Coping with Dental Caries
From NEW BEGINNINGS, Vol. 17 No. 4, July-August 2000, pp. 134-136, 149
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
"Toddler Tips" is a regular feature of the magazine NEW BEGINNINGS, published bimonthly by La Leche League International. In this column, suggestions are offered by readers of NEW BEGINNINGS to help parents of toddlers. Various points of view are presented. Not all of the information may be pertinent to your family's lifestyle. This information is general in nature, and not intended to be advice, medical or otherwise.
My two-year-old daughter has severe dental decay in her front four top teeth. My dentist calls it baby bottle mouth but he said the cause was extended breastfeeding, particularly at night. He says that she will require extensive dental work to repair the damage and he insists that I no longer nurse her at night or before sleep. In fact, he recommends that I stop nursing altogether in order to prevent any additional dental caries. I have heard that none of the pediatric dentists in our area are very breastfeeding friendly. What have other nursing mothers done about night nursing when their toddler develops dental caries and what is the best way to communicate with dentists who don't approve of extended breastfeeding?
There is more than one way to cope with severe dental decay. Before agreeing to your dentist's recommendations, seek another opinion from a pediatric dentist. You may find someone who is willing to work with a nursing child and who will not require the use of general anesthesia to treat your child.
I have found such a pediatric dentist who has been treating my daughter's severe dental decay since she was 20 months old. I had noticed some decay earlier but couldn't believe an exclusively breastfed baby could get cavities! According to my daughter's dentist, a small percentage of children (between five and ten percent) suffer decay whatever their diet. It's not clear exactly why, but genetics are a clue (I had severe decay as a child too). Once you understand your child is in that category, remember that breast milk itself is not causing decay, just the special type of bacteria that are attacking your child's teeth. So, weaning is not necessary. Instead, a consistent routine of teeth cleaning is! Brushing or rinsing or wiping the teeth after every nursing or feeding is recommended.
However, night nursing presents a particular challenge. Some of us nurse through the night and don't wake up, much less wipe or rinse a child's teeth! My daughter's dentist believes weaning at night would decrease the decay. However, I have not weaned my daughter from night nursing and the dentist knows that. My daughter is three years old now and I still feel that night nursing is important to her health, emotional and otherwise.
Instead, I have worked in partnership with the dentist to stop the decay as well as we can. My daughter's dentist sees her once a month. The dentist uses no anesthetics. While my daughter sits on my lap, the dentist gently fills the cavities with a white paste that hardens and usually lasts until the next month, when another application is applied. This treatment slows the decay process until the time my daughter is old enough to sit through a normal procedure for permanent fillings. Our dentist feels the risks of general anesthesia outweigh the benefits of permanent fillings at such a young age. However, the dentist has also told me that if we weren't consistently cleaning our daughter's teeth several times a day, she would consider treatment that is more drastic.
Be assured that breastfeeding itself is not harming your daughter. Like any chronic condition, susceptibility to dental decay can be managed if you can find the information and support. Explore as many options as you can so you can make the best treatment decision for your daughter—good luck!
New York NY USA
This has been a challenge for our family too. I took my son to a pediatric dentist just before he turned two and was told he had eight or nine cavities. I was shocked. What was more difficult was being told this was due solely to breastfeeding (especially night nursing) and that if I chose not to wean, his teeth would rot. In our case, too, the dentist lumped together "baby bottle mouth" with breastfeeding. She obviously did not understand that breastfeeding and bottle-feeding are not the same. General anesthetic was recommended and I was told I would not be allowed to be with him before or during the procedure. We decided to seek a second opinion. We found another pediatric dentist who had basically the same findings but a big difference in attitude.
I found that it was possible to try this procedure with an oral sedative instead of general anesthesia, that his decay was due to multiple reasons (poor brushing habits, heredity, and diet to name a few) and that of course I could be with him throughout the entire procedure. Above all I was accepted and respected for my decision about continuing to breastfeed my son. Seeking a second opinion and researching dental caries in breastfeeding infants and toddlers was our best course of action.
