Toddler cavity - being told require IV Sedation and possible crown -help!

[tawstuart]

Hi Mamas,

Need your ears and advice. This past weekend was changing my 2 year old son's diaper and noticed the tooth behind his canine looked hollowed out and tinged with brown stain. We immediately took him in first thing this morning (first time at dentist and they worked us in) to be evaulated. We should have prepared him better - they rushed us back to the room and the doctor did not spend much time getting to know him before she started prodding in his mouth. So of course he started to scream and not be cooperative (they did not even have the DVD player above him where he could see it until he started to scream). The dentist said he had a very dep cavity - close to the nerve - possibly may need a crown (!!!) and 2 other possible smaller cavities. She did not even attempt an x-ray but said he would need to be IV sedated to get an xray for a better idea as to what was going on and we could not be in the room with him during the procedure - oh and $2000. (Of course my husband forgot to add our son onto our dental plan this year - it rolled over from last year when he was 1 and hubby forgot to add him).

I feel horrible because he still night nurses and I don't wipe his gums like I should. We brush with his electric toothbrush and xylitol toothpaste evey night (and try to during the day as well). He also has white spots on his teeth which the doctor said was from too much iron (I did give him a multi with minimal iron when he had bloodwork that said low on iron but did not give it to him for a long period of time) and that it may also be on his permanent teeth. Our pediatrician said he did not need to see a dentist until 2 and I let our family hygentist peep in his mouth when he was 1 and she thought everything was ok. At his 2 year check up in May the doctor said it was time to go but he had an ear infection at the time - which did not resolve - and we dealt with that until June - then he had an explosive bloody stool in June - so we were at the GI specialist - and it just seemed like there were other things to take care of than his teeth. I just feel horrible - I have failed him.    

Add to it - we are leaving to go out of town in 2 days and will be away for 2 weeks - so I feel like I have to do something quickly.

We are getting a second opinion but wondered if any other of you mamas had a simliar story and how you dealt with it.

Thanks for your help!

Trish

[Lula's Mom]

We had pretty much the same story, hollowed out tooth and all.     My son was a little older, maybe 4?  He's NOT trusting of strangers, and the first dentist we went to was awful. Though he was a ped dentist, and had a lovely carousel outside, it didn't change the fact that he was gruff and brusque, and didn't respect my concerns or anything I had to say.  He also told me that my son would need IV sedation and a crown, which he didn't do in office. So it would be in the hospital.

I really dislike doctors with a God complex, so I found a different dentist.  And it wasn't right away.  We waited for months, making sure to brush well, use xylitol etc.  When my son began to complain of pain, we took him to the new dentist. This man and his staff took 2 full hours getting my son comfortable on his first visit.  And they did. They were able to get him to open his mouth, take x-rays, etc.  Being a dentist, he admitted that he really would like to save the tooth by doing a pulpectomy (baby root canal).  I said I'd rather have the tooth pulled and a spacer put in, so that is what we did.  This office offered IV sedation on certain days, so it could be done in office.

Because of how comfortable my son was, we did not end up doing IV sedation though!  We used Versed, which my son actually drank in a cup; I couldn't believe it.  I was freaked out by the description of it as an amnestic, and so worried that ds wouldn't do well with it.  But he just got woozy, never fully asleep.  He was able to follow instructions during the extraction. Afterwards he came out of it quickly and felt great- no fear whatsoever.  He didn't remember the extraction, just reading a book before, and getting a prize after.  He actually loves going to this dentist.

His father and I were both there for the extraction.  There is NO WAY IN HELL I would let my son go through that without me there (there's no way they would have gotten him to stay if I left, anyway!)   There are a lot of dentists who have the policy that parents aren't allowed back, even for checkups.  That is just wrong and I won't support those dentists.  Would a pediatrician ever ask you to leave during your toddler's exam? No.  It's the same, and I would find another dentist who allows parents. There are plenty of those too.  Ask for recommendations in Finding Your Tribe, if you haven't already.

Good luck! I know it's worrying, but don't rush it.  Find the right dentist.  A couple of weeks is not going to make a difference.

