Our first-born son is eight months old and seems to run a lot of fevers. A friend told me that it is probably because he is teething and we may need to slit his gums. I can’t imagine doing that! Can you give me some guidance here? We don’t have a pediatric dentist yet.
Melanie
Dear Melanie,
Photo courtesy of St. John’s Pediatric Dentistry, St. John’s, FL
The first thing I am going to say is not to slit your child’s gums. I’ve never even heard of that for teething children. Doing that runs the risk that the roots are not adequately formed and they will erupt prematurely now unable to properly support the tooth. Let nature take its course. The teeth will erupt when the root is ready.
That being said, teething can cause fevers. However, it will only be a mild fever. Teething infants will also be a bit fussy, drool a whole lot more, and eat a bit less. Giving them some infants Tylenol will help some.
There is a slight difference when it comes to adult teeth erupting. If the baby teeth are still in place and you see the adult teeth breaking through, you need to seek some help from a pediatric dentist to remove the baby teeth. If you don’t, the adult teeth will get deflected, which will cause them to come in out of alignment. From there, you will be looking at expensive orthodontics that you might have gotten away with needing.
As your son is approaching a year old soon, I recommend beginning your search for a pediatric dentist. It is always best to acquaint them with a dentist before a problem arises. This way their first experience with a dentist is a positive one and not a scary emergency appointment.
My eleven-year-old broke her two front teeth quite badly. Most of the structure is gone. She only has the top and sides left. Everything else is gone. We went to our pediatric dentist and he suggested removing the teeth. I wasn’t keen on that idea so I took her to my dentist. He said that dental bonding was the solution. I was so glad to hear that she could keep her teeth, I didn’t even look into the procedure. When the results were done, her bonding was so awful. It was lumpy and uneven and in places the color didn’t even make sense. She’s horrified and I don’t blame her. I don’t know what to do. Is there any way to fix this? I’m devastated for her.
Carolyn
Dear Carolyn,
I’m shocked that your pediatric dentist suggested you extract her teeth. That was quite extreme. I expected he would have suggested dental crowns, but that would be a bad idea as well. The pulp of our teeth shrink as we age. In an 11 year old, that pulp is still quite large. Doing a crown on their teeth can kill the pulp.
Your other dentist was on the right track in recommending dental bonding for the repair. The problem lie in he did not have the skills to do such a massive repair. Dental bonding has to be done freehand and takes a great deal of training and artistry. When done well, it will blend in perfectly with the remainder of the tooth structure, as evidenced by the image above.
My suggestion is you look for a practice that has a dentist who is accredited with the American Academy of Cosmetic Dentistry on their staff. Ideally, they should also be a practice that enjoys working with children. But, if you had to choose, go with the AACD accredited dentist. Your current dentist should be willing to give you a refund.
This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.
Can you tell me why my dentist wants to fill a baby tooth? My son has a cavity on one of his back teeth, but this isn’t his adult tooth. As it is just going to fall out anyway, why should I spend this money and put him through the procedure?
Callie
Dear Callie,
Nobody wants unnecessary medical or dental procedures so I completely understand your question. While some baby teeth will start to fall out soon, his back molars need to stay in until he is around 12 years of age. You don’t want this cavity to turn into a dental infection. A simple cavity is easy to treat, with little trauma. If the tooth gets infected, you will need a child’s version of a root canal treatment, called a pulpotomy.
In most cases, you will want to prepare ahead of time and possibly even arrange to have oral conscious sedation used during this procedure, so he is as comfortable as possible. If you let the tooth go, it could go downhill fast, which will mean a dental emergency. In that case, oral conscious sedation may not be an option for him which would make the appointment more traumatic for him.
What If He Loses This Tooth?
Another problem with letting the decay continue is that the tooth may become unsaveable. If that happens and it has to be extracted, you will need your pediatric dentist to place a space maintainer in that spot. This will prevent the other teeth from shifting and tipping into that spot.
Without that, the other teeth will drift. This will mean there is not correct placement left for his twelve-year-old molars and will lead to crowding. Crowding means crooked teeth and expensive orthodontics.
A little prevention now by getting this tooth filled can save you and your son a lot of expense and hassle.
My daughter Ava, 4, is mildly autistic and has difficulty with new and different stimuli. Her first dental visit is coming up, and I thought bringing her favorite weighted “blankie” and her beloved stuffed panda might be a good idea. I’m just worried about keeping her calm throughout the procedure. I do have an odd question, though. She adores her twin sister Rachel and was asking if Rachel can come along and sit in the room while she gets her cleaning. The twins do everything together and have a very strong bond. I honestly feel it would really help her. Rachel is not on the spectrum as Ava is. She already had her cleaning last week (and did great!) but Ava had another appointment that day and couldn’t come in at the same time. Rachel has such a calming effect on Ava, so I thought it might be a good idea. I will sit in the room with them as well, instead of leaving the dentist with two four-year-old’s! Does this sound like something that might work?
