I’ve been trying to gather information about dental care for very young children, and your blog seems to be well informed. My daughter is four years old, and to date has not really had a true dental appointment. I’ve taken her to several different dentists, but she refuses to open her mouth for any of them. My first question is whether you think a pediatric dentist would have better luck than a general dentist, or if I will have to think about letting them sedate her, as the last dentist suggested. I hate the idea of sedation, but things are getting critical.
She lets me look in her mouth occasionally. I can see four teeth on the top that have cavities, and two of them look really deep. I don’t see anything really worrisome on the bottom teeth yet, but have not had a really good look at those in a while. The two teeth on top that are really bad have started to chip away, and that brings me to my second question–can anything be done to salvage those teeth? From the reading I have done, I know that if those teeth are pulled, it could mess up the alignment of her teeth permanently, even though they are baby teeth. I’ve been reading about porcelain crowns and white fillings, and both of those sound like good options, if they will work with really damaged teeth. I don’t want her to feel self conscious if we have to do some kind of metal filling or crown.
I know you can’t make a definitive diagnosis just from my descriptions, but any information you can offer would be great.
Doreen in Tallahassee
We recommend locating a pediatric dentist that has experience with sedation dentistry. That way, if your daughter can’t be persuaded to open her mouth, you can have a “Plan B” in place to get her the dental care she needs.
You are absolutely right that the best course of action would be to salvage those decayed teeth. If they cannot be saved, she will need some kind of space maintainers so her permanent molars do not drift forward, which would be expensive to fix down the road. Because these are baby teeth, your dentist will recommend a temporary fix kind of solution, such as a stainless steel crown. This will not look nice, as you point out, but if you are willing to pay for a porcelain crown that will only last a few years, your dentist will certainly place it. If the decay is not too widespread, your dentist might also be able to use white fillings or direct dental bonding to protect the remaining tooth structure. The best advice I can give you in this matter is to listen carefully to what the dentist recommends, and make your decision from the options presented. It is usually a bad idea to push a dentist into doing a treatment that they don’t feel comfortable with.
Another matter that must be addressed is how your daughter’s teeth wound up with this level of decay. The kind of decay you describe has to be fed continuously, all day, every day. Unless you want to face this situation again and again, you’ll need to change the way your daughter eats. She should only eat every three or four hours, and she should be brushing or at least rinsing with water every single time she eats.