Tooth decay in 4-year-old

[EmmalinaC]

My 4-year-old DD has cavities in 2 of her milk teeth. Our local NHS dentist recommended we do nothing but see if they get worse and possibly fill them some time in future. I wasn't happy with this 'supervised neglect' so I took her to my own (private) dentist, who also happens to be a friend of DH, for a second opinion. He recommended the teeth are extracted immediately under general anaethetic because any other treatment could cause a life-long phobia of dentistry and to use his words 'they aint gonna get better'.

Has any one else had to make a decision about this? I just don't know what to do and feel wholly responsible* for DD being in this situation. Although I absolutely do trust my dentist, general anaethesia seems pretty drastic.

I would be really grateful if you could share your experiences.

*FWIW I want to add that we have brushed her teeth regularly, she has never eaten a lots of sweets but it seems raisins, fruit juice and night-time milk etc plus inheriting my crappy teeth has done for her. I feel terrible about it

EmmalinaC - sorry to hear about your DD and her teeth and I do sympathise with how you feel.

My dd had a cavity in one of her molars. She was 4 or 5 at time. Our dentist filled the tooth and put a silver cap over it. (needed the silver cap as the filling was so large.) This was done under general anaesthetic. There is no way we'd have been able to do it in dentist chair without holding her down and holding her mouth open - extremely traumatic for everyone. GA was better in our case at least.

Hope that helps.

Two of my boys had fillings in a couple of their back teeth when they were young. I think what the private dentist is suggesting is a little over the top. I think your NHS dentist has the right idea. It won't affect her adult teeth at all.

Also, fillings on milk teeth aren't traumatic, my boys thought it was hilarious having their teeth "tickled".

extraction is a bit drastic - I would have probably gone for the 'keeping an eye' option especially if they are only baby teeth

It would really depend on how big those holes are. Four is pretty young to be co-operative for dental treatment as treating a child is the same as an adult it still requires local anaesthetic and drills if it's done properly.
If she is not having any pain I would look at changing her diet; cutting out all drinks but water between meals, cutting out grazing (including fruit) and try to give her savoury snacks wherever possible. Is she still having milk at nightime?
I would prefer to avoid a general anaesthetic for my child as the teeth could be treated in a year or so in the dental chair but if they are large holes already, realistically they are unlikely to last until the adult teeth come through.
You could book an earlier check up in three months and ask your NHS dentist whether the teeth are likely to have decay into the nerve. If they are you private dentist may well have a point.

dd1 has weak enamel, and had 3 crowns done under GA at the age of 5....she coped very well, and is proud of her 'silver teeth'. We had to have it done privately, and found a childrens' dentist who handled it beautifully (apart from the anaesthetist, who lied about the needle hurting ).

Don't be hard on yourself, we never knew raisins were so bad either - although in dd's case, it was even more obtuse: her teeth are perfectly aligned but close-fitting, and apparently we should have been flossing as the decay was between the teeth

I agree I think the private dentist is being a little OTT. A GA is also a traumatic experience (think canula, going to sleep surrounded by strange people etc).

My dd needs a front tooth out following an accident and there is no way I am letting her have a GA for that...I have agreed with the dentist that when its wobbly enough the dentist can pull it.

I would maybe seek another opinion, but I would wait and see.

Thanks for your replies.

The private dentist is referring us back to the NHS - department of paediatric dentistry at St George's. It is his belief that although the original dentist was technically right to say 'wait and see', the decay will certainly reach the nerve (and may develop into something much more serious such as an abcess) before the tooth falls out naturally in 4-5 years. Part of the problem is that at 4 she can't be X-rayed, so there's no way of telling (as you could with an adult) how far decay had spread.

He also believes that 4 is way too young to undergo dental treatment without a GA but that by getting these problem teeth out now (before decay spreads to more important teeth) we can start again with healthy teeth (no more raisins or apple juice!) and build trust in the dentist so that if there are problems in a year or so's time they can be treated by the dentist.

So we have decided to take her to St George's for a THIRD opinion and then make a decision...

My dd has cavities in her back molars, which is something I could slap myself for daily. She goes every three months and they put temporary filling in them, to stop the decay getting any deeper. Seems to be working so far.

How old is your DD jenny?

I asked the dentist about this and he said it's different with back molars - because they guide through the adult molars, dentists will do anything to keep them in place. Because DD's are 4th molars the dentist believes she doesn't need them and therefore would be better off (in the long run) without them.

Ah, I could slap myself too. The worst part is that we thought we were looking after her teeth!

