Dra. Mariana Costa

Médica Dentista 

The importance of deciduous teeth
Taking care of the present to ensure a healthy future

HPA Magazine 24 // 2025

Deciduous teeth, commonly known as baby teeth, are structures that, despite being temporary, play a crucial role in a child's development. In addition to their aesthetic function, they are essential for chewing, speech, proper jaw growth, and the orientation of permanent teeth

Chronology of deciduous teeth
The eruption of deciduous teeth begins, on average, around six months of age, usually with the lower central incisors, and is completed around two and a half years (30 months) with the eruption of the upper second molars. This dentition consists of a total of 20 teeth: 8 incisors, 4 canines, and 8 molars. Their physiological exfoliation (falling out) usually occurs between the ages of 5 and 13, a period in which they are gradually replaced by permanent teeth. During this period, there is the simultaneous presence of deciduous and permanent teeth – the so-called mixed dentition – a particularly sensitive and critical phase for craniofacial development, in which occlusal patterns and maxillofacial growth are consolidated.

Essential functions of baby teeth
• Efficient chewing, essential for adequate digestion and balanced nutrition;
• Development of speech and correct articulation of sounds;
• Maintenance of the child's aesthetics and self-esteem, relevant factors with an impact on the socialization process;
• Preservation of the dental space necessary for the correct guidance of the eruption of permanent teeth;
• Functional and harmonious growth of the jaws and facial structures.Early changes in the integrity or presence of these teeth can trigger long-term consequences, such as occlusal dysfunctions, orthodontic needs, or eating and emotional disorders.

Childhood dental caries
Childhood dental caries is one of the most common pathologies in paediatric age, in which bacterial adhesion to the enamel and the formation of biofilm contribute to the persistence of the cariogenic process. This is caused by the action of acids produced by bacteria in the oral cavity that metabolize sugars present in the diet, thus leading to demineralization of the enamel and, if left untreated, progressive destruction of the tooth.
In deciduous teeth, the progression of the carious lesion is generally faster due to the thinner mineralized structures (enamel and dentin) and the proximity of the pulp chamber (nerve), increasing the risk of pulp involvement.

Main factors associated with the development of caries in children
• Inadequate or non-existent oral hygiene;
• Inadequate use of toothpaste (without fluoride);
• Diet rich in sugar;
• Prolonged use of baby bottles with sugary liquids, especially during the night; 
• Lack of regular dental check-ups;
• Socioeconomic and educational factors.

Consequences of not treating cavities
Failure to intervene in cases of cavities in primary teeth can result in:
• Pain: with a direct impact on quality of life (eating, sleeping, school performance);
• Serious infections: untreated cavities can develop into infections that affect the soft tissues of the face (cellulitis), with a risk of systemic spread;
• Nutritional impairment: resulting from pain when chewing, which leads many children to avoid hard or healthy foods, such as fruits and vegetables, resulting in a poor diet;
• Problems with speech, socialization, and self-esteem: premature tooth loss can affect diction and cause emotional and psychological impact;
• Increased risk of future cavities: children with cavities in their baby teeth are more likely to develop cavities in their permanent teeth, which justifies surveillance and intervention strategies;
• Disorders in the development of permanent teeth, including retention, changes in the correct position of the teeth, and loss of space;
• Long-term clinical and social costs: failure to intervene may lead to more complex treatments and expensive rehabilitation in the future, including extractions, space maintainers, or corrective orthodontics.

Why should cavities in baby teeth be treated?
A misconception still persists among many caregivers: that, because they are replaced, baby teeth do not need care or treatment. However, untreated cavities can cause pain, infections, difficulty chewing, and changes in speech development. In addition, they can negatively affect the formation of permanent teeth and cause changes in the dental space, predisposing to orthodontic problems. Therefore, cavities at this stage must be taken seriously, due to their rapid progression and negative impacts in the short and long term, thus preventing future complications and promoting oral health habits that last a lifetime.

The importance of early intervention
The treatment of carious lesions in primary teeth has a therapeutic, preventive, and educational approach. Early intervention aims to preserve oral functions, control the focus of infection, maintain the eruption chronology, and reduce anxiety associated with dental treatment.
 The American Academy of Paediatric Dentistry (AAPD) and the Directorate-General for Health (DGS) recommend that the first paediatric dental appointment should take place within the first year of life.
 Clinical monitoring from the first year of life allows:
• Detecting any condition or habit that may harm the child's oral health;
• Clarifying the stages of tooth eruption and the symptoms that the child may experience;
• Evaluating and controlling risk factors;
• Explaining and implementing preventive measures;
• Developing a positive relationship between the child and the oral health professional;
• Reducing trauma associated with treatment;
• Promoting consistent eating and oral hygiene habits;
• Treatment of cavities according to the dentist's instructions, thus preserving oral functions, preventing infections, and contributing to the child's general well-being.

Prevention of cavities in paediatric age
The prevention of dental cavities should begin at birth, with a focus on parental education and environmental control. Family motivation, combined with public policies on children's oral health, is crucial for successful prevention. There are some fundamental strategies that can be implemented early on, such as:
• Parental education: knowledge about oral health should be promoted from pregnancy, since the child's oral microbiome is influenced from an early age and vertical transmission (mother-child) is a frequent route of bacterial colonization, especially in contexts of poor oral hygiene and a diet rich in sugars;
• Oral hygiene from birth: with gum cleaning with gauze before eruption and brushing with fluoride toothpaste after the first teeth appear;
• Dietary control and reduction of sugars: limit the consumption of sugary foods and drinks, especially between meals;
• Promotion of fluoride use: regular use of fluoridated toothpaste with professional guidance regarding concentration and frequency;
• Regular monitoring: first consultation up to the first year of life and subsequent periodic monitoring adjusted to the child's risk of caries.

Treatment is also education
The clinical approach to caries in primary teeth requires an integrated and multidisciplinary approach. More than treating lesions, it is essential to act preventively and educate about health. Baby teeth are essential for the balanced growth of the child and must be preserved until their physiological exfoliation.
 Neglecting them compromises future oral health and represents a missed opportunity to promote healthy habits.
 Treatment of caries in childhood is not limited to resolving the lesion. It is also an opportunity to educate children and caregivers, implement healthy habits, and establish a positive relationship between the child and the dentist. Preventing episodes of pain and trauma favours more collaborative attitudes in the future and contributes to maintaining oral health throughout life.
It should be emphasized that a child's first appointment should not be for emergency/pain but rather for prevention. In addition to creating bonds, it also creates the habit of visiting the dentist in a routine and relaxed manner.
Investing in paediatric oral health ensures not only a healthy smile but also a future with greater well-being, self-esteem, and quality of life for our children.