Treat - yes
Fix (fill or cap) - sometimes
2 years ago my 3yo had rapid decay (over 3 mos) and fell and chipped 3 out of 4 of his front teeth. My (adult) dentist blamed it on night nursing. I went to a fantastic pediatric dentist who didn't.
This was 2 years ago and we've been doing ONE thorough brushing at night with topical fluoride before bed and the caries on his incisors have hardened and last year we filled the molars with nitrous in the dentist's office.
1 year appt pediatrician noticed reduced enamel on backs of front uppers advice: stop nursing him at night. Took DS to my (adult) dentist who advice: stop nursing him at night and see me in 6 mos.
3 months later: Ds fell and chipped 3 of his front teeth - they looked horrible! Took him immediately to my dentist and got an immediate referral and appt to a wonderful pediatric dentist. He scraped out a bit of the softest decay and gave us APF (acidulated phosphorous fluoride 1.2%) and said it was not the worst he'd seen that remineralized, but 8/10.
2y3m: incisors were hardened, but molars were just a little bit better so we filled with composite with nitrous oxide - DS did great. Pediatric dentist said it's more difficult to get molars to remineralize than incisors.
3y3m (now): DS has an appointment next week for a big boy cleaning. Still no sign of softness on the front teeth or new spots of decay. The former caries are black, but plenty hard.
I think it is absolutely necessary to TREAT
the caries. Look at diet, habits and eliminate juice (although my DS only had BM or water when he had his decay), frequent carb snacks, increase xylitol and pay attention to mouth hygene including at least one super good brushing before bed. You can still night nurse, but from www.brianpalmerdds.com
adding BM on top of food does contribute to caries, BM on clean teeth does not. We DID hold DS down to brush his teeth.
For us, topical fluoride was key. A teeny drop once a day with the night time brushing (we did it 2-3x a day in the beginning to get things under control).
As far as FIXING
teeth, we went both ways. On the molars which were only getting slightly harder, we chose to fix because he's going to have those teeth for many years to come before they fall out. For the fronts, which will be his first to fall out, we chose not to 'fix' because the caries had remineralized (hardened) and caps would just be aesthetic.
Even if you 'fix'
teeth with fillings or caps, little mouths are still at risk because unless you change the environment, caries can still come back. If you 'treat'
the little one with changes in diet, oral hygene, etc you're reducing the opportunity for caries to form.
In our case, DS mouth was acidic most of the time, apparently something we share. We've been adressing this tendancy to acidity with diet and have made improvements with that as well. For him, this was part of his treatment.
Hope that helps.