Child's rotting teeth!
August 3, 2021 2:36 PM   Subscribe

My 9 year old daughter has just been to the dentist for emergency dental work. Woke up with bad tooth ache and the dentist managed to fit us in same day. X-rays were taken and three teeth were found to be badly decayed. One required immediate removal to alleviate the pain. I know YANMD

This has happened before to my daughter a few years ago and on that occasion we were asked to do food diaries and the only thing that was highlighted was maybe stop having sultanas as a snack as they're sugary. Otherwise we don't do cola, we don't do squash, don't do tropicana's water with meals and pretty healthy eating. Not saintly, there are treats, but they're exceptions and they're proportionate.
So this time I said to the dentist: "Is having weak enamel a thing - because I feel like that might be what's going on here"
The dentist whilst not unkind was not receptive to that idea.

So I put it to the hive mind - what's going on with my daughter's teeth?! I hate it that she keeps losing them. I was not brilliant with my teeth - I feel like I abused them quite a bit but until a few years ago (I'm 40 now) I had no fillings whatsoever, now I have one. I feel like my teeth can take a bit of a hammering but it's the opposite with my daughter.

Thanks all!
posted by dance to Health & Fitness (36 answers total)
I'm wondering if she is "on the spectrum" and possibly chewing on non-food items for oral stimulation? That wouldn't show up in a food diary but could explain unexpected wear on her teeth.

Is the decay between teeth (where food could get trapped, possibly leading to toothpicks etc being jammed in), or on the sides, or on the biting surface where grinding or other repetitive actions could be part of the cause? (just thinking out loud here... no specific response to different answers)
posted by CyberSlug Labs at 2:49 PM on August 3, 2021

Just to check the basics - she goes to the dentist for cleanings regularly (possibly a US-centric perspective but 2x/year is normal here), and she's getting fluoride somehow? (Toothpaste, local water supply, treatments at dentist?) Surely your dentist has asked this too but just in case...
posted by february at 2:52 PM on August 3, 2021 [12 favorites]

Was your daughter on a lot of antibiotics when she was little? Apparently that can affect how prone kids' teeth are to cavities. (Google has more info on that.)
posted by small_ruminant at 2:53 PM on August 3, 2021 [6 favorites]

I'm pretty sure it can be a thing. I remember someone in my community who had a whole bunch of kids (and was a pretty attentive mom) had one of her younger kids just have a huge slew of problems like that. I think at her stage of parenthood/level of experience, if it were only about not helping little kids brush correctly or what they eat she would have had it happen with her many other kids, but they were fine.

If it were me I'd look for a different dentist who might be able to work with you better--maybe there are prescription fluoride treatments or other things to try (beyond behavior changes) so it doesn't keep happening.
posted by needs more cowbell at 2:57 PM on August 3, 2021 [2 favorites]

I was a chronic tooth grinder as a child (and still am) and it left my teeth ripe for cavities and falling apart because of all the little stress cracks it made.

Also check she's getting fluoride and fluoride treatments.

If the dentist isn't offering advice or treatment plans on how to help your daughter and to avoid this, find another dentist.
posted by wwax at 3:26 PM on August 3, 2021 [9 favorites]

How about sticky carbohydrates like bread or crackers? According to my kids' dentist, items that wash away quickly like juice, while sometimes problematic for teeth, are nothing to the problems caused by bread that just gets in there and sticks for hours and provides an environment for decay-causing bacteria. Even chocolate, from what I've read, is not the worst for teeth, as it washes away with saliva.
posted by Knowyournuts at 3:26 PM on August 3, 2021 [3 favorites]

I think your question about enamel was a good one! Some people have more cavities than others for sure. I’m wondering what her other parent’s teeth are like? Did they also have lots of fillings? And one thing my dentist pointed out to me when I mentioned our home water filter (we pay for a reverse osmosis system - it’s related to our work). He said that if you have nice, filtered water from a service, it likely filters out fluoride. He recommended we use tap water for cooking and for some of the drinking water for kids. I wanted to mention it because it never would have occurred to me.
Of course we’re also fortunate to have nice tap water, so ymmv.
posted by areaperson at 3:26 PM on August 3, 2021 [4 favorites]

Aw, this sucks. I had SO MANY cavities as a kid. SO MANY.