[tawstuart]

Lula - thank you so much! I also spent hours online last night unable to sleep and found Dr. Ellie. http://www.drellie.com/  Going to try to stabilize things while I find the right person. :) I really appreciate your feedback and help!

[tawstuart]

Oops - I meant Kristi :)

[HappyMonkey]

Here's a good Yahoo group for information too: http://health.groups.yahoo.com/group/veryyoungkidsteeth/

I just went through this.. our daughter had to get 3 teeth pulled and three filled. It all happened in about 3 months from first sign of a cavity (tiny) to some teeth being almost gone. Not all decay acts this quick though. She was 18 months almost when they were fixed/pulled under a general anesthetic. I got to be there when she went to sleep and was there when she woke too.

[Baby Mama]

You didn't fail your child.  Once a baby tooth gets a cavity it spreads really quickly because the enamel is so thin. Teeth can also form in such a way that makes it impossible for toothbrush bristles to reach (eg. if there are little pits in the surface).  If you are brushing 1+ times a day then it looks like your LO does have some kind of susceptibility that may require added preventive measures.  But you can only do so much so perhaps better preventive measures should include at brushing well at least 2 times a day, maybe 3.  

A previous poster noted that her LO was able to do well with a dentist with a better bedside manner.  However, your LO is only 2 and therefore not likely to be responsible to a gentler personality, (ie. a 2 y.o. doesn't usually have the emotional capacity that would allow him to be able to be coaxed into receiving a needle, pulpotomy, and crown, let alone have the capacity to be able to lie still for the whole procedure).  Furthermore, once a 2 y.o. decides it's freak out time, good luck.  Also consider the fact that once they start crying their little noses get plugged up; you can't expect dental work to be to be done if they can't breath out of their noses, (ie. drilling involves water spraying into their mouths which would preclude them from breathing through their mouths).  To me, $2000 is nothing if the work can be done in a safer way.  I've seen a lot of dental work done on children who really should have had it done under some kind of sedation and it makes me really angry to have witnessed such events, (for so many additional reasons that i can't get into or this post is going to be horrendously long).  

With respect to some dentists requiring that parents be out of the room when work is being done, there usually are reasons.  If your dentist or doctor asks for that, ask why.  Sometimes it has to do with the very real fact that children tend to be much more uncooperative when parents, especially moms, are in the room.  But of course this is only a factor in the "potentially cooperative child", which your 2 y.o. probably is not, so whether you are in the room or not is probably not going to help/hinder anything.  

[LynnS6]

We had to have several cavities and a crown when dd was 2 1/2 or so. Same story -- frequent night nurser, milk pooled on one side of her mouth and combined with bacteria she got from someone in the family, she got deep cavities.

We were able to do the Versed partial sedation and she was fine. We had a super pediatric dentist whose whole crew was amazing. It's definitely worth searching out a dentist with a good "chairside" manner. Also, when you call to make the appointment, explain that your child is a bit cautious and needs time to warm up.

[tawstuart]

Thank you all for your help and feedback. I am truly grateful.

[Italiamom]

Originally Posted by Lula's Mom 

There are a lot of dentists who have the policy that parents aren't allowed back, even for checkups.  That is just wrong and I won't support those dentists.  Would a pediatrician ever ask you to leave during your toddler's exam? No.  It's the same, and I would find another dentist who allows parents.

[MeredithA]

I agree that it is important to find a dentist that will make the child comfortable. Any doctor for that matter should try to put your child at ease. When my ds needed tubes in his ears we saw three different ENTs before deciding who did the surgery. 

Don't beat yourself up about the cavity - you haven't failed him. Like another poster said, some kids are just more susceptible. 

[McGucks]

DS1 had a similar situation.  It seemed ridiculous to do all that work on a baby tooth, so we opted for a pediatric dentist (had to in order to obtain a small dose of Valium and nitrous) who just took the darn thing out. 

Whether you are prone to cavities has a ton to do with genetics, by the way.  You didn't do anything wrong!  Another child could have been on the exact same regimine and nursing schedule and nothing would've happened.