Case Study:  A Child’s Tooth Decay

When you have a cavity, you go to the dentist and have it filled – some novacaine, an hour and around $160.  Then you leave knowing there’s another appointment in six months.  For a small child, cavities aren’t that simple.  Let’s examine why in a not too far-fetched scenario.

Ralphie is four years old and an exam with the family dentist finds three cavities, two on the upper level on either side of the mouth and one down below.  Because she doesn’t feel comfortable doing significant repair in a small child’s mouth, she refers you to a pediatric dentist.  A pediatric dentist specializes in children and understands that a scary experience can have huge repercussions later on.

The pediatric dentist’s judgment is to remove the teeth due to the severity of the cavities.  These aren’t little pinhole cavities, but large and discolored pits that crater the center of each tooth.  Since Ralphie could wind up traumatized from the stress of having multiple shots and devices in his mouth, she suggests that it be done on an outpatient basis and under a light anesthesia.  She also suggests coating the teeth with a thin veneer to help prevent further decay.  You’ve now gone to two dentists and are looking at outpatient surgery.

After the teeth are removed and the veneer applied, you’re going to spend the better part of that day and the next with a groggy and sore preschooler.  Ralphie is utterly miserable, which means that you’ll be too.  You’ve missed that time from work and incurred outpatient surgery charges dwarfing your adult dental costs.

But wait, it gets better.  Ralphie now has gaps in his mouth from three missing teeth.  A small child’s mouth is not immobile.  It is dynamic and the teeth can shift like the North American tectonic plate.  Like a teenager that expands to occupy any free space on a couch, Ralphie’s teeth will start to move to allow themselves more room in this newly vacant area.  Because Ralphie’s mouth will be gradulally increasing from 20 baby teeth to 32 adult teeth, there are other teeth coming that might not be able to grow into Ralphie’s mouth because they are blocked by those free-loading baby teeth.  Then you have to consider additional surgery down the road.  The pediatric dentist wants to forestall that chance by now referring you to an orthodontist.

If a parent isn’t scared by the thought of an orthodontist, it’s only because he is one.

The orthodontist can handle this particular problem by inserting little devices into the gaps called spacers.  These are metal bands – fortunately not heavy – that wrap around the teeth adjoining each space in order to maintain the empty space.  Because the bands are attached to the teeth, they will remain there until those teeth come out.  And by the way, Ralphie can no longer have chewy candies like Tootsie Rolls, licorice or gum due to the risk of displacing the spacers.  In which case you’re back to the orthodontist.

This may read like a worst-case scenario and other cases aren’t so severe.  Yet it highlights that the changing space needs of the mouth, and the effect on the child’s psyche will involve more than would occur with you or Mom.  Unfortunately, it isn’t far-fetched either.

And if the next dental visit  isn’t an experience this side of hell, then it’s a testament to the manner and care of the pediatric dentist.

Be sure to let her know it. 

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