5 year old needs teeth extracted.

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We took my 5 year old daughter to an emergency dental appt as her gum had swollen.

At her last check up we were told she had a small cavity that might need attention.

This time they did a full check up and found that the swollen gum was an abscess caused by the cavity reaching the nerve. That tooth will need to be extracted. Two other teeth are not looking good and may also need extracting.

We’re devastated for her. She drinks water, no squash. She eats healthily - egg on toast every breakfast and no sugary cereal (both the water and the egg are her choice, we’re not total authoritarians!)
Sweets only on a Friday after school - we go to the shop as a treat. She does eat a lot of fruit, so could be that.

Her teeth look clean, we help her to brush them. We use a 3-6 year toothpaste and an electric brush.

I just don’t understand how this can have happened and am hoping the knowledge of Mumsnet might be able to throw some light on it. Also what to expect if anyone has gone through this. I can’t imagine how to extract a tooth from a terrified 5 year old.

In general if someone has more than three/four sugar attacks a day they will get decay . So even a sip or a bite of something with sugar/starch produces acid which takes an hour to be neutralised.
Also the time of day makes a difference eg eating or drinking something sugary/starchy just before bed , even if you brush teeth afterwards, is a problem because the saliva flow that neutralises the acid is much less when asleep.
The hidden sugars are in fruit juice/smoothies which are just as bad as fizzy pop for teeth
low sugar squash still has sugar in it and can just s easily cause decay
raisins or any fruit that's dried is just as bad as sweets
yogurt unless plain and unsweetened is just as bad as a chocolate bar
starchy foods like crisps convert to sugar very easily
grain/granola/fruit bars are just as bad as sweets for sugar content
honey/agave syrup is still sugar

do a diet sheet over three days , every mouthful, every sip of something and times and count sugar attacks . More than 3/4 a day (breakfast , lunch and dinner will all have sugar content so it's what they are eating/drinking in between meals is the problem) and you will know what the problem is.

Grazing is particularly bad for teeth , ie constantly nibbling on something means teeth are under attack virtually all day.

You can , sometimes, take one tooth out on a co operative 5 year old with just an injection. Most will need either gas and air or , most likely , a general anaesthetic. If they have a general anaesthetic they will take out all teeth that look a bit dodgy as don't want to be repeating in a few months /years time.
They will have to be referred for sedation/GA and waiting lists vary. It's around 2 years in my area , a few months in others.

Thank you so much for your comprehensive answers. I think we will do a diet sheet. She has a lot of bread and pasta, and maybe we’ll be surprised about other things too.

Luckily we are in a position where we can make a few changes and pay for treatment if we need to, so hopefully that will speed things up a bit.

Tooth decay isn’t 100% avoidable/guaranteed based on sugar consumption - there are other factors as well. Diet and hygiene simply improve the odds.
I wouldn’t stress too much, nor would I turn my child into a nervous mess over food.

I assume these are milk teeth? If so, extracting them wouldn’t be particularly traumatic. I remember pulling my own milk teeth out when they started loosening.
Local anaesthetic is safer and easier.

If you trust your dentist, have a conversation about all the things you are worried about. If you don’t trust them, find another dentist (via recommendations).

Weak teeth can be genetic too, how are your and your partner's teeth? Or certain health conditions like coeliac disease.

But also what Lollygaggle said, teeth can only handle food or drink so many times a day. The dentists in my country say maximum 5 meals/snacks a day for milk teeth so no grazing. Xylitol after every meal and snack helps, and make sure morning teeth brushing is done before breakfast, not after.

My DD had to have a tooth removed when she was 5 as she knocked it loose and was bothering her too much to leave it in. Wasn't easy but she managed just with local anaesthetic and a hell of a lot of patience from the dentist as he had to keep stopping while she worked up her courage again (I could see he was losing by patience by the end but thankfully it came out at last!)

My son had some teeth out when he was that age. It was all relatively painless they give them an anaesthetic delivered by mask. He didn't feel a thing and we came home the same day. They're not out right out so come round very quickly. X

Sorry but in order to have decay you must have
tooth
bacteria
sugar.

The mouth has a natural bacterial balance so sugar is the one thing you can take out. Fluoride toothpaste helps but decrease sugar and you will decrease decay.
in a 5 year old the back teeth have npbeen through for around 2 years, if you do not change the diet the child will lose more teeth , worrying as adult teeth start to come through at 6.

Back baby teeth can be quite demanding to take out , particularly if you need more than one out. It is demanding of both dentist and child to get the co operation to inject and take tooth out .

Baby teeth come out easily when they are supposed to because the root gets eaten away so there is nothing , other than a bit of gum holding them in. A back baby tooth is supposed to last until child is 10 to 12 so in a 5 year old will have all of the tooth roots , to all of their length, and will also have a fair bit of decay so is a very skilled job to get it all out.

Genetic "weak teeth" is very,very rare , especially on baby teeth and is easily spotted as the teeth look very different from normal teeth (amelogenesis imperfecta).

Decay , unless child has low saliva due to medication , is down to diet and , in general, decay passes on in families because diet and eating habits are very similar .

xylitol is very good , but have to be careful how much you give a 5 year old because stomach upsets can follow. Also should absolutely not be a substitute for changing diet/eating patterns particularly not eating/drinking anything other than water just before bed.

5g of xyltol a day is the recommended dose, too much can give laxative effects though I expect it takes quite a bit more than 5g for that.

