6y-o Goes To The Dentist...

[bkkmick]

Hi

Our 6y-o has pretty bad milk teeth. I put it down to us giving her (diluted) fruit juice at bedtime when she got to about 3 or 4 years old. With our second child we didn't give her any fruit juice and her teeth are beautiful. Might be a coinidence, but that's my thinking anyway.

Today my wife brought our 6yo to the dentist and after a check up the dentist says that she needs fillings. I haven't heard the full details of which teeth need filling yet as my missus has just phoned.

I'm confused. I thought that over the next couple of years all her milk teeth will drop out to make way for her 'real' teeth.

My question is: Do kids with milk teeth need fillings in their teeth or is the dentist just trying to make extra dosh? I've absolutly no problem paying for her dental work (obviously) it's just that it seems unneccessary to put her through that discomfort.

Any thoughts?

Thanks

Mick

Edited October 11, 2007 by bkkmick

[onethailand]

Our 6y-o has pretty bad milk teeth. I put it down to us giving her (diluted) fruit juice at bedtime when she got to about 3 or 4 years old. With our second child we didn't give her any fruit juice and her teeth are beautiful. Might be a coinidence, but that's my thinking anyway.

Probably coincidence.

I'm confused. I thought that over the next couple of years all her milk teeth will drop out to make way for her 'real' teeth.

My question is: Do kids with milk teeth need fillings in their teeth or is the dentist just trying to make extra dosh? I've absolutly no problem paying for her dental work (obviously) it's just that it seems unneccessary to put her through that discomfort.

My youngest one had basically rotten front teeth for the first six years of his life. For some reason his milk teeth never developed properly, or else he was constantly fighting my wife every time she tried to put a dropper full of that calcium booster stuff which tastes and smells horrible.

He has beautiful front teeth now, we tease him all the time because now he's been told he has to bite for himself

I think you need to see which teeth needs filling - most likely they will be the molars, in which case you're only talking about a couple of teeth and those won't drop out until she's at least 9-10 - so I would put fillings in those.

[Goldenbead]

I think you should do it. Get it sorted. I do believe that the juice at bedtime was probably the culprit. If you don't do it, she may well turn out just fine with beautiful permanent teeth, or, these decayed teeth may affect the development of the permanent ones.

[taxexile]

Our 6y-o has pretty bad milk teeth. I put it down to us giving her (diluted) fruit juice at bedtime when she got to about 3 or 4 years old. With our second child we didn't give her any fruit juice and her teeth are beautiful. Might be a coincidence, but that's my thinking anyway.

its no coincidence , deciduous ( milk ) teeth are much more susceptible to caries than the permanent teeth and fruit juice at bedtime would be a major contributing factor to your child's dental problem

Today my wife brought our 6yo to the dentist and after a check up the dentist says that she needs fillings. I haven't heard the full details of which teeth need filling yet as my missus has just phoned.

I'm confused. I thought that over the next couple of years all her milk teeth will drop out to make way for her 'real' teeth.

My question is: Do kids with milk teeth need fillings in their teeth or is the dentist just trying to make extra dosh? I've absolutly no problem paying for her dental work (obviously) it's just that it seems unneccessary to put her through that discomfort.

Any thoughts?

the first deciduous teeth to fall out will be the incisors at about age 6 to 8 as the permanent incisors push up.

then the 4th and 5th teeth back from the centre line at age 9 to 12

then the canines (3rd back from the centre line) at age 10 to 13

the first permanent molars will start to erupt at age 6 to 8 , these come through behind the deciduous teeth , (i.e.behind the 5th tooth back from the centre line)

if your child is 6 now , some of the deciduous teeth wont fall out for another 6 years.

if they are lost early , then there is a chance that the permanent teeth will erupt in a less than perfect position , this might need correcting later by orthodontic treatment.

if there is decay and it is not treated , then in most cases it will lead to pain , abscesses and extractions.

i think it is very unlikely that a dentist would try and overprescribe treatment for a 6 year old , and if you are in any doubt , then ask the dentist to show you which teeth need filling , and go somewhere else for another check up and second opinion before deciding how to proceed.

thai dentists are usually very good , and especially with children , and ideally , if your child has decayed deciduous teeth , then , providing the decay is not too advanced they should be filled .