As a grownup, I brush and floss regularly and see my dentist every six months, and that manages to mostly keep them at bay. Whereas my husband sees a dentist like, every THREE YEARS and never has a cavity. So I think there's definitely differences in teeth strength/mouth bacteria composition or something. She may need to a) gargle with a fluoridated mouthwash and b) see the dentist much more frequently.

PS. For a little bit when I was a young adult, I forgot to brush the tops/buttoms of my teeth. Seriously. I diligently brushed the sides and flossed...but not the tops. Don't ask me why. This too resulted in a lot of cavities. So, um, check her technique.
posted by stray at 3:30 PM on August 3, 2021 [6 favorites]

A friend's kiddo had regular high fevers when young (eventually he needed his tonsils removed), and this messed up the formation of enamel on his baby teeth. He was very prone to cavities and had a bit of discolouration as well. I believe that other things can also affect enamel during sensitive periods of tooth development, like some antibiotics, but IANADentist....
posted by DTMFA at 3:33 PM on August 3, 2021 [1 favorite]

Does the dentist offer fluoride varnish for her? It’s a semi-permanent ‘varnish’ that they paint on kids’ teeth to prevent decay. The dentist or hygienist does it usually at every checkup. It saved me a fortune when my kids were coming up.
If this dentist didn’t offer it then I would certainly look for a new pediatric dentist.

As for weak enamel, I’m sure I have it . My whole life I’ve had decay almost every visit and I’ve been meticulous with my dental hygiene and checkups. Dentists will deny it but I’m positive it’s a real thing.
posted by 2CatsInTheYard at 3:37 PM on August 3, 2021 [9 favorites]

Fluoride varnish helped my kid with bad teeth. My kids by adoption inherited their family’s fantastic teeth and have barely any cavities their whole lives, aside from trauma injuries. My kid by birth lost the genetic lottery and got my terrible teeth. She sees a dentist every three months and has only twice had no cavities. I was really strict on snacks and sticky food (cheese and nuts are good snack options for bad teeth our dentist said) and brushing and still! Cavities. It really is strongly influenced by nature over nurture.

I would increase your check ups as a precaution. Also, when one kid needed urgent dental work for multiple teeth, we opted for a GA to get it all done over the challenge of extended dental work that the kid was terrified of.
posted by dorothyisunderwood at 4:04 PM on August 3, 2021 [3 favorites]

Aw, poor kiddo! I doubt that what she's eating is really the problem. It's more likely related to her brushing/flossing/possible grinding. Has the dentist given her lessons in brushing and flossing, to make sure she's doing it right? A water pic can help get the tough spots between teeth, and I find I get a much more thorough (and enjoyable!) brushing when I use an electric brush with nice soft bristles. Look into fluoride treatments, see if she needs a night guard and ask your dentist about plaque disclosing tablets. I used them when I was a kid, and I don't know if they really highlighted plaque like they were supposed to but they did at least make me brush extra thoroughly to get the pink gunk off my teeth.
posted by Ursula Hitler at 4:09 PM on August 3, 2021 [2 favorites]

Weak enamel is absolutely a thing, and I think a lot of people also have chemical issues with their saliva and undiagnosed acid reflux. Dentists just don't want you to let up on your hygiene just because it doesn't work as well for you as it does for other people.

I mean, give me a break. How could it NOT be a thing? Everyone knows someone who doesn't even own floss and never had a cavity, and everyone knows someone who's religious about cleaning their teeth and has had multiple root canals.
posted by potrzebie at 4:15 PM on August 3, 2021 [11 favorites]

One thing you didn't mention is whether the teeth are permanent teeth or primary teeth. I would be surprised if a dentist recommended extraction of a permanent tooth on a 9 y.o..

Dental decay is caused by bacteria digesting carbs and producing acids that eat away at the structure of the tooth. enamel is hard, but does vary across populations, and once the enamel has been breached the bacteria take up residency and continue to do damage. any active cavity means there is an overabundance of the bad bacteria and puts all of the teeth in that mouth at greater risk. this is why people who have cavities tend to get more, and people who don't tend not to.