My DD also had four teeth removed aged 5. Like you, I was utterly mortified as I thought we'd looked after her teeth.

Some good advice from PP so I just came on to say don't beat yourself up over it.

My DD is now 16. She's never had a filling and she's got beautiful teeth.

On a 5 year old more than 5g May well cause stomach upset.

Also coeliac disease does not affect baby teeth as they are formed in pregnancy. It may affect adult teeth but it is normally a cosmetic problem , however other aspects of coeliac disease such as dry mouth can mean increase in decay as saliva has an important role in preventing decay.

Ooh one other thing...

Like you our DD had one tooth with quite severe decay, and two others were iffy. The fourth one was removed for balance to keep them aligned on the advice of a dentist friend. Worked a treat and adult teeth are all straight.

They were removed under GA in a matter of minutes and she was home on the sofa eating chips within a couple of hours. She got two days off school and so we took her to Chessington. She remembers it all fondly

Does she brush twice a day? I had a friend who’s child need tooth extraction- by their own admission due to sweets and lack of brushing. Waiting list was ridiculously long as at that age you’re basically on the wait list for an anaesthetist, child kept being put on antibiotics in the mean time due to pain etc.

Not an expert, my DD got crowns on 4 molars at that age - baby teeth
dentist sent her to the dental hospital where they did mentioned gas an air and even the possibility of removing on full anaesthetic
we had to keep a food diary…
dentist that saw her was lovely, explaining everything twice, once to her in kid friendly terms and then to me in more technical ways
i was also mortified, turns out it was something while I was pregnant, her molars had almost no enamel, so no protection - her adult teeth are all fine! So don’t blame yourself
obviously depends where you live but kids tend to have shorter waiting lists

Just want to add that I understand my older 2 DC have no issues with their teeth but my youngest has decay and we asked for him to be referred to a specialist. Took over a year and I too am mortified but dentists are lovely and said they have a child in every week getting extractions.

Ours aren't at the extraction point yet but I really empathise with how stressful it is trying to do everything right. It is actually pretty common though so please don't be too hard on yourself. I suspect weak enamel in my DS too as his older siblings are on the same diet and toothe past and have no issue.

One thing my dentist did mention though is to not be afraid of adult tooth paste if your DC will take it!

Tooth decay is the number one cause of children needing to go to hospital. Over 25,000 children went to hospital last year to have teeth extracted , more than double the next most common cause which is tonsilitis .

Almost 25% of 5 year olds in the U.K. have decay in their teeth.

The average U.K. child eats 7 times a day

The average U.K. 5 year old eats over twice the WHO advised amount of free sugar a day.

Yes she does brush twice a day, both times with our help.
I’m going to keep a food diary, without telling her, just to make myself feel better really! I’m fairly confident she eats 3 meals and 2 snacks. I suspect I might see that she eats way too much fruit and starchy food.
I also wonder if it has anything to do with her having had a bottle at night until she was about 2 and a half. Who knows. I’ll stop beating myself up over it one day.
I think I’m still in shock over the whole thing. Poor little girl - she’s being very good about it.

Could it be hypermineralisation https://happykidsdental.co.uk/preventing-and-protecting/dental-hypomineralisation/ ?

My oldest has hypermineralisation, the dentist suggested probably linked to him having lots of antibiotics as a baby for each infections. He got his first filling aged 2 and I think has one in almost all of his baby molars now at 8. He's on 3 month check ups, so we catch issues early, and has 3 monthly fluoride treatment which has made a huge difference.

Even aged 2 he had less sugar than many of my friends children, and as we've realised he is sensitive to decay we've become much stricter and the gap has become bigger - their children all have healthy teeth. In addition, my younger 2 have the same diet and have completely healthy teeth too.

We mostly don't allow fruit as snacks because the sugar / acid combination is particularly bad for teeth. The dentist said it was ok when had with main meals though. When you say your DD has a lot of fruit what does that mean and when is she eating it? Other than that, what your DD eats sounds like it has less sugar in than what a lot of children who have completely healthy teeth eat.

Sorry, have just remembered one other factor - where we are doesn't have fluoridated water, which apparently makes it significantly more likely children will have problems with their teeth. Is your water fluoridated?

According to the website I linked above 'Five-year-olds in fluoridated areas are 28% less likely to have tooth decay than those in non-fluoridated areas. In fluoridated areas there are 55% fewer hospital admissions of young children for tooth extractions.'

I don't understand how this happened

She hasn't brushed her teeth properly and often using adequate toothpaste and a good toothbrush?

That’s really interesting, thank you. I’ll mention it at the next visit.

We do the majority of the brushing, with an electric toothbrush and 3-6 toothpaste with 1450 fluoride

I assumed everyone had fluoridated water, but after a comment above I checked, and ours isn’t.

When I was 3 I had my molars extracted because I used to store food in my mouth like a hamster (no idea why!). I was put under general anaesthetic for it but not sure if this is standard or not

Hypomineralisation in baby teeth is very obvious , they look different. It also is not caused by antibiotics given as a child because they are formed during pregnancy . The only antibiotics that affect teeth (adult teeth) whilst they are forming are tetracyclines which are rarely given to young children because of this.
However many medications eg movicol are highly sugared and can easily cause decay themselves. Many children's medications are sweetened to make them palatable and if they use sugar this causes decay.Likewise soya milk which is high in sugar and many other substitute milks like oat and almond are sweetened to make them more palatable and do not neutralise acid like animal milks .