Dental decay in children

AlasAnAlias

5 children, no dental issues with first 3. Looked at teeth of two youngest, age 7 and 5. They both have quite obvious decay on 2nd lower molars on one side (badly worn down all around/hollow in center/dark). Appreciate that this is from poor brushing/sugary foods etc. and would like to get the correct treatment for them, and prevent complications and issues with other teeth.

Called the local health center, who tried the fob-off, of 'unless they are really sore, we'll see you sometime next year through the school. They are milk teeth and don't need anything done'. Well............... wasn't taking that, so they gave an appointment for tomorrow. Have already had a bad experience there earlier this year - the now 7 year old, had 2 bottom middle teeth coming up behind his non-loose milk teeth in his gums. They told us to try wiggle them out and come back in 2 weeks if we couldn't get them out ourselves. By the time the 2 weeks passed, the new permanent teeth had almost entirely erupted, the milk teeth were not going anywhere, and had to be extracted, and now he has 2 completely angled new teeth!

Can you kindly advise us what to expect tomorrow?
Will they just refer us privately? (funding is an issue)
From reading on-line, it appears these teeth absolutely need treatment as they are not shed til 11-12 years of age, in the form of fillings at the very least (they look really badly decayed). Do the local dental clinics provide this treatment?
And what is the criteria to be eligible?
When asked, the elder child offers that pain occurs with some foods. Younger child says sore with ice-cream on that tooth.

Thanks in advance for replies.
Based Dublin

Dianthus

They won't be turned away if they are in pain. However, the treatment you receive from a general dentist (5 years undergrad training) can be quite different to the treatment you receive from a paediatric dentist (5 years undergrad training, further 3 years full-time specialist training in childrens' dentistry)....eg: pulpotomies, stainless steel crowns, ect. Particularly in a health board setting, & in the famed "current economic climate", you're looking at serious constraints on resources& funding; it's simply not feasible to provide sedation/general anaesthetic for such treatment, for everyone.
**Fissure seal the first permanent molar teeth asap in both children**
Also, if it's of any consolation, the crooked front adult teeth you mentioned would likely still have been crooked even if the baby teeth had been extracted at the first visit; 2 weeks would not make or break the situation.
Best of luck, let us know how you get on.

AlasAnAlias

Dianthus wrote: »

They won't be turned away if they are in pain. However, the treatment you receive from a general dentist (5 years undergrad training) can be quite different to the treatment you receive from a paediatric dentist (5 years undergrad training, further 3 years full-time specialist training in childrens' dentistry)....eg: pulpotomies, stainless steel crowns, ect. Particularly in a health board setting, & in the famed "current economic climate", you're looking at serious constraints on resources& funding; it's simply not feasible to provide sedation/general anaesthetic for such treatment, for everyone.
**Fissure seal the first permanent molar teeth asap in both children**
Also, if it's of any consolation, the crooked front adult teeth you mentioned would likely still have been crooked even if the baby teeth had been extracted at the first visit; 2 weeks would not make or break the situation.
Best of luck, let us know how you get on.

Thanks for that detailed, informative reply.

It was bit of a shock to see their their teeth, and definitely feel bad about it. Looking to rectify it now with the least amount of pain for them (and financial pain for us, thou that is secondary). Yes, appreciate the HSE constraints. I would really hope to get this resolved, in a somewhat timely fashion :eek:, without sedation, but I don't know if that is possible. I don't know anything about paediatric dentistry.

Thanks for the note about the 2 crooked teeth, had been thinking if we'd been assertive, or gone privately, we could have avoided this for the child. Re the sealants, will do as you suggest. We've had a lot of hassle with sealants the last few years, in that we've had them done through the school programme, some have come off in no time, back on privately, back off again.........back on.......... We're also about to embark on our first orthodontic appointment for evaluation for braces for the eldest child (thankfully the cost can be paid evenly/monthly for the duration with no deposit), but will sideline this if advised to go privately tomorrow. There is another challenge in this particular HSE clinic as the dental assistant 'speaks for' the dentist, when you are speaking directly to the dentist, so it is excruciating to attend there in the first instance! Will let you know. Thanks again.

Dianthus

Still attend the orthodontic consultation for your eldest child...you need not necessarily go ahead with said treatment, but at least you'll be aware of any ramifications re deferring it months/years - you will need to ask specifically the orthodontist specifically what the consequences of late or no treatment (re cost& complexity of treatment). It's a question commonly asked in recession times, & important to know the answer.
Sealants can be unpredictable if it's difficult to keep the tooth completely free of saliva during placement. In which case, wait; a poorly placed sealant will cause more problems than no sealant at all. After placement, they would still need to be monitered (leakage, wear, ect)
The whole ventriloquist thing should be excruciating only for the dentist:D

AlasAnAlias

Dianthus wrote: »

Still attend the orthodontic consultation for your eldest child...you need not necessarily go ahead with said treatment, but at least you'll be aware of any ramifications re deferring it months/years - you will need to ask specifically the orthodontist specifically what the consequences of late or no treatment (re cost& complexity of treatment). It's a question commonly asked in recession times, & important to know the answer.
Sealants can be unpredictable if it's difficult to keep the tooth completely free of saliva during placement. In which case, wait; a poorly placed sealant will cause more problems than no sealant at all. After placement, they would still need to be monitered (leakage, wear, ect)
The whole ventriloquist thing should be excruciating only for the dentist:D

Well, dumbstruck here. Clearly, been too complacent having had no problems with other children, and having brought them to a paedi dentist privately (Celtic Tiger days), subconsciously thought we were plain sailing. Not so.

