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8 cavities in 22 month old- Update on pg. 2  

post #1 of 31
Thread Starter 
Update on page 2

My heart is just breaking over this. We took dd to a ped. dentist today and he confirmed what I had been suspecting anyway- cavities. I was not expecting 8, though. Her 4 front teeth and her 4 molars are all affected (she does not have her 2 year molars yet). Her right front tooth is the worst off- he said there might be some nerve damage to that one, but won't know until he gets in there to fill it. The other 7 are surface cavities, not giving her any pain at this point. He said we would not need to do caps, that fillings will work, but wants to put her under General Anesthesia. I have a lot of mixed feelings about this- the risks of GA vs. the trauma to her having to have 8 teeth filled in an office. If it was just 1 or 2 teeth I would not do GA- but 8 teeth? I just think that is a lot for her to go through. The dentist was pretty wonderful, though- he also told me that on a scale of 1 to 10 for children's health issues, this is a 1. He said that they will fix her teeth and she will be fine. Our issue is that we do not have dental insurance. We do have medical, which they are hoping will cover the surgery center and the anesthesia- I do not know what we will do if they won't. But the estimate for him today is $2,400 and has to be paid in full before the surgery. I don't know how we are going to come up with that, either. If our medical won't cover the anesthesia it will be closer to $10,000. I am just so sad.

The hygenist asked if she drinks bottles- no, if she drinks from a cup- yes, what she drinks- water only- she will have a sip of juice every once in a blue moon, but it is 99% water still. I said that she is still breastfeeding- she did not ask how often or if she nursed at night- she just asked how old she was and I said "almost 2". She asked how often I brush her teeth- I said twice a day. The dentist did not mention anything about me still nursing, and did not say anything about needing to wean, at night or otherwise. I have read probably every article ever written on the relationship between breastfeeding and cavities, and I am not convinced that it is the cause. But she does not eat sweets, raisins, fruit leather. She does not drink much juice or cows milk. She drinks a lot of water. She nurses a lot. Maybe her teeth were already susceptible to this, and nursing at night triggered it. Maybe if she hadn't nursed so much at night it would not be this bad. There is nothing else in her diet that would cause this many cavities other than being latched on to my breast most of the night. I have been good about brushing her teeth- but obviously I haven't been good enough.
post #2 of 31
From what I know, some kids are susceptible to cavities because of their saliva content. Night nursing for those kids can be problematic. Of course, you don't know what type of kid you are going to get. If you had a crystal ball, you might have done things differently. I wish I had good advice though because I definitely hear your frustration.
post #3 of 31
I know you siad you brush twice a day. But does she ever get any food besides the breast milk or water after the night brushing? My (limited) understanding is that bm is not supposed to be a problem, but if there is any residue from other food that it can react with that.
post #4 of 31
Quote:
Originally Posted by mamasgirls
I have read probably every article ever written on the relationship between breastfeeding and cavities, and I am not convinced that it is the cause...
I got kind of curious because I have seen several posts about unusually bad early tooth decay from nursing moms, so I thought I'd look for myself.

It seems as though if you compare bf to not bf, you'll find some studies that show no difference, and a few that suggest a mild increase in the bf kids.

But if you stratify to look at nightime bf on demand, then it does start to really pop up as a significant cause of cavities. Here's one study that found these kids who fed twice per night had thirty five times the risk for cavities than those who didn't night feed, and if they fed longer than 15 minutes total, their risk was one hundred times higher. They found that all of the nighttime feeders had cavities, and none of the non-nightime feeders did.

Wow. Anyway, I thought I'd share that with you.

J Dent Res. 2006 Jan;85(1):85-8.

Risk factors of early childhood caries in a Southeast Asian population.
van Palenstein Helderman WH, Soe W, van 't Hof MA.