She is 4yo. Sorry, I didn't realise we weren't talking about the same teeth! Luckily, dd loves our dentist and feels comfortable with her. Last time we went she had to have a little drilling, and I was behind the chair with tears streaming down my face while the dentist glared at me in case dd saw me.

It really is awful.

Hi Emmalina, My dd 4.5 is to have her two back bottom teeth out on the 15th of this month.
Her back teeth have been crumbling for months, and our dentist just kept painting them with flouride! We had an appointment booked for the 1st of march, turned up to find a note on the window saying she had left giving no notice and to ring the main practice.

I did so and was told we would have to wait until a new dentist started in July, and as we were under our dentist we were not able to use the other practice!

So since March we have been back and forth to the emergency dental centre half an hour away to try and sort her out, she had had abscesses on those back teeth and has been in awful pain.
Finally managed to get them to make a decision so we could get this sorted once and for all!

My four year old daughter has tooth decay on her. Two middle top incisors, i have four children, two grown up and two youngere. All my children have had the same healthy balanced diets (minimal sweets, i.e. christmas and birthdays) and they were breast fed for the first two years and i feel so bad that my youngest is suffering. We had her teeth coated which worked for over a year but the decay is worsening, and now there is nothing much to coat. I was hoping we could manage until her teeth fell out naturally but we are now facing the terrible dilema of what to do for the best. I feel so responsible and fearful of the options. I wish I could turn back time and see the badness in raisins and fruit etc....I really thought I was doing the right thing and feeding my children sensibly and healthily.

I thought that taking them out meant the adult teeth began to grow sooner and the mouth couldn't handle it so it's best to put off as long as possible. I'm not a dentist, but I'd certainly choose a filling over an extraction. For me and DDs.

don't feel bad about it kelou, if all your children had the same diet and only one has problems, perhaps they just had weak enamel? ds2 has shocking enamel on a few teeth and will probably need fillings later on but it's just he way his teeth formed

my dd 8 is waiting to have 4 teeth out, 2 of them permanent teeth
She had regularly been to the dentist then last year dentist asked us to return for a filling when we went back she said oh no this is not something I can sort out I will refer you to the dentist at the hospital, the referral was refused Dentist then resent it and it was accepted, when we got to out appointment I was shocked to be told most of her teeth were shot to pieces. I could slap myself to but I struggle to see why the rapid decline happened
to her teeth.
I feel that dd has not received quality care from the Primary care trust of whom I am an employee!!

Dentist did recommend me to start using Proenamel for children as it has higher fluoride. And also use a straw with drinks

Any over top tips would be gratefully received????

Chocolatespiders look at your daughter's diet really critically. She still has a lot of adult teeth to come through which will be healthy, so making changes now will be really beneficial.

Decay is simply demineralisation of teeth caused by acid produced by the bacteria in the mouth. The bacteria use any sugar that is eaten to make the acid, saliva will neutralise the acid eventually but it's a slow process so if you frequently have snacks or drinks containing sugar the mouth is acidic and decay happens.

Sugar can be hidden; there's obvious sugar in cakes, biscuits but hidden sugars in fruit including raisins, smoothies (particularly bad for teeth as the fruit is smashed up), milk has milk sugars in even ketchup and some flavours of crisps contain sugar. Beware of thinking because squash says it's sugar free it's ok for teeth it still contains fruit sugar. Look on labels for sucrose, glucose, fructose,lactose they're all sugars. Bacterial wil use sucrose which is caster/granulated sugar most easily but they will use other sugars as well.

Try to encourage your dd to drink water if she's thirsty, stick to juices at meal times only. Try to avoid grazing sadly children who graze on fruit often get decay despite having a healthy diet. Encourage her to have a sandwich, crackers,cheese, pitta bread and dips rather than anything sweet between meals.

If you are happy with her to have chewing gum after a meal one containing xylitol can help to prevent decay.

She needs to be using a toothpaste with 1400ppm fluoride (adult strength) brushing on getting up and just before going to bed. It's better to eat with clean teeth rather than brushing after eating as those bacteria work really fast.
Ask your dentist to seal her other teeth as they come through.

I hope this helps.

Really helpful post thank you Millymollymardy- lots of great ideas

Will try and find the chewing gum you recommend

Her biggest problem is she has always eaten 6 small meals a day as she has always hated big meals.. She is as thin as a pick and used to drink lots of smoothies we now limit this and only allowed with a straw.

Dentist does not seem keen to seal her teeth coming through I have asked wasn't taken as a serious question- maybe I need to insist or look at having it done privately.