To insist on a referral?

[WaveorCheer]

When DS2 was nine months old, I noticed that the enamel on his top front four teeth was patchy. Over the next couple of weeks I realised it was crumbling off so I took him to the dentist sharpish. She confirmed it was coming off but didn't seem particularly worried. She asked me to go back in six months.

Three months and lots of visible loss of enamel later (chips a couple of millimetres big flaking off, loss of about two millimetres off the bottom of the two front teeth), I took him back and asked to be referred to the hospital. She declined and said he only needed to go there if the teeth disintegrated to the point that they had to come out, but that this was the worst case scenario. Losing the teeth isn't just cosmetic, they also act as place markers for the adult teeth and without them he could end up with poor spacing. She stared him on a course of fluoride painting every three months.

Two months later and I'm wondering whether to go back again. Those four teeth are basically stubs. He is highly averse to having his teeth brushed. But the worst thing of all is his sleep, which is appalling. Last night he woke up maybe 20 times. On a good night he wakes every 1-2 hours. When he wakes he often rubs at his face. Now obviously I can't prove he's in pain (dentist seemed to think it shouldn't hurt) but it seems a reasonable assumption to think he is. I'm a physical wreck.

Should/can I insist on a referral? The rest of his teeth are perfectly fine btw, the only explanation I've heard so far is that I might have been ill at the point in pregnancy when the enamel formed.

[TweedleDi]

Does your dentist accept that there isn't an issue of sugar exposure going on?

At some point it is highly likely you will also be referred to your GP to eliminate the possibility of some other underlying issue, for example Vitamin D insufficiency. They will probably do a full blood screen and may refer you on to a consultant (since your GP is indeed a General Practitioner).

There is a connection with the damage you describe and coeliac disease btw, and this is not restricted to adult teeth.

Either way, you need to get to the bottom of the issue.

[Wabbitty]

It will NOT be coeliac disease - that will only effect teeth that are developing. Not teeth that are already formed. That's why it only affects adult teeth. The baby teeth will all have already been formed before coeliacs will have developed.

So it is either decay or something that happened whilst you were pregnant or a genetic condition. Most likely to be decay due to the teeth involved.

[WaveorCheer]

In that picture, is it only the middle two teeth that are affected? I'm assuming that condition is to do with bottles rather than bf'ing?

Here's a clearer pic

[WaveorCheer]

I'm not worried about coeliac because the rest of his teeth, including molars, seem fine.

I don't accept that it's decay. It was apparent by nine months old, by which point he had been:

• ebf to six months, no bottles at all
  
• blw on family foods but not eating much at all
  
• had never drunk anything other than bm and a few sips of water

[hercules1]

Hi. Dd was 2 and a half when shed virtually lost her front two top and front two bottom teeth. We'd been back and forth to the dentists for a long time and they said she was grinding them. We'd never noticed her grinding her teeth ever. I then took her to a different dentist who said she needed referring- to do so through nhs would take too long to save the issue you've mentioned re her adult teeth so we went privately to I think it was Harley street. We were told there it was through breastfeeding(ds was bf till 4 and now at 18 hasn't had as much as a filling) but I believed them and cried with guilt. They put false teeth type things on the fourth teeth and we paid I think £2000. These stayed on her teeth until her baby teeth naturally fell out and her adult teeth are fine. The specialist said it was caused by a dry rot that wouldn't have been picked up by normal dentist.
We were always careful of sugar intake and teeth brushing etc so it was blamed on breast milk

Fast forward to when dd was 8. She was diagnosed with gastroesophageal reflux disease which she'd had since birth it seems. Her throat had scarring due to the acid and her gastroenterologists confirmed her teeth issues had been caused by the acid due to affecting the back of her teeth and only the front ones.

She is now 10 and has great teeth. She is seen more frequently by the dentist and has minimal damage behind her teeth caused by the acid - she's been on medication for last two years. When she is an adult she may well have gold plates put on her teeth.

[hercules1]

We were the same - nothing but water to drink, very few sugary foods etc.

[hercules1]

Dd's teeth looked very similar to your lo's.

[BackforGood]

I'm no dentist / tooth expert, but can I ask why you are linking the sleep issues to the teeth issues?
They might be linked, but surely there's also the possibility that they might be two, completely separate issues ?
Waking 20 times a night is pretty extreme.