WHO Collaborating Centre for Oral Health Care Planning and Future Scenarios and Department of Preventive and Restorative Dentistry, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.

w.vanpalenstein@dent.umcn.nl

A retrospective cohort study on ECC and associated factors was conducted among mothers with 25- to 30-month-old infants in a community where prolonged breastfeeding was common practice...Breastfeeding during the day beyond the age of 12 months was not associated with ECC, but infants who were breastfed at night > 2 times had an OR for ECC of 35 (CI 6-186), and those who were exposed to > 15 min per nocturnal feeding had an OR for ECC of 100 (CI 10-995)...
post #5 of 31
Thread Starter 
Quote:
Originally Posted by blessed
I got kind of curious because I have seen several posts about unusually bad early tooth decay from nursing moms, so I thought I'd look for myself.

It seems as though if you compare bf to not bf, you'll find some studies that show no difference, and a few that suggest a mild increase in the bf kids.

But if you stratify to look at nightime bf on demand, then it does start to really pop up as a significant cause of cavities. Here's one study that found these kids who fed twice per night had thirty five times the risk for cavities than those who didn't night feed, and if they fed longer than 15 minutes total, their risk was one hundred times higher. They found that all of the nighttime feeders had cavities, and none of the non-nightime feeders did.

Wow. Anyway, I thought I'd share that with you.

J Dent Res. 2006 Jan;85(1):85-8.

Risk factors of early childhood caries in a Southeast Asian population.
van Palenstein Helderman WH, Soe W, van 't Hof MA.

WHO Collaborating Centre for Oral Health Care Planning and Future Scenarios and Department of Preventive and Restorative Dentistry, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.

w.vanpalenstein@dent.umcn.nl

A retrospective cohort study on ECC and associated factors was conducted among mothers with 25- to 30-month-old infants in a community where prolonged breastfeeding was common practice...Breastfeeding during the day beyond the age of 12 months was not associated with ECC, but infants who were breastfed at night > 2 times had an OR for ECC of 35 (CI 6-186), and those who were exposed to > 15 min per nocturnal feeding had an OR for ECC of 100 (CI 10-995)...
That is really interesting. Thanks for sharing. My dd cosleeps and has nursed on demand throughout the night since birth. I mean, even if she was predisposed, or for some reason at a higher risk for cavities- something still had to trigger them, and the only culprit in her diet would be nursing at night. Somebody asked if maybe I didn't have her teeth clean enough, or maybe she ate something after I brushed them, and I think any of those could be possible, but I don't think that would be a consistent cause- or frequent enough to cause the amount of decay she has in her mouth. Anyway- I have been reading articles all day about this, and am thinking I may need to night wean my dd- I do not want her teeth to get worse.
post #6 of 31
I'm guilty of a nightime bottle still with my little one, and she is 26 months old. Luckily we've not had cavities popping up, yet anyway. Usually she's finished the bottle off well before she actually falls asleep, so maybe that helps reduce her risks.

I suspect the pooling of the liquid in their mouths after they're asleep - be it breast or bottle milk - is probably the worst thing.
post #7 of 31
Oh - Im so sorry-
it is so heartbreaking - I had just written to you - then saw that this thread was you, mamasgirls.
To have to worry about money on top of the pain etc. is too much.
I wish you all the best.
post #8 of 31
Thread Starter 
Thanks for your well wishes. We actually went to a 2nd dentist today- was pretty much told the same thing- she will need GA in the hospital, but the dentist today was $1,000 less than the first. Plus we can get her in to have the work done ASAP- we don't need to wait 2 months. So I think we are going with the first office. Other than the cost- I am doing okay. My dd is not in ANY pain- none of her nerves have been affected (yet) and even though it is a large number of teeth, the decay is minimal on each tooth. I know it could be worse, and am happy we took her when we did. I am feeling positive that she is still going to be a very happy and healthy girl- who maybe just doesn't nurse at night anymore Everything in her mouth will be resin (white)- so I don't think it will be noticeable at all.

