments, and then carrying out the procedure. The child and her parents were also taught proper tooth-brushing techniques. They agreed that treatment would be performed gradually rather than rushed.
“A psychological approach is necessary to ensure that patients can cooperate and communicate.” The results became apparent during the second visit. The child was already willing to open her mouth, and treatment could begin.
Five visits were completed in a structured manner.
During the first treatment visit, tooth 54 was cleaned of caries and restored with Glass Ionomer Cement (GIC), while tooth 52 was restored using the sandwich technique, combining GIC as a liner with composite resin and a strip crown for an aesthetic result. The second visit focused on teeth 51 and 61, which had pulp necrosis. Both underwent single-visit pulpectomy with saline irrigation, filling with calcium hydroxide and iodoform (Metapex®), and subsequent restoration with strip crowns. Further visits involved systematic restoration of the remaining teeth. By the fifth visit, all treatment had been completed, followed by the application of topical fluoride as the final protective measure.
Why GIC and Fluoride Were the Main Choices
The choice of materials was not accidental. GIC was selected because it gradually releases fluoride ions, tolerates the high-moisture environment of a child's mouth, and is relatively easy to apply even when the patient is less cooperative. In children with excessive salivation or difficulty cooperating, GIC can be particularly useful.
The topical fluoride applied at the end of treatment works by inhibiting enamel demineralization while strengthening the remineralization process. The calcium fluoride layer formed on the enamel surface gradually releases fluoride ions, providing longer-term protection.
The final treatment outcome showed significant improvement, both functionally and aesthetically. The upper anterior teeth, which had initially been severely destroyed, appeared intact again thanks to the strip crowns. More importantly, the child demonstrated good compliance with the oral hygiene routine that had been taught.
Baby Teeth Are Not “Just Temporary”
A widespread misconception remains in society: baby teeth do not need treatment because they will eventually fall out anyway. This belief is incorrect and potentially harmful.
Premature loss of primary teeth due to untreated caries can interfere with the development of permanent teeth, alter speech patterns, make chewing difficult, and affect a child's self-confidence. The study cited in the report indicates that the highest prevalence of caries is found among children under five years of age—the group most likely to be overlooked.
The case of this young patient at the UGM Dental Hospital demonstrates that with early detection, collaboration among dentists, patients, and parents, and patience combined with an appropriate behavioral approach, even baby teeth can be saved. And along with the recovery of her teeth, the child's confidence can grow again.
Source DOI: http://10. 29238/ohc.v12i1.2390
Authors: Nanda Ayu, drg. Achmad Zam Zam Aghasy, M.Kes.
Photo: Pexels