I think you need to see which teeth needs filling - most likely they will be the molars, in which case you're only talking about a couple of teeth and those won't drop out until she's at least 9-10 - so I would put fillings in those.

onethailand is wrong here.

there are eight deciduous molars , and they should ideally stay put until age 9 to 12 , when they will be pushed out by the erupting permanent premolars. if the deciduous molars are lost early , then the first permanent molars , (which erupt at or about age 6 behind the deciduous molars) may drift forward into the empty space and cause problems when the permanent premolars try to erupt in the same spot.

Edited October 11, 2007 by taxexile

[onethailand]

its no coincidence , deciduous ( milk ) teeth are much more susceptible to caries than the permanent teeth and fruit juice at bedtime would be a major contributing factor to your child's dental problem

Oops - missed the word "bedtime".

I think you need to see which teeth needs filling - most likely they will be the molars, in which case you're only talking about a couple of teeth and those won't drop out until she's at least 9-10 - so I would put fillings in those.

onethailand is wrong here.

there are eight deciduous molars , and they should ideally stay put until age 9 to 12 , when they will be pushed out by the erupting permanent premolars. if the deciduous molars are lost early , then the first permanent molars , (which erupt at or about age 6 behind the deciduous molars) may drift forward into the empty space and cause problems when the permanent premolars try to erupt in the same spot.

?

I said I *would* put fillings in those as they won't drop out until she's at least 9-10?

[taxexile]

are you a dentist onethailand ?

[onethailand]

are you a dentist onethailand ?

Would you or would you not put fillings in molars that aren't going to drop out until the child is at least 9-10?

[taxexile]

there is no possible way i can answer that without knowing the dental history, the extent of the caries and in which teeth , and in the standard of oral hygiene present.

but this synopsis of a research paper , (noting especially the highlighted sentences ) might help the father to make up his mind and give him some ideas for questions to ask the dentist.

Dental Health Services Research Unit, University of Dundee Dental School, Park Place, Dundee DD1 4HR.

OBJECTIVE: To investigate the outcome of non-restoration of carious deciduous teeth by means of a retrospective analysis of clinical case notes of children regularly attending two general dental practices and receiving preventive care.

DESIGN: Using a carefully defined protocol the fate of deciduous teeth diagnosed as carious into dentine but symptomless and left unrestored was determined from the sequential examination of the clinical records of 481 children attending at least annually.

RESULTS: The age at initial diagnosis of carious teeth ranged from 1-12 years with the majority of cavities (1,005) presenting by 6 years of age. In all, 1,587 teeth were followed until loss from the mouth. Of these, 190 (12%) were extracted because of pain and a further 60 (4%) became painful and were treated, leaving 1,337 (84%) that remained symptomless until being lost. Of the 1,337 symptomless teeth, 178 were extracted under general anaesthesia at the same time as painful ones. The final group of 1,159 (74%) teeth were exfoliated without causing pain after a mean survival time of 1,332 days. Excluding from the analysis the 178 extracted, but symptomless teeth, leaves a total of 1,409 teeth of which 18% gave pain and were extracted or treated and the remaining 82% exfoliated. The strongest determinant of pain was age on diagnosis, the other factors being tooth type and extent of the cavity when first seen. The carious teeth most likely to cause symptoms were found to be molars that developed cavities with pulpal involvement by the age of 3 years, 34% of which caused pain. In contrast, those least likely to cause pain were carious molar teeth presenting without pulpal involvement after 8 years, only 6% of which produced symptoms.

CONCLUSION: In these patients, the majority of unrestored carious deciduous teeth remain symptomless until shed. The results provide evidence to aid the treatment planning of carious deciduous teeth in children regularly receiving regular preventive dental care.

PMID: 12199130 [PubMed - indexed for MEDLINE]

[think_too_mut]

Our girl has pearl teeth, never sucked mother's milk. The mother has beautiful teeth too, so had I until age of 30.

Bad teeth could be predestined if such a young child has them.

[onethailand]

there is no possible way i can answer that without knowing the dental history, the extent of the caries and in which teeth , and in the standard of oral hygiene present.

LOL.