Good luck to you, too- I had never even heard of using GA for dental work until I read the forums here- I am surprised at how common it seems for young children. I asked both offices we went to about conscious sedation and was told in our state they can only do that in a hospital as well, because an anesthesiologist has to be present. Both dentists told me I would have trouble finding someone to do conscious sedation on a 22 month old. I am nervous about the GA, but also realize that my dd's teeth need to be fixed as well.

Hope all goes well for you.


Quote:
Originally Posted by tgrlilly
Oh - Im so sorry-
it is so heartbreaking - I had just written to you - then saw that this thread was you, mamasgirls.
To have to worry about money on top of the pain etc. is too much.
I wish you all the best.
post #9 of 31
Mamasgirls I am sorry you are going through this. May I suggest you move heaven and earth to get the work done ASAP. Those precious teeth can deteriate quickly. I finally got things scheduled for my 34 month old girl. I noticed her teeth starting to develop cavities around 14 months or so. We had no medical or dental insurance at the time. Dental was a long time in coming and a couple of other chances to get the money ($800 ontop of dental insurance) together fell through. Now my precious girl is losing her 4 front treeth and has 4 other cavities to be filled. We are opting to put sealants on her other molars.

I have been through the sedation and the GA with my oldest son, who is Autistic and I would rather do the GA. My son did not respond well to sedation. It is good that a dr would be present for either option in your state as a child died from oral sedation done at the same dental office my son's work was done at. With my son there was no dr present for the sedation, only the dentist and his aids. Anesthetic compunds are very short acting and leave the system very quickly. I also know each person is unique and no one option is right for everyone.
post #10 of 31
Thread Starter 
Quote:
Originally Posted by atozmama
Mamasgirls I am sorry you are going through this. May I suggest you move heaven and earth to get the work done ASAP. Those precious teeth can deteriate quickly. I finally got things scheduled for my 34 month old girl. I noticed her teeth starting to develop cavities around 14 months or so. We had no medical or dental insurance at the time. Dental was a long time in coming and a couple of other chances to get the money ($800 ontop of dental insurance) together fell through. Now my precious girl is losing her 4 front treeth and has 4 other cavities to be filled. We are opting to put sealants on her other molars.

I have been through the sedation and the GA with my oldest son, who is Autistic and I would rather do the GA. My son did not respond well to sedation. It is good that a dr would be present for either option in your state as a child died from oral sedation done at the same dental office my son's work was done at. With my son there was no dr present for the sedation, only the dentist and his aids. Anesthetic compunds are very short acting and leave the system very quickly. I also know each person is unique and no one option is right for everyone.
Thank you for your thoughts. We have decided to go with the 2nd dentist- who is $1,000 cheaper and my dd seemed more comfortable. She was a very sweet and gentle dentist and I trust her. I am still very, very nervous about the GA- but feel for her 8 teeth this is best. We will have it done within the month- I am crossing my fingers that her teeth do not get worse in that time.

That is so sad hearing about the child that died from the oral sedation- from what I have read that is very rare- I just cannot imagine. I am also sorry to hear that your dd has to have the extractions. My older dd has such great teeth- I never imagined we would be in this predicament, or that so many others go through it, too. I have learned a lot in this forum, and am very thankful for it
post #11 of 31
I am so sorry to hear this. Dental stuff is so hard to see with such a wee one. My DD had her top 4 teeth crumble very rapidly at the age of 18 months so I know that terrible mama guilt feeling. I am so glad to hear that you will be going with GA. I made the mistake of doing restraint and paid dearly for it afterwards with trust issues and tantrums from DD.

Night nursing does not cause cavities. If it did, then our species would have had all their teeth rot out at an early age. See this page for more info:
http://www.brianpalmerdds.com/bfeed_caries.htm
So then why are there so many conflicting reports and problems with early decay with breastfed children? I beat myself over my head with this many times when I was trying to figure this all out. What I found out was that diet makes a big difference in milk quality, and my diet and thus my milk was deficient so her teeth could not remineralize properly.

