5yr old been advised to have 8 teeth out

[Hungrycaterpillarsmummy]

Honestly I am in shock
We took DS to the dentist a couple of months ago because he told me his tooth/cheek hurt and I noticed a bit of one of his molars (D) had chipped. They did X rays and said that tooth definitely needs to be pulled. They did a check of his other teeth and found decay starting on some but didn't say much about it. They referred us to discuss the plan for this tooth to come out and whilst there, they told DH that really, ds needs 8 teeth removed. The 4 back teeth on the top and bottom.

I'm in shock because nothing of the sort was mentioned at his first appointment. Although they did find a hole on his left second molar (E) and it does look like that needs pulled.
Mh and DH had an appointment with the dentist today to discuss it all without da being there. Essentially the top 4 teeth on having starting signs of decay.
We have put so much more focus on teeth brushing, limiting sugar etc since the first appointment that I feel we can try and repair the damage caused to those 4 upper teeth.
The dentist is recommending we pull all 4 from the bottom which I do kind of agree with. But I'm not sure I agree with the top and the reason they are giving, is because they don't want to have to do a second general anaesthetic months down the line.
Whereas, I'm not convinced would need them out at all if we really focus on his teeth.
They did suggest we could cap those 4 upper teeth but that involves 8 appointments. One person tooth to put the elastic spacer on, and one person tooth to put a cap on it.

I suggested we pull the bottom 4 and monitor the top 4 but they said they just wouldn't pull the bottom 4 In that case! I'm so confused. It seems conflicting to the online advice of extraction being the absolute last resort and that filling teeth isn't an option. Whereas we have read baby teeth can be filled..

Anyone have any advice?
Please be kind as we are really feeling so guilty about it already.

It's not dental neglect. My son didn't have sugary foods, we brushed once teeth arrived and we started dentist visits very young and went regularly. The dentist could see the work needed to be done but my son couldn't sit still for her to do it. Had to get referred to a specialist paediatric practice who could do GAs. They said the enamel never developed properly in his baby teeth.

isnt sugar free better than sugar in the context of teeth?

When I took him a year ago they said his teeth were perfect... So the next thing I know he has a sore tooth and now all of a sudden he needs all these out.
One thing where we went wrong was giving him a cup of milk after he brushed his teeth to drink from through the night. He also witholds pooing so as recommended by the doctors we give him raisins and prunes etc which are obviously not good for teeth. Neither are laxatives.

The only people I know who had this issue were the ones who breast fed on demand after lots of teeth came through.
(Although I’m sure it’s also an issue if you put sugary drinks in a bottle or give them constantly.)

So the reason for extracting lots of teeth under general anaesthetic is because your son is so young. It's a bit of a struggle to get young children to sit through dental treatment. But then if they are sending children for extractions under general, they will often take out teeth with ANY signs of decay, purely because they won't want to be putting a child under general anaesthetic more than once.

The most important thing in avoiding tooth decay is diet. It's not about how much sugar you eat, but how often (e.g if you ate a whole packet of biscuits in one go, that would be better for your teeth than eating five spread over the day - obviously not better for your waistline!).

Be very careful of products which say "no ADDED sugar"; they often contain sugar. Also almost all breakfast cereals contain sugar (from memory it's only shredded wheat and plain porridge which don't). There is sugar hiding in everything - bread, sausages, sauces. Anything which has an ingredient ending in "-ose" listed in it contains sugar (it's quite often dextrose).

As well as trying to avoid snacking between meals, make sure your son is using a fluoride toothpaste twice a day and spitting, but not rinsing (with water or mouthwash) afterwards.

Hope this is helpful and doesn't seem like too much of a (massively long!) lecture x

Sugar free is deceiving. It's full of sweetners which rot teeth. I drank regular squash for years with no issue. Switched to sugar free thinking it was sensible and found out the hard way it was a bad decision when it costs me a fortune in fillings. I have a fabulous dentist who does a lot to prevent issues (probably because it's private so they get paid a small fortune regardless of the work done) and she also gave me the pack the tooth with toothpaste tip. It stopped one of my molars decaying.

