Caps or fillings for a young child?

August 10, 2007 1:38 PM

Dentist wants to cap my 5 y.o. kid's teeth under general anesthesia. Anyone with experience or knowledge of this? How did it work out?

After 2 years of no-problem-at-all regular dental checkups, suddenly all hell has apparently broken loose with my kid's teeth and the dentist wants to cap a bunch of them, partly because fillings might need future work, and partly as a preventative for any further decay. I'm just wondering if anyone else out there has done this, and how it went. We need to decide between caps and fillings. Thanks for any info you can give me!

posted by DarkForest to health & fitness (31 comments total)

Definitely get a second opinion.
posted by FergieBelle at 1:42 PM on August 10, 2007 [1 favorite]

we had to cap three of my youngest's teeth, in addition to some fillings. the thought was quite traumatic to me since at 38 i had never even had a cavity. They used nitrous plus local anesthetic (mosquito bites, they called them) and she did very well. she would have been about 5.5 when all this happened.

The only ones they capped were the ones far in the back that she won't be losing for many years. everything else they filled. if they are suggesting capping something your child may lose in a year or two, i might get a second opinion. that is lots of extra expense and trauma if it is not necessary.

When they say general anesthesia, do they mean administered through an IV, knocked out cold by an anesthesologist? That would be my second choice after how we did it - just for the added risk, unless your child already has anxiety about this.

my daughter has had a small cavity filled with just local since then and is still not afraid of the dentist. if your dentist is calm and matter of fact and you are calm and matter of fact, it will go along way to making their experience as positive as a dentist experience can be.
posted by domino at 1:52 PM on August 10, 2007

When I was a kid (about 1989?), my dentist coated my molars with some sealant of some kind. Despite my then-horrible dental hygiene, I was pretty much cavity-free throughout adolescence. Is this what your dentist is talking about? There definitely wasn't any general anesthesia in my case, but I don't remember the visit being any more stressful than a normal trip to the dentist.

IANAD, of course.
posted by lauranesson at 1:54 PM on August 10, 2007

Seconding the second opinion idea. I have sealant on my molars due to deep fissures. It's a pretty quick process and didn't require any kind of anesthesia.
posted by weebil at 1:55 PM on August 10, 2007

Echoing the recommendations for a second opinion. I think of general anesthesia as something that should only be used for major surgery.
posted by amyms at 2:10 PM on August 10, 2007

Thanks for the responses. A little more information:

All of my child's problems seem to be between the teeth (despite daily flossing) so sealants don't seem to apply in our case.

I believe the dentist meant general anesthesia, as in completely knocked out. He would be doing it in a hospital setting.

My main concern is for both my child's future health (naturally) and how traumatic the whole thing might be. Is there any difference in terms of complications or difficult maintenance for caps vs fillings? Will either one or the other be a do-it-and-don't-worry-about-it type of thing, or be a source of ongoing problems (what I'd obviously like to avoid)?
posted by DarkForest at 2:18 PM on August 10, 2007

We're talking baby teeth right? I think what your dentist wants is for you to hand him a bunch of money. Ask another dentist. Also, general for kids is generally inhalants, and is relatively safe. Make sure that she doesn't have food in her stomach first.
posted by a robot made out of meat at 2:22 PM on August 10, 2007

We had to put crowns on 3 of my daughter's molars, which came out with no enamel on them. I think she was either 4 or 5 when they deteriorated to the point that she needed major work on them.

The dentist was originally going to do it in the office with nitrous, but my daughter didn't like the mask at ALL, even after pre-dosing her with Versed. They gave us the choice of holding her down in the chair and continuing with the procedure while she screamed or taking her to the day surgery place and knocking her out with an IV anesthetic. We chose knocking her out! Again, they pre-dosed her with Versed, and she reacted much better to having a "shot" (the IV) than she did in the dentist's office to the mask. Much less traumatic.

Other than a day or so of soreness, she's had no ill effects at all. She has a ring spacer that occasionally comes loose, but that's no big deal. Her crowns don't bother her a bit. She'll be 8 in a couple of months.
posted by Addlepated at 2:26 PM on August 10, 2007

I'd definitely opt for a second opinion. And, perhaps, a different dentist.

At the risk of sounding like a old-fart, the idea of putting caps on a 5-year-old...on baby teeth that are going to start falling-out in the next year or so...seems just a bit like overkill.

