What can be done about decaying baby teeth?

I have a four year old son who has some fairly significant dental problems. Before I take the next step, I am trying to research as much as I can. At least four of his upper molars have cavities. The ones in the first molars are small, but quite deep, and the second molars on both sides have started to chip away because of the decay.

What I want to know is do I have to have those second molars pulled, or can we put some kind of a crown on them until his permanent teeth are ready to come in? I’ve also seen where other dental websites talk about white fillings, porcelain onlays or dental bonding to fix teeth that have been chipped or damaged. Which would you suggest for a child his age?

I’m also wondering if I have to send him to a pediatric dentist. We’ve had two different dentists, and my son refuses to open his mouth for them. Do you think I will have to have him sedated for treatment? That seems so extreme, but my son now says that one of his molars hurts when he chews, so I think I have to take action.

I appreciate any insight you can give me.

Thanks,

Ellen

Dear Ellen,

Yes, I do believe that you need to visit a pediatric dentist, and yes, it is likely that they will need to sedate your son to get this dental work done. So you’ll need to locate a good pediatric dentist that practices sedation dentistry. Even though he only has baby teeth right now, those teeth are still important. He needs them, not only to eat, but to maintain the proper spacing for his adult teeth. If he does have to have those molars pulled, your pediatric dentist should suggest the use of space maintainers. Without them, his permanent molars will drift forward, and you’ll almost certainly be looking at fairly pricey orthodontic work when his permanent teeth are in.

In young children, the goal of most dental work is usually short-term maintenance, so the pediatric dentist may place a stainless steel crown. This will cost considerably less than a porcelain crown.

Of concern here is also the behaviors that led to this problem in the first place. Decay to the degree you describe has to have been fed all day, every day. I would lay good odds that your son is a “grazer,” in other words, that he eats pretty much continuously all day. If this is the case, you’ll need to find a way to change that eating pattern, or your son will continue to have serious dental decay problems all his life. At this point, he really needs to be eating only every three or four hours, and because of his problems, you should have him brush his teeth every single time he eats. If he cannot brush, have him rinse his mouth out with water.

Posted in Sedation Dentistry, Tooth Decay, Uncategorized, White Fillings | Comments Off

What is “sleep dentistry”?

I am writing on behalf of my mother. She has not been to a dentist for many, many years, but at her most recent checkup, her regular doctor told her that she appears to have some kind of infection in her gums, and that several of her teeth look to be severely decayed. From my own experience, I know that the kind of work she needs done will not be quick or easy. She has avoided the dentist these many years because she had a bad experience and is quite frankly terrified of going to the dentist.

How can I help her? I’ve read something about “sleep dentistry”, but is that dangerous for an elderly person? Her general health is good, but she is nearly 80 years old. How is she sedated, and what are the possible side effects?

She really needs to have her teeth taken care of. Her doctor told her she might lose them all if she does not address this issue right away. Please help me find a way to help her overcome her fear.

Phyllis in Delaware

Dear Phyllis,

Thank you for taking the time to try and help your Mom. Luckily, a lot of options exist that can make her dental care experience much, much less stressful than what she has experienced in the past.

“Sleep dentistry” is a layman’s term for sedation dentistry, which is the use of oral sedatives, nitrous oxide (NO gas) and sometimes anesthesia in the administration of dental care. The level of sedation is determined by the extent of the patent’s anxiety and the potential length of the procedure. Here in our office, we use an oral sedative (a pill) for our anxious patients.

With all sedation patients, a careful case history is taken to verify that they are able to tolerate the medication, and that none of their existing medications contraindicate the use of the oral sedative. During the procedure, our patients are monitored by a trained staff member at all times, using a blood pressure machine and a pulse oximeter monitor.

Side effects include drowsiness, and occasionally nausea, which is usually brought on by not being able to eat before the appointment. Nearly all patients who experience nausea feel rapidly better after eating or drinking something post-treatment.

In all likelihood, your mother will have little or no memory of her treatments, and will experience no discomfort whatsoever. A successful visit or two will also go a long way towards easing her anxiety for subsequent visits!

I hope this helps you help your Mom. Her quality of life will really improve if she can restore her oral health.

Posted in Dental Fear, Sedation Dentistry, Sleep Dentistry | No Comments »