Parenting through dental anxiety (mine)
July 30, 2018 8:38 AM Subscribe
I have dental anxiety, and usually manage it by picking a well-reviewed office/dentist and then just going along with whatever they say, because left to my own devices I'd object to everything and never come back. In the case of my young child, however, I want to make sure that this is actually the best strategy.
My child is three and, at their routine six-month checkup, the pediatric dentist found excessive plaque buildup behind their top middle front teeth and took an x-ray. One of them, either 8 or 9 (whichever is on the right in x-ray) had a small cavity on the medial edge. The dentist said it's not through to the dentin and strongly recommended silver diamine fluoride treatment. She brought up SDF after giving a very fast-paced speech about how little kids don't tolerate drills and need general anesthesia at the hospital for extensive work and it generally made me feel like she was doing a bad cop/good cop routine all by herself, but again, that's how I feel about basically all dentist recommendations and normally I just push through my prejudices. Then she said that she'd also very lightly drill the gap between 8 and 9 to make the space cleansable.
In thinking it over during the month since then, I believe that the problems with cleaning between those teeth have generally been alleviated by natural growth. My kid had open heart surgery for a valve defect last year, and their growth has really taken off since then, and floss no longer gets stuck between any of their teeth, making the whole process infinitely easier. Also, they no longer need multiple daily medications, all of which had sugar in them (Their pediatric cardiologist is fine with whatever the dentist wants to do, and does not consider my child at any greater risk for infection or other complications than anyone else would be). Moreover, I feel like I now understand much better the goals of flossing at this age, which I had figured were 1. Get the kid used to it and 2. Get macroscopic food chunks out, instead of 1. Thoroughly clean all surfaces of the teeth. I know that sounds foolish, but here we are. Also, since I'm listing my failures, I hadn't realized that we were supposed to be using fluoride toothpaste at this point, because my kid doesn't really understand spitting it out, and I thought that had to happen first, so we were just using a xylitol gel. Our pediatrician had recommended that when the child was younger, and I guess I just lost track of needing to change over in the stress of arranging/having the heart surgery, which was days before their second birthday. That pediatrician has since retired from general practice and toothpaste just hasn't come up with the new one/their residents.
Anyway. All of this is to say, we've made a bunch of improvements in the oral health routine, have been very diligent about getting two flossing/brushing sessions in daily (sometimes the child skips nap at daycare and goes to bed really early instead, and I had been misinterpreting some of those bedtimes as "just a nap" and planning to brush later, but then they would sleep through to morning and I obviously didn't want to wake them, so now we brush right after daycare if they haven't napped and just do it again later if needed), and have cut out crackers, which were the only thing the hygienist mentioned that my kid actually ate (so no cow's milk, juice, soda, dried fruit, candy, etc.). We have an appointment for SDF tomorrow, which as I said is a month after the initial x-ray, and I'm thinking of requesting that, if it doesn't look like there's any additional damage, the dentist just do the SDF on the one cavity she saw on x-ray without drilling. Am I fundamentally misunderstanding anything here? What risks might there be to taking that more conservative route? I've read case studies on SDF and it seems like they can just clean the teeth and paint it on, no drilling required (if SDF might not be the correct path, I'm open to hearing that too). I don't want her to take off healthy tooth if it's not necessary, and honestly would like to minimize the black spots from SDF too. (My kid might care; I'd say it's 50/50. They don't mind the big chest scar at this point, thankfully, but nobody ever comments on it, whereas the hygienist said after SDF people might think there's something stuck between their teeth and point it out.) I'm sure the dentist will respond and explain too, but I'll obviously have a very curious young child with me and with my anxiety would really really rather have some written responses/resources to process beforehand.
Thank you so much for reading through all this, and any advice or support you can offer!
My child is three and, at their routine six-month checkup, the pediatric dentist found excessive plaque buildup behind their top middle front teeth and took an x-ray. One of them, either 8 or 9 (whichever is on the right in x-ray) had a small cavity on the medial edge. The dentist said it's not through to the dentin and strongly recommended silver diamine fluoride treatment. She brought up SDF after giving a very fast-paced speech about how little kids don't tolerate drills and need general anesthesia at the hospital for extensive work and it generally made me feel like she was doing a bad cop/good cop routine all by herself, but again, that's how I feel about basically all dentist recommendations and normally I just push through my prejudices. Then she said that she'd also very lightly drill the gap between 8 and 9 to make the space cleansable.
