Anyone had their toddler's teeth filled/capped privately?

[Cel982]

Our two-year-old has very advanced tooth decay on her four top middle teeth. It started very early - our nice NHS dentist feels breastfeeding at night may be partly to blame, otherwise diet is good and we try to brush as frequently as possible. Anyway, since the teeth don't seem to be causing her any pain the dentist is keen to leave them until they fall out naturally when she's 5 or so. I can understand this, and I appreciate that it's NHS policy. However, she'll be going to nursery next year and I really don't want her suffering the stigma of having very obviously 'bad' teeth. We don't have a lot of spare cash for private treatment at the moment, but would be able to scrape it together from somewhere.

So... is this an option? Has anyone had their very young child's front teeth filled or capped in this scenario? What sort of anaesthetic was required? How much did it cost? Any advice/experiences would be very gratefully received, thank you!

What do you call top middle teeth? The central and lateral incisor? Because on those you cannot really do much for decay.

But I would worry more about the future, because early childhood caries is a big warning sign for further caries.

When you say the diet is fine, what is she snacking on? The worst are dried fruit (sultanas, apricot, ....) , juices even diluted, and of course all sweet things from "healthy" one, such as honey in milk to chocolate . Because it is on the front I would say it is something she drinks. Coke? Squash? Breakfast cereal? Cereal bars, especially the health ones?

Breastfeeding should not cause it www.breastfeeding.asn.au/bfinfo/breastfeeding-and-tooth-decay so focusing on this may let you overlook and ignore the true cause.

Last, fixing the decay on 4 teeth might be quite traumatic in a 2 years old. Change toothpaste for a fluoride one, speak to your dentist about a fluoride mouthwash you can maybe apply on her teeth with a cloth or fluoride pills. Focus on prevention and start a sugar free diet now for the whole family. Sugar is everywhere even on savoury things, even rice crackers, so it might be a little bit difficult at the beginning. Educate yourself with books from the library.

Thanks Aussie but, with respect, this is all stuff I've been over at length with the dentist. I'm a doctor myself so I'm reasonably well educated on dental health. The evidence on breastfeeding and caries is mixed; I agree with you that it doesn't strongly support a link, but certainly our dentist doesn't concur. DD has never drunk anything but breastmilk or water, and we've cut out all sugary snacks. She's been having fluoride varnish applied every three months but is still losing enamel very quickly, unfortunately. My question is more about treatment options; obviously at her age that would require some degree of sedation so I'm looking for others' experiences.

Other 2 year olds don't care what their friends teeth look like. The reason for the NHS position is because of the sedation and the trauma for such small children. My daughter has had a cavity sealed on NHS. A friends 6 yr old had a filling and it was horrendous. She is now terrified of the dentist.

Don't do it for cosmetic reasons.

I think cost to the NHS is definitely a factor, Huckleberry. This article is a few years old but is interesting nonetheless.

And yes, I know that two-year-olds are blessedly unconcerned about what their little pals look like. But these teeth will be there until she's five or six, and the reality is that other children, not to mention teachers and parents, will notice and make judgments because of it, as we all do. The last thing I want is for her to feel any sort of stigma from something that's not in any way her fault. 'Cosmetic' does not always equal 'superficial'.

Is she with someone during the day? Could this person give your DD some treats, such as a lollipop she would be sucking on for a while?

Antibiotics taken during pregnancy can also affect the enamel.

This was the case for my DS2. Out of 9 months of pregnancy I waa taking AB during 4. He has had 2 fillings in molars when he was 5. You couldn't see them, so I was surprised but the dentist could feel them with her instrument. He had them filled in 2 sessions and the private dentist was extremely nice and patient and taking the time. He had a local anaesthetic. The chair was under a tv screen on the ceiling, so my son was watching a movie during the procedure. Even so, it was quite distressing.

The cost at that time 4 years ago was 100 euros per filling. We were posted in Spain. Just adding they don't do sedation in Spain.

He doesn't fear dentist, always happy to go. He had the sealant applied and we do check ups and scale/clean every 6 moths which cost a fortune here in Australia $400!!! Again a private, very nice gentle dentist, who puts sunglasses, lip balm and jokes during the whole time.

Just book a visit with a private dentist and listen to your options. As I was telling, incisors are not easily cured because you have to drill and remove the decay. If it is just about the aspect of the teeth, so cosmetic, perhaps the dentist would be able to apply composite and fill the gaps. Pain free and not very expensive, certainly less than curing a carie. A friend chipped an incisor while drunk and I sent her to my dentist and he filled the gap for 40 euros. But it was the bottom of the tooth not the top, not sure how it can be done. After the work, you couldn't see the difference.
No need of anaesthetic for that.

Thanks Aussie, that's useful information. I'm home with my little girl full time at the moment so can't blame anyone else for her poor dentition, unfortunately I've had a lot of fillings myself from a young age despite very strict dental hygiene, so I do feel she may have lost that particular genetic lottery...

DD has a condition (genetic- called Incontinentia Pigmenti, consider me outed)

This causes primarily (for her) blindness in one eye- and discoloured skin pigment in patches as well as conical and missing teeth. I can confidently tell you that nobody has commented/ no bullying or teasing from peers and she has just turned 5. HOWEVER, the NHS have agreed to cap her teeth when necessary. This will be painful and may cause her further dental pain in the future. Veneers are not a viable option for children due to extensive cost and upkeep. Filler is an option, and can be a cheaper alternative for us.

