Respect the Primary Teeth

Carla Cohn, DMD


The term baby teeth is indeed a misnomer. The truth is that they are so much more than that. They serve not just as the baby teeth, but rather as a combination of toddler teeth, kids teeth, tweenage teeth, and even adolescent teeth.

A far better term would be primary teeth, transitional teeth, or deciduous teeth. But all of those labels seem cumbersome and technical to use in conversation with the parents of our child patients. As a result, baby teeth comes out in my discussions far more easily and far more frequently than I care to admit.

Since baby teeth implies a very short duration only, these first teeth do not command the respect they deserve. They are too often thought of as disposable. I have heard too many times from parents and colleagues alike that “they’re just baby teeth, so don’t bother to fix them” or that they “will just fall out.” 

The Need to Protect Primary Dentition 

While it is true that primary teeth will exfoliate, physiologically, they have a specific function and the same innervation systems as permanent teeth. The lifespan of primary teeth can be many years. The average age of the last tooth exfoliating is 12 or 13 years. 

Decay left untreated can progress to the point of affecting the pulp very rapidly, resulting in pain and infection. Imagine enduring that same scenario and resultant toothache in a permanent tooth for any period of time. That is, simply put, unacceptable! It is equally unacceptable to leave decayed or infected primary teeth untreated

Consider that the primary dentition serves so many important functions. These teeth allow our children to eat and grow. They also are space maintainers or space holders for our developing permanent dentition. They help to guide the permanent dentition into place. And, they afford our children a happy smile.

A healthy dentition is so important in the formative years of childhood that one could state that the primary dentition plays a much more important role than permanent dentition does in an already grown individual. 

Prevention and Restoration 

The importance of prevention is immense and cannot be dismissed. There is nothing more beautiful than a healthy, caries-free primary dentition. But unfortunately, cavities happen, and they happen often, so restorative procedures are necessary. 

Paediatric restorative dentistry is unique. It involves so much more than little fillings on little teeth, and so much more than a bandaid approach. Clinically, we must consider the unique anatomy of primary teeth, the risk assessment of our young patients, and the properties and longevity that each different restorative material offers. But beyond this it is so very important to recognize what is possible to accomplish for each individual child.

Guidelines on pediatric restorative dentistry can be found at the American Academy of Paediatric Dentistry website. It is imperative to understand and follow these guidelines and to understand the clinical indications of our many varied restorative materials and modalities. It is then our responsibility to assess our patients’ needs and apply our clinical judgement and expertise for our individual patients. 

As we are all well aware, children’s behavior and cooperation in the dental chair can be excellent, but can on occasion be a challenge. As we strive to provide the best possible indicated treatment for our children, we must also be aware of what we are capable of providing and what our child patient is capable of receiving.

Restorative options for our pediatric patients have never been more vast and varied as they are today. Years ago, amalgam and stainless steel crowns were the only alternatives. Today we have so many more choices: silver diamine fluoride, glass ionomers, resin modified glass ionomers, bioactive composite resins, ormocers, prefabricated pediatric crowns, and resin infiltration, to name a few. 

The Considerations

To determine what is best for our patient, we must consider many factors to guide the best techniques and restorative materials. Preliminarily, we consider the age of our patient and ability to cooperate with treatment, which gives us the first indication of patient tolerance. Tolerance can be inversely proportional to the amount of treatment required.

The extent of decay in our patients (number of teeth affected and complexity of treatment plan) will influence the number of appointments required and the patient’s ability to carry through with treatment. More decay requiring multiple appointments leads to less ability to tolerate multiple appointments.

The age and stage of cooperative development indicate whether we are likely to control our working environment with proper isolation. The ability to isolate must be evaluated indicating success with hydrophobic materials, our water-hating composites. Alternately, the inability to isolate determines by necessity our choice of hydrophilic materials, such as our water-loving glass ionomers.

As all of our materials are not created equal in their resistance and strength, the number of surfaces and the width and depth of decay (per individual tooth) must be assessed so we may choose a material with appropriate strength.

Caries risk assessments must be done, which will then indicate the advisability of treating minimally invasively or more thoroughly to ensure success. The stage of dental development also must be assessed to determine the necessity for longevity.

As we are aware of average ages of exfoliation and eruption, we recognize that they vary quite greatly. It is not enough to assume that since our patients are within the appropriate age range that they will be “average.” Finally, parental preference must be considered, as they may guide the choice of materials. 

So much must be considered to keep our children and their primary dentition happy and healthy. Wishing you happy practicing, and always respect the primary teeth!

Dr. Cohn graduated from the University of Manitoba in 1991 and completed a postgraduate internship in pediatric dentistry at Health Science Centre Children’s Hospital in Winnipeg, Manitoba, Canada. Her private practice at Kids’ Dental is focused on prevention and the growth and development of a cavity-free generation. She has also been a part-time clinical instructor of pediatric dentistry at the University of Manitoba for more than 20 years. Dr. Cohn is a member of several dental organizations and has recently co founded the new Women’s Dental Network in Manitoba. She has served on the Manitoba Dental Association Board and as president for the 2016 to 2017. Dr. Cohn enjoys speaking nationally and internationally on all aspects of pediatric dentistry for the general practitioner. She can be reached at

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