Yeah...get a second opinion.
posted by Thorzdad at 2:28 PM on August 10, 2007

Oh, the affected teeth are molars, so they'd have to last 5-6 or more years before they fell out. If it was just a year or so, then we'd just go with something less extreme than caps. The dentist seemed to feel that with fillings, there'd be the chance of needing further work on them in that time.
posted by DarkForest at 2:38 PM on August 10, 2007

Addlepated: is the spacer ring something to do with the caps, or is that for a different problem? I don't think the our dentist mentioned anything about that.
posted by DarkForest at 2:41 PM on August 10, 2007

If getting a second opinion is in your future, I'd recommend the obvious choice of a pediatric dentist.
posted by whatisish at 2:45 PM on August 10, 2007

The spacer ring was because they had to extract one of the molars; it's just to keep the other teeth from claiming that empty space.
posted by Addlepated at 2:50 PM on August 10, 2007

BTW, the dentist we used is a pediatric dentist, and she's awesome. If you happen to be in the Austin area, her name is Pamela Singletary. I can dig up her number if needed.
posted by Addlepated at 2:53 PM on August 10, 2007

Thanks Addlepated. We're pretty far from Texas. Otherwise I might take you up on that.

We do use a pediatric dentist, but I am thinking of getting a second opinion on the whole thing. I think our dentist is concerned about the sudden change in the status of her teeth (as am I), so I think his idea of crowns is as much preventative as anything else. Obviously, we've also stepped up our dental vigilance as well to try to head off further problems.
posted by DarkForest at 3:11 PM on August 10, 2007

OP, it sounds like you're talking about crowns, not caps.

Anyway, get a good second opinion.
posted by JimN2TAW at 3:47 PM on August 10, 2007

Anyone else out there with a story to share? Any info appreciated!
posted by DarkForest at 3:48 PM on August 10, 2007

OP, it sounds like you're talking about crowns, not caps.

Is there a difference? I thought they were the same thing. I believe the dentist said "steel caps".
posted by DarkForest at 3:51 PM on August 10, 2007

I'd get a second opinion. I just read http://www.readersdigest.ca/mag/1998/09/think_01.html this, which shows the variations between what happened when one reporter went to 45 different dentists.
posted by la petite marie at 3:51 PM on August 10, 2007

If you're worried about how the kid will deal with going under in the hospital, I had that done over 20 years ago when I was 8 years old. I was a horrible dental patient and badly in need of many fillings. I would physically resist the dentist's attempts to numb my mouth with the big needle of novocaine and nitrous oxide caused me to puke all over another dentist (I went through multiple dentists), so the hospital OR was a final (and costly) resort. My mother was totally freaked out, but to me it was all sort of an interesting excursion. I remember hearing the sound of my heartbeat on the monitor as I drifted off and when I woke up after, it just felt as if I'd taken a nap.
posted by mandymanwasregistered at 4:06 PM on August 10, 2007

Apologies. Apparently "crown" and "cap" are often used synonymously.

In my experience, at least colloquially, a "cap" has always meant a cosmetic layer applied to the outside of a tooth to conceal an off-color, fill in a gap, etc.

But now the Web Oracle tells me that this sort of cosmetic device is officially called a "dental veneer."
posted by JimN2TAW at 5:04 PM on August 10, 2007

Stainless steel crowns are very commonly used on primary teeth. I had them myself over thirty-five years ago.

It is important to keep baby teeth for the spacing of the permanent teeth to emerge in proper positioning. The molar teeth will be replace by permanent bicuspids, at age 10-12, sometimes later, so there are many years for your child to use them.

Letting them continue to deteriorate is ill-advised, they will become abcessed at some point, putting your child in pain and the risk of infection and having this treated is much more traumatic than getting them filled under general.

As an aside, my husband has an autistic son, and he has only recently been able to tolerate his semi-annual teeth cleanings without drugs, prior to this, even his teeth cleanings were done under general anesthetic. But if he had a huge traumatic event, as a filling can be to some children, he would never walk through the dentist office door again. I think that is what is important here, your child *could* get dental work done, with a struggle, under local and nitrous, but she may become a dental phobic the rest of her life.
posted by Jazz Hands at 5:39 PM on August 10, 2007

even his teeth cleanings were done under general anesthetic

Thanks, Jazz Hands, this is the kind of thing I'd like to hear about - how 'routine' is it for general anesthetic to be used or caps to be given to children this young.
posted by DarkForest at 6:12 PM on August 10, 2007

la petite marie, Thank you for that link. Interesting article.


