My toddler urgently needs dental care. I've been quoted 6k. Is this normal? London

[punjama]

Due to what we believe is digestive bacterial infection which we can't specifically diagnose (loads of inconclusive tests and white poo and tongue) our 21m toddler has loads of cavities on 8 teeth with some going into the verge of decay (she has a very healthy diet with no sweets and brush 3x a day). We've been told If she wants to keep her teeth it's unlikely we'd be able to wait 1 year for NHS. One private dental clinic we went to gave us a quote of 6k including anaesthesia in hospital. Said our BuPa would cover hospital and anaesthesia but around 50-60% of cost out of pocket. Another clinic said they'd do it via sedation and it would cost around 2.2k. is this standard? Were somewhat fortunate to be able to pay this because we deny ourselves (ie no car no home ownership no holidays etc) everything but how do others deal with it? Just wait for NHS? Were afraid that she would lose her teeth and will be toothless as a kid and get bullied....

Go to a NHS dentist and they'll refer you to Kings College. Our daughter was there from about 5 years as she had an issue with weak enamel (something to do with how she developed in the womb the dentists thought). They were very good, we got students to treat but if you can afford it you can get the consultants as although students were generally good and lovely it did mean every visit was at least an hour with all the checking etc. They really looked after us.

Has she been checked for an upper lip tie as that can promote decay in the upper front teeth?

I'm confused what treatment has been proposed for that sum. Cavities at base of teeth , especially front ones are tricky to fill. Why are you not cleaning them after breakfast instead of before, as the juices must sit in her mouth for hours afterwards, when does she bf in the day?

@dementedpixie

Has she been checked for an upper lip tie as that can promote decay in the upper front teeth?

the GP told us when she was 3m that she didnt have upper lip tie although my wife tells me she thinks she might have small element of it in her opinion (although when i google this the pictures i get are extreme and its definitely not that bad at all)

Its the white poo and possible liver problems that seem the most serious issues here. They can be related.
If you are in Crystal Palace you could ask for a referral to paediatrics at Kings College Hospital which is close to you.
Don't be fobbed off by Gp. If necessary change Gp.

its fine to brush teeth before breakfast especially if you're eating/drinking anything acidic

@LIZS

I'm confused what treatment has been proposed for that sum. Cavities at base of teeth , especially front ones are tricky to fill. Why are you not cleaning them after breakfast instead of before, as the juices must sit in her mouth for hours afterwards, when does she bf in the day?

tbh i dont know why its done like that. we can switch to post breakfast or pre and post. we have no issue.

its not like she has bf sessions but more that whenever shes anxious or upset or in pain (e.g. fall over) she goes for the boobies! many times she just sucks without drawing milk its like a soothing experience. if were out all day in the park she wont have it for hours.

@sallyedmondson

Its the white poo and possible liver problems that seem the most serious issues here. They can be related. If you are in Crystal Palace you could ask for a referral to paediatrics at Kings College Hospital which is close to you. Don't be fobbed off by Gp. If necessary change Gp.

thank you i think thats what we will do first thing on monday. does it help if we have BUPA (through work)? its something i signed up for but not sure if its of help. we tried to use it once but again it was just as lock down happened so we didnt end up going to the paediatrician back then.

would you say we should go through GP to get the Kings Hospital referral at same time as we go through our NHS dentist for the treatment? or do one then the next?

You shouldn't brush too soon after eating as the acids produced will mean you will be brushing away enamel from the teeth. The most important time to brush is before bed

The pattern of decay you have described sounds like nursing/bottle caries. Classic pattern. Obviously in this case would be nursing caries caused by extended on demand night breastfeeding. It is rare but does happen. I'm a dentist and I've had one case in 10 years of a 2 year old where this happened and we examined the diet in detail and this was the only possibility (plus non fluoride toothpaste unfortunately). I'm pro breastfeeding too and breastfed my DC until 2 but night-weaned at 12m for this reason. My MIL is a paediatrician and also warned me of iron deficiency anaemia with extended breastfeeding if low food intake so this may explain white stools. I would seriously consider night-weaning. Unfortunately extraction under GA is the only viable option as any fillings on a child of that age will have an extremely high failure rate.
Sorry to hear she's in pain; that must be awful for you. I'm private but I do refer to NHS if requested and it takes about 2 months minimum for special cases normally 6-9. Private you'll be seen straight away but £££. There's plenty of paediatric dentists in London I would go for a consultation. They'll give you all the options and also examine the diet in detail. There may be enamel defects but it is impossible to get caries (decay) without frequent exposure to a sugar,

@Mrsmorton
It's also banned in the UK and has been for decades...

It was banned around 2002 after the deaths of several children. A very sensible move. No one expects to lose a child whilst having a tooth out 😔

Hello, NHS dentist here.