7yr old - what we thought was the 2nd molar (i.e. child's 2nd premolar) is, in fact, the 1st adult molar (#6) and is "badly decayed".
http://www.ada.org/2930.aspx, The other three 1st molars are through too, and have "very weak enamel".
First front tooth is just visible erupting and is "hypoplastic" and you can see patches on it.
Advised: Appointment in 2 weeks for flouride and a filling the following week, IF it is possible to treat it, but the tooth might not last.
Told it was probably due to child having antibiotics about age 1, which has made all the teeth weak ().
I asked about sealants and told that they weren't needed til the teeth were fully developed (), though I knew/know from your previous post .
I asked about x-rays and told not needed either.

5yr old - both lower 2nd pre-molars have decay.
Advised: Appointment in 2 weeks for fluoride to get child prepared for treatment. Then composite filling for one pre-molar, and leave the other for now as "it just has a hole".

Here's what I'm thinking - had called four paedi dentist offices this am before HSE clinic appointment (one of which we've been to), to get appointment availability and pricing. Was very happy with the previous one and they have an appointment next Tuesday. All info/suggestions welcome. Am very concerned about the 7yr old. Absolutely think we should go privately (this was not suggested to us by the clinic today).

AlasAnAlias

Dianthus wrote: »

Still attend the orthodontic consultation for your eldest child...you need not necessarily go ahead with said treatment, but at least you'll be aware of any ramifications re deferring it months/years - you will need to ask specifically the orthodontist specifically what the consequences of late or no treatment (re cost& complexity of treatment). It's a question commonly asked in recession times, & important to know the answer.
Sealants can be unpredictable if it's difficult to keep the tooth completely free of saliva during placement. In which case, wait; a poorly placed sealant will cause more problems than no sealant at all. After placement, they would still need to be monitered (leakage, wear, ect)
The whole ventriloquist thing should be excruciating only for the dentist:D

Great, will do. Child is 15 and very agreeable, which helps! We could maybe start later in the year given the payment play option. Re the underlined comment, do you mean if the child in un-cooperative during placement or can saliva production just be an individual problem during placement, i.e. how do I know when to "wait"?? Is it just the case that we need to re-establish going privately for all children from now on? The 7yr old above, as mentioned, had had those 2 teeth extractions earlier this year so that did give a false sense of security also, though we cannot recall if this included the school programme check (just finished 1st class).

Dianthus

Re 7yo, google "molar incisor hypomineralization"(MIH). Can be v difficult to restore these molars; hypersensitive, decay advances rapidly, longterm prognosis can be dubious no matter who treats them- timing of extraction(if indicated) generally on orthodontic&/paediatric dentist advise.

Re the fissure seals, it's a bit of everything- cooperation, saliva production, available space. Parents are understandably very keen to have fissure seals, however, if you notice that it's taking numerous attempts(on the same visit) to place the sealant, there's generally a reason why, and it's generally poor isolation. In which case, defer/review in a few months. Dentist would generally be able to guage situation within minutes of beginning the procedure.

The school checkups are in 2nd, 4th, and 6th class, however this has been reduced to two visits in some areas (again, recession times:rolleyes:). It's crazy that 2-3 visits over a 12 year period is considered adequate.
Also, the health clinics tend to just treat emergencies/specific problems, as opposed to screening the whole mouth/preventative dentistry.

The paediatric dentist consultation next Tuesday would be money well spent imho, you're very concerned& at least all the options, pros, cons ect will be outlined properly, you can always change around as required. Good luck!

AlasAnAlias

Dianthus wrote: »

Re 7yo, google "molar incisor hypomineralization"(MIH). Can be v difficult to restore these molars; hypersensitive, decay advances rapidly, longterm prognosis can be dubious no matter who treats them- timing of extraction(if indicated) generally on orthodontic&/paediatric dentist advise.

Re the fissure seals, it's a bit of everything- cooperation, saliva production, available space. Parents are understandably very keen to have fissure seals, however, if you notice that it's taking numerous attempts(on the same visit) to place the sealant, there's generally a reason why, and it's generally poor isolation. In which case, defer/review in a few months. Dentist would generally be able to guage situation within minutes of beginning the procedure.

