dental work in child

fiona562

ok so some background.....my daughter is 5, born at 34 weeks at 2lb15- didnt need help breathing thankfully but did recieve the first of many antibiotics at 3 days old. has had numerous antibiotic since for chest infections which is now under control with asthmas medications including singulair and inhalers. she also grinds her teeth when unwell esp. if there is any sign of a temperature.
first filling went okish, second one though was the deal breaker for her- she felt evry bit of the needle and after that was a no go!
i changed tack then and got her dad to bring her as he would be more confidant with the dentist than me, but again same story- first visit where they just look goes ok but second one a different story.
now daughter really needs the work done so dentist recommends that we see a different, more specialised dentist, which we did this morning,
We didnt get x rays done but her estimate is one root canal and 3 crowns totaling nearly €3000.
i dont know what to do,,,cant afford that anyway and dont have a medical card but doubt that would be covered on it anyway.
if i dont get this work done and just have the teeth taken out am i creating more problems down the line?
can i just go to the school dentist with her even though she only started school this year? do they refer you on if it has th be done under general anthestic?
the teeth dont give her any pain that she tells us of, the one filling she did have done has a hole in it now so surely that would be causing discomfort at the least,,,,,
oh what to do??? anyone go down the road of the dental hospital? (sorry dont know if im allowed name them?)
anyone get this kind of extensive work done to their child before id appreciate any views or opionions on this feel like i have totally let her down with this!
thanks in advance...

flahavaj

The HSE ("school dentist" you refer to) have no service for dental restorations under GA, only extractions.

You can attend their emergency clinics without appointment in your local health centre. Check locally for emergency times or what days the dentists sits. However the HSE does not routinely restore asymptomatic primary teeth (ie teeth with cavities but no pain) and tends to manage them on a symptomatic basis (ie treats them if they're giving pain). Studies show a very high proportion of primary teeth that have cavities will fall out without giving pain (up to 85%) so it makes sense for a Public Service to concentrate its (rather limited and every dwindling) resources on treatment of the permanent dentition.

To get long lasting, reliable multiple restorations done on a young 5 year old child you're looking realistically at going to see a paediatric specialist, which can be expensive. Bear in mind also that treatment thats done at this age will shape how she/he sees the dentist in the future - you may very well get all the teeth filled etc now, but she may be a more reluctant patient in future years. Dental anxiety is a seperate condition that can be far harder to treat in future years than any amount of dental decay.

day dreamer

Hi fiona

you should not feel too guilty that your little one has some decay problems. You had more important issues to worry about when she was born and it sounds like you had a tough time

Yes decay is preventable but you have to deal with where you are now. I would have to disagree with Flahavaj, I feel it is better to start treatement at an early age as it reinforces good behaviour. Those who get decay early and dont have it treated are more likely to have further problems. In the ideal world we would all treat decay in the deciduous or baby teeth as it preserves space for the adult teeth and promotes good habits for the future. Indeed the current HSE policy of refusing to treat decay in deciduous or baby teeth has been stongly criticised by experts in the area as unethical and not providing best practice.

If you cannot afford the paediatric dentist then I would bring your girl to the local HSE clinic. If the teeth need to be removed they can arrange this for you. If not they can monitor the situation as as she grows. You can receive this service from the HSE without a medical card if your daughter is in pain.

The problem is that she may develop pain or an infection if the decay is not treated, on the other hand there may be no problems either as often decay is painless. Without an examination, it is impossible to say which way things will go but early loss of the baby teeth can create orthodontic or crowding problems later.

It is important to keep up her oral hygiene and prevent future problems and dont get too worried about what has gone on in the past

btkm8unsl0w5r4

Patient come into me all the time talking about how when they were kids dentist only took out teeth. This is all they knew of dentistry. I feel with the current HSE policy that we have returned to these 1950's standards of dental care.

eric hoone

There were many unnecessary extractions in the 50's; of adult and baby teeth alike. We're not going back there, or hordes of work-hungry solicitors would have the dentists for breakfast.

Artanisf

Hi Fiona, I agree with Flahavaj's advice. The HSE policy in question advises dentists to only fill baby teeth where a clear health gain is evident. And it is by no means clear that filling baby teeth is the best way to deal with the problem. Check out this BBC report (not, by the way, from the 1950s, from 2009):

http://news.bbc.co.uk/2/hi/health/8112603.stm

In the UK, this is currently a big research question. The choice isn't to fill or extract symptomless baby teeth - it's to fill or to leave alone, or maybe to take an intermediate approach known as ART - atraumatic restorative treatment. Critical is an emphasis on correcting the cause of the decay and putting in place a proper preventive regime which, of course, will also benefit permanent teeth as they erupt.

flahavaj

http://www.controlled-trials.com/ISRCTN77044005

I presume this is the study referenced in the BBC article. The results of it will go a long way to informing the current debate on the restoration of primary teeth.

