6 year old dental phobia and deep cavities in four molars.

[Jessica moon]

Hi, my 6 year old daughter has some deep cavities in her top and bottom molars 4 in total. With adjacent teeth starting to get smaller cavities. She is extremely anxious in general and has massive dental phobia. The cavities have gotten worse since we first found out when she was four because I was also so terrified of the thought of her having to go under GA for treatment as I knew she would not be capable to sit in the chair at that point. We eat well, no sweets, and brush but dentist thinks this happened due to snacking and extended breastfeeding and night feeding (til 4 years) she also had reflux as a toddler.

I researched other treatment options that are less invasive and we ended up getting her to sit in the dental chair twice to get SDF treatment (silver flouride) to arrest thr decay and buy us some time. But time is ticking on and the cavities are reasonably close to the nerves. It has taken us various attempts to get xrays as well, we finally got the top two done and now need the bottoms.

The plan was to get them capped with stainless steel crowns (hall technique) but recently when we tried to go to get the bottom xrays and the bands before the caps were placed she was way too anxious as she just bumped her head in the park before coming in and was out of sorts so couldn't face doing it.

Then somehow now we are looking at the possibilty of GA treatment and having either partial pulp treatment and caps or extractions. I'm thinking the dentist after seeing her non compliance is worried we are running out of time since the cavities that we have viewed are close to the nerve but not touching. She is worried that maybe some of the bacteria has got across into the pulp and may get worse once sealed in but she said there is no way of really knowing. However she is asymptomatic at present.

I'm so anxious about this whole situation I can't even sleep. I would be so relieved if we didn't have to do GA and get the caps done in the chair and treat surrounding cavities with SDF as they are only small. But my daughter is so anxious. Any advice on how to help her with her anxiety in a timely manner would be so so much appreciated. Thank you so much.

 

[Gordon]

I'm sorry, but (other than GA) there really isn't a quick fix for this, it's going to take some time and a number of visits to sort out.

RA (nitrous oxide) sedation is quite effective on children if you can persuade her to go down that route. I've had some success using a small amount of Temazepam before the appointment to help get the child more relaxed and co-operating with the RA, but that assumes a LOT of experience with sedation on the part of the operator, which your dentist may not be comfortable with.

Do you have access to a paediatric or special care specialist in your area who could be referred to?

I'm a bit worried that the decay sounds (from your description) still progressing, if your diet is OK then it shouldn't be, so it might be worth keeping a (brutally honest!) diet diary and going over this with your dentist.

 

[Jessica moon]

Thanks so much for your reply Gordon I appreciate it. We actually eat really well, the only chocolate my daughter has eaten is combantrin when she had pinworms and she was so excited! No soft drinks, lollies, sweets of any sort at all, no sweet biscuits chips junkfood at all. But she obviously does eat carbohydrates in fruit, vegetables, grains ect and has honey sometimes. And she has a history of grazing quite a bit so I guess her teeth don't get a good break. After ths diagnosis we are also flossing day and night, brushing, using tooth mousse, rinsing with water after eating most meals but maybe the damage was already done. We do see a specialist paediatric dentist who is amazing and she said that everytime you eat carbohydrates the process of demineralisation occurs and then when you brush ect it stops like an on off process. So I guess as time has passed as we were trying to be minimal intervention things have maybe slowly progressed.

 

[Gordon]

Stopping the grazing habit is more important than stopping all the "fun" foods, you'll just make her more likely to crave them when she's older
You wouldn't believe the number of 13-18 year olds who suddenly develop massive decay problems at that age when they can go and buy their own stuff...

It's not so much the amount of carbs that are the problem, it's the frequency.

If you limit her to eating 4-5 times a day and nothing in between then you get a balance between demineralisation and the saliva buffering the acid produced by the plaque bacteria and things stay stable.

 

[Jessica moon]

Yes we are definitely trying that now. Thanks so much for your advice Gordon.much appreciated. .