Demineralization of teeth in children

Causes and remineralization treatments

Demineralization of teeth is a common issue among children, affecting both primary (baby) teeth and permanent teeth. This can lead to complications such as enamel dysplasia or dental cavities.

Therefore, regular visits to a pediatric dentist are recommended every 6 months, starting from the emergence of the first teeth. This can help prevent future problems, which can only be addressed with the help of a dentist. In the following, we will cover everything you need to know about tooth demineralization in children, as well as preventive and treatment methods that can support your efforts to ensure your child has a beautiful and healthy smile.

What is tooth demineralization and how does it manifest?

Tooth enamel – the hard outer layer that protects teeth from dental cavities – has a complex composition and structure, consisting of various minerals. Among these, calcium and phosphates are the most important and form hydroxyapatite, but enamel also contains a variety of other minerals such as strontium, magnesium, lead, and fluoride.

Given the structure of enamel, the loss of certain minerals – or demineralization – can pose a threat to both the health and appearance of the teeth. After demineralization, teeth can become harder to maintain, and white spots may appear, which are aesthetically displeasing. Additionally, demineralization can lead to surface roughness – a risk factor for the development of bacterial plaque and tartar. Oral health can be compromised and complications may arise if demineralization is not treated.

Symptoms of tooth demineralization

There are several signs that indicate possible damage to the teeth due to demineralization:

• The appearance of white spots on teeth indicates a decrease in the optimal level of fluoride in the tooth structure. In advanced stages, demineralization spots may become darker in color.
• Changes in the texture of affected areas – spots will have a rough texture, in contrast to the smooth, glassy texture of healthy enamel. As demineralization progresses, the porosity of the affected areas will increase, giving the tooth a chalky appearance.
• Sensitivity of the affected teeth – since the enamel is compromised, demineralization can cause sensitivity to very cold or very hot foods and drinks.

Although demineralization is not, in itself, a medical condition, it can contribute to tooth damage by eroding the surface, affecting the dentin, and increasing the risk of cavities. In children with demineralized baby teeth, poor dental hygiene, unhealthy eating habits, and delaying treatment at the dental office can lead to premature loss of these teeth and may jeopardize the foundation for permanent teeth.

Fortunately, tooth demineralization can often be stopped or even reversed.

How to recognize signs of tooth demineralization in children

Firstly, visits to a pediatric dentist from the emergence of the first baby teeth are crucial for prevention, as specialists can observe the early signs of demineralization. Additionally, you can also check at home, with the naked eye, for signs of tooth demineralization.

Causes and risk factors for tooth demineralization in children and babies

There are several factors that can contribute to tooth demineralization in children. For a specific diagnosis of the cause, a dental consultation is recommended.

However, here are the most common factors:

• Excessive consumption of citrus fruits – the citric acid in these fruits can affect tooth enamel and lead to calcium loss in the teeth.
• High sugar intake – sugars and sugar-containing foods are a significant risk factor for mineral loss in tooth structure.
• High intake of fermented dairy products – yogurt, buttermilk, or kefir can increase the pH level in the mouth and thus lead to tooth demineralization.
• Consumption of carbonated soft drinks – the acids in these drinks can attack tooth enamel when consumed frequently.
• Consumption of starchy foods – starches increase the amount of fermentable sugars, affecting tooth enamel similarly to sugars.

Risk factors for tooth demineralization

In addition to the causes that can lead to tooth demineralization in children and adults, there are also several risk factors for predisposition to this problem:

• Digestive disorders such as gastroesophageal reflux can cause acidity and affect tooth enamel.
• Dry mouth (xerostomia) can be a risk factor for demineralization, as saliva helps neutralize acids in the oral cavity.
• Bacterial plaque and poor or inadequate oral hygiene also contribute to increased acidity in the mouth.
• Wearing braces represents a risk factor because it requires meticulous oral hygiene. Otherwise, the dental enamel might suffer. Although orthodontic appliances are not inherently harmful to tooth enamel, when combined with inadequate oral hygiene, they can become a risk factor for demineralization.
• Fluorosis is a condition characterized by a high level of fluoride in the teeth, which can affect the structure of tooth enamel in children, especially during the period when baby teeth are replaced by permanent ones.
• Administration of certain medications that increase acidity in the oral cavity.
• Dental trauma to temporary incisors can lead to demineralization issues in the permanent incisors.
• Dental hypomineralization leads to incomplete maturation of the enamel and sensitivity of the teeth, factors that can contribute to their demineralization.
• Amelogenesis imperfecta (a rare congenital condition associated with gene mutations that lead to abnormal formation of enamel and the outer layer of the dental crown) or hypocalcification of the teeth, which can affect the entire dentition, in both temporary and permanent stages.

Diagnosis of dental enamel demineralization

Sometimes associated with breastfeeding and bottle use, dental demineralization can be accurately diagnosed only after a specialized consultation with a pediatric dentist. They will be able to distinguish between demineralization and conditions such as enamel dysplasia or hypoplasia and will identify the causes that led to the deterioration of the dental surface.
The pediatric dentistry specialist will also observe any complications of demineralization, such as dental caries, and will be able to establish an effective treatment that will also prevent damage to the permanent teeth.