Read my story here:
http://mothering.com/discussions/sho...d.php?t=419877

More of my thoughts re: causes of tooth decay (my posts start on pg2)
http://www.mothering.com/discussions...3&page=2&pp=20

Not all breastmilk is the same (very extensive discussion about nutrients in breastmilk according to mama's diet):
http://www.mothering.com/discussions...d.php?t=343188

Here is an interesting thread that had an offshoot discussion about personal effects of changing diet on breastmilk:
http://www.mothering.com/discussions...d.php?t=414949
Especially read firefaery's post, #34

HTH!
post #12 of 31
Wow, we were in the same exact position a month ago.

Our DS was 22 months and had 8 cavities. There were only 2 visible when we consulted with the dentist, but 3 weeks later when he went in to have them fixed 6 more had become visible.

DS had IV sedation in the dentists office. We paid for the anesthesiologist to come there instead of the hospital. His fee was around 1,000 dollars total. 10,000 seems terrible high. The anesthesiologist classed DS's IV sedation as general anesthesia because he put him completely and totally out. With older kids and adults IV sedation is often not general anesthesia because they are partially awake.

The drugs they used with DS were a ketamine shot, which was wonderful because it didn't bother him at all when they took him away from us, and IV propofol. Propofol is good because it wears off relatively quickly.

I won't lie to you. It was a terrible experience all around, especially coming out of anesthesia. But, it was infinitely better than doing the work awake and traumatising our baby.

I agree with you about the night nursing. DS was an all night nurser, as in he would nurse in his sleep for 10-12 hours straight every night. He had no other source of sugar except for fruit about once every 2 weeks. Even Dr. Sears says a child with dental problems shouldn't nurse at night. We night weaned DS even though he was not in any way ready. We did not want him to have to go under anesthesia again due to us not ceasing night nurseing.
post #13 of 31
Thread Starter 
Quote:
Originally Posted by toraji
I am so sorry to hear this. Dental stuff is so hard to see with such a wee one. My DD had her top 4 teeth crumble very rapidly at the age of 18 months so I know that terrible mama guilt feeling. I am so glad to hear that you will be going with GA. I made the mistake of doing restraint and paid dearly for it afterwards with trust issues and tantrums from DD.

Night nursing does not cause cavities. If it did, then our species would have had all their teeth rot out at an early age. See this page for more info:
http://www.brianpalmerdds.com/bfeed_caries.htm
So then why are there so many conflicting reports and problems with early decay with breastfed children? I beat myself over my head with this many times when I was trying to figure this all out. What I found out was that diet makes a big difference in milk quality, and my diet and thus my milk was deficient so her teeth could not remineralize properly.

Read my story here:
http://mothering.com/discussions/sho...d.php?t=419877

More of my thoughts re: causes of tooth decay (my posts start on pg2)
http://www.mothering.com/discussions...3&page=2&pp=20

Not all breastmilk is the same (very extensive discussion about nutrients in breastmilk according to mama's diet):
http://www.mothering.com/discussions...d.php?t=343188

Here is an interesting thread that had an offshoot discussion about personal effects of changing diet on breastmilk:
http://www.mothering.com/discussions...d.php?t=414949
Especially read firefaery's post, #34

HTH!
Thanks for all the information! I appreciate all of the links. I have read through them and it is very interesting. I am still conflicted with the cause of it, and I may never know 100%. What I do know is that she eats/drinks very little sugar other than breastmilk. I am careful about what I eat also, and I do know that my milk is fatty b/c I can see the separation of the cream when I pump- dd in her first year was off the charts in height and weight and has now dropped to about the 90th percentile for weight. Anyway- I have been researching the effects of the raw milk and butter, and the cod liver oil, etc. I really believe that if she had not nursed all night long for so long then this wouldn't have been so severe- she may have still had cavities, because of weak enamel, etc. But she would not have the classic decay pattern of Early Childhood Caries- her 4 top front and her 4 molars decaying with the bottom front teeth and eye teeth not affected. She has never ever taken a bottle, she really only drinks water and breastmilk. There just has to be some correlation with the fact that she has been an avid nurser at night and her pattern of decay. Maybe it is my milk b/c of diet- but it still means that *my* milk is the cause, or part of the cause, and again, maybe she would not have had this patten of decay if her teeth had not been exposed to *my* milk every night of her life. I have always been careful about brushing her teeth before nursing for the night. I had previously read the Brian Palmer article, and I agree with most of what he is saying- but diets are so different (even when you eat 'well') than they were in prehistoric times- I know decay wasn't even an issue back then. I also think that some risk factors need to be in place for this to occur- maybe genetically weak enamel in combination with a certain diet and nursing at night- who knows. But it is obvious that not every baby is at risk for this.