His child has already been to a dentist. The dentist recommends fillings. The child did not obviously complain of pain. And I happen to agree with you that Thai dentists are generally very good.

Assuming we are talking about molars - and based on what you have already presented - is it reasonably safe to assume that molars should be filled?

Don't tell me I'm wrong - because it is clearly not so. I may not be a dentist but common sense dictates that teeth which are not about to be shed, unless in unusual circumstances (which apparently have not been indicated by the child's dentist), should be treated.

[taxexile]

I may not be a dentist but common sense dictates that teeth which are not about to be shed, unless in unusual circumstances (which apparently have not been indicated by the child's dentist), should be treated.

common sense is often shown to be wrong when confronted with the results of sound scientific studies.

well , as a dentist with 25 clinical practice to my name , i will repeat that there is no possible way i can answer that question without knowing the dental history, the extent of the caries and in which teeth , and in the standard of oral hygiene present ...... and that if you read the synopsis , you will see that the treatment outcome is pretty much the same whether you restore them or not , providing the child is being seen regularly.

The appearence of this study is timely following the recent publication of the findings from similar studies1-4 in the north west of England and the ensuing debate in the letters page of the BDJ. This study reported the outcomes of unrestored carious primary teeth in 481 children attending two dental practices in Leeds and Halifax. The principal finding was that over 80% of carious unrestored primary teeth remained symptomless until natural exfoliation. Pain was significantly more likely to occur if caries was first recorded at a very young age. Pain was also more likely in molar teeth and teeth with multi-surface lesions. Perhaps the most surprising findings were that only 34% of the teeth considered to have the worst prognosis (pri-mary molars with pulpal involvement at the age of three) caused pain, and that 60.4% of teeth with pulpal exposure painlessly exfoliated. If the 70 teeth that had no pain but were extracted were excluded, 74.6 % of teeth with pulpal exposure exfoliated without pain.

This study looked at the outcomes of the care provided by one dentist, yet they correspond closely with the findings of a pilot study involving four dentists1 and a larger study of 50 dentists.2-4

In the studies reported by our team there was no difference in the outcomes of restored and unrestored primary teeth, and although there was a variation in the mean percentage of teeth filled per child by the dentists, the majority of carious primary teeth were filled (40.5% incisors and canines, 81.1% first molars, 84.3% second molars).3 It is perhaps unfortunate that Levine et al. could not present data for restored carious primary teeth, however similar results were achieved by eschewing a restorative approach and adopting a preventive model of care.

Both the study by Levine et al. and our analyses found the same significant relationships between adverse outcomes and tooth type, lesion size and the age when caries was first recorded. The results of these studies tell similar stories and increase confidence in the validity of the findings. These studies should force the profession to re-evaluate the nature of dental caries in the primary dentition. If approximately 80% of carious teeth exfoliate naturally without pain; just how big a public health problem is the disease in the primary dentition, and can costly,5 possibly traumatic clinical interventions be necessarily justified? Further research is needed to answer these fundamental questions if the profession is to maintain its commitment to evidence-based policy and practice.

1 Tickle M, Milsom K M, Kennedy A. Is it better to leave or restore carious deciduous molar teeth? A preliminary study Prim Dent Care 1999: 6; 127-131.

2 Milsom K M, Tickle M, King D, Kearney-Mitchell P, Blinkhorn A S. Outcomes associated with restored and unrestored deciduous molar teeth Prim Dent Care 2002; 9: 16-19.

3 Tickle M, Milsom K M, King D, Kearney-Mitchell P, Blinkhorn A S. The fate of the carious primary teeth of children who regularly attend the general dental service Br Dent J 2002; 192: 219-223.

4 Milsom K M, Tickle M, Blinkhorn A S. Dental pain and dental treatment of young children attending the general dental service Br Dent J 2002; 192: 280-284.

from the above , you can see that the dentist will need to know how long the lesions have been present ( this can be deduced to a certain extent from the size and depth of the lesion , which teeth are affected and whether the lesions are multi surface or single surface.

only by having that knowledge can the treating dentist plan the treatment according to the best principles of evidence based dentistry and arrive at a treatment plan that is in the best interests of the patient .