Good news is if there is no decay in her permanent teeth, you've got a second chance with the permanent teeth to ramp up prevention and keep the mouth cavity free.

Sealants are good. xylitol (gum) is good. fluoride toothpaste is good. No cavities in parents and siblings is good (you will share those bacteria). cheese is good. regular check-ups help us to see things when they are just beginning and allow us to intervene at the earliest possible time, and intervention doesn't necessarily mean fillings these days.
posted by OHenryPacey at 4:25 PM on August 3, 2021 [8 favorites]

My partner was told they have deeper than normal grooves/valleys/whatever the term in their molars, which traps food and makes them much more prone to cavities than your average person.

Dry mouth is another culprit, if she’s on any meds (ADHD meds, for example, often elicit this).

Has your dentist recommended a mouth wash?
posted by brook horse at 4:28 PM on August 3, 2021 [3 favorites]

Some people just don't win the genetic lottery on teeth. Lots of people make it for decades with basically no damage even with mediocre habits, and some people can't breathe without some enamel going bad. I'd push back on the dentist to give you a more comprehensive assessment of what they, the expert, think is going on and how to proceed.
posted by Lyn Never at 5:10 PM on August 3, 2021 [3 favorites]

This doesn't sound normal to me, as you said, she is only 9 years old. I would take her to a doctor and get a blood draw and see what her normal Iron levels, etc. are, before I would listen to the dentist. It could be nothing, but you are her mother and I think your instincts are right.
posted by Marie Mon Dieu at 5:47 PM on August 3, 2021 [1 favorite]

How much milk does she drink? Nine year olds are growing bones, but their teeth need calcium too.
posted by basalganglia at 5:55 PM on August 3, 2021

The extent and speed of decay doesn't sound normal at all. I know you think there may be something you are doing or not doing that's behind all of this, but my gut says no. In fact, I would do some research about potential medical causes and consult with the appropriate specialist(s) to follow up. I'm blessed with some broadly-educated dentists, but many are just laser-focused on dentistry and aren't aware of more peripheral and infrequent issues. IANAD, just someone who has had teeth for many years and has been around dentists a lot.
posted by DrGail at 6:00 PM on August 3, 2021 [3 favorites]

Does the child have a vegan diet?
posted by Riverine at 7:29 PM on August 3, 2021 [1 favorite]

My kid is 3.5 and has tons of cavities. There’s a lot of reasons for this that may not apply to your kid (reflux, sensory issues, food allergies so no safe toothpaste) but our dentist explicitly said “he has soft teeth - some people just do.” My husband does as well. I find it very strange that your dentist said that was not possible.

Please try to be gentle with yourself - it’s easy as a parent to beat yourself up for not doing “a better job” or whatever, but you’re doing great. Ask about silver diamine flouride on existing cavities - super easy to apply and protects the tooth/prevents the cavity from growing, though it does stain the teeth (may be best for back teeth at your daughter’s age). Hang in there - I had so much guilt around this at first but realized that it’s really a combo of factors and mostly not within my control.
posted by bananacabana at 8:13 PM on August 3, 2021 [2 favorites]

My brothers baby teeth lacked enamel and basically he lost a few to rot (like clearly rotted)
before they caught on to what was happening. His adult teeth had thin enamel and he has always had significant dental issues. Basically confirming this is a thing.

Or at least a dentist told my mom this is a thing.
posted by AlexiaSky at 8:19 PM on August 3, 2021 [2 favorites]

My stepfather was a dentist. Did a lot of pediatric dentistry. He said that some people just have teeth prone to cavities and rot and some never get cavities and most are in between.
posted by AugustWest at 9:07 PM on August 3, 2021 [4 favorites]

I had teeth like that, but not quite to the point of removal (fillings in every tooth by the age of 12 instead). GC Tooth Mousse was a revelation - a year of daily remineralisation treatment got me to the point most of my dental trouble relates to old fillings chipping away. So was a proper tutorial where a dentist specialising in gum issues watched me floss and brush in the dental chair and corrected my technique until she was satisfied. Definitely the fluoride coatings too, had them all the time as a kid before the tooth mousse was available.