Anyway- I am just rambling now- I thank you again for taking the time to post those links- I really appreciate and enjoy reading every possible angle of this and learning as much as I can- and to all you have been through as well
post #14 of 31
Thread Starter 
Quote:
Originally Posted by NathanaelsMommy
Wow, we were in the same exact position a month ago.

Our DS was 22 months and had 8 cavities. There were only 2 visible when we consulted with the dentist, but 3 weeks later when he went in to have them fixed 6 more had become visible.

DS had IV sedation in the dentists office. We paid for the anesthesiologist to come there instead of the hospital. His fee was around 1,000 dollars total. 10,000 seems terrible high. The anesthesiologist classed DS's IV sedation as general anesthesia because he put him completely and totally out. With older kids and adults IV sedation is often not general anesthesia because they are partially awake.

The drugs they used with DS were a ketamine shot, which was wonderful because it didn't bother him at all when they took him away from us, and IV propofol. Propofol is good because it wears off relatively quickly.

I won't lie to you. It was a terrible experience all around, especially coming out of anesthesia. But, it was infinitely better than doing the work awake and traumatising our baby.

I agree with you about the night nursing. DS was an all night nurser, as in he would nurse in his sleep for 10-12 hours straight every night. He had no other source of sugar except for fruit about once every 2 weeks. Even Dr. Sears says a child with dental problems shouldn't nurse at night. We night weaned DS even though he was not in any way ready. We did not want him to have to go under anesthesia again due to us not ceasing night nurseing.
Thanks for sharing- I am sorry you have just been through this. We actually got a call from the second dentist we saw and there was a cancellation on Monday- so she will be having all the work done then under General Anesthesia, in a Children's Hospital. I am very nervous about it, but am happy that there is not much chance for this to get worse. We found out our medical insurance will cover the hospital procedure- we will pay 20%, not sure how much that will be yet, and the second dentist we saw was a cheaper than the first- $1,400. I will be happy when this is all over.

We are starting to night wean her- it isn't going that great, but I know it needs to be done. I read the article on Dr. Sears' website that talks about night weaning in children with decay problems, which is what helped me realize it needs to be done.

Anyway- Thank you for your thoughts
post #15 of 31
My 2.5 yr old has four cavities, which she will be getting filled in July (we found them at the end of December - this is the only dentist we have coverage for tho, so we have to deal with the loooong wait). Both of my daughter's front teeth have grey in behind them, and one has partially chipped away. Sometimes she has pain from that one if she bites down too hard on something.

Instead of GA, they are going to give my daughter Versed (Midazolam) in chocolate syrup, which apparently will make her drugged/sort of drunken. Would something like that be an option for you?

Good luck.
post #16 of 31
For me, as a surgeon, I worry more about conscious sedation (versed, ketamine) done in the dentist's office than I do about general anesthesia.

During concious sedation, it's up to the dentist and whomever is assisting him, maybe a nurse, maybe just an assistant, to monitor the baby's breathing and oxygenation and make sure that the baby is sedated, but not SO sedated that s/he isn't breathing adequately to provide oxygen to the brain.

All sedatives depress respiratory function, and respiratory arrest or depression is the dreaded side effect that is constantly monitored for, and HOPEFULLY corrected as it occurs and is recognized.