[onethailand]

thai dentists are usually very good , and especially with children , and ideally , if your child has decayed deciduous teeth , then , providing the decay is not too advanced they should be filled .

So basically you are saying that if the OP's child's dentist said to put fillings in, that you might not agree? And yet in another breath you said that Thai dentists are pretty good?

Based on the information that the OP provided, it is a reasonable assumption that if the teeth in question are molars, then they should be treated with fillings. Anything to the contrary indicates a distrust in what the dentist has recommended.

Given a situation where a poster were to ask a similar question without the child having gone to the dentist, I most definitely defer to your knowledge. And either way, what I said was not incorrect - just admit that you misread what I said and let's move on, okay? Or were you saying I was wrong because there are eight molars and not just "a couple" (by which I obviously meant likely only a couple of molars affected)?

Edited October 11, 2007 by onethailand

[MrSquigle]

Anybody know any dentists in Bkk that are really really good and really really good with little kids.

[onethailand]

LOL... the $64K question...

I use Samitivej Hospital, but of course they cost more than most other places. They've been very good both with fidgety kids and fidgety adults

You might also want to consider Thonglor Dental, who have just moved to a new larger complex right on Thonglor so they must be doing something right. And right on the corner of Thonglor and Sukhumvit there's Asavanont Dental Clinic.

I'm sure there must be many good places, I'm just naming the ones I know of in my area.

[bkkmick]

Hi guys, thanks for the replies which I read with interest.

My wee girls front teeth are causing her the problem (no pain there though). A little bit more information now.

The past couple of days she has complained about a sore tooth at the back of her mouth. The dentist has recommended filling the back tooth (which seems in line with what you are saying as they'll be around the longest - and it is causing her some pain). Yesterday he also addressed one of her 'narrow' teeth in the front. Sorry, I don't know the technical terms, but, basically the top row roughly the middle two (big) teeth and two to either side look decayed or underdeveloped. He seems to have put a cap (or something) onto her left big front tooth. There is an issue here. My poor wee girl is pretty (all fathers say that, I know) but she has recently been embarrassed by those teeth. When I got home from work yesterday she was so happy about her 'new' front tooth, smiling from ear-to-ear. Today she's saying that her friends at school said that her new tooth is beautiful (6 year old girls, eh). I'm realising now that not only is oral health an issue but vanity is starting to play its part as well.

If filling (or somehow correcting) those teeth in the front of her mouth won't cause her any problems then I think that I'll go ahead and get them done. She is so happy with the one 'new' tooth!

Thanks again for the feedback.

p.s. they both clean their teeth when they get up and before they go to bed and after their meal at school. Should be enough.

Cheers

Mick

Edited October 12, 2007 by bkkmick

[onethailand]

Hi guys, thanks for the replies which I read with interest.

My wee girls front teeth are causing her the problem (no pain there though). A little bit more information now.

The past couple of days she has complained about a sore tooth at the back of her mouth. The dentist has recommended filling the back tooth (which seems in line with what you are saying as they'll be around the longest - and it is causing her some pain). Yesterday he also addressed one of her 'narrow' teeth in the front. Sorry, I don't know the technical terms, but, basically the top row roughly the middle two (big) teeth and two to either side look decayed or underdeveloped. He seems to have put a cap (or something) onto her left big front tooth. There is an issue here. My poor wee girl is pretty (all fathers say that, I know) but she has recently been embarrassed by those teeth. When I got home from work yesterday she was so happy about her 'new' front tooth, smiling from ear-to-ear. Today she's saying that her friends at school said that her new tooth is beautiful (6 year old girls, eh). I'm realising now that not only is oral health an issue but vanity is starting to play its part as well.

If filling (or somehow correcting) those teeth in the front of her mouth won't cause her any problems then I think that I'll go ahead and get them done. She is so happy with the one 'new' tooth!

Thanks again for the feedback.

p.s. they both clean their teeth when they get up and before they go to bed and after their meal at school. Should be enough.

Cheers

Mick

Good one Mick... especially if your little one is happy! And your description sounds exactly like my little one, but he's 7 now and all those teeth are gone. Now I wish he would start gaining some weight!