Our decision is to wait until she is (eg) 7 and see how her adult teeth start to come through (if at all). Then we will look at bridges, caps and veneers- potentially implants have also been mentioned but we need to weigh up the cost of potential future pain rather than immediate pain.

Obviously we are 'lucky' to have the opportunity of this on the NHS- but I would take into account the potential of future damage to adult teeth by capping or implanting baby teeth, and to look into the future dental health

Thanks for the info, Improbable, and sorry to hear about your little girl's health problems. I do realise how lucky I am to only be worrying about something that's relatively trivial in the grand scheme of things. Hope things continue to go well with your DD.

cel, you could perhaps make an appointment with a private dentist who has experience who can outline the choices for you. My DD has had to have some serious dental work (weak enamel, teeth out, filings). I was so distraught when I heard that I booked a private appointment, found out the facts, and have had excellent treatment from the NHS. However I felt better having the time to speak through everything, find out options etc.

There is lots that can be done with teeth. I would arm myself with what you can do, what your options are et. Can you get yourself referreed to the paediatric dental unit. We went to ours and they were wonderful with my daughter. They are used to dealing with children, and my daughter had to have 3 teeth removed and we did this with gas and injections.

Also from around 4 a lot of children start losing teeth, so it's quite usual for lots of gaps, missing teeth etc! My friend had a daughter who had her 3 or 4 front teeth removed (also from breastfeeding).

Good luck, I understand this is a difficult time, and like you I also (eventually) gained perspective on it, and that this is something fixable.

Cel not a problem at all! She's right as rain despite that I was just letting you know what the NHS has given as options- and pros and cons for each option that might be worth looking in to.

Primarily you know your daughter and family so go for it if you feel it's right for you!

Hi OP,
It would be reasonable to ask your family dentist to refer your dd to a specialist paediatric dentist. These dentists usually work in either dental or children's hospitals or the Community Dental Service. There are also a handful on the paediatric Specialist list who work privately in London.
The main problem for dental treatment in preschool children is cooperation, it is an achievement for most 2 year olds to sit on their own in the dental chair for an examination, let alone permit treatment. Generally if a 2 year old needed dental treatment, in the UK this would realistically be under GA and could only be justified in cases of pain, trauma, sepsis.
In your dd's situation, a preventative strategy would be key to her treatment. It sounds as if your family dentist has already done this.

Options for UK children's dental treatment include local anaesthesia, conscious inhalation sedation-nitrous oxide+oxygen and GA. A 2yr old is unlikely to entertain intra-oral local anaesthesia without restraint-this is done in the USA with the papoose board but definitely not in the UK.
Inhalation sedation+/- local anaesthesia is possible in those aged 6 and over. Quite a lot of cooperation required from the child for this- ie breathing in a specific way, permitting a nasal mask; mouth breathing negates its efficacy etc. There are other types of paediatric IV sedation techniques discussed occasionally in the British Dental Journal, but this is far from mainstream dental treatment +Controversial.
Possibly when your dd is older, if the clinical situation permits, atraumatic prep + restoration with a material such as Glass Ionomer (which releases fluoride) could be placed. Again, better chance of success with a dentist who specialises in paed dentistry; + this definitely does NOT necessarily equate to a Private general dentist !!!!
Finally,it is not unusual for extensively carious teeth to become infected; so 3 month reviews are a must. Also good idea for you to check the gums above your dd teeth on a daily basis, ideally when you do the night toothbrush. Reflect the upper lip, and keep an eye out for small white lumps -a sinus / abscess.
Hope this essay is of some use to you
Am a dentist of many years btw in this area.
Best wishes + ask your GDP for a referral to the above!

Many thanks all for the advice; it's great to get the perspective of dentists and also parents who have been there. It's a very emotive thing, vuvuzela, isn't it?

Thanks especially for the info on inhalational sedation, andanddec - I hadn't realised kids would need to be quite so old for it to be practical. I certainly wouldn't want to subject her to a GA unnecessarily. We're being seen every three months anyway, and our dentist is happy there are no signs of infection yet.

OP please do not feel bad- this is clearly not your fault. For all the smug ' my child's teeth are perfect' parents, there are plenty of others who care for their kids teeth just the same way but the kids still have cavities, because bad luck means some people just don't have strong teeth. For what it's worth- I would not subject her to treatment just for the sake of other people's reactions. Children won't notice or care. I would just be guided by your dentist.

My DH is a dentist. He agrees that you don't need to go to a private dentist but an NHS community dentist who deals with children

You can discuss options there.

If your DC does have "weak enamel" or is otherwise more susceptible to decay (which is fairly rare), then diet and dental hygiene are even more important. There's a lot of hidden sugar is food - eg pasta sauces. It would be worth keeping a detailed food diary and then reviewing it with the community dentist

Finally, it's not the amount of sugar but the number of intakes. It's worse to have 5 teaspoons of sugar across the course of one day that 5 teaspoons in one go. The vast majority of decay is dental related rather than hygiene related (hence the apochryphal stories snout great uncles who never brushed their teeth but had no fillings - when you review their diet, their sugar intake was very minimal and very infrequent) so diet is key to sorting this out as the best predictor of future behaviour is past behaviour - ie the decay will continue (even if there are underlying reasons)

Hi there
It’s been a while since you posted, but I’m curious how did things go with you and your DD. By now she hopefully has a bright new set of upper incisors! My poor son has the same issue and I’d really appreciate hearing how you navigated this situation and if you experienced any social stigma. Many thanks!