Help and Info re. My dd's Teeth Please

[ElisaMarie]

I am a lurker here at Mothering, but I have encountered a situation which I would like input on, and I have heard raves about SmileMomma's help.

My daughter is 3 1/2 and is still nursing. She nursed quite a lot at night until I nightweaned her at about 2 1/2 primarily due to recurring ear infections. She is allowed very little sugar and we cut her juice (when she has it) by at least 50% with water. We faithfully brush her teeth twice a day.

I noticed a problem with her front right incisor at the gumline and dh took her to a pediatric dentist yesterday. I am very upset with the findings.

She has 12 cavities. They have recommended we switch to a flouride toothpaste. (We had her on the non-flouride as she still tends to swallow the paste.) They need to put a crown on one tooth. They have recommended a combination of amalgam and composite fillings for her teeth (Composite on visible teeth and amalgam at back.) They have given us the option of doing the work in one session under GA or 4 sessions with local anesthetic and nitrous oxide.

I have three people in my family (though I am not one of them, neither is dh) with extremely "soft" teeth which are prone to decay. My mom has put thousands of dollars into her mouth and my youngest brother has had even more. They all care for their teeth fanatically and still have problems, and it seems that my baby girl takes after them in this regard. <sigh>

I am extremely uncomfortable with the mercury risk in the amalgam fillings and would prefer to pay the higher amount for all composite, but my husband understood that the amalgam was preferred for molars due to safety/stability issues. Are these issues a concern? Is the stability risk any greater than the mercury risk?

We are also very, very uncomfortable with the idea of general anesthetic. Are there any risks with the local/nitrous combo? Should I be concerned that the first treatment will be traumatic and cause her fear to return and complete the other treatments?

How can I make this as easy as possible for her? Any tips or tricks to explain the process in a non-frightening, developmentally appropriate way?

Thanks in advance for any info, experiences, or links you can share!

[mother culture]

IMO it would be better to use the GA and get it all done in one fell swoop. I have had many friends who were meticulous about dental care and 2 of their children had to have all 4 front teeth capped and they tried the composite at first and they failed to stay put and the process had to be repeated.
I feel for you . It is hard to need medical care that you are not comfortable with.
Your daughter will be much less stressed by the procedure than you and your husband!
good luck!

[4evermom]

My ds just got 10 cavities filled under GA in January. We tried so called "conscious sedation" which was an oral sedative (very bitter tasting, mixed with juice. I had trouble getting it in him) and nitrous but it didn't make him complacent enough to be a good option. It was less expensive to do GA because the oral sedative cost $250 each time, but the anaesthesia was covered by our insurance (we have medical but not dental). I had previously switched dentists because the first one didn't respect my concern about amalgam fillings. The new one couldn't believe the old one would even consider them! I think the issue of whether the white fillings are hard enough is that they didn't used to be but they have improved. Anyway, they don't have to last forever since they are baby teeth.

I didn't feel I had a choice about GA since the other way didn't work. I lost a lot of sleep over it for months, slept 2 hrs the night before. They gave him an oral sedative first (again bitter mixed in syrup, I had to hold him tipped back and squirt it in) which made him drowsy and drunk. We looked at a book til it kicked in (hold child securely, they loose balance and coordination) then the anaesthesiologist carried him to the OR. He had a tube in his nose and an IV. It took about three hours. He was uncomfortable and groggy coming out of it. I think a lot of the discomfort was from dry mouth and scratchy throat. Also, my ds is exceedingly cranky when tired. He was sleepy until evening. The doctor said to feed him soft foods for the rest of the day and skip brushing teeth that night. Although it was an experience I would have liked to skip, ds doesn't remember it beyond drinking the yucky stuff. With the conscious sedation, ds remembers getting the "pinch" (novacaine injection).

Evidently, baby teeth have such small pits in them that toothbrush bristles are too big to clean them. My dentist recommended applying fluoride mouthwash to the teeth with a Q-tip. My son's teeth are so much easier to clean now.

In so far as preparing my child, I talked about the upcoming procedures in advance, but somewhat vaguely. Mostly, I just said we were going to the dentist's to get the holes in his teeth filled up so they didn't get bigger. It was important for him that he knew where we were going in advance. It was also important to not give too many details for him to get anxious about.

It cost us about $2,000 which we didn't have, so onto the credit card it went. Good luck

[4evermom]

More thoughts on the subject...

I think some dentists might prefer to use amalgam fillings with kids because the white ones are sensitive to moisture and it's harder to keep the area dry with a wiggly kid. If my ds just needed one, I might have gone along with it but I wasn't comfortable with 10 amalgam fillings in my 35 pound child.

The first dentist reassured me that I shouldn't worry if ds was crying during the conscious sedation because he would just be scared, not in pain because he would have been given novacaine. I didn't find this comforting, needless to say. I had visions of him plowing through with the work despite ds's distress. I got a recommendation from our homeopathic doctor for a new dentist who has a much better "bedside manner." The new one (Dr. Harshaw in Bryn Mawr, PA) said he he didn't use dental dams with young patients because it freaked them out, he didn't give me hard time about not using flouride, he was respectful (not condescending like the other), didn't give me a big lecture on sugar (my ds did not have a high sugar diet).

After the conscious sedation, before the GA, my ds kept saying he wasn't going to open his mouth next time and he was going to spray yucky stuff to make everyone go away (like a skunk). I told him OK you can do that, which made him feel better, more empowered. I knew it wasn't going to be an issue with the GA but with my son I think that probably would have been the best approach regardless.

[4evermom]

The other thing with amalgam fillings is that they require more drilling because the hole has to be shaped right to help hold the filling in.