[taxexile]

onethailand

most likely they will be the molars

patients father

My wee girls front teeth are causing her the problem (no pain there though).

onethailand

Don't tell me I'm wrong - because it is clearly not so

If filling (or somehow correcting) those teeth in the front of her mouth won't cause her any problems then I think that I'll go ahead and get them done. She is so happy with the one 'new' tooth!

are these deciduous (milk) teeth you are talking about?

[onethailand]

onethailand

QUOTE

most likely they will be the molars

patients father

QUOTE

My wee girls front teeth are causing her the problem (no pain there though).

onethailand

QUOTE

Don't tell me I'm wrong - because it is clearly not so

laugh.gif

Duh...

The dentist has recommended filling the back tooth (which seems in line with what you are saying as they'll be around the longest - and it is causing her some pain).

One - the molar - needs filling. The OP mentioned that the dentist said "needs fillings".

Maybe you need to put on your reading glasses, taxexile.

Edited October 12, 2007 by onethailand

[bkkmick]

I don't know where you get your attitude from OneThailand, but piss off please. That's me being polite. This is a conversation for adults, you're obviously not one.

I did say "which seems in line with what you are saying" implying that I understand that the work needs done, and it will be done.

[onethailand]

Huh?

I was responding to taxexile... and I complimented you on your decision?

Ah, I see the problem. Next time I will quote the post directly above me...

... ok fixed. Sorry for the confusion.

Edited October 12, 2007 by onethailand

[lopburi3]

I can highly recommend Dr. Ubonrat Somwangprasert at Vejthani Hospital who treated our five year old granddaughter last month. She is extremely careful to not mention needle or anything that might cause anxiety for patient. This was a cavity that was not treated and became infected so not a simple filling (two visits a week apart) but there were no tears and almost no pain (not enough to scare child at all).

[taxexile]

one of the big problems with internet forums is that you never know if the advice you are given is correct or not.

you just dont know who you are communicating with.

on matters dental i speak from a position of the the experience and knowledge i have accrued from being in that profession for over 25 years.

i cant claim that my advice is gospel , but if a dental query is posted here that is beyond my knowledge or experience then i usually keep away from saying anything that might affect the decision of the poster.

i wont advise on breast implants , fuel injection for malfunctioning diesel engines or how to wire a house so you dont get electrocuted , because i dont know anything about those subjects.

i have no wish to enter into an argument with onethailand , but with respect , he should not be giving advice about something he has had no real knowledge of.

i posted some general dental knowledge about tooth eruption times and quoted a research paper that is very relevant to the posters original question , and i hope that that information will help him to come to an informed decision about his daughters treatment , or at least suggest some relevant questions for the treating dentist to answer.

i apologise for winding onethailand up , but his statements were based on hearsay and guesswork rather than evidence and experience.

[onethailand]

one of the big problems with internet forums is that you never know if the advice you are given is correct or not.

you just dont know who you are communicating with.

on matters dental i speak from a position of the the experience and knowledge i have accrued from being in that profession for over 25 years.

i cant claim that my advice is gospel , but if a dental query is posted here that is beyond my knowledge or experience then i usually keep away from saying anything that might affect the decision of the poster.

i wont advise on breast implants , fuel injection for malfunctioning diesel engines or how to wire a house so you dont get electrocuted , because i dont know anything about those subjects.

i have no wish to enter into an argument with onethailand , but with respect , he should not be giving advice about something he has had no real knowledge of.

i posted some general dental knowledge about tooth eruption times and quoted a research paper that is very relevant to the posters original question , and i hope that that information will help him to come to an informed decision about his daughters treatment , or at least suggest some relevant questions for the treating dentist to answer.

i apologise for winding onethailand up , but his statements were based on hearsay and guesswork rather than evidence and experience.

Oh please. I hardly made myself out to be a dentist - and I did not give advice about being a dentist. What I said equated to "if the dentist told you the child needs fillings, and if they turn out to be molars, she won't lose them for a couple years so you should fill them". What other advice would you give? Don't fill them? Get the teeth pulled instead? Besides which that would obviously be against the dentist's recommendations?

It doesn't take medical knowledge to state the obvious - and there WAS a recommendation from the dentist already present.