Initially we chose not to wean our son at night but to step up the brushing and really watch his diet. The dentist we chose to work with was very helpful and supportive with preventive information. As far as preparing for the procedure, talking to your daughter about what she may experience when she has the work done can help. A visit to see the office ahead of time may help as well.
About a month after our son had his work done we decided to wean him at night for other reasons. At his next check up five months later, two more cavities had developed...despite weaning him at night.
Talking with the La Leche League Leader(s) in your area and to other breastfeeding mothers may lead you to some other dentists. Ask many questions. There are generally more options than are initially given. I hope you find what is best for you and your daughter.
Broomfield CO USA
This was a huge challenge for our family only a few months ago. My two-and-a-half-year-old was diagnosed with seven rather large cavities. Our first dentist informed us that we would have to leave our son in restraints and under sedation (with a medication that causes temporary mild amnesia) in another room while his teeth were corrected. He also told us we had to wean our son. Knowing the personality of our son—he is a high-needs child—we knew that this treatment and weaning would break both his and our spirits. We decided to get a second opinion and we are so happy that we did. We found another dentist who explained our son's dental situation to us and gave us some options for treatment. Our decision to continue breastfeeding was never an issue. Our new dentist explained that the decay needed to be corrected first in the teeth that he would lose last —the molars. Then he gave us three options for correcting the cavities:
- Stop decay with a clear coating applied periodically until he was old enough to be reasoned with and understand treatment.
- Use a medication that would merely relax him and possibly relax him enough to nap during treatment.
- General anesthesia in the hospital.
- We opted for the second option. Our son relaxed enough to have three cavities filled and the rest varnished until the next visit when we can hopefully fill three more. There were no tears due to the fact that my husband could hold and talk to my son during the whole treatment.
I urge you to find a dentist who respects you as a parent and gives you the opportunity to make an informed choice about your daughter's dental health.
Billings MT USA
Wow! Every issue of NEW BEGINNINGS seems to hit me right where I live! There has been no other issue so emotional for me in the past year as dealing with my two-year-old son's dental caries.
Here's some practical advice. Either over the phone or in person, interview several pediatric dentists in your area. Some dentists are willing to work with you regarding nursing an older child; some find the idea of nursing a child as abhorrent as lollipops for breakfast, lunch, and dinner. The latest information shows that the antibiotic properties of breast milk attack decay-causing microbes. No matter how well informed you become about pediatric dentistry, remember that your dentist is a professional and someone who needs to work with you, not against you, in fixing your child's teeth. The best information I was able to glean from many sources convinced me that no one really knows the cause of early childhood caries. Certainly bottle-fed babies have more caries than breastfed ones. I felt so unfortunate being the only mother among my circle of friends who nursed toddlers, who had this problem. I couldn't understand why something so wholesome was being so indicted by some dentists. I read articles that said antibiotics taken during pregnancy are a contributing factor. Diet, genetics—who knows for sure?
My child's teeth were malformed before he even began to nurse. They appeared with funny spots on them (a condition known as enamel hypoplasia) and the enamel wore off more with time.
Even if your dentist, friends, or family members believe you ruined your child's teeth with breastfeeding, remember the lifelong benefits of nursing, the protection against disease, and the attachment benefits. The effects of early dental caries only very rarely extend into later childhood. With early detection and care of decayed baby teeth, the decay will not reach your child's adult teeth already up there in his gums.
The decision to wean completely or to night wean is totally up to you. As with all other advice you may get from any health care provider (to use a pacifier or to supplement with formula because it "can't hurt," or to keep your child out of your bed), do your research and weigh your options. In our case, our dentist advised night weaning. I chose to continue to work toward my goal of child-led weaning. My husband and I also chose to apply topical stannous fluoride to our son's teeth and increase his daily brushings. We continued with night nursing, and my son's nursing reduced gradually over the period that he was being treated for his tooth decay. At his last check-up, there was no further decay.
