Other Experiences with Dental Caries
From NEW BEGINNINGS, Vol. 19 No. 5, September-October 2002, pp. 168-69
Web editor's note:These stories are companion pieces to another article from the same issue of NEW BEGINNINGS, Avoiding Dental Caries. They were originally responses to a "Toddler Tips" situation featured in the March-April 2000 and July-August 2000 issues.
The first pediatric dentist we saw told us that he wouldn't do any corrective work until my son, Eli, was completely weaned. He believed ongoing nursing would cause ongoing problems and an ongoing need for corrective procedures. If Eli weaned first, the dentist said, Eli would probably stop having caries and wouldn't need additional dental work done later. He also said that when the work was done, Eli would need general anesthesia in a hospital.
This did not make me happy. Since one tooth had already rotted off and three others had obvious cavities, this put me in an awful bind—wean Eli before he was ready, which would be traumatic for all of us, or let his teeth rot away? Furthermore, I felt tremendous guilt that the extended nursing that I viewed as beneficial to my child was now (I thought) the cause of all this trouble. Luckily, a co-worker mentioned a different pediatric dentist in our area, and we sought a second opinion. What a difference!
The second dentist did suggest reducing our night nursings if possible and also recommended that Eli take a few sips of water after any nursings, night or day. He did not insist, however, that Eli be weaned before corrective work could begin; in fact, he encouraged us to proceed quickly because of the risk of infection in the decayed teeth. This dentist also told us that most early tooth decay is genetic—bottle or no bottle, night nursings or no, weaned early or late—children who are predisposed to bad teeth are going to have problems. This made me feel so much better, knowing that Eli's caries were not my fault, and that I could continue nursing him until he was ready to wean without fear that it was harming his teeth.
Eli ended up needing two visits to repair all the damage, primarily because his small body couldn't handle very much novocaine at once. The night before each visit, he had breast milk only after midnight, and nothing at all after 4 a.m. We got to the office at 9 a.m. and Eli was given a liquid dose of a quick-acting, short-duration tranquilizer that left him quite conscious but very relaxed. The dentist also used nitrous oxide and novocaine during his procedures. The tranquilizer had worn off before we even got home, and Eli complained of very little pain.
Eli ended up having one extraction, two pulpotomies, one cap, and four fillings all together. He has no memories of the time he spent in the dentist's chair (a side effect of the medication). He was not at all traumatized, and even said right after his first session that he still liked the dentist "because he fixes my teeth."
Chatham NY USA
When my daughter was two years old, we discovered caries in two of her teeth. Because the cavities were in molars, which wouldn't come out until around age 12, we agreed that they needed repair. After interviewing several dentists, we found one who told us he could perform the needed work in his office using nitrous oxide and a calming medication. I was able to give the medication to my daughter before leaving for the dental office, which put her in a very agreeable mood. The repair work was completed in just under 30 minutes, to my astonishment, and since the medication was still in effect, she was fine! The dentist did restrict my presence in the treatment room, but I was allowed to escort her to the chair and get her settled. All things considered, I was happy with the outcome.
My next experience with dental caries was more difficult, mainly because our second daughter had more extensive damage at an earlier age. At 17 months, I noticed spots on her teeth, which were confirmed as caries in eight teeth, some with multiple caries. One was close to an infectious state. Again, we agreed that repair was necessary. However, because more work needed to be done, our dentist recommended general anesthesia at the local children's hospital. He explained that he could not complete the needed work in a time period during which he could rely on nitrous oxide to be effective. In short, he anticipated that the gas would wear off before he was finished, compromising our daughter's comfort and his ability to work. We made the arrangements to have the dental work done under general anesthesia.
Again, we found a group of health care workers who were sensitive to our concerns as parents. The policies of the local hospital allowed us to be with her until she went into the operating room. She was given medication before starting anesthesia to calm her and ease the work. I was told that I would be summoned to the recovery room as soon as she awakened. Although I felt that this was not the best situation, I chose not to argue the point. I was unhappy that she was already crying when I reached her, but I was allowed to nurse her immediately, and she calmed instantly. Recovery went well, and we went home with no complications, six new caps, and two fillings.
In both instances, I provided my dentist with literature to support my being allowed to nurse my daughters until just a few hours before the surgery. My dentist was wary, but agreeable. Our first daughter had her work done at an early morning appointment, which made for some difficult nighttime hours, but we coped. Learning from that, we scheduled our second daughter's surgery for around noon, which allowed me to nurse her when she woke, and then distract her with play. I knew that the morning when she was awake would be easier for both of us to cope with than the lack of nursing in the middle of the night. Both our children had outpatient surgery and we were home and comfortable the same day. My second daughter needed over-the-counter medication for the swelling, but her reaction was fairly mild and she tolerated the procedure well.
Both my daughters continued to nurse at night after their surgery, and no further caries occurred in any of their unaffected baby teeth. We did take up a careful brushing routine and eliminated many suspect foods (our second daughter is still not allowed to have sticky candies or soda pop), but otherwise made few alterations in our main diet and nursing routine.
Dayton OH USA
When my son had multiple cavities at age two, we were lucky that our dentist did not immediately demand that I wean him. She did express displeasure at his nighttime nursing, but was still willing to work with us. She made some suggestions to help reduce the risk of plaque and caries, including making sure my son swallowed the last mouthful of milk so it didn't rest in his mouth for hours. This can be accomplished by something as simple as having the child roll over, or even removing him from the breast. She also suggested that we be vigilant about daytime oral hygiene: brushing teeth frequently, drinking water after snacks or meals, and limiting things such as sticky dried fruit or sugary fruit juice.
Obviously, there is a difference in opinion between dentists about appropriate treatment of caries in breastfed toddlers, and there is no hard and fast rule for what must be done. That means parents have some leeway in deciding what is most important and appropriate for their child.
In terms of the actual dental work, parents may also have some room to maneuver. If the caries are not too severe, a dentist may be willing to wait a little while until the child is older and more able to deal with the treatment.
In my case, my son's cavities were so extensive and obvious that the dentist wanted to fill them right away. Surprisingly, she suggested trying to start the procedures without any anesthetic. She felt that many children were so scared by the shot and the numb feeling that they couldn't deal with the fillings themselves. I was amazed that my son, at two-and-a-half, was able to sit through six fillings without anesthesia of any kind. When he was a little older and needed more fillings in his back teeth, she did opt for local anesthetic because she would be working closer to the gum. All of the work was carried out in the regular office, and each procedure took no longer than 30 minutes. We used an over-the-counter pain medication right before the treatment so it would start working before any pain or discomfort started. We also focused on a special treat that we would get after the fillings, such as lunch out or a new small toy (worth the expense on these special occasions). The only time my son cried was when a new dental technician didn't know she was supposed to offer him prizes from the goody basket. Not getting stickers was worse than getting a filling!
There is no conclusive evidence that extended breastfeeding leads to "bottle mouth." Just think of the millions of children around the world who nurse for years, and whose teeth are not affected! Anecdotal evidence supports the idea that children get cavities in spite of nursing, not because of it. My daughter nursed at least twice a night and several times during the day until she was almost three, and has, in the words of her dentist, "perfect teeth." Her brother nursed on approximately the same schedule, but suffered numerous health problems as an infant that I believe contributed to his tooth decay.
Hamden CT USA