And until those take effect, dentist every six months. Honestly I'd start by changing to a good pediatric dentist because no way should they have missed something that bad long enough for her to lose a tooth, it doesn't happen that fast.
posted by I claim sanctuary at 11:39 PM on August 3, 2021 [4 favorites]

I attribute my low lifelong cavity count squarely to the fluoride supplements my mother fed me daily before fluoridated water became a thing in the city I grew up in. Ate enough fluoride as a child that fifty years after these teeth erupted they're still slightly yellowed and a tiny bit mottled from it. They sure don't rot, though. And it's not genetic; both my parents and all my grandparents had way more fillings than I or my siblings do.
posted by flabdablet at 11:56 PM on August 3, 2021 [1 favorite]

Reinforcing what AugustWest said, I once asked my dentist why I even needed to bother seeing him when every single time I went, all I ever got was a clean and I never had cavities. He told me I basically won the generic lottery and that some people have an enzyme in their saliva which helps them not get cavities while others lack it.

He said for those people, they can be obsessive about cleaning, flossing, eating well, seeing the dentist, you name it and no matter what they do, they’ll still have teeth that just crumble and decay. It’s just luck of the draw. Obviously I’m no dentist and I can’t comment on your child but you might be looking at a situation like that. The same dentist also asked where I grew up because he could tell by my teeth that it was somewhere that they put fluoride in the water. He was right.
posted by Jubey at 1:28 AM on August 4, 2021 [1 favorite]

My partner saw a specialist dentist a few years ago who mentioned that (in the case of vaginal births), the microbiome a person's mouth gets colonised with based on the microbiome of their mother's birth canal can also have an impact on lifetime oral health, as well as genetics and what the individual does or doesn't do to care for their teeth.

Personally, I really struggle with medical providers who insist that everything comes down to personal action and personal responsibility - it strikes me as a microcosm of the cult of hyperindividualism that sits at the rotten heart of modern western society. Oral health is clearly complex and multi-faceted, influenced by some things that the individual does have control over and also some things they don't. If this were me, I'd be looking for a new dentist who's capable of understanding that complexity, rather than insisting that the part that the individual has control over is the only or most important factor in maintaining healthy teeth.
posted by terretu at 2:04 AM on August 4, 2021 [5 favorites]

I have very little enamel on my teeth, so my dentist referred me to a gastroenterologist. Turned out I have GERD, but since I'd always had it, just thought having reflux all the time was normal. This was in my early 20s. So, if it's an issue with the enamel being worn away, that's potentially something else to consider. Note, previous dentists had noticed the issue since I was a kid but always asked if I threw up regularly and never followed up when I said no.
posted by Kris10_b at 3:56 AM on August 4, 2021

Another medical possibility is celiac - people with it often have a lot more tooth decay - worth checking with a blood test.
posted by leslies at 4:51 AM on August 4, 2021 [1 favorite]

You've gotten a lot of good advice here but I'll add to the anecdata: I have always been very cavity-prone, to the point where now as an adult all my teeth have fillings. This doesn't seem to correlate at all to the amount of care I give my teeth. I never flossed regularly till my late twenties; then I started flossing religiously and saw no difference in the cavities they'd find at my cleanings/checkups. I do think it's something to do with genetics. My dad has very straight teeth and tons of cavities, and so do I; my mom had years of braces but I think she's had one cavity ever.
posted by fiercecupcake at 7:24 AM on August 4, 2021

Alexiasky sky has it. My children went to a pediatric dentist and one of them had a bazillion cavities. The other, none. The dentist believed that my child with cavities had teeth with severely compromised/non-existent enamel. They fixed the cavities and did a sealant on all of her teeth. The cavities were decidedly less on forthcoming visits. I had terrible teeth growing up. My father had dentures by the time he was 38 years old. It seems to point to a genetic disposition. Add poor brushing flossing habits and you end up in a situation. I will note that my wife has never had a cavity in her life. So, her understanding was that it was a not-brushing well and often scenario. The dentist agreed that would be helpful but that it appeared that my child had this condition. Just my .02.