Instead of general anesthesia, our dentist used a papoose restraint and minimal medication for managing pain and helping our son to relax. I talked to our son before the procedures about what was going to happen and insisted on being with him during the dental work. I stroked his feet and sang to him during the drilling and so forth. He cried, and I was miserable, but my presence seemed to soothe him. My dentist told me my calm behavior was exemplary and probably helped ease his patient's anxiety a great deal. My son was calmer for his next procedure, and he even opened his mouth "Wide like a dinosaur" all on his own for the dentist. There's no doubt that dental work can be traumatic (even for some adult patients as well) but like all difficult things, having someone there for you before, during, and after helps. Being an attached parent never came in so handy as when my child was having uncomfortable dental work done.
Good luck—I know how difficult this all can be. It helped me to remind myself that I was lucky my child had holes in his teeth and not something life-threatening.
Baton Rouge LA USA
I know exactly what you are going through. Our son was diagnosed with severe tooth decay at 18 months of age. Our pediatric dentist recommended that I wean immediately, schedule for surgery, and begin an arduous schedule of dental hygiene aimed at preventing future dental caries. I immediately began to educate myself. I read articles from the LLL website, contacted my Area Professional Liaison and other LLL Leaders, met with my pediatrician, and got a second opinion from another pediatric dentist. Much of the information I found was contradictory. Our pediatrician supported my decision not to wean. I felt, and he agreed, that keeping the breastfeeding relationship intact was vital to getting through this stressful event for our family. I also felt that my son had developed decay in spite of being breastfed, not because of it. Although our two dentists disagreed with me, we had to make the choice for our family based on the information we had.
Our next decision was to choose to do the surgery in the hospital under anesthesia or in the dental office under mild sedation. For our child, we felt the cavities were too numerous and severe to be done in a series of visits to the dentist's office. We also felt that emotionally, such an ordeal would be too trying on us and our son. In preparation for the surgery, I enlisted the help of my pediatrician and the lactation consultant from the hospital. I also contacted the anesthesiologist to arrange to nurse my son up until six hours before surgery. The standard time would have been eight to 12 hours. The hospital's policy did not allow parents in the preoperating or recovery room. I felt very strongly that I needed to be in continuous contact with my son during this scary and painful procedure. I enlisted the help of our pediatrician to talk to the hospital administration in our behalf. He obtained permission for me to be with my son at all times except in the actual operating room. This made an enormous difference in that any time my son was awake, I was with him. They took him from my arms, asleep, from the pre-op room and I nursed him in the recovery room even before his eyes were opened. This made all the difference to us! I hope things go exactly as you plan for you and your daughter.
Florence SC USA
How I remember the sick feeling that washed over my whole body when I first noticed the black spot on the back of my 15-month-old's front teeth. Because I feared that the only way to get her teeth repaired was to put her under general anesthesia, I found many ways to postpone visiting the dentist. She was over two when I finally took her in, without any noticeable increase in the decay. The dentist was able to clean it out using a spoon, a manual instrument, instead of an electric one, while she was lying on me. He used no medication. I asked him what would happen if I didn't get her teeth fixed. The result, he claimed, wouldn't affect her adult teeth, but the decay would spread and end up causing pain.
Within a few months, her filling fell out twice, and I didn't get it replaced the last time. The decay still hasn't spread, she has never experienced pain, and she is now four-and-a-half.
When my third daughter was one-and-a-half, I noticed decay on two of her teeth. This time I talked to a few parents I knew who had chosen to not repair their children's teeth, and became more confident about not doing anything unless she had pain or other complications, which hasn't happened. I feel more worried about the negative physical and emotional effects of dental work on my toddler than the pain of the tooth decay that hasn't yet materialized.
Coincidentally, the day I read your letter, I had just returned from a visit to my doctor, who told me that some dentists believe that some children's baby teeth are severely decayed before they fall out without any ill effect on the permanent ones. It was encouraging to have a medical professional endorse leaving cavities alone. Like many other health situations, it seems that even the experts don't agree on the best way to handle decay in baby teeth.
Choosing to do nothing is what feels right to me. Whatever you decide, make sure that you are not scared into it and that whatever negative effects are predicted for your child are substantiated by independent studies. Do what truly feels right to you, you are the expert on your child!
Eliane Ste-Marie Proctor
Westmont IL USA