In thinking it over during the month since then, I believe that the problems with cleaning between those teeth have generally been alleviated by natural growth. My kid had open heart surgery for a valve defect last year, and their growth has really taken off since then, and floss no longer gets stuck between any of their teeth, making the whole process infinitely easier. Also, they no longer need multiple daily medications, all of which had sugar in them (Their pediatric cardiologist is fine with whatever the dentist wants to do, and does not consider my child at any greater risk for infection or other complications than anyone else would be). Moreover, I feel like I now understand much better the goals of flossing at this age, which I had figured were 1. Get the kid used to it and 2. Get macroscopic food chunks out, instead of 1. Thoroughly clean all surfaces of the teeth. I know that sounds foolish, but here we are. Also, since I'm listing my failures, I hadn't realized that we were supposed to be using fluoride toothpaste at this point, because my kid doesn't really understand spitting it out, and I thought that had to happen first, so we were just using a xylitol gel. Our pediatrician had recommended that when the child was younger, and I guess I just lost track of needing to change over in the stress of arranging/having the heart surgery, which was days before their second birthday. That pediatrician has since retired from general practice and toothpaste just hasn't come up with the new one/their residents.
Anyway. All of this is to say, we've made a bunch of improvements in the oral health routine, have been very diligent about getting two flossing/brushing sessions in daily (sometimes the child skips nap at daycare and goes to bed really early instead, and I had been misinterpreting some of those bedtimes as "just a nap" and planning to brush later, but then they would sleep through to morning and I obviously didn't want to wake them, so now we brush right after daycare if they haven't napped and just do it again later if needed), and have cut out crackers, which were the only thing the hygienist mentioned that my kid actually ate (so no cow's milk, juice, soda, dried fruit, candy, etc.). We have an appointment for SDF tomorrow, which as I said is a month after the initial x-ray, and I'm thinking of requesting that, if it doesn't look like there's any additional damage, the dentist just do the SDF on the one cavity she saw on x-ray without drilling. Am I fundamentally misunderstanding anything here? What risks might there be to taking that more conservative route? I've read case studies on SDF and it seems like they can just clean the teeth and paint it on, no drilling required (if SDF might not be the correct path, I'm open to hearing that too). I don't want her to take off healthy tooth if it's not necessary, and honestly would like to minimize the black spots from SDF too. (My kid might care; I'd say it's 50/50. They don't mind the big chest scar at this point, thankfully, but nobody ever comments on it, whereas the hygienist said after SDF people might think there's something stuck between their teeth and point it out.) I'm sure the dentist will respond and explain too, but I'll obviously have a very curious young child with me and with my anxiety would really really rather have some written responses/resources to process beforehand.
Thank you so much for reading through all this, and any advice or support you can offer!
Why not get a second opinion from another pediatric dentist?
posted by k8t at 11:29 AM on July 30, 2018
posted by k8t at 11:29 AM on July 30, 2018
Cavities are like a brown spot on an apple in that they are often tiny on the surface, but much larger in that second, softer layer, called the dentin.
It may be that the dentist wants to be certain that the sdf will reach all of the affected area, or that they simply plan to eliminate the demineralized enamel. You mentioned that at the time of diagnosis the dentin was not penetrated (according to the xray), so the dentist might just want to confirm this. in most cases "taking off healthy tooth" is not really involved.
SDF would not be indicated if there is no dentin involvement. topical fluoride should halt demineralization and might encourage reversal of the incipient lesion, this is standard care.
Also baby teeth are designated by letters to distinguish them from permanent teeth and the front two are E and F.
posted by OHenryPacey at 12:19 PM on July 30, 2018
It may be that the dentist wants to be certain that the sdf will reach all of the affected area, or that they simply plan to eliminate the demineralized enamel. You mentioned that at the time of diagnosis the dentin was not penetrated (according to the xray), so the dentist might just want to confirm this. in most cases "taking off healthy tooth" is not really involved.
SDF would not be indicated if there is no dentin involvement. topical fluoride should halt demineralization and might encourage reversal of the incipient lesion, this is standard care.
Also baby teeth are designated by letters to distinguish them from permanent teeth and the front two are E and F.
posted by OHenryPacey at 12:19 PM on July 30, 2018
This thread is closed to new comments.
If this were a permanent tooth, I'd urge against SDF, for the cosmetic issue. It might be worth drilling on a permanent tooth, but maybe you can wait a year until your kid might sit still better for drilling.
Yes, please use fluoride toothpaste, and if you don't have fluoride in your water, get your kiddo some fluoride tablets or drops.
Lastly, I understand your anxiety, but I know you're doing the best you can. It's a tiny cavity on a baby tooth. Your kid will be just fine! They've been through open heart surgery! They are flossing at the age of three - that's quite an accomplishment! Your anxieties don't have to be your kid's anxieties. And the less you acknowledge the anxieties, hopefully, the less space they take up in your mind.
posted by hydra77 at 8:52 AM on July 30, 2018 [5 favorites]