The school checkups are in 2nd, 4th, and 6th class, however this has been reduced to two visits in some areas (again, recession times:rolleyes:). It's crazy that 2-3 visits over a 12 year period is considered adequate.
Also, the health clinics tend to just treat emergencies/specific problems, as opposed to screening the whole mouth/preventative dentistry.

The paediatric dentist consultation next Tuesday would be money well spent imho, you're very concerned& at least all the options, pros, cons ect will be outlined properly, you can always change around as required. Good luck!

Appreciate that. I was never given a diagnosis except "weak enamel", or even a potential one, despite asking but heard the hypoplasia recorded, and it was obvious that the dentist, and the ventriloquist, were concerned. And in a first ever, all 4 molars were shown to me and the enamel defect highlighted. Here is the link to what I had googled before my previous post, and the 2nd picture is exactly what I'm seeing. http://www.uiowa.edu/~c090247/ENAMEL_HYPOPLASIA.pdf

Have looked at MIH and understand it. Would be great if that wasn't it. Here's hoping. Will take the appointment next week and get whatever treatment is needed organised. Am not bothered (in the grand scheme of things) about the 5yr old, but may as well bring them too.

I've never stayed in the offices during the fissure sealant applications (to give the dentist 'space'), so can't comment on attempts - only to say the child is barely in, and they're out!!

Many thanks. Things are always better in the morning

AlasAnAlias

If this is MIH and maybe a road ahead, can the case be referred to The Dublin Dental Hospital and treated there publicly?? Or is that not done?

Dianthus

AlasAnAlias wrote: »

If this is MIH and maybe a road ahead, can the case be referred to The Dublin Dental Hospital and treated there publicly?? Or is that not done?

No idea (not local!)- could be a long wait though. Best get a definitive diagnosis first& go from there.

AlasAnAlias

Dianthus wrote: »

No idea (not local!)- could be a long wait though. Best get a definitive diagnosis first& go from there.

You sound like you're based in the hub of The Dental Hospital :cool:

Will do!

AlasAnAlias

Called and told waiting list about 3 months for the Consultant Paediatric Dentist the child would need to see. Of note, this was one of the 4 dentists (offices) I called yesterday re a private appointment, and there is no wait. There is no wait with any.

(1) I do not think that I can go privately to see this consultant and then ask to be referred to The Dental Hospital (to that same consultant)? Or indeed, be referred publicly?
(2) I do not think that I can call back the local HSE clinic requesting a referral, considering the dentist there would like to do a filling? (I am aware of pressures too on The Dental hospital and un-necessary referrals. I do, however, feel it necessary. Said child has sensitivity in 2 new molars, including the clearly decayed one. They do not need to go to The ED).
(3) Assuming we go to a non-Dental Hospital Paediatric Dentist, can I request a referral this route if the child does have MIH? This child had not been to a family dentist, and I think that paying €80, instead of €150 for a specialist, is a false economy.

I'd like to add - no smart comments please - that I do not think I am being unreasonable asking public treatment options, given the potential private costs. 20 years x 2 of us paying tax, I feel (like we all probably do here) that we have contributed. And if this child's case warrants public treatment, and there is availability, that we could be listed.

Dianthus

1/ Probably not
2/ No reason why not.
3/ Yes.
I'd agree with you that it's entirely reasonable& sensible to explore the public option, however I'd strongly recommend discussing the 3 month wait with the dentist who has seen your child. As he's the only one who's seen the teeth thus far, he's the only one thus far who can guage the severity/urgency.
Also, even more importantly, there will probably be something he can do temporarily to relieve the pain in the meantime; 3 months is a long time if you're a child.

AlasAnAlias

Dianthus wrote: »

1/ Probably not
2/ No reason why not.
3/ Yes.
I'd agree with you that it's entirely reasonable& sensible to explore the public option, however I'd strongly recommend discussing the 3 month wait with the dentist who has seen your child. As he's the only one who's seen the teeth thus far, he's the only one thus far who can guage the severity/urgency.
Also, even more importantly, there will probably be something he can do temporarily to relieve the pain in the meantime; 3 months is a long time if you're a child.

Thanks for your prompt reply - The HSE needs you!

Absolutely agree that waiting 3 months is too long. I can see that a mile off. The child is complaining of pain today, probably from all the prodding yesterday. This child never complains. In truth, I'm half afraid to ask the local clinic as, in effect, it was an ordeal just to get "weak enamel" off them and I'd be asking the dental assistant (who, you might recall, speaks for the dentist!). What's demoralizing, is that I'm interested but not hoovering; would like to know; and to know how I can help the child, and ask the correct questions. Gets me nowhere. I understand this is not representative of other clinics. Will discuss referral with The Paediatric Dentist privately next week, re treatment and if the child's case merits referral to The Dublin Dental Hospital given current constraints. Thanks again, you've been exceptionally helpful. Feel saddish for the child, but getting help on here helps (them and us)