Milk and water are the only recommended drink for teeth. If you have squash etc it's better to have it with food and after puddings/treats/flavoured drinks it's good to get in the habit of drinking water or milk to "wash" the teeth

I haven’t RTFT but as a paediatric dentist, I would never complete a GA prior to ensuring the child was going to be dentally fit afterwards. For most five year old who are unable to tolerate treatment under LA or sedation, that unfortunately means extracting any/all carious teeth - not risking a tooth flaring up a week after the GA and your back to square 1 (pain, swelling, time off school, sleepless nights, months on a waiting list etc).

Decay is the number one reason children are admitted to hospital, and is completely preventable (99%) of the time. It costs the NHS on average 60million a year (for under 12s) so it’s a very limited resource and you, as the parent, can’t select which teeth are ‘bad enough to come out’.

It’s something you can learn from. It’s not your fault. Having kids is hard, cleaning teeth is hard, cutting down snacks and sugary foods is hard - but it must not happen again and you now have the information to prevent it.

The only private GA services are on Harley Street in London, where I have worked. My average private GA case was +£5000 - so it’s an option if you have lots of money. I absolutely did not receive that amount (after everyone’s been paid - anaesthetist, three nurses, two ODPs, two dental nurses, recovery staff, hospital theatre rental fees, equipment, X-rays, insurance) no profit was ever made unless treatment prices were very high on top. And the risks of GA, although very small, are not worth it in my opinion to heroically save a baby tooth that will eventually exfoliate and may not be salvaged anyway.

I cannot believe a dentist would want to extract 8 baby teeth unless the child was in considerable pain from decay. Worse, they suggested to cap them! It’s horrendous. In another few months, all his teeth will start falling out naturally.

Well, this is clearly different. The OPs child has dental decay. You have described an ‘enamel condition’ possibly hypomineralisation, which is different and not preventable.

I breastfed until 18 months so yes he would have had a lot of teeth by then.

This again is incorrect. At what stage do you believe a five years old teeth ‘all start to fall out natrually in a few months’. Anterior, yes, Posteriors, where the decay is - no. Age 10+.

Ha no that's fine! I do know this stuff but since sugar, as you say, is in most things it's very difficult to keep a reduced sugary diet.
My son is very set in his ways so he would eat Cheerios for breakfast. Or a tonne of fruit etc.

Do most people give their children eggs or something for breakfast? I'm wondering what other people have done to avoid all this because from what I see my friends children eating and school friends...it's all the same 🤦

I don't know if you specifically need a Paediatric dentist, our private dentist recommended a specific one because of our DS SN. The Paediatric dentist had a lot of experience with Autsitic kids. I'm not in the UK. Where I am if you're going private you'd see a private dentist first and they'd refer you to someone who has the right to do dental surgery at a private hospital. If you're going public you'd see a public dentist and they'd refer you to a dentist who does dental surgery at a public hospital and that takes about 2 years. It's a couple weeks for normal fillings, its the hospital spots under GA that have a long waitlist. If anyone needs treatment under GA they go private if they can remotely manage to. Some dentists used to do it under twilight sedation in the chair but that's no longer an option where I live.

what does he drink?

Mine suffers with hypomineralisation, as did I as a child. My siblings also had multiple teeth out due to overcrowding so unfortunately in our case it seems to be bad genetics.

They planned to take 6 teeth out, but by the time my daughter had moved up the waiting list (almost a year later) the three worst teeth had fallen out so they decided to fill the other two and wait for the 6th crumbling half tooth to fall out. The x-rays we had indicated she doesn't have several of her adult molars. She's since had two silver caps to try to keep her adult teeth in place.

It's not always a case of poor oral hygiene. Mine floss, mouthwash and brush at least twice a day because of the issues I had with my teeth, but there hasn't really been anything we could do. Our other two children have no issues.

My child breastfed on demand until 3.5 years old. The dentist said it was the equivalent of giving her spoonfuls of sugar through the night (something the pro-breastfeeding NHS failed to mention!) She had several teeth out under GA aged 5, bounced back within days and her adult teeth are now coming through beautifully. I'm so glad we got them all out in one go - much less traumatic for little ones.