Many thanks,
M.M.
Dear M.M.,
Twins are a special delight to be sure–congratulations! These are great questions; let’s see what we can do to ensure a wonderful first-time visit for your angel. There are a couple of things to consider:
The First Pediatric Dental Visit is Meant to be Fun
Some pediatric dentists are fine with parents coming back with their children. Others, prefer to work with the child with just his or her assistant so they can build a rapport. In fact, some children are much better-behaved on their own than their parents might suspect. This is especially true if you as the parent have any deep-seated dental anxieties of your own. Though not intentional, these fears may inadvertently be transferred to your child; children are very intuitive.
That being said, this is a “first” visit, and that makes it a special type of fun. While yes, Ava is here to have her teeth cleaned and examined, she’s also here to get a first-time view of the dental office and we want that to be favorable. We all know first impressions count, and the goal is to have her leave the chair with a smile. If this includes you and her twin sister sitting in, then it shouldn’t be a problem. Just be sure to mention this to the hygienist before being called back to a chair, so she can prepare. Explaining your daughter’s special circumstances will help.
Following Visits May be Different
Once Ava has successfully completed her first visit, she will have hopefully formed a good opinion of the dental office and what it entails. If further visits are needed, such as for fillings if any decay is found, the assistant may ask you and Rachel to remain in the reception area.
You Know Your Autistic Child’s Tolerance Best
Autism and its effects can be a challenge for parents. In the practice, we often see patients on varying degrees of the spectrum, and what works for one may not work for another. Some may require prior medication, such as dental sedation. Some require shorter visits; some do fine without any of these. I’m glad you’ve had the foresight to suggest bringing her special blanket and stuffed toy. These things will certainly help. You know her best, and we don’t forget that.
Twins Are Wonderful
All children are gifts, yet twins are another thing altogether! I can recall having 5-year-old twin girls in the operatory once, very similar to your situation: one in the chair, the other watching from the corner. These two had formed their own rudimentary language, and I’ll never forget listening to them talk to one another in their unique chatter! It was an amazing experience.
My seven-year-old daughter developed a cavity on a back tooth, which is weird because they have sealings. I took her in for them to do the filling and they could not get the numbing medicine to work. She is in agony and ended up thrashing about. He did seven shots to no avail. He finally just sent her home without the tooth dealt with. Where do I go from here?
Maggie
Dear Maggie,
I am sorry you and your daughter had to go through this. It is agony watching our children suffer. The good news is I have a solution. It appears that your current pediatric dentist is not aware of the connection between anxiety and numbing medication.
If a patient is very anxious, it has the effect of metabolizing the numbing medication very quickly. Sometimes so quickly that the patient gets no benefit out of it. I feel this was what happened to your daughter. Traumatic experiences like this are what keep people away from the dentist in adulthood.
Our goals right now for her are two-fold. First, get the cavity dealt with before it blows up into something more substantial or even a dental emergency. Two, give her a positive experience at the dentist so she can feel good about her oral health care.
I want you to find a dentist who is good with children that also offers dental sedation. It doesn’t have to be a pediatric dentist. There are many general dentists who enjoy treating children and are qualified.
Under normal conditions, she would only need some nitrous oxide to relax her. However, after her recent experience, I am concerned that will not be enough. Look for someone who offers oral conscious sedation. It is so strong that she will sleep through her whole procedure. In fact, some people call it sleep dentistry for that reason. She is still conscious. This is not anesthesia. It just completely relaxes her which will allow that numbing medication to do its job.
Be aware that she will still be woozy for a few hours after that procedure. You might want to set her up a little castle on the couch and let her binge watch something like “A Series of Unfortunate Events,” which will entertain her while simultaneously realizing her life isn’t so bad.
As for her sealants. Sometimes those will come off. Make sure you have the dentist check that the others are still intact.
This blog is brought to you by Lafayette, LA Dentists Dr. Foreman and Thimmesch.
I have a five-year-old daughter who is extremely uncooperative at the dentist’s office. I have been through four pediatric dentists in our small city trying to find one who can get her to cooperate and it just hasn’t happened. She needs a lot of dental work and is having trouble eating. I’m worried. She has four teeth with decay right now and some of them have even lost tooth structure. What do I do?
Katie
Dear Katie,
I can tell you love your daughter Katie very much and want to get her the best care possible. She is in a position now where you almost have a dental emergency on your hands. The first thing I would do is find a dentist who works with children and also offers dental sedation. It does not necessarily have to be a pediatric dentist. There are general dentists who are good with children. If she is uncooperative, this will at least allow her to get the work done she needs.
While these are baby teeth we are dealing with, they are still most important for her to keep for two reasons. One, so she can eat properly. Two, if any of them are molars, she will need to keep those in place until she is twelve years old. If the teeth cannot be saved, then make certain the dentist places space maintainers there to keep the space open. Otherwise, her other teeth will shift and it will lead to crowding.
