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....

@icansmellburningleaves
Dental extractions under GA have been banned in dental practices since the 90s after a report found an unacceptable number of deaths (due to no anaesthetists/support if things go wrong). They are routinely carried out after referral to hospital by hospital based dentists with anaesthetists carrying out the GA

@punjama
Within the NHS/community the school of thought is to extract every tooth with decay present in young children to avoid the (very low) risk of a repeat GA. Privately you will have more options with risks/benefits discussed. They will advise you on what in their opinion is best for your daughter. They shouldn't rush you into any treatment. I am completely non profit driven and have the patients best interests at heart. As your little girl is in pain with repeated doses of antibiotics the best thing would be to act quickly though

My ds has had 2 lots of dental treatment at the st Thomas's in London in the paediatric dental department there. They were great. In both cases we were referred by an NHS dentist and seen in about a month first time (urgent ish) and 3 months second time, non urgent. I would be surprised if they would do fillings for a 2 year old. I also think it's unlikely that a 2 year old would be able to have fillings under sedation. My ds was around 6 when he had work done under sedation and they said they rarely did complex dental work / extractions without GA for younger kids. They thought he could manage with sedation as he was able to sit still through the xrays. I suspect 6k is right if you have a GA as you need multiple HCP there.

hi all as promised here are the pics.

only have one side of the bottom but its like that on both sides of mouth ie on top and then on top half its on the side. + what you can see on front teeth.

also looking at the photos it does look like she has a bit of lip tie?

Poor little thing that looks quite severe. As others have said have you tried getting in touch with all london dental hospitals? Your wife may even have to try cutting down on breast feeding at night if thats been advised. 6k sounds extreme for treatment a child needs.

i'm a retired dentist so no longer on dental register my opinion is that the upper front teeth with brown type stain can be left if it doesn't go between teeth, dark brown can mean that there was caries and it has now stopped progressing it is unsightly but possibly not urgent
however what appears to be the lower right molar has a big active cavity that could cause pain, sometimes they use something call the HALL technique and basically cement a metal cap over the whole tooth generally the results for this technique developed in Dundee are much much better than having a filling this tooth does need something doing to it or it could get painful
however these are photos not an examination so it is only an opinion

We have a prescription toothpaste and use an electric toothbrush which has been a big improvement (the one with the circular head as much smaller). Is she in pain? If she is they should push her forwards.

certainly the upper teeth look like they were affected by "nursing caries" but they are no means the worst case i have seen if you google it you will see that however just because there are worse cases doesn't mean you don't have a problem

I agree with teacup

I dont think the upper teeth need removing. They will be difficult to fill as well.
It might have already arrested (so it was decay but has stopped progressing) or you could get it to arrest with flouride and good OH. Either way i would leave that alone for now. It doesnt need treatment

The lower molar will need treatment, halls crown would be ideal but it depends if the child is co-operative enough. I would probably want an xray before though

I still think a a paediatric dentist is your best bet.

She doesnt have a lip tie. Its most likely becauae of the lack of flouride toothpaste

Ex dentist... still on register. Agree with teacup and dish. Arrested caries is preferable to extractions by an order of magnitude.

Rev the back tooth... that's a big hole for a baby tooth. Definitely needs treatment

Get her seen by paediatrician to look at all the issues and get referral to specialist dental clinic

I'm not a dentist or medical practitioner so this is purely based on my own personal experience.
I'm a twin. We were fed the exact same diet. We were bf at the same time and for the same length of time. My teeth were and still are perfectly healthy. Even at the age of 30 I have never had a tooth pulled out or filling or anything for that matter. However my twin has had an awful time, their teeth literally crumbled away as a toddler, cavaties, extractions etc... Also twin had a dairy intolerance and bad eczema. No other test were undertaken because this was the 80s but I reckon if they had been then more would have been discovered.
During my 2 pregnancies I developed an autoimmune disease and as a consequence have developed multiple allergies etc and my skin, teeth and nails I can tell are starting to decline.
What I am trying to say is I believe that autoimmune conditions/ intolerance/allergies which all go hand in hand are often misdiagnosed and the impact of them on the body are misunderstood. Thats where I would be looking.

I was told to prevent dental carries you need to wean with tap water rather than filtered as it is floridated. And use a flouride toothpaste. Ban juices etc. Bottle feeding can cause them period, but sometimes breastfeeding at night can also cause them as that is when your supply is highest.

I would suggest feeding cows milk during the day as well as plenty of yoghurts with her normal food. Then try to wean her off night feeds.

Tap water isn't fluoridated everywhere (isn't in Scotland). She can't have cows milk if she's dairy free. Did you read any of the OPs posts?

In answer to your question about seeing hospital or dentist first I would say try to get a referral to the dental Hospital at Kings at the same time.

