I really need some advice, please

[Kimmiepie]

My dd, 6, went to the dentist about a year and a half ago and had 4 cavaties. They filled them (with mercury fillings because I didn't know any better at the time). This was a dentist that was recommended by my dad as he goes to his church and they have been friends for a while. Plus he gave us a discount.

Well, he did a horrible job because one of her fillings started coming out. I was terrified of her swallowing some but I know she did. She then started complaining of pain. I called the dentists but couldn't find anyone who would take medicaid. Finally I got it worked out and we went back to a different dentist yesterday. This one does silver, mercury free fillings.

OMGoodness! The poor darling has 3 *new* cavaties and the fillings had fallen out of TWO teeth. One of the teeth was badly infected. I am so angry at the other dentist. He did a horrible job and my baby probably swallowed the mercury crap and now has all sorts of problems with the teeth they were in! :

So, she gave me an presciption for some amoxicillan which I hate because she hasn't taken any antibiotics in over 3 years...but if it's infected I think I need to. She wants to fill the new cavaties, and do TWO baby root canals on the other two, possibly pulling the one that's badly infected. She said they would then have to put a cap in it.

Okay, this is where I need advice.

1. I originally told the dr we didn't want her sedated because we don't like to use drugs or unnecassary procedures, which she understood. But I've heard horror stories about root canals and she's already anxious and would probably cry and move through the whole thing. Do you think I should sedate her? The thought terrifies me, but so does seeing her in pain...I'm torn and confused.

2. If they do have to remove the infected tooth would she really need a cap? It's not the back molar (and of course she doesn't have her 12 yr ones yet) it's the one in front of the back one. So the cap would be for cosmetic purposes mostly right? I would think that since she's going to lose her baby teeth soon anyway, that a cap might not be necessary?? She's already losing them one after the next. And I'd be less concerned about cosmetic issues on a back tooth anyway. Thoughts?

3. Are silver fillings okay? They are mercury free but I don't know much about the silver.


4. Flouride. They gave her some to swish in her mouth after her cleaning (told her it was vitamins: ) and her tummy hurt the rest of the day. She said she swallowed a little bit. I don't know if it was her nerves or the flouride. I really don't like them using it, but I'm afraid if I request them not to they will think her problems are because I don't let her use flouride and find me neglectful or something. (We had a cps issue one time due to using aloe vera for a burn so I am ultra paranoid about the medical field and the choices I make) Do you think she should be using flouride? We used to, but even when we did she had the 4 cavities...so I don't know.


The funny thing is that we don't eat much sugar, and no soft drinks etc. We eat better than most kids. My son eats the same stuff and has no cavaties. I suppose it could be hereditary since me and my brother the same way when we were kids....I brushed and had a ton of cavities and he didn't and never had any.

Thanks! I'm just really worried about all this.

[kaPOW!]

Hi. Good questions. I'd be ticked at that dentist too, but also at this new one. I'm sorry that you have to worry about this.

Originally Posted by Kimmiepie

So, she gave me an presciption for some amoxicillan which I hate because she hasn't taken any antibiotics in over 3 years...but if it's infected I think I need to.

I would too, for that. Along with probiotics, of course.

Originally Posted by Kimmiepie

She wants to fill the new cavaties, and do TWO baby root canals on the other two, possibly pulling the one that's badly infected. She said they would then have to put a cap in it.

Hm. That doesn't make sense. Caps are put onto the original roots, they are the same thing as "crowns" just a different term. If she's planning to pull the tooth then she might be talking about placing a bridge or something. But a cap needs a root. Is there a chance that she plans to do a root canal and then cap? That is common; they remove all of the decay on the crown of the child's tooth, do the root canal, and then place a porcelain or stainless steel cap or crown.

Originally Posted by Kimmiepie

1. I originally told the dr we didn't want her sedated because we don't like to use drugs or unnecessary procedures, which she understood. But I've heard horror stories about root canals and she's already anxious and would probably cry and move through the whole thing. Do you think I should sedate her? The thought terrifies me, but so does seeing her in pain...I'm torn and confused.

If they're using Novocaine, it really shouldn't be any more painful than a filling. I've never had one, but most of the people I know have and I've done a lot of reading, and I think that a lot of the horror stories are coming from a time in the past when perhaps they were more painful. From what I understand, they really shouldn't be. What can be, and is, painful is if they fail (get reinfected), which would cause a painful abscess.

Originally Posted by Kimmiepie

2. If they do have to remove the infected tooth would she really need a cap? It's not the back molar (and of course she doesn't have her 12 yr ones yet) it's the one in front of the back one. So the cap would be for cosmetic purposes mostly right? I would think that since she's going to lose her baby teeth soon anyway, that a cap might not be necessary?? She's already losing them one after the next. And I'd be less concerned about cosmetic issues on a back tooth anyway. Thoughts?

Well, the bridge wouldn't be for cosmetic purposes but it's debatable whether it would be necessary. As I mentioned earlier, they won't put a cap in if they yank the tooth. If they do a root canal and remove the decay on the crown of her tooth, they they will need to place a cap for sure, in order to protect the dead root. If they pull the tooth, then the logic behind a bridge would (I think) be to maintain that space for the permanent tooth, as well as prevent shifting in the upper jaw. Personally, I'd have to think a long time about whether or not I'd go with a bridge or partial denture for a child - and I'd get another opinion. I would definitely have them place a cap.

Originally Posted by Kimmiepie

3. Are silver fillings okay? They are mercury free but I don't know much about the silver.

This is the reason why I said that I would be ticked at the second dentist as well. There is no such thing as a mercury free silver filling. I am absolutely certain of this. She MAY have meant that they would place a stainless steel cap or crown, in which case that would be mercury free and I'd be okay with that for a molar. But there are zero mercury free fillings. Either she was flat out lying, or she is unbelievably mistaken, and unforgivably at that, because it's such common knowledge for a dentist.