There is a medial term for having compromised/non-existent enamel: Enamel hypoplasia.
posted by zerobyproxy at 8:00 AM on August 4, 2021 [1 favorite]

Woke up with bad tooth ache and the dentist managed to fit us in same day
... So this time I said to the dentist: "Is having weak enamel a thing - because I feel like that might be what's going on here"
... The dentist whilst not unkind was not receptive to that idea.

It sounds like the dentist squeezed you in during a busy day. I wonder if their hesitation was more along the lines of "oh gosh, that's a good question, and there's a lot to talk about, but there's not much time today."

Also, it's better to ask open-ended questions than to fixate on one specific diagnosis. That keeps it a conversation and not a debate.

I would urge you to set up another appointment (or a phone appointment) with the dentist to talk over preventive measures.
posted by dum spiro spero at 8:08 AM on August 4, 2021 [1 favorite]

Do you drink bottled water? Most municipal water has added fluoride, which bonds with teeth and strengthens them. If you drink bottled water, ask the dentist for recommendations. I have bad teeth because I am kid 5 and pregnancy 7 of a Mom who had poor health, and women's bodies run out of calcium with successive pregnancies. My poor younger brother's teeth are even worse.

Use the toothpaste with the most fluoride. I brush my teeth, wash my face, then spit, to give the fluoride extra time to work. Brush and floss often. Some gum has xylitol which has anti-cavity properties; I got some and chew it occasionally. Chewing gum stimulates saliva, which is generally good for teeth, and does some cleaning.
posted by theora55 at 10:08 AM on August 4, 2021 [3 favorites]

My son has had a lot of trouble with his teeth, starting as an infant. He eventually had cavities in every single one of his baby teeth. Now he is 14 and has no cavities in his permanent teeth. It has been a long journey, but I’ll tell you how I did it.

1. He uses a Radius toothbrush. These clean amazingly well with very little effort.

2. He uses an electric toothbrush for his incisors. Especially the back of his lower incisors, where for him plaque has a tendency to calcify for various reasons.

3. Waterpik morning and night. He uses the the middle setting. Give it some time to work up to that level, don’t start there.

4. ACT fluoride non-alcohol mouthwash. Swish for at least 5 minutes.

5. Air purifier in his bedroom. In addition to his natural tendencies toward tooth decay, he also has allergies that may have caused him sleep with is month open, causing dry mouth. After he got the air purifier in his room he also stopped grinding his teeth and looked better rested.

6. I took the responsibility of his nightly dental hygiene. I personally made sure every surface was brushed and every space between the teeth was Waterpik’ed. I have been doing this every night for over a dozen years. I never miss a night no matter what. I know it sounds crazy but his teeth were just rotting and it had to be stopped. After he is done with braces I think he’ll be fine to manage his teeth on his own. He’s totally on board with the hygiene routine, so that helps.

7. My son only drinks water, besides milk at mealtimes.

All of my son’s cavities started between his teeth, but xylitol and flossing didn’t help him. He really needed the Waterpik to flush all the food and bacteria. There was visibly less plaque forming on his teeth after we got up to a high enough level on the Waterpik and his gums became a very lovely, healthy pink. The bacteria in the mouth are the cause of the decay, and they are contagious! All other teeth can be affected unless you keep the bacteria levels down and strengthen the teeth with fluoride mouthwash.
posted by GliblyKronor at 12:19 PM on August 4, 2021 [2 favorites]

We have several children, with all basically the same mouth hygiene. One of them had to have a couple teeth pulled when he was around 5, because of massive cavities and an infection.

It really is genetic. Don't beat yourself up. Do take much of the excellent advice above about fluoride varnish, innovative toothbrushes, and the like.
posted by heigh-hothederryo at 9:01 PM on August 5, 2021

I want to add that I recently started giving my son vitamins D3 and K2. There’s some evidence that they promote dental health, and I figure he needs all the help he can get.
posted by GliblyKronor at 10:17 AM on August 8, 2021

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