One other thing, the only way to get that much decay at her age is for her to snack quite a bit during the day. You may have to show some tough love. Do not let her eat between meals. This includes having too much juice. Try to limit her to water until her teeth are under control.
My daughter fell and broke a chunk off her front tooth. I immediately called our pediatric dentist and he said the soonest he could see her is six months from now. I told him we are pretty anxious to get it fixed and asked him to recommend somewhere. His response was that everyone will tell us that the nerves need time to calm down and then they can see us. For some reason that felt like an excuse to me. If not, why not say that upfront instead of originally saying he’s booked for six weeks? Is there really a necessary time to wait?
Belinda
Dear Belinda,
Your instincts are good. There isn’t really a reason you should have to wait. I’m guessing your pediatric dentist just didn’t want to lose any business. This can be treated right away.
If you have the piece that broke off, a good cosmetic dentist can reattach it. If not, the solution would be to have dental bonding done. This will also need to be done by a good cosmetic dentist. It doesn’t necessarily need to also be a pediatric dentist. There are general dentists who work well with children.
As she ages, the pulp of her tooth will get smaller. At that point, it may be necessary to do a dental crown. Until then, bonding or reattachement are your best options for her.
If she gets nervous at the dentist, look for someone who offers dental sedation. They can give her something to relax her. It doesn’t have to be very strong, even just nitrous oxide will be enough.
I have a ten-year-old daughter. Today she fell and broke a front tooth. I am a bit frustrated with my dentist who said that he can fix it but he cannot see her for six weeks. When I told him I did not want to wait that long, he said it was necessary for the tooth to desensitize anyway. If that is the case, I’ll wait. However, I got the impression he was just saying that. If that is the case, I’d rather go somewhere else. What is the right thing for me to do?
Cassie
Dear Cassie,
No, there is not a medical reason to wait. I suggest you take her to another pediatric dentist to be evaluated and treated. If you tell them what happened, they may be able to schedule an emergency appointment for you. It would be ideal if it is a dental practice that also has a highly-trained cosmetic dentist on staff. It’s okay if they don’t, but you’ll want a skilled cosmetic dentist to do the repair.
If you have the piece that broke off they may be able to re-attach it. If that peice is missing, then dental bonding will be the right solution. Both require expert cosmetic dentists as I mentioned above.
As she gets older, the pulp of her teeth will shrink. At that point, she’ll need a single dental crown. Be aware that dental insurance only pays for the cheapest option. For children, that is usually a silver crown. I doubt you’ll want that on her front tooth, so call the office and find out what the price difference will be from what the insurance will cover and what you want for her. If you start saving now when the time comes it won’t be as much of a financial burden.
I hope this helps. This blog is brought to you by Lafayette, LA dentists Drs. Foreman and Thimmesch.
My two-and-a-half-year-old had a nasty fall. It caused a lot of tooth trauma, which led to him losing his front two teeth. Our normal pediatric dentist retired and we were sent to another one. Our old dentist had always warned me that we want to save as many baby teeth as possible because if they’re taken out too early the teeth would shift. Now, here my son is with two front teeth missing when he is a toddler. I spoke to the new dentist about getting him a dental flipper and he just snapped at me and said the idea was ludicrous. Now what do I do? I don’t want his teeth to shift everywhere.
Kelsey
Dear Kelsey,
First, I want to talk about this new dentist and then I’ll answer your question. I know this is the dentist you were sent to, but I think you need to find another dentist. This one is not serving you well. One of the most important skills of a pediatric dentist , other than the actual dentistry part, is good communication with the parents.
These are your children and you are responsible for their care. Of course, you will have questions! It’s ridiculous of HIM to think that your question is stupid. After all, if you went to dental school you wouldn’t need him. He’ll have the information you don’t and instead of acting the way he did, he should have kindly and patiently explained to you why he didn’t think it would be a good solution.
Whether he was right or not, he handled this badly. I would like you to find a pediatric dentist who is more receptive to questions.
As it turns out, he was actually correct about the dental flipper. There are a few reasons why you wouldn’t want one for your sweet boy. First, it is removable. Even if he was the most responsible toddler on the planet and never removed this device that will likely feel weird to him in his mouth, it is a choking hazard.
Additionally, he is constantly growing, including his jaw. This means he will outgrow the flipper many times between now and the time his adult teeth come in.
There is good news for you, though. When your retired dentist told you about teeth shifting, he was referring to the importance of keeping in his baby molars. These have to stay in place until your son is around twelve years of age. The other teeth are fine to come out much sooner. His front teeth will be fine with the space left as is.
You may now be wondering, well what if he loses a molar? Great question! Dentists have a way of protecting that space using a space maintainer. It is a small apparatus placed in the open area in a way that keeps the space open until his twelve-year-old molars are ready to come in.
I hope this helped to put your mind at ease. This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.