[WaveorCheer]

That's me clutching at straws, Back

[BackforGood]

With that little sleep, I'd be clutching at anything
but I'd certainly be talking to the GP / HV about the sleep issues. well, if I'm honest, I'd probably have gone under before now - I like my sleep

[TweedleDi]

Just a little aside on the question of coeliac (which I agree is not very likely) in case of future searches by others asking similar questions.

Dental enamel defects in teeth are common in children who develop symptoms of coeliac disease before 7 years of age. However - the rationale for children who display such enamel damage in baby teeth being occasionally linked to coeliac, is not so much in the implied dietary damage, but more to do with immunologic and genetic factors. These are likely to be more important in the etiology of the defects than nutritional deficiencies (at this stage). Interestingly, dental enamel defects are also found in healthy (asymptomatic) first-degree relatives of patients with coeliac.

I think a possible gastroesophageal reflux issue also suggests that the GP as 'gatekeeper' for these sorts of investigations could usefully be brought into the loop.

[WaveorCheer]

Reflux isn't something I've ever considered though, and doesn't seem likely as he has no other symptoms apart from shit sleeping. He was a fine sleeper up until about nine months, which is why I'd linked the two.

He was a very chilled newborn - six months. And surely the bottom front teeth would be damaged too? He's had four front bottom for as long as he's had the four up top and they are completely undamaged.

[WaveorCheer]

The front plane of each tooth is as damaged as the rest of it, if that makes sense.

[WaveorCheer]

Right, DS is thoroughly sick of me taking pictures of his face, but this is a decent shot of what I mean

[WaveorCheer]

Bump - anyone?

[CbeebiesIsAboutToPop]

Bumping for you, that looks awful, but I have no expiearience or advice.

[WaveorCheer]

Thanks Cbeebies - it does look horrendous, doesn't it :(. They're disintegrating.

[NoArmaniNoPunani]

I think an NHS dentist would monitor these and if they give pain then refer for extraction. You may find someone (a pp mentioned a dentist on Harley st) who you can see privately for restorations.

[WaveorCheer]

If it was your child's teeth, Armani, would you go with the wait and see approach (which I suspect in my son's case would lead to extraction sooner rather than later), or would you stump up £2k for private capping. I mean, one seems like the obviously superior option (costs aside), but I really have no clue.

[WaveorCheer]

Oh dear, "stump up." No pun intended

[Oinkypig]

It is impossible to tell why his teeth are like that from pictures on the Internet but it also doesn't really matter interns of your treatment options.

He will need a GA for any treatment and that won't be done by the NHS unless he is in pain or has an infection as the risks of a GA need to outweigh the benefits. If it is felt he is in pain or has an infection the teeth would be extracted. If front baby teeth are so damaged they cause pain or infection trying to fill them is very difficult and unlikely to work and you would be faced with the risk of another GA for extractions when they fail.

You could possibly find a private dentist to do treatment but if it was my child, given the pictures you have posted, I would opt for extractions if he was in pain and then if needed, orthodontic treatment in the future.

You would not be being unreasonable to ask for a referral at all, but your dentist is treating him correctly.

Also he is unlikely to be in pain fr

[WaveorCheer]

Thanks oinky (phone wants to correct that to kinky!). I see you point about the risk of a GA.

I assume that the bit missed off the end of your post was that if he was in pain we'd be seeing more extreme behaviour? Off food etc? He shows a definite preference for soft food, but he eats loads of that :).

[MandScookiesrule]

Completely agree with oniky
Difficult to see clearly on photos, but NHS dental treatment would be extraction under GA if causing pain/infection.
If painful would likely to be very upset when eating. HTH

[NoArmaniNoPunani]

If this were my child's teeth I would wait and see and go with the fluoride applications every 3 months that your dentist has already advised. I would continually monitor for signs of abscesses, at which point the teeth will need extraction, at his age GA will be needed for that. I wouldn't bother with crowning teeth that will exfoliate around age 6. If you're worried about the teeth holding the spaces as guidance for the adult teeth (a valid concern) you'd be better off putting your 2k aside for possible Ortho treatment when he's older (he may of course meet the criteria for NHS Ortho and your money won't be needed)

I doubt the sleeplessness is related to this

[NoArmaniNoPunani]

Cross posted with oinky, who has basically said the same thing :)