The thing is, he has no pain whatsoever...not even on the tooth where there's decay almost into the root (although I know it must become painful soon) so fair enough that should come out.
So should the other where o can easily see the decay. The four top teeth have barely anything at all. It seems madness to pull them now. Surely it would be better to leave them and hope the new measures we are taking prevent further decay but if there was to be further decay...he would be older by then and maybe be fine with LA.

It seems like cost is the issue here to kill two birds with one stone except the second bird isnt actually real yet.

Have fillings put on the decaying teeth. Better to keep the baby teeth in there for as long as possible

Mainly diluting juice or water now he started school. Before that we gave diluted apple juice (because I thought that was better than diluting juice and he refused plain water)

I'm not an expert but there are always significant risks to putting anyone under GA so they will want to minimise how often it's done.

Kids are a nightmare for dentistry work. My son has repeatedly had the same filling redone because saliva got in every time. He's older that yours so could this be a reason why?

I didn't find out until recently that the enamel on some of his molars didn't form properly due to pregnancy complications. Obviously sugar has played part but he needs to be extra careful. I wish we had been told that at the beginning of his dental issues as I have always felt so guilty and confused as to why he had decay so early.

But they won't fill them!!

We do porridge with a bit of nutmeg/cinnamon in it and sometimes banana. I am also very sad and read bread labels to get the stuff without sugar in it! Jackson's doesn't tend to contain sugar, and most sourdoughs don't either

I would ask for another opinion
My daughter has severe silent reflux which goes in and out of control with medication. When she was 3 she in a bad place with her reflux and started chewing on her refluxed oat milk which caused a cavity in one of her molars and she has staining in 2 more. We didn't have an NHS dentist at the time so she has diagnosed by a private dentist. He recommended fluoride treatment every 3 months some changes to diet and tweaked our night time brushing regime. He said the cavity needed monitoring and hopefully they would catch it at moderate damage and would cap it or if we didn't they would refer her to the hospital for removal or see what other treatment options were available. We managed to get an NHS dentist soon after and they have agreed to continue the 3 monthly fluoride treatment but said that the NHS wouldn't cap her teeth they would just remove them so we would need to go private at £200+vat per tooth for the cap or have a hospital referral to see a specialist dentist. At the next appointment 3 months later they said they would be able to do the caps if we needed.
We are 1y on from first finding out about her cavity and it's stable. Her dentist is now optimistic that she won't need treatment on her cavity and the other two teeth haven't developed cavities so far. We have kept up the dietary changes, tooth care and we are really careful about making sure her reflux meds are keeping her reflux at bay and keep an eye on her reflux in the night to avoid her chewing acid into her precious teeth

I completely understand, but what happens when (and Sod’s Law this ALWAYS happens) he has a GA to remove the ‘bad ones’ and then the following week, another flares up? Where’s the end point, a GA for each subsequent tooth?

Small areas of decay are still decay, just like big areas. Due to the shape, size and morphology of primary teeth - the decay tends to move quicker towards the pulp. Generally, if decay is visible on a radiograph, it’s 25% word clinically.

If he hasn’t managed radiographs, then there’s no way he will manage anything else. If this is decay with the naked eye only, you can guarantee it’s a lot worse clinically and you have no ide how far is has spread, even if it doesn’t look like a giant hole to you.

It’s absolutely not the cost that’s the main driving factor. It’s your child’s welfare and the risks (to life) with each GA, and the need to be ‘dentally fit’ post-GA. Extractions take five minutes. You want every decayed tooth filled, crowned, root treated, the works - that’s three hours under GA for baby teeth, in a mouth that has a VERY HIGH RISK of further decay (so all that work/time has a very low success rate anyway).

Again, I promise I'm not trying to lecture because honestly NOBODY knows this stuff, but diluting doesn't really make a huge difference. It's not amount of sugar, it's how often, so any drink with any amount of sugar in it is a bit of a nightmare, because you tend to sip it throughout the day rather than downing it in one go! Unfortunately boring water is the only safe option (and despite me being very aware of this, I'm still a fizzy drink addict 🤦🏻‍♀️!)