What complications can dental demineralization have:

Untreated demineralization of dental enamel in children can lead to complications such as:

• Baby bottle tooth decay - affects primary teeth, except for the mandibular incisors. The occurrence of baby bottle tooth decay is associated with improper use of the bottle and "sweetening" the pacifier with honey or sweet foods.
• Chronic decay - can occur at any age, affecting both primary and permanent teeth. Frequent snacking, high consumption of unrefined carbohydrates, and dry mouth or reduced saliva production are common causes of chronic decay.
• Enamel dysplasia - while demineralization represents a structural defect, enamel dysplasia is a condition with manifestations both in the shape of the tooth (uneven surfaces or striations) and in its color (white-yellowish or brown spots).

Remineralization treatments for primary and permanent teeth

Most often, demineralization of teeth in children is treated through local fluoridation and sealing. In adults, treatment may additionally include teeth whitening procedures to restore a uniform tooth color.

Here’s what you need to know about these types of treatments:

Fluoridation or fluoride prophylaxis

This treatment is performed by applying fluoride to the dental enamel in the form of a gel containing this mineral. The gel is applied either with a special brush or using a fluoride tray. Fluoride prophylaxis is a simple, safe, minimally invasive treatment that can be applied to both primary and permanent teeth. The fluoride applied in this manner is gradually released into the enamel and has a number of beneficial effects:

• Inhibits the demineralization process, strengthening the structure of the dental enamel;
• Improves remineralization;
• Reduces bacterial growth, thereby preventing the formation of cavities.

Fluoride prophylaxis can be repeated, depending on the dentist’s recommendations, every 3-6 months.

Tooth sealing

Tooth sealing is a dental procedure that involves applying a resin to the enamel of primary teeth to protect them against cavities. This treatment is temporary and lasts approximately 2 years, performed in a single visit to the dental office, and is applied to molars and premolars affected by demineralization. Following sealing prophylaxis, proper dental hygiene is essential.

Methods of prevention for dental enamel demineralization

Although remineralization treatments exist and are effective, the best treatment is always prevention. Here are some preventive measures to avoid demineralization of your child's primary or permanent teeth:

Proper dental hygiene

Bacteria entering the oral cavity through the ingestion of food or beverages can lead to demineralization of the teeth. Acids present in bacterial plaque can accelerate this process, leading to cavities. An effective way to remove bacteria and avoid these effects is regular brushing of children's teeth. Like adults, children should brush their teeth at least twice a day to remove food debris and dental plaque.

Most toothpastes contain fluoride, so this habit also helps reintroduce this mineral into the structure of the teeth and dental enamel. However, consult with your pediatric dentist before choosing a fluoride-rich toothpaste for your child.

Use of fluoride

Fluoride is present not only in toothpaste recommended for remineralizing teeth but also in various other products. You can increase fluoride intake by using tap water, as it contains this mineral. Fluoride supplements such as mouth rinses, foams, creams, or dental gels can also be helpful. These should be used based on the dentist’s recommendations following a dental check-up.

Consumption of foods rich in vitamins and minerals

Calcium, vitamins, and minerals can help stop and reverse demineralization. Many foods such as spinach, grapes, and certain types of seafood are rich in fluoride, and including them in the diet can enhance the absorption of this mineral.

Additionally, dietary supplements containing magnesium, calcium, collagen, vitamin D3, and vitamin K2, administered under the guidance of a doctor—if a deficiency is observed—can improve mineral absorption, including at the level of the bones and teeth.

Limiting sugar and highly acidic foods

Sugar, fruits, fruit juices, dairy products, and starchy foods promote bacterial growth and increase the acidity of the oral cavity. Acids attack the protective enamel of the teeth, which can lead to demineralization. Small dietary changes, such as replacing regular snacks with sugar-free options, can be a first step in this direction.

As for highly acidic foods, don’t limit yourself to fruits and soft drinks. This includes food ingredients that contain phytic acid, known for preventing mineral absorption, such as almonds or rice and wheat bran. While consumption should not be avoided entirely, as such foods can have various health benefits, moderation is necessary.

Proper hydration and maintaining optimal saliva levels

Saliva plays an important role in neutralizing acids in the oral cavity produced by harmful bacteria. Issues such as dry mouth syndrome can exacerbate demineralization of teeth in children. This can be caused by dehydration or other problems. Saliva substitutes and optimal hydration can help avoid demineralization of your child's teeth.

In conclusion, although demineralization of teeth is not, in itself, a medical condition, it can lead to some, such as dental cavities. It is important to observe it in its early stages so that preventive and treatment methods can have quick results. Therefore, it is important to take your child to the dental office at regular intervals, at least twice a year.

Resources:

• https://www.wearebitesize.com/5-things-secretly-harming-children-tooth-enamel/
• https://www.drubiorthodontics.com/how-to-stop-demineralization-of-teeth/
• https://www.monavaledental.com.au/chalky-teeth-in-children-molar-hypomineralisation/
• https://happydent.ro/despre-dintii-temporari-si-despre-demineralizare-la-pediatric-dentist-copy/
• https://pubmed.ncbi.nlm.nih.gov/16510911/
• https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P01848