So to be referred via NHS pathway you will need to go back to your NHS dentist and request a referral to a dental hospital where they have paediatric specialists. It will take a long time, it can take about a year sometimes so that may be a factor to consider. Obviously private treatment will be lot faster due to less demand and you can see paediatric specialists / consultants privately. Obviously the treatment plan is a decision to be made by yourselves and the dentist - if they think it’s urgent it’s possible that either the decay is so deep it’s likely to cause pain at some point, or that leaving the decay to progress may leave that tooth unrestorable (and needing to be extracted).
For now I would definitely recommend continuing to use fluoridated toothpaste, brush in the morning and last thing at night - we recommend drinking nothing but water after that last brush. Unfortunately it is true that breastfeeding through the night will increase risk of caries in toddlers.
I can’t comment on the cost of treatment as I’m not in that sector and I don’t know what treatment is needed. I’m sure you will get good care either way however it really depends on how fast you want it doing or if you wanted a particular private dentist.
Good luck!

OliviaPopeRules if breastfeeding has been found to be the cause of issues for OP’s DD then absolutely, I would recommend following medical advice. However from what OP has said no cause has yet been found for the problems with her digestion etc, and I read the ‘just get told to stop BFing’ as being said in the dismissive, ‘we aren’t going to investigate way’, hence my ‘that is frustrating’ comment.

I don’t think all posts saying BFing might contribute are coming from an anti-BFing stance. Like I said it was the two threads so close together, both with posts jumping on BFing straight away, that I found odd and made me comment on it.
As for the teeth, whether the BFing is the sole cause, or contributing in anyway, then stopping is not going to fix the damage done already, she needs dental treatment and that’s what the OP was asking about. Obviously if it is contributing then reducing the night time feeding would be good, but as we aren’t the professionals we don’t know that. My own dentist said that BFing frequently at night may contribute in some cases because of the duration, but that bottle feeding in the night can also be problematic because of the mechanism. I think we can all agree that such an extreme-sounding level of decay is unusual and needs proper investigation and treatment rather than diagnosing on MN.

I’m off now, so hope you get DD sorted OP. Dental hospital route would be my choice, but as the system in London may be different I apologise if that’s no help.

KTCluck
Op said in an earlier post he was told by doctors and dentists to stop BF.

Any with my friend they did investigate lots of other reasons as I suspect they have here. If multiple doctors/dentists are saying it then it is for a reason. Read the posts form other dentists.

Isn’t she in a lot of pain if 8 teeth need removed?

Yes Olivia and I agree with that. The original post blaming BFing before OP had even mentioned it was the one I was referring to, I responded to that before OP said they’d been told to stop, and read the being told to stop as having been said by a GP without getting to the bottom of the problem. If I’ve picked that up that wrong and OP has completely disregarded advice given based on knowing what the issue is then I take back my “that’s frustrating comment”. I wouldn’t advocate ignoring medical advice from a qualified professional.

I’ve seen the posts above and I am not arguing with them. Just saying that none of us have seen the teeth , and most of us aren’t qualified to give medical/dental advice. I really didn’t post on the thread to get into a debate.

I have never had a case of a child with rampant caries that has been due to breastfeeding if I am honest. PHE advise that theres no evidence stopping breastfeeding in children under 2 will reduce caries rate. When combined with a high sugar diet and poor oral hygeine it may lead to worse decay, but without sugar/poor OH unlikely.

However if you are insistent that there isnt any other sugar in her diet then this is the only option. Given the extensive damage to her teeth then I would look at weaning off night feeds. I wouldnt normally recommend stopping breastfeeding at night.

I think the teeth and the tongue are a red herring. The white poo is the concern, I would sort of assume a GP would have ruled out liver problems/coeliacs. I think you need to focus on this and ignore the teeth when you talk to your GP. Teeth confuse GPs

Your dentist will refer you to a peadiatric dentist. Not your GP. The dentist will know how and where to refer, they know what teeth are damaged. Why are you so reluctant to get your dentist to do the referral?

@PulpHorn

The pattern of decay you have described sounds like nursing/bottle caries. Classic pattern. Obviously in this case would be nursing caries caused by extended on demand night breastfeeding. It is rare but does happen. I'm a dentist and I've had one case in 10 years of a 2 year old where this happened and we examined the diet in detail and this was the only possibility (plus non fluoride toothpaste unfortunately). I'm pro breastfeeding too and breastfed my DC until 2 but night-weaned at 12m for this reason. My MIL is a paediatrician and also warned me of iron deficiency anaemia with extended breastfeeding if low food intake so this may explain white stools. I would seriously consider night-weaning. Unfortunately extraction under GA is the only viable option as any fillings on a child of that age will have an extremely high failure rate. Sorry to hear she's in pain; that must be awful for you. I'm private but I do refer to NHS if requested and it takes about 2 months minimum for special cases normally 6-9. Private you'll be seen straight away but £££. There's plenty of paediatric dentists in London I would go for a consultation. They'll give you all the options and also examine the diet in detail. There may be enamel defects but it is impossible to get caries (decay) without frequent exposure to a sugar,

Thank you for your response. Def no iron deficiency, tests showed that. Is extraction really the only option? I'll try post picture later tonight, it doesn't look extraction level bad yet but we are concerned as to what will happen if we wait too long...but you are saying it's lost cause? We will def seek an alternative opinion as 6k is too much. The 2k sedation option is more acceptable but I need to confirm if they understood her age. I think 2k immediate Vs 9m wait for free would probably be acceptable for me but again if it's extremely high failure rate that's concerning.