Nobody is saying stop breastfeeding - just that it's not good for teeth to breastfeed during the night. I breastfed DS till 2y8m but night-weaned at 12 months in line with our dentist's advice to protect DS' teeth.

OP - do ask for a blood test to check for anaemia.

The top teeth are not decayed. It’s staining from chromogenic bacteria, can be polished off by dentist but as they cause no harm it’s ok to leave them (as she’s so young it might be difficult for dentist to clean them), they just don’t look very nice. Bottom back tooth definitely has a cavity

First thing that sprung to my mind is Crohns. The saliva in people with Crohns is different and it can cause more cavities than normal. Passing blood and general aching of joints is also a sign. Wheat could aggregate too.

We were told my son needed 8 teeth removing at 28 months due to cavities caused by having no enamel on any of his teeth. I refused and we eventually settled on the worst 2 being removed and crowns put on 2 others. This process took 12m due to his young age. He had sedation fir tooth removal. He is nearly 11 now and whilst his teeth are not great he has never needed to have the rest out. I am glad I refused as the removal of 2 was tricky and removal of all molars was obviously unnecessary. I would not want my child to be sedated and have 8 teeth removed as we found 2 traumatic and painful enough for him. He said it was the sounds that he didn’t like and they wo t let you hold your child’s hand, you just have to watch froma distance.

Has anyone considered Rickets?

You mentioned her vitamin D is low and it can be linked to liver problems and cause dental issues.

Children with allergies also have low vitamin D

[quote PulpHorn]@icansmellburningleaves
Dental extractions under GA have been banned in dental practices since the 90s after a report found an unacceptable number of deaths (due to no anaesthetists/support if things go wrong). They are routinely carried out after referral to hospital by hospital based dentists with anaesthetists carrying out the GA

@punjama
Within the NHS/community the school of thought is to extract every tooth with decay present in young children to avoid the (very low) risk of a repeat GA. Privately you will have more options with risks/benefits discussed. They will advise you on what in their opinion is best for your daughter. They shouldn't rush you into any treatment. I am completely non profit driven and have the patients best interests at heart. As your little girl is in pain with repeated doses of antibiotics the best thing would be to act quickly though [/quote]
Dental extractions under GA have been banned in dental practices since the 90s after a report found an unacceptable number of deaths (due to no anaesthetists/support if things go wrong). They are routinely carried out after referral to hospital by hospital based dentists with anaesthetists carrying out the GA

Unfortunately they were still happening in the late 90’s, causing death. I was involved in one myself. Very traumatic. It’s much better now with an anaesthesiologist involved.

@RyanBergarasTeeth

Poor little thing that looks quite severe. As others have said have you tried getting in touch with all london dental hospitals? Your wife may even have to try cutting down on breast feeding at night if thats been advised. 6k sounds extreme for treatment a child needs.

we have gotten in touch with our local dentists who have examined her before and they said they will put in a referral to Kings College Hospital but said that waiting times could be into next year (previously were 16 weeks or so). Should we take additional steps and try get GP to referr us to specialist dentist too? apologies if this has already been explained, getting confused and overwhelmed with all the options between GP, dentists, specialist clinics and dental hospitals :-( thank you very much

also just wanted to clear up - we are not disciples of 24/7 breastfeeding just we never had the will power to do cry outs. i am pleased to say that for past week we have been doing a minimal amount of boobie (sometimes none) before bed to fall asleep and yesterday she slept whole night without latching on. so we are slowly getting there.

@TeacupDrama

i'm a retired dentist so no longer on dental register my opinion is that the upper front teeth with brown type stain can be left if it doesn't go between teeth, dark brown can mean that there was caries and it has now stopped progressing it is unsightly but possibly not urgent however what appears to be the lower right molar has a big active cavity that could cause pain, sometimes they use something call the HALL technique and basically cement a metal cap over the whole tooth generally the results for this technique developed in Dundee are much much better than having a filling this tooth does need something doing to it or it could get painful however these are photos not an examination so it is only an opinion

thank you. we will mention HALL technique when we visit the dentist. she isnt in any visible pain atm from what we can tell but this cant be good.

@DishRanAwayWithTheSpoon

I agree with teacup

I dont think the upper teeth need removing. They will be difficult to fill as well.
It might have already arrested (so it was decay but has stopped progressing) or you could get it to arrest with flouride and good OH. Either way i would leave that alone for now. It doesnt need treatment

The lower molar will need treatment, halls crown would be ideal but it depends if the child is co-operative enough. I would probably want an xray before though

I still think a a paediatric dentist is your best bet.

She doesnt have a lip tie. Its most likely becauae of the lack of flouride toothpaste

hi thank you for your reply. we have booked a fluoride treatment with our local dentist and they said they will start referral process to Kings dental unit however said it might take a lot of time. do we still need to visit a paediatric dentist in your opinion? apparently kings said not to do any referrals or something so unless the other dentist can refer to another dental hospital?