My 5-year-old daughter is dealing with massive decay. I don’t know how to help her because she doesn’t cooperate with a dentist whenever there is more work needed than just a cleaning. At the moment, she has four back molars that need work. Two of them have mild decay, and two of them have pretty extensive decay. I have three questions. First, what is causing her to develop this much decay if we brush her teeth every day? Second, how do you get an uncooperative child to safely have their teeth worked on? Finally, what kind of treatment will she need?

Catherine

Dear Catherine,

I can tell you care about your daughter a great deal. We’ll start with your first question. In general, for decay to get that bad it would require almost constant snacking or drinking of juices and sodas. Is it possible your daughter drinks a lot of juice or snacks throughout the day? When we eat, our saliva is very instrumental in preventing decay. It contains bacteria-fighting minerals. However, it needs time to work. If she doesn’t have a few hours between meals, then the saliva doesn’t have a chance to do its job and the bacteria from the sugars in our food and drink will eat away at the teeth.

The first thing I would do is limit her snacks. If she goes a few hours without eating, I promise it won’t kill her. She’ll be fine. She may be grumpy for a few days, but her body will adjust. You’ll likely find her more willing to eat at mealtime too!

Dealing with Dental Anxiety In Children

Even some adults struggle with having dental work done, so don’t be too hard on your daughter in this aspect. She’ll need a compassionate pediatric dentist (or family dentist if you prefer to go that route). However, you also want one who offers a couple of levels of dental sedation. Usually, a dentist who offers sedation will be compassionate and is used to working with patients that have anxiety, but you never know, so check their reviews to see how patients (or patient’s parents) felt about them.

With children, it’s always preferable to do the lowest level of sedation possible, though both are safe. The reason it is better to start with the lowest has more to do with how high maintenance her care will be to you afterward.

I’d start with nitrous oxide. This is sometimes dubbed laughing gas. It won’t make her goofy, but it will completely relax her. Most children sleep through their procedures when using it. Once the work is done, her dentist will simply switch the gas to oxygen and in a few moments she’ll be completely back to normal.

For some patients, their anxiety is just too high. If you find that is your daughter’s experience, your next level of sedation is oral conscious sedation. This is so strong that she’ll be loopy for likely the remainder of the day. She’ll also be unsteady on her feet, so help her to the bathroom when she needs to go. Ideally, she’ll sleep it off or just have a Netflix binge.

As for what procedures she’ll need, it varies. For the small decay, a simple white composite filling will suffice. The other teeth, with extensive decay is a different story. Ideally, you want to preserve her back teeth for as long as possible so if you can get away with a dental crown, that is best. If not, and the tooth has to be extracted, make sure your dentist places a space maintainer. Otherwise her other teeth will shift into the open areas which will lead to crowding. Then, when she’s older she’ll be pretty much guaranteed to need braces or Invisalign.

This blog is brought to you by Hoffman Estates Dentist Dr. William Becker.