Alright future/current dentists, now is your time to shine. Jeff needs some dental work. Despite our best efforts of brushing and flossing, Jeff had and abcess and major decay on (looks at paper) tooth S which they suggested be extracted, then a pulpotomy and stainless crown on T. The other side needs a composite 2 surface on K and a pulpotomy/crown thingy on L. Obviously you guys can't see the X-rays but they did say that the T and Lcould just need fillings and not a pulpotomy. There wasn't any perforation to the root on either of them. Oh yeah, and an appliance on T to keep the space open. Honestly, the S does need to be pulled, I saw the amount of infection and how gnarly the tooth is, so yeah, its coming out, but this pulpotomy business just seems like overkill. The tooth will come out in a few years so why crown it and such when you can just do fillings. However, I have no clue about any of this so I ask for your advice. The image above is from the first dentist he saw last week, who was rather impatient if you ask me. He then referred us to a pedodontist who is recommending the work described.
Oh yeah, and how can we help Jeff and Darcy floss better? Obviously we aren't doing a good job.
8 comments:
It's difficult to make a judgement call without seeing him or the x-rays. As for the stainless steel crowns, I think they are crap. I have extracted so many teeth that were crowned with SS, only to have decay get under them and turn into a ticking time bomb. My wallet thanks the pedodontists that placed them, but my heart goes out to the kids and parents.
Pulpotomies are good, if they are needed. Again, it's just tough to know if they are needed without seeing him. It couldn't hurt to go to a second pedodontist for another opinion.
As for your kids, I would personally brush and floss their teeth for the next few years, as you have much better dexterity and maturity for it. Also, you should probably look at their diet. How much sugar are they consuming? In what frequency? Are they sipping on juice all day? Did they have bottles when they went to bed at night as babies? Do they eat a ton of candy? A change in their diet would help avoid any future decay from beginning. Constant and consistent consumption of sugar turns a kids mouth into a petri dish for caries.
Lastly, don't take it too hard personally. Sometimes despite a parents best efforts, the kids still get some cavities. Keep me updated on his progress.
Cody is a good dentist. I don't have a lot of experience w stainless steel crowns, but I can see how they would cause decay underneath them. The thought is to reinforce the tooth as long as possible to keep it in the mouth since it maintains space for the larger permanent teeth that will emerge later on. So the space maintainer is important for the extracted tooth and could save you ortho money in the future. Lori works in a pedo office and you could ask her what is done more often. Deciding between a stainless steel and just a composite usually depends on how big the decay really is. As far as the number of caries....yeah, limiting sugar consumption. It's okay for kids to have sugar around meal times, but snacks all throughout the day and juices multiple times per day is no bueno. Cheese is a good snack, as it can actually stop caries from progressing. Oh, and periodic dental visits for topical fluoride applications which I'm sure you've had a hard time doing as a student. Baby teeth are more caries prone than permanent teeth as well.
The pulpotomy would be needed if when they take the decay out it goes to the pulp (nerve and blood vessels) and so they take out the infected pulp and then would need to put a stainless steel crown on top since the tooth isn't as strong as it once was. So that's why they say it might not need the pulpotomy and might just be able to be filled. Hard to know till you get in there.
Thanks for the info guys. The kids don't drink all that much juice. We get some juice boxes about twice a month but they drink water mostly. We never gave them bottles in their cribs and still don't. Glass of water, crust of bread for Jeff!
Yeah, the sugar consumption could improve, but that has to start with mom and dad first! But keeping it around mealtime is a good suggestion.
Joe nailed it when he brought up the student thing. This was Jeff's first time to the dentist simply because of cost. While we had to pay out of pocket for these initial visits, my Health/Dental should kick in the next week or so to cover all the stuff I outlined.
I just found out that Rocklin's water is not fluoridated so we need to get an Rx for that.
Again, thanks for the advice. Keep it coming.
While I don't have as much experience as Cody or Joe, I do have an uncle who is a pediatric dentist in Washington state and after talking with him it sounds like he would have recommended the same treatment plan. I think the dentist is likely giveing you the worst case senerio with the pulpotomies. If the decay goes to the pulp then ya just have to do it. Hopefully that won't be the case. As far as stainless steel crowns, while I have only had to remove one, it seemed like the tooth it covered was still in good shape. I think it would be a bit brash to say that they are crap. They are not supposed to be a lifetime restoration but if they are placed correctly they can provide tooth strength, maintain space and protection from decay. As far as flossing and brushing I agree that you should do it for your kids for a few years. Maybe let them do it for a min so they learn the habit of just having to do it but then you follow up and do it right. It's hard enough to floss your own teeth let alone someone elses, but if you buy those floss pickers it can be a lot easier. I think there are some in the shape of dinosaurs Jeff would like.
Like I said....I'm still a student but I hope that helps
JP
Ahh--it happens sometimes even when you're doing your best. If you trust the dentist, get done what he tells you needs to be done. If you don't trust him, get another opinion and then make a choice and get it fixed. Delaying treatment can cause more problems.
Kids generally need their teeth brushed and flossed for them at least once a day (preferably twice) until they are eight. Then they can learn to do it themselves, they'll need to be taught and watched and you still have to check them over really well--forever (okay, until they won't let you because they are bigger than you or they start caring what the opposite gender thinks about their smile and breath).
When you give them snacks, let them rinse with water after. When we brush Blake and Lizzie's teeth we have them lay on the ground and they open wide (or we force them open wide) and brush from behind their heads. Blake is really good about letting us do this--Lizzie still fights (she's good somedays, though). Good-luck.
Floss 1 X a day--night's easiest for us. Floss their teeth in the same position as you brush their teeth.
You guys got me all scared. I'm taking my kids to the dentist next week.
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