Dentist advice

[OneFrenchEgg]

Hi so my 15 year old had awful toothache and saw an emergent dental therapist last week (our dentist was closed). The xray showed that decay was under some fillings , reaching to the nerve and they have said he needs root canal work. They tried to remove a filling and have replaced most of it with a temporary one. Also antibiotics.

What now??? We are away for a week and then do we and the original (usual) dentist? I am really worried about committing to such a big intervention.

15 is awfully young to be missing a tooth and without a root canal he will likely lose it.

Well you definitely need to see your dentist and decide from there. If he has decay going into the pulp he only has two options, root canal or extraction. If you do nothing his pain will just get worse.
It’s important that you look at his diet going forward to prevent this happening again

It just feels very drastic. I don't really understand : he eats a good diet, flosses, none of the others have poor teeth.

If he eats or drinks something sugary or starchy more than three times a day he will get decay .

It doesn’t matter what he eats or drinks at meal times it’s what he eats and drinks in between that’s the problem. Each time he takes a sip or bite of a sweet or starchy food the acid attacks his teeth for an hour afterwards. If he eats or drinks sugary/starchy stuff just before bed , even if he brushes his teeth afterwards , the acid attacks are even longer because less saliva is produced overnight.

That’s not just sweets, chocolate , biscuits , cakes but fruit juice, smoothies , protein shakes , energy drinks , yoghurt. , raisins , granola bars , fruit winders etc all of which are as bad as fizzy pop and sweets for teeth .

Unrefined sugars eg honey , agave syrup etc are just as damaging for teeth as white sugar.

Is he a grazer ? This is the worst thing for teeth as it means they are constantly under attack.

Does he use a fluoride contains toothpaste?

Diet,diet , diet is the problem. He already has had fillings and now there is decay under those fillings . He will lose teeth soon if he doesn’t change his diet now.

So it sounds as though he's been eating sweets a lot when out with mates etc. at least there's a fairly obviously solution. I have no idea if the fillings were the issue (can they be done 'badly') or if it's caused by him and bad luck it's him and not his mates.
We will see his dentist, and see what they say. Thank all.

If he has already had fillings at 15 and continues to eat sweet/starchy things more than three times a day then he will continue to get decay around the teeth and under the fillings.

If he had decay but hadn’t had the fillings done but stopped the sweet/starchy stuff the decay would have got no worse. The fact it has gone to the nerve shows he still has a diet that is destroying his teeth.

It is what he is eating and drinking every day that is the problem. What does he eat between meals at home and what does he drink? Sweet stuff when out with mates is not ideal but to get decay this bad it’s not the occaisional treat of even what’s happening a few times a week , it’s that combined with his eating and drinking habits at home.

Grazing continuously on sweet stuff means your teeth are constantly under attack from the acid produced by sweet/starchy foods.

I honestly don't know. They all have the same basic food available - cereal and cows milk, he makes pasta a lot and avocado and eggs. He eats things like lasagna, chilli, jacket potatoes. He eats dips and chips as a snack. He says he's been eating a lot of sweets but I don't really make them available. We used to give them a packet of small sweets once a week. Fizzy drinks 5 times a week? It's very stressful to try to unpick when they all have the same options, I don't know always what he has in between. Coffee is a new one - those coffee drinks. School lunches are usually macdonalds or pizza or toastie if on site

Then get him to do a food diary of everything that passes his lips in a whole week, and the exact timings. He has a phone, shouldn’t be difficult

It is not what he eats or drinks at meal times that’s the problem. It could be nothing but chocolate , wouldn’t be healthy but wouldn’t decay his teeth. It’s what he eats and drinks inbetween meals, what he nibbles, snacks and drinks that has to be sugar free.

Coffee drinks ….. a vanilla frapaccino has 10 spoons of sugar in it , and he will probably be sipping on it rather than drinking it in one go

cereal most/all cereals will have sugar in them or added to them

dips and chips … most dips will have sugar in them chips/crisps are very starchy and convert to sugar in mouth easily

Its not just sweets , it’s everything that goes into his mouth inbetween meals must be sugar free or else he is going to lose teeth soon if he is 15 and has had repeated fillings and now needs a root canal on a tooth that has been in his mouth 9 years at most .

Thank you, I am trying to understand. We have a lot going on with illness and disability which makes it easier for things like this to slip - not an excuse but it's another one to prioritise and move something else to a lower number on the list. So I will do, I didn't realise it was in between stuff and not meals. Since he had a filling he's been flossing a lot and using sensodyne repair (dentist told him to) but he also gets terrible mouth ulcers, definitely doesn't smoke vape or drink.

Mouth ulcers can be hormonal , stress and anaemia/vit b related . Some people can also be sensitive to SLS (sodium laurel sulphate ) in toothpastes . Ask the dentist next time you see them .

It is everything he eats and drinks in between meals , not meals or drinks consumed at mealtime, that’s the problem, even worse if he eats or drinks anything just before bedtime at or in bed , even if he brushes teeth afterwards , because the decreased saliva at night means the acid is not washed away .

It’s good he’s flossing but flossing stops gum disease , not decay . It’s his snacking, grazing , drinking inbetween meals that’s the problem .

@Lollygaggle I really appreciate your insight; it was very overwhelming as I'd kind of thought teeth were doing ok, he'd been following the dentist advice on flossing and brushing etc but I've not understood the impact of grazing at all.

That’s why doing a true food diary will help. Honestly, it’s been a real eye opener for my patients. I’ve got them to note on their phones every time they eat, drink, sip, taste, pinch across the desk from…..! That includes if they’re sitting in front of the telly and any snack that lasts longer than half an hour is counted as two!! ( I’m very strict!) it also includes if you’re cooking and tasting…
He and you have had a shock, now is the perfect time to truly analyse what he ( and the rest of the family) are really doing.
Keep sugar to main meals, make these meals larger than you think, they then won’t need to snack.
@Lollygaggle is absolutely correct, it’s snacks that cause the problem. Unfortunately there aren’t any ‘good’ ones when it comes to teeth (except water!) as even fresh fruit has sugar.
In todays world it’s really hard, you have health food industries labelling high sugar foods as healthy, starches convert to sugars… etc…
But it is manageable with understanding

@Pinkypinkyplonk sorry I forgot to reply; I think you are right. It's difficult to get him to do because he's having to do one for neurology and it's like pulling teeth (literally). I would love to solve the ulcers as well; he has five at the moment and is really struggling.

Speak to dentist about ulcers , take a photo of them to show dentist and let them know how long they have had them , how long they last etc. Also if he has any rashes anywhere else.

Good luck with the diet diary and cutting out the sugar/starch inbetween meals . Drinks like the iced coffee are deadly because they are full of sugar and tend to be sipped on over a period of time so the teeth are constantly bathed in a sugary/acid bath.

It's been such a useful thread and I really appreciate the advice from you all. He's already stopped having juice outside of meals (we are on holiday and would buy fruit juice normally if out) off the back of it. And only one Diet Coke today with dinner and then back to water.