You, on the other hand, don't read what has been said before replying - and then you want to start calling people wrong? No hearsay, no guesswork - the dentist had already done that, thank you very much. If Bkkmick did not want opinions from other parents then he surely would have said so - or else he would have said "Need a second opinion from a dentist" - so get over it already.

BTW, if you would be so kind, please show me where I was wrong in the part you quoted from my original post. I was wrong about the fruit juice because I missed the word "bedtime" but I didn't see you quote that part when calling me out.

Edited October 12, 2007 by onethailand

[taxexile]

[onethailand]

Glad to see you took my advice

[chonabot]

The words - 'Argument' and ' Empty waiting room ' ring to mind , eh Tax ?

[fletchsmile]

While it's important to look after your teeth well, and take dentists advice, I think a lot of teeth issues are genetic. I know people who have looked after their teeth very well, but still have a lot of problems, and the opposite where people have done all the "wrong" things and have a great set. Another observation, is that the individual teeth I have problems with are, in exactly the same position as my mum, i.e cap then bridge in exactly the same place. fillings same place. etc

I'd go with your dentists advice, as I believe your teeth can be a good reflection of overall health. Also dental hygiene problems that could impact/ lead to complications/ infections elsewhere.

Slightly off topic, but what age do kids usually get milk teeth? I thought it was 6-12 months. Our daughter is 14 months now and no teeth. Perhaps it runs in the family as her great grandma on my side has no teeth either and she is over 90...

Would be interested to know tho. The wife suggested it may be due to lack of calcium. I don't think so and kids seem to develop in different things at different speeds. Anyone any thoughts?

Edited October 14, 2007 by fletchthai68

[taxexile]

you will find the information here.

eruption times for teeth

they may come through early or late.

if you think that they are long overdue , and if there are no little bumps under the gum where the tooth should erupt then a visit to a dentist and an x ray will confirm whether the teeth are in fact present or not.

milk teeth are much "softer" than the permanent dentition and do decay much easier and faster, and with todays sugar loaded diets and some childrens reluctance to brush or allow parents to brush for them decay in milk teeth is common.

the first permanent molar which erupts at about age 6 is the most common tooth to need fillings and crowns , its usually the first adult tooth to erupt after the incisors and suffers the most as at that age oral hygiene and diet can be less than perfect.

[Screws]

p.s. they both clean their teeth when they get up and before they go to bed and after their meal at school. Should be enough.

Cheers

Mick

Mick,

The best oral hygiene is this;

Shortly after each meal, but most importantly shortly after the last meal of the day, floss thoroughly, then brush using a soft toothbrush and a low abrasive fluoride toothpaste.

The reason that shortly after the last meal of the day is important is that the biggest hazard to your teeth is sleep - if you teeth are not clean. Especially if sugars or starches are present.

Flossing removes about 60 - 70 % of the plaque, brushing about 20 - 40 % of the plaque. Between them they remove 90 to 95% of plaque. Then in the few hours before sleeping, the bodies natural oral hygiene kicks in and removes most of the little plaque remaining.

If you get the kids doing this, they will probably never have any more cavities (depending on the effectiveness of the cleaning and the timing, and diet etc) and they should never have oral halitosis. (same for adults)

Cleaning the teeth when they get up in the morning is all but a complete waste of time. That is when many people do clean their teeth, because they wake up in the morning with the proverbial 'bottom of the cocky cage' taste in the mouth, so that is when the 'squeaky wheel' gets the attention. Unfortunately, however, by then the damage has been done.

Limit snacking; sugar, candy etc; as little as possible, but clean teeth asap afterward; also don't continuously sip coke, suck on all day suckers, etc. (Wait for half an hour to an hour before cleaning after drinking carbonated or acidic drinks; they can soften the enamel, which then gets brushed away by the toothbrush. Waiting a little while allows the teeths' 'mothers milk' (saliva) to help repair that softening (demineralization).

Good luck.

P.S. Can recommend Dr Asavanant (cnr Thonglor & Sukhumvit) and Dr Sunil (near Ekkamai) 0816 485 780.

[taxexile]

(Wait for half an hour to an hour before cleaning after drinking carbonated or acidic drinks; they can soften the enamel, which then gets brushed away by the toothbrush.

interesting .

can you post the link to that research.