WWYD? baby's tooth

[blondieblonde]

Our baby (13 months) broke one of her front teeth and it now has a little pus-filled blister on it, i.e. it is infected. She is happy and not in any obvious pain.

The dentist said that we can either:

a) have it removed with general anaesthetic

b) treat it with antibiotics and try to keep it clean for a year or two, maybe until she is old enough to have it out with local or is bigger to reduce the risks of GA

I'm really not sure what to do. It is right at the front of her mouth and looks red on the gum. We haven't done anything yet. It's not spreading quickly like a grown-up abscess would.

Nobody is suggesting repeated antibiotics, I said to try with antibiotics once and see how the tooth goes. Once again I will say that adult infections are different to deciduous infections. Yes an adult tooth with infection will repeatedly infect due to the root of the tooth. Deciduous teeth behave differently ,the root resorts completely to allow the tooth to fall out when the time is right and is less prone to repeated infections.

But the baby is 13 months. The tooth has to last until she is roughly 6. The tooth is broken and obviously infected. I disagree that deciduous teeth are less prone to repeated infections. The infection is not due to the root but the fact the tooth is broken.

That's where you are incorrect, the tooth isn't broken due to decay, it was trauma that broke it. The infection is caused from the nerve becoming infected in, guess where, the root.

Hi OP
Sent you a PM /essay about hospital and community specialist paediatric dental service and how to access. Best wishes

Where have I mentioned decay? The infection is caused by the pulp being exposed to the external environment, whilst the tooth is broken. Unless you can clean out the infected tooth tissue and place a coronal seal the infection will recur.

In short the tooth has poor long term prognosis and is best off out

I use this website

I would go for the anesthetic tbh. I would be thinking it might cause pain later down the line and her have to be knocked out to get it out in maybe a month or so. I would rather sort something now than later. I know there is a risk with kids and anesthetic but its so minor.. my sis was filled full of the gas they used to use at the dentist (not sure if they still do it that way) when she was 2 and besides her being rather amusing for an hour or so afterwards it never did her any harm...

The problem with websites is its all very black and white, as a dentist we are trained to diagnose and treat patients on a case by case basis not a one size fits all advice sheet,. OP the choice on treatment is solely yours, you know your child and I'm presuming you trust your dentist, as numerous dentists have told you it's not as black and white as definitely remove or definitely keep.

I've been told that once a child reaches 6 months, then the risks re. GA are the same until they hit 35yo.

I would probably want it removed ASAP if it is confirmed as dead. Because if it does get infected and spread, that would be a worse outcome IMO.

We had similar with dd1 years back, same age she fell and broke her front tooth in half, no infection though but dentists (multiple) felt the adult tooth could be infected so they removed it in hospital under ga, she was tongue tied so they did both procedures at once. I saw her to theatre, held her until she was asleep and left, I went to do for fresh air and before I got to the front door (down one flight of stairs) the nurse ran after me to say she was done, very easy, a little groggy but home by the afternoon. I can't advise either way as I'm not a doctor but just to assure you that it was quick and painless if you decide to have it removed

Effected not infected sorry

Really sorry that you are in this situation OP.
Am a dentist that works in the specialist paediatric dental services doing GA and sedation, for referred children from General Dental Practice (will have to NC now!).
Your DD situation isn't unusual in that toddlers/ babys often sustain similar dental trauma when learning to walk. However, the vast majority of traumatised deciduous teeth are asymptomatic , even when the nerve dies off. Often if the nerve dies , the tooth will discolour but will exfoliate at the usual time.
However, if the child then develops associated infection either with or without pain, then the deciduous tooth absolutely must be removed. There are two issues that we worry about most, firstly the damage to the underlying permanent successor can be very severe if exposed to long-term sepsis.
Secondly, without being alarmist, sometimes innocuous low grade chronic infection can suddenly blow up into facial cellulitis; and a child would have to be admitted to hospital as an emergency for IV antibiotics plus GA removal. While children recover quickly, it is obviously not nice for child or family. I have seen a lot of this, so have a different perspective to dentists in General Dental Practice.
So by far the most sensible option is for your family dentist to refer your DD to the nearest specialist children hospital e.g.GOSt, Alder Hey, Manchester, Sheffield childrens hospital-they all have specialist paediatric dental departments. A child of 13months would have GA in a specialist children hospital with a specialist paediatric anaesthetist. That's what would happen where I am based anyway!
I know it is a frightening thinking about GA but there is no other viable option until your DD is at least 5 when local anaesthesia may be possible. Children generally need to be at least 6/7 to use inhalation sedation with nitrous oxide + local anaesthesia with success.
The actual GA extraction will be done very quickly and you will be with DD at induction and immediately afterwards in recovery.
Our lovely anaesthetist always tells parents that the riskiest part of the day is statistically the car journey to and from the hospital.
Hope this helps you.

RobinHumphries.....website is the trauma bible !

I'd go with the GA like a shot, tbh. It'll just be a teeny tiny dose of anaesthetic and it will all be over in two or three minutes.

Mangetout thank you!

Hi everyone,
Thank you all for your excellent replies. So I guess we are doing a combo of both -- we've got amoxicillin now as DD does have a proper infection and it needs to be cleared up asap. Also we're being referred to a paediatric dentist who will hopefully put us on the waiting list to have the tooth removed (at the very good hospital here, which has a children's hosp attached), and we will agree to it.
They said it could be about 6 months wait to have the tooth out!!
I felt a lot better when the dentist explained that it was not a very strong GA like you'd have for a long op. My husband realised he'd had it several times as a child.
So, we will hope the antibiotics keep the infection at bay until we can have it out.
The dentists weren't too keen to prescribe antibiotics but I'm glad we pushed for them as I hear what you are saying about the effects of long term infection.

ps Mangetout do you know if they will x-ray DD before removal? I only ask as I wonder if the tooth had some abnormalities (it broke without cause a few weeks after erupting) and wonder if it has a funny root etc.

Personally I'd get it out. Then it's not hanging over your head, you don't need to worry about repeated courses of antibiotics and you don't have to worry about the adult tooth

My DD had both front teeth extracted after an injury to one, which caused it to go up into the gum. She developed an abscess about 1 year after the accident and they came out then. She was 5 1/2. No pain, quick recovery. The only thing that was a bit tricky was when the adult tooth came down, the gum was harder so it took longer to come through.
That's just my opinion though. (But was recommended to me by two dentists (I got a second opinion)

Ps. She had a general. I didn't want her to get any negative associations with the dentist

Was there a waiting list Newman? I have been told it would be up to 6 months waiting.

When I was three I was under GA to have two teeth removed. I was fine.

I went private Blondie, the health insurance we had covered it mostly

I've just pmed you

Ah! Nice.