Originally Posted by Kimmiepie

4. Flouride. They gave her some to swish in her mouth after her cleaning (told her it was vitamins: ) and her tummy hurt the rest of the day. She said she swallowed a little bit. I don't know if it was her nerves or the flouride. I really don't like them using it, but I'm afraid if I request them not to they will think her problems are because I don't let her use flouride and find me neglectful or something. (We had a cps issue one time due to using aloe vera for a burn so I am ultra paranoid about the medical field and the choices I make) Do you think she should be using flouride? We used to, but even when we did she had the 4 cavities...so I don't know.

If she's unable to keep from swallowing it, then it's probably a bad idea to use it again. I hope it was just nerves, but the stomach ache may very well have come from the fluoride and that's no good.

I'd get another opinion at this point. That silver filling thing would bother me in itself, and it also seems like the dentist wasn't very clear. Did you find any other dentists that take Medicaid? Is there anyway you could go with a recommendation from your tribal area? Good luck with everything.

[SomedayMom]

I can try and help a bit, since I'm a dentist

1. How did she do a year and a half ago? If you are talking about pulpotomies, baby root canals...it's an extra minute of work added on to a filling, and no additional pain. If she's anxious, I would certainly consider nitrous as it is a safe and easily reversed solution. If you feel like there will be emotional trauma involved in having the work done, consider sedation.

2. A cap (crown) on a primary tooth would typically be done because of the size of the filling that would need to be a done. An extracted tooth would not get a cap, but perhaps a space maintainer? That would be IMO neccessary to prevent her permanent teeth from shifting. The neccessity of a crown on a primary tooth really depends on the dentist and the materials that they use. I use only composite fillings and feel pretty comfortable with just placing larger fillings on primary teeth. The material your dentist is wanting to use is not one that I would choose, and would not be as appropriate for a large filling as a stainless steel crown would.

3. There are silver fillings for kids that are NOT amalgams. Google Ketac Silver. They are not long lasting fillings and would not be my personal choice. Our pediatric patients get the SAME fillings as our adult patients...composite.

4. Fluoride would be YOUR choice in my practice, but all dentists have different levels of belief in the benefits. I do still reccommend fluoride toothpaste and treatments at cleanings, but I don't typically do additional fluoride supplementation. I make reccommendations based on diet and I do reccommend my patients look into xylitol.



And yes, genetics are a factor. You can really evaluate her diet...look into amounts of carbs in general, stickier foods (my patient base fex has a big fruit snack problem), juices, etc. Also evaluate your brushing habits and make sure she's flossing if her teeth touch. But, all realizing that genetics ARE a factor and there are factors we don't know about yet. I mean, yeah, I see some kids walk in with a sippy cup full of apple juice or the mom that says "no we gave up juice, she drinks water...mixed with sprite" and some things are obvious, but sometimes there isn't anything obvious at work.

HTH at least a little.

[Kimmiepie]

Thanks to you both. Very informative!

Maybeknott-

After reading your post I did a search on fillings. Then I rechecked my dentist's advertisement and it actually says tooth colored mercury free fillings. I am wondering if she offers both and my dad said that usually they give the tooth colored ones to adults for cosmetic reasons. So my plan is to call on Monday and ask if we can get the tooth colored ones (assuming that they are porcelin or whatever).

I also think you are right about the bridge. I think she is going to put caps on the ones she's refilling and put a bridge in if she removes the tooth.

Thanks!!

Somedaymom-

I am going to call on Monday, but generally what is a tooth colored mercury free filling? Would that be porcelin?

I am going to ask about the type of material she would be using on the caps. She only said silver to the fillings. So I should ask about composite?

I will have to do more research/thinking about the bridge.

She did fine last time she had them filled, but he did it fast...hence the falling out. So I would think she would do okay if it truly only takes a bit longer and doesn't cause any more pain. I feel much more comfortable not sedating her. Yes, she called them baby root canals.

We have cut out all juice, but did drink quite a bit of the "natural" kind before 6 months ago. We also only drink sodas when we go out to eat, which is very rare and never any diet or caffeine. All in all, they mostly drink filtered water and organic whole milk.

Thanks so much for your help. I'm so glad I posted!

[SomedayMom]

I am going to call on Monday, but generally what is a tooth colored mercury free filling? Would that be porcelin?

The tooth colored fillings are composites. Porcelain is used for crowns, onlays, inlays, veneers, but only for permanent teeth.

I am going to ask about the type of material she would be using on the caps. She only said silver to the fillings. So I should ask about composite?

The caps (crowns) would be stainless steel. There are composite crowns or stainless crowns with tooth colored fronts for the front teeth though. I know of two mercury free silver fillings. Ketac Silver would be used more often on kids, but it is not particularly strong. Galloy is the other and not one I've ever touched, so I don't know much about it. We had to use Ketac some in dental school.

I will have to do more research/thinking about the bridge.

To research it, look up space maintainers. If you go through this link you can see pictures of them, and some of the stainless steel crowns too.

http://depts.washington.edu/peddent/.../space009.html

They are pretty simple really.


Good luck!

[Kimmiepie]

Thanks so much!

So, the porcelin are only for adults? Why is that?

This is concerning me more and more. If the dentist doesn't carry the 2 kinds you mentioned before, then she has to get the mercury ones.

There is only one other dentist in the 4 towns surrounding us that takes medicaid and he uses all mercury ones. *sigh*

Would you fly down here and fix dd's teeth for me?

Okay, nevermind...I think you're saying the tooth colored ones my dentist is talking about are composites like we want, but the porcelin is something different that is only used for permanent teeth!!