Mar
I often get questions from my patients concerning their children’s teeth. This particular letter had a lot of good information I thought I’d share with you.
Hello,
My husband and I are both patients. We currently live overseas and will be coming to Santa Barbara for a vacation and will be scheduling ourselves at that time. However, I have a much more urgent question regarding our daughter, who is almost 2 1/2 years old.
We took her to a local dentist this morning and he confirmed our concerns that she has cavities in her molars, and also that the enamel on her front teeth is starting to wear away (there is what looks like a faint brown sheen on her top front teeth). I think this is a result of letting her take a bottle to bed when she was younger (yes, we feel like bad parents). At any rate, he is recommending sedation for about two hours to have the cavities filled and file away the damage on the front teeth. He recommends we go to South Africa to have the work done, as he said there is no facility of sufficient quality locally to do the work. He recommended we get the work done in the next two months or so to prevent further decay. I told him we are headed to the U.S. in June and would rather wait to have the work done by Cynthia or someone reputable that she recommends, which he said was possible although of course any time that passes increases the risk of progression. He gave us some tips for keeping her mouth as wet and non-acidic in the meantime to try to inhibit any further growth of the cavities (they have not yet reached the root). I can forward his official report and findings as soon as he sends it to me, which he has promised to do.
Thank you so much for your thoughts on this. My preference would be to schedule an appointment for our daughter with you or someone you recommend in late June when we are going to be there, but I am interested in your opinion on whether we can wait that long.
Best,
Jane
Hi Jane,
I understand your concern. The true depth of the cavity lesions are unknown by anyone unless x-rays have taken. This means they may be less than or greater than what they appear in the mouth.
My preference with very small children is to book a time with our anesthesiologist and while the child is under safely, access and treat everything (whether it’s two teeth or several), while there is excellent isolation and control of the tissues.
Conserving healthy undamaged tissue and judicious removal of the infection and damaged tissues are paramount. I prefer microabrasion over a handpiece (drill), especially in young children for this reason.
Materials: Amalgam has a large mercury component. Avoid it if you are able. Being in a country where your choices are limited, if you truly are under the pressure of time and it’s the only way to retain a tooth’s health, you may need to. Other options include glass ionomers, composite resins, or hybrids of the two.
Amalgam has the disadvantage of requiring more tooth removal in the preparation for it to stay in. Biocompatible materials mentioned above may need to be replaced (when your child is older) due to wear.
The front teeth are more challenging to predict. Much depends on where the lesions are, how erupted the teeth are and how much enamel remains. Options here range everywhere from treating with baby tooth resin “crowns” to removing fracturing enamel and palliatively coating with fluoride varnish (a coating placed only on the teeth to be treated) judiciously placed at home.
Since 2.5 year-olds cannot really spit, I would avoid fluoride tooth paste – it is of limited value and will be swallowed. Have several toothbrushes around. Brush often and dry, with water only, or a very diluted solution of water and baking soda (which tastes almost sweet) several times a day and after meals. Make it quick, thorough and frequent. Your child needs to see you doing this for yourself as well. A clean brush or the “right place” to brush is less important than frequency.
Only very diluted juices (all the sugar and none of the real benefit of whole fruit), and no dried fruits.
Lastly, make sure that your child is only “swapping spit” with those who themselves do not have dental issues. High loads of the Strep (cavity causing) bacteria are transmitted from caregivers to child.
Best,
Dr. Cynthia