Note also that the HSE doesn't "refuse" as such to treat primary teeth. Treatment decisions are left ultimately to the discretion of the dentist. My own experience is that most teeth do go unfilled however.

Its definitely an area in which more research is needed. If figures from previous studies (that show that 85% of carious deciduous teeth exfoliate naturally without giving symptoms) are replicated in the FiCTION study then certainly a general policy of non intervention in the primary dentition (and prioritisation of maintaining the permanent one) in a public service with very limited resources seems more than reasonable to me.

flahavaj

Theodore Massive Castle wrote: »

Patient come into me all the time talking about how when they were kids dentist only took out teeth. This is all they knew of dentistry. I feel with the current HSE policy that we have returned to these 1950's standards of dental care.

Not sure if this might be better debated in the Dental lounge, but......

In my experience children these days have a far happier time at the HSE dentist. In fact I often hear parents talk of how awful their own experience was of the service back in the day only to speak in glowing terms of the way their children are looked after these days - even those unfortunate enough to need an extraction! Comparing the level of service that is provided nowadays to 1950's dentistry does HSE dentists a great disservice IMHO.

---

In a well run public service where children are screened early and appropriate preventative procedures such as flouride application, diet counselling etc are administered as well as sealants placed on permanent teeth before they too become decayed there should be no reason why the need for extractions can't be minimised. Not all carious primary teeth inevitably require extraction. In fact few do if appropriate measures are taken.

There is a very good case to be made for the argument that placing multiple restorations in every young patient with carious primnary teeth could cause just as much if not more adverse experiences of the dentist in the population as a whole than extracting the small fraction of these teeth that become sufficiently symptomatic. Dental anxiety is itself a disease that in many ways is more difficult to manage than dental caries.

And none of this takes into account the huge investment that would be required to
-employ the 150 dentists it would need to currently make up the shortfall there exists in dentists currently in the HSE
-employ anaesthetists and specially trained nursing staff and hospital equipment that would be needed to provide much of these restorations under GA.

The HSE dental services is struggling to provide adequate services to patients in terms of treating permanent decay as it stands. There simply isn't the manpower to begin treating primary caries as things stands. AFAIK patients in Cork (including special needs) currently face a one year wait to have extractions done under GA. Its all very well talking about 1950's healthcare, but the reality is that the service is receiving 1950's level funding. Until that changes child and special needs patients will continue to receive a skeleton service and debating the pros and cons of restoring primary teeth will remain a moot point.

/rant.

btkm8unsl0w5r4

lets continue in the lounge........

fiona562

i have to thank ye guys for all the replys and lots of interesting reading there,,
we did go to the hse dentist and i have to say they were great, i felt i needed a second, actually third view on her teeth, and i have to say found hse dentist more willing to talk to me about different treatments rather than agreeing with one and sticking to it, she recommended that if there was no pain to leave them alone, ob. if there if any discomfort or signs of infection to come back down and they would help her.
i am very impressed with the sevice they provided, sooo different from my day, i didnt know they could prescribe and dispense antibiotics for kids there and then, such a great service for children,,i completely understand that the budget for this area cant stretch to things like root canals and to me that is understandable, i hope in the up coming budget that they dont get hit too hard!
again everyone thanks for the advice, Ive told my daughter now that there will be no more dentists for a while so she has to mind her teeth now until its time for the tooth fairy to come!!!!
wonder if because she got her teeth a little later will they be longer in falling out!!!!
again everyone thanks!

fifofum

Please remember that her first permanent(adult) molar teeth are scheduled to erupt around the age of 6. {NB: these appear behind the last baby molar teeth, so you won't be alerted by any tooth falling out}.With the history of decay in the baby teeth,& also the illness at birth (look up Molar Incisor Hypomineralisation), it would be a good idea to place fissure sealants on these teeth.
Try to build up a routine/relationship for your child with the dentist, so each visit isn't a treatment(?traumatic) one, versus "don't worry, we won't go to the big bad dentist".
Routine checkups(even watching mum/dad having a checkup& being relaxed) build a childs' confidence& mean there's more of a focus on preventative dentistry. Kinder in the long run!