Also - everyone should try understand that we would love it if she didn't demand breast at night. My wife gets no sleep at all. We'd love it if she could sleep on her own too but we don't have the heart to have her cry out into sleeping alone and no breast at night. Wife is doing it gently - recently she's started falling asleep without breast feeding but she still demands it in her sleep at like 3am etc

I’ve had two kids treated on NHS for teeth issues v young. Both via MaxFax. The one most similar to yours has dental hypoplasia. (She has cp). Ultimately they titanium capped the affected teeth (which ultimately came out when her adult teeth came in.)
I do have an acquaintance where diet was deemed to be the cause of the ds’s issues and his teeth were all removed. (In that case it was a preponderance of the great British baked bean that was deemed to Be the cause).
Mostly as this type of issue is related to milk teeth it isn’t given huge priority, but treatment is freely available on the NHS for serious cases.
If you don’t want to wait, then you will of course pay whatever the going private rate is.

@FelicityPike

Isn’t she in a lot of pain if 8 teeth need removed?

Sorry for confusion but I don't think they need removal at this stage. I will post pictures later. We are just worried how they will be if we wait 6-9m. Part of that might be the private dentists scaring us too much to try get the treatment done right away.

@LIZS

I'm confused what treatment has been proposed for that sum. Cavities at base of teeth , especially front ones are tricky to fill. Why are you not cleaning them after breakfast instead of before, as the juices must sit in her mouth for hours afterwards, when does she bf in the day?

You shouldn’t brush your teeth after eating, this leads to enamel damage. If you do chose to brush after eating you either need to wait for an hour or swill your mouth out with lots of water.

Teeth are a real issue for lots of the extended bfers I know, but my extended bf friends are also suspicious of fluoride and so don’t use it. It’s hard to isolate a specific cause when it could be a combination.

@DishRanAwayWithTheSpoon

I have never had a case of a child with rampant caries that has been due to breastfeeding if I am honest. PHE advise that theres no evidence stopping breastfeeding in children under 2 will reduce caries rate. When combined with a high sugar diet and poor oral hygeine it may lead to worse decay, but without sugar/poor OH unlikely.

However if you are insistent that there isnt any other sugar in her diet then this is the only option. Given the extensive damage to her teeth then I would look at weaning off night feeds. I wouldnt normally recommend stopping breastfeeding at night.

I think the teeth and the tongue are a red herring. The white poo is the concern, I would sort of assume a GP would have ruled out liver problems/coeliacs. I think you need to focus on this and ignore the teeth when you talk to your GP. Teeth confuse GPs

Your dentist will refer you to a peadiatric dentist. Not your GP. The dentist will know how and where to refer, they know what teeth are damaged. Why are you so reluctant to get your dentist to do the referral?

Thank you for your response. Wife is in full agreement that it's the white poo and potential liver issues which is the main thing that we need to deal with and the teeth situation is a by product. We haven't been able to get traction on this but we have booked a gp appointment for next week and will ask them to make a referral to a Bupa specialist.

We will ask our dentist for referrals to pediatrist dentist. Apologies if I've made it seem as if we've been reluctant. The one we go to did the check up and said they don't treat under 5 years which is when we went to the super fancy clinic which gave the 6k quote. We will ask our local one to give a referral for DD.

Many doctors and dentists know little about Bf. I’ve been told to Stop Bf by several HCP and they were all wrong.

Health visitor said at baby’s 8 months check “ well you will want to give up now as he’s too old “.

A consultant endocrinologist told me there was no benefit to the baby after 6 months and I should stop so she could treat my thyroid disease. The drugs she prescribed are not contraindicated for BF and the benefits of Bf ( to mother and baby ) are dose related.

A dentist told me I had to stop to have dental treatment under sedation. No I didn’t. If I was conscious enough to feed, it was ok. Even if it wasn’t, I could pump and dump.

My Gp told me I had to stop to take hay fever meds, even though the drug I was taking could actually be prescribed for the baby I was feeding.

Not one of these HCP did an assessment of the risks to me and my child of stopping Bf unnecessarily.

So I can understand why the Ops wife is reluctant to stop Bf the child on the basis of “ we don’t have a clue what’s wrong with your child but why don’t you try this. Now off you pop. “