Our 2 year old had some front teeth that came in without enamel on them. Just dentin. Then he promptly fell and broke them. A local dentist wanted us to sign a "do whatever you want" waiver to put him under general anesthesia in the hospital to do all kinds of things...extractions, pulpotomies, partials, spacers. Said it would be around $8k. But it sounded silly to me. They're baby teeth! Plus I had heard that any plates or bridges in toddlers' mouths tend to fall out, leading to more surgery to redo the work.

After joining a couple of Yahoo listserves about kids' teeth and researching for a while, we found doctor Chris Kammer in Middleton, WI (suburb of Madison, a thousand miles from our home). My wife and son have been to him 4 times since March. He uses a technique called Atraumatic Restorative Therapy (ART) which involves minimal invasiveness. Basically, instead of worrying about cosmetics, he gently scrapes any decay off and applies a glass ionomer temporary filling (Fujii is the brand he uses) all over the affected teeth. It's basically a "stall and fall" approach: stall decay until the teeth fall out and the adult teeth arrive. He also uses ozone to kill the decay-causing bacteria on the teeth, and is one of only 3 dentists in the country to use a HealOzone machine to do this. This ART approach has been very popular in Europe, Asia, and Australia for over a decade, but isn't well known here. We also use a remineralizing agent called GC Mousse (from Europe, purchased on ebay, and also known as MI Paste) in place of toothpaste, and have added dietary supplements such as cod liver oil to his diet.

We've had good results so far. The decay hasn't spread, the teeth are harder, and we've avoided surgery. The air travel and multiple visits have actually cost more than the original quote for the invasive surgery, but we just couldn't see the point of subjecting our son to the risks of general anesthesia until we have to. That is, as long as his baby teeth are functional and pain-free, we'll stay with this approach.
posted by Bradley at 6:25 PM on August 10, 2007

General anesthetics are dangerous, even when administered by a real anesthesiologist rather than a mere dentist. This capping seems like lunacy to me. I would definitely get at least one more opinion. There are dentists out there just looking to make a buck who push expensive procedures. I am not a dentist, and this might be perfectly legit, but I wouldn't do this to my kid without much more investigation.
posted by caddis at 6:27 PM on August 10, 2007

I would absolutely get a second opinion. I have no idea where you live, but we have a fabulous pediatric dentist here in Florida that even my kids like whom I would highly recommend.
posted by misha at 7:02 PM on August 10, 2007

I can also recommend a couple of great pediatric dentists in the Bay Area, if that's helpful. Second opinions are always good when it comes to this kind of thing.
posted by padraigin at 7:18 PM on August 10, 2007

Thanks for the recommendations. I'm in the far northeast and our insurance situation probably isn't going to allow for using out of state dentists. Thank you Bradley for your story. That's the sort of approach I'd like to use if I had the chance.
posted by DarkForest at 5:37 AM on August 11, 2007

My 5 yo girl had to get two steel caps on those two bottom teeth just behind the vampirish pointy ones. The procedure was performed at the dentists office without a general. Rather, it was some kind of oral sedative that made her way sleepy. What was nice, though, is that we were present for the entire thing to help her through it. It wasn't traumatic and she still doesn't fear the dentist.

We, too, are much more attentive to preventative care.

Side note: She's had other kids ask her about them. I can't help but think things like this are where the seeds of self-consciousness are planted.
posted by whatisish at 10:07 AM on August 11, 2007

When your teeth are capped the entire tooth isn't covered with the cap/crown. There is a small sliver of exposed tooth just a little bit above the gumline a lot of the time. I'm wondering if capping will really help. If the decay is in between the teeth, what is to keep the tooth from decaying where that small part of it remains exposed between the cap and the gumline? Putting a 5 yr old under general just seems a little extreme for future decay that "might" occur and for fillings that "may" need work in the future. Maybe flossing everyday with floss that has been dipped in fluoride rinse would be the safest route although with a 5 yr old I don't know how safe fluoride rinse dipped floss would be either.
posted by GlowWyrm at 11:35 AM on August 11, 2007

At five, my brother had a whole faceful of steel caps put in. He had a general anaesthetic, and had it done by a dental surgeon in the city, five hours from our house.

At the time, the alternatives were either to accept the risk of decayed and broken hillwilliam teeth with crooked permanent ones to follow, to increase dental visits to monthly, with painful checkups and inevitable fillings, or to install some super cool bionic robot teeth.

He threw up in the car all the way back home. And kids called him Steve Austin Face. Convincing him that they were kind of cool ahead of time helped him deal with this.

His adult teeth came in straight and even, and his visible caps had all been Tooth Fairied away by the time he was nine.
posted by Sallyfur at 4:47 PM on August 12, 2007