During general anesthesia there is a trained physician or anesthetist at the baby's head, whose entire career is doing nothing other than providing safe and effective anesthesia. The baby's breathing and airway are secured before the case even starts and all of the ventilations and oxygenation are provided - unlike in concious sedation in which the baby has to continue to breath on his own. If his or her breathing is inadequate, then it depends on the nurse or other personnel to recognize it, and do something about it, like bag ventilate the baby, wake the baby up, or some other maneuver. It's more likely that they'll just watch closely as baby's oxygen saturations are suboptimal, and allow the procedure to continue to the end. Did the baby incur some brain injury? Who knows?

Despite extensive studies there has never been any neurodevelopmental or other downside to general anesthesia demonstrated, and don't forget the drugs used for concious sedation are heavy hitters as well!

I'd choose general anesthesia for my own child.
post #17 of 31
Holy crap, that's really scary Blessed. Thanks for the information, I had no idea. I will be making a phone call on Monday to the dentist's office.
post #18 of 31
Quote:
Originally Posted by blessed
For me, as a surgeon, I worry more about conscious sedation (versed, ketamine) done in the dentist's office than I do about general anesthesia.

During concious sedation, it's up to the dentist and whomever is assisting him, maybe a nurse, maybe just an assistant, to monitor the baby's breathing and oxygenation and make sure that the baby is sedated, but not SO sedated that s/he isn't breathing adequately to provide oxygen to the brain.

All sedatives depress respiratory function, and respiratory arrest or depression is the dreaded side effect that is constantly monitored for, and HOPEFULLY corrected as it occurs and is recognized.

During general anesthesia there is a trained physician or anesthetist at the baby's head, whose entire career is doing nothing other than providing safe and effective anesthesia. The baby's breathing and airway are secured before the case even starts and all of the ventilations and oxygenation are provided - unlike in concious sedation in which the baby has to continue to breath on his own. If his or her breathing is inadequate, then it depends on the nurse or other personnel to recognize it, and do something about it, like bag ventilate the baby, wake the baby up, or some other maneuver. It's more likely that they'll just watch closely as baby's oxygen saturations are suboptimal, and allow the procedure to continue to the end. Did the baby incur some brain injury? Who knows?

Despite extensive studies there has never been any neurodevelopmental or other downside to general anesthesia demonstrated, and don't forget the drugs used for concious sedation are heavy hitters as well!

I'd choose general anesthesia for my own child.
ITA with you!
post #19 of 31
Quote:
Originally Posted by thismama
My 2.5 yr old has four cavities, which she will be getting filled in July (we found them at the end of December - this is the only dentist we have coverage for tho, so we have to deal with the loooong wait). Both of my daughter's front teeth have grey in behind them, and one has partially chipped away. Sometimes she has pain from that one if she bites down too hard on something.

Instead of GA, they are going to give my daughter Versed (Midazolam) in chocolate syrup, which apparently will make her drugged/sort of drunken. Would something like that be an option for you?

Good luck.
I also want to say, beware of Versed. Not all babies react the same way to it. My DS had it recently in the ER so he could get staples in his head and instead of calming down he fought like a drunkard! I would not want my child able to fight like that during dental work.
post #20 of 31
Quote:
Originally Posted by thismama
My 2.5 yr old has four cavities, which she will be getting filled in July (we found them at the end of December - this is the only dentist we have coverage for tho, so we have to deal with the loooong wait). Both of my daughter's front teeth have grey in behind them, and one has partially chipped away. Sometimes she has pain from that one if she bites down too hard on something.

Instead of GA, they are going to give my daughter Versed (Midazolam) in chocolate syrup, which apparently will make her drugged/sort of drunken. Would something like that be an option for you?

Good luck.
I also want to say, beware of Versed. Not all babies react the same way to it. My DS had it recently in the ER so he could get staples in his head and instead of calming down he fought like a drunkard! I would not want my child able to fight like that during dental work.

FWIW, DS's anesthesiologist for his dental work said that small children don't do well with conscious sedation because they still fight.
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