Dentist quest's? Abx necc. 4 abscess? Anesth for 5 y.o.?

[zebaby]

Lots o' questions before our appt...

So far, we've been pretty alternative with dental care for my 5 y.o. son (ozone, MI paste, spry, cell salts, no fluoride). Unfortunately, he's got continuing decay. There is one cavity in particular that looks awful. It's located between two molars (lower right) so I've been unsuccessful in cleaning it out properly. It's progressed significantly, and now has signs of an abscess on the gum below the tooth (small pea sized lump). He has no pain other than occasional discomfort when brushing. I've come to grips that we'll likely have to drill and fill to keep it under control.

We're going to a pediatric dentist (they seem pretty traditional, but have the diagnodent as well as digital x-rays, so I'm hoping they'll be open to alternatives). I'd like to know what to ask the dentist regarding treatments and possible alternatives. My son's never had x-rays, so I'm also wondering of the safety of digital x-rays.

Regarding the abscess, is there ever a case when abx are not necessary (I've heard some dds just monitor it)? Can the body heal itself in that case? Are there different kinds of abx or strengths to ask for?

If/when we go through work on the tooth, what is the safest anesthesia to use with a young child? My son is very cooperative, but he's never had a negative experience at a dds office. I'd like to be as holistic as possible when choosing anesthesia, but also want to make sure his experience is as comfortable as possible if we do have to go the route of drilling.

Sorry, just thought of another question, if the decay has not gone to the nerve (he never had pain to indicate so), can the decay be removed and remaining tooth be left to remineralize? or does it need to be capped (when is that called for?)?

Thanks in advance for any advice!

[onlyboys]

I would think that abx are necessary when the tooth has an absess.  Normally, a quick course of amoxicillin can help with it, and it is fast.  I think you might need to speak to the pediatric dentist for the rest.  I personally prefer to use a family dentist for my children; somehow they seem more relaxed about not using sedation and they are a lot less expensive. 

[desertdentist]

I am a general dentist, and can give you a "heads up" about this upcoming appointment for your 5 year old son. X-rays will be necessary to evaluate the abscessed tooth and would be helpful to diagnose any other areas of decay.  (Digital x-rays have 80% lower radiation than traditional x-rays.)

Once the tooth has abscessed, the decay has infected the nerve and the body cannot fight off the infection without treating the decay.  The dentist will evaluate after looking at the x-rays to see what type of treatment is needed, and if antibiotics are necessary.  Talk with the dentist about the type of anesthetic needed to perform the work. Often it is scary for children (or adults, too!) to have dental work done, so the pedodontist may recommend sedation for your son's comfort during the dental appointment.

Good luck to both of you!

[zebaby]

Thanks for your advice! I did end up doing digital x-rays. I also asked about sedation. On the one tooth, the decay did reach the nerve. I'm very torn about extraction. Of course, I would hate for any complications in DS' health in any way, but the more I think about it, I feel extraction could be a traumatic event. DS has been very cooperative at the dentist office - absolutely no trauma whatsoever. However, the thought of a dentist yanking the tooth out and him realizing that a part of him is missing, is potentially devastating. He hasn't lost his first tooth yet, though one is loose. I get the feeling that he's a little tentative about losing it (he's not trying to wiggle it at all and doesn't like it much when I do), so I'd hate for his first one to be prematurely extracted - kwim?

For those in the dental field out there, is it unreasonable of me to wait until he loses his first 1 or 2 teeth (they're both quite loose - wiggle even during flossing) before moving forward? He's started antibiotics, so I'm not sure if that will buy us any time. The dds said it could buy us a few months, up to a year, but not enough time until it falls out on its own. On a related note, if it is decayed down to the root, will it just fall out on its own earlier than usual anyway? Sorry if that's a preposterous of me to ask, I just would hate to set my child up for a traumatic experience if it could be avoided 

[LynnS6]

The danger with waiting until the tooth falls out on its own is that the decay could get into the adult tooth and then he'd be starting with a tooth that needs to be filled.

Why do you think that an extraction would be traumatic? I've known a couple of kids who've had extractions and they think it's cool! The other question to ask is whether the dentist can do a root canal and a crown. It's a lot cheaper to pull the baby tooth, but it is possible to get the crown. Our dd has a crown because one of her molars was abscessed when she was 2 and the dentist didn't think that it was a good idea to extract it so young. Dd is 8 now and is probably a couple of years away from losing that tooth, so I'm glad we made that decision.

[choochootwo]

Zebaby, 

I'm sorry, what a stressful time you're having! I also know all too well your struggle. We have a 22 month old with ECC. 

We're also using all of the protocols you mentioned plus more. We would like to avoid extraction too, it would really be a last resort. From our perspective, if we can stop the decay, then we're in good shape. But, if my son did have an abscess and it did not go away with antibiotics, I would go for extraction. That or pain would be my only exceptions. An active abscess *that does not respond to antibiotics* scares me. It's too close to the brain and also poses a greater risk of infecting adult teeth. Like you, we're trying everything to halt decay. Even our holistic DDS said our son's upper molars may decay all the way down, but as long as the roots are not infected, they would be good spacers for the adult teeth...I hope that gives you an idea of how "alternative" we are about this issue. If his abscess responds to antibiotics, wonderful. But, if it doesn't, I would lean towards extraction. I wouldn't risk further issues with decay getting into the bone, adult teeth. 

Good luck and keep us posted!