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Early Childhood Caries — Shane’s Story

December 12, 2009
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(I have to apologize in advance — this got incredibly long, and stayed long, regardless of how much I edited out.  If you make it all the way through, thank you for reading!)

My son has Early Childhood Caries.  Two cavities already, one on the inside of one of his top incisors, the other on one of his molars.  He also has chalky white patches on several of his teeth that are spots where the enamel had become demineralized, and may develop into more cavities in the future.

I’m heartbroken, and feel as though I’ve failed him, somehow.  He was exclusively breastfeed until six months and is still nursing several times a day.  We skipped baby cereals and practiced baby-led weaning once we began introducing solids.  We were careful about introducing potential allergens.  We’re trying the best we can to enjoy a diet of minimally processed foods, and buy organic as much as financially possible.  Here we’ve been, trying to make our parenting decisions with his health and well-being in mind…and yet, he still developed cavities.  I feel so very guilty, and wanted to curl into myself and cry when we first found out. 

A little back-story:  Back in August, I had begun noticing some discoloration developing on the front of his teeth, and started asking around for recommendations for a pediatric dentist.  Then, one evening while getting him ready for bed, I spotted a black spot on the inside of one of his top incisors. He was sitting on my lap while I was trying to brush his teeth  He threw his head back to get away from me, opened his mouth wide to yell…and there it was. A small black spot.  I called and made an appointment for him the very next morning. 

Luckily, they were able to get us in the very next week.  That dentist was…ok. Patient with Shane at first, showed him all her equipment and tried to set him at ease, but when it became evident that he wasn’t going to cooperate, she was all business. She quickly checked & cleaned his teeth, then applied a fluoride treatment. I had to hold him screaming on my lap while she did, while her assistant held his legs so he couldn’t kick & thrash…and it was heartbreaking. She made an off-hand comment that it was a good thing I brought him in, but she’d talk to me more about that when she was done.

I wanted to cry, too. 

Once back out in the waiting room, Shane continued to sniffle tugged on my leg, chanting “Bye-bye! Mama, bye-bye…” while the dentist handed me a pamphlet about Early Childhood Caries, complete with photographs of children with crumbling, black, decaying teeth. 

The treatment options?  Given how Shane tweaked out during the cleaning, she said we have two options: keep a watch on them, try to do better w/ the brushing, keep doing the fluoride treatments, and see if we can hold off until he’s a bit older to take care of the cavities.  Or, we can go to a pediatric dentist in Boston who will sedate him in order to treat them now. The thought of that, of sedating him, had my insides flipping.

She then glanced at the paper work I had filled out before the appointment.  In response to the question: “When did your child wean off the bottle,” I had crossed out bottle and wrote that Shane was breastfed, and had not yet weaned. Well, apparently, she was far from pro-breastfeeding. I was told in no uncertain terms that I needed to wean him right away. That very night.  Cold turkey. According to her, “he’s too old for that, he doesn’t need it anymore,” and “the AAP recommends that you stop breastfeeding when they’re 12 months old.” Not being able to keep my mouth shut, I corrected her on the AAP statement (which, if you’re interested, is this: exclusive breastfeeding for approximately the first six months and support for breastfeeding for the first year and beyond as long as mutually desired by mother and child. Source).  I informed her that I’m not intending on weaning him just yet. In fact, I’m a dues-paying La Leche League member, and strongly believe in the long-term benefits of extended nursing.

I wept on the drive home.

Once home, I sent an e-mail to my La Leche League leaders, asking for information and advice, and they quickly responded, sharing a barrage of information. Links to various medical studies, links to the opinions of dental researchers, even a link to a statement released by the American Dental Association which redacted its earlier position that breastfeeding increased the risk of developing cavities. The truth is that there’s no link between breastfeeding and early childhood caries (source). The belief that breastfeeding was a risk factor for early childhood caries is outdated & incorrect, and was based on studies which had showed that letting infants fall asleep with bottles of formula or juice can lead to developing cavities. Breast milk is actually anti-cariogenic. Unsurprising, really, because breast milk has been proven to have antibacterial properties, and cavities are caused by a bacterium called mutans streptococci. Cavities form if a child is exposed to these bacteria, and the conditions in their mouth create a hospitable environment in which it can develop unchecked.  So, it is partially our fault that Shane developed cavities, but not because I’m nursing him. He was more than likely exposed to mutans streptococci at some point.

I wanted to get a second opinion on the right course of treatment for Shane. One of my La Leche League leaders passed on the name of the pediatric dentist who treated her daughter for early childhood caries, and I was able to make an appointment for the following week. I can’t even begin to explain how much more comfortable I was with this dentist. Shane cried a bit during the exam, but the dentist continued to speak calmly to him, and would periodically stop to give Shane a break. He barely reacted when he heard that Shane was still nursing, and just recommended that we work on getting him to either let us brush his teeth before falling asleep.  Or, if that’s not possible, to wipe them down with a damp cloth or even just give him a drink of water after nursing.

He also didn’t believe that the decay is anywhere near as bad as the previous dentist stated. The dark spot on the back of his front incisor is “as hard as a rock,” no softness, no decay. It should be watched, but it doesn’t need to be treated at this point in time. And the discoloration on his front teeth is merely cosmetic, so no treatment is needed for that. However, he felt the cavity on his molar needed to be filled, and the sooner the better. One option was to have it filled in his office, with a local anesthetic and no sedation, and they’d wrap Shane up in this Velcro swaddling-thing. He wouldn’t feel anything, but he would be completely awake and aware during the procedure. Alternatively, we could bring him to Boston Children’s Hospital, and they would sedate him in order to fill the cavity. Honestly, from my perspective, both options were lousy. While having him sedated terrifies me, having him awake and alert but immobilized during the procedure just sounds horribly cruel and traumatizing for him.

So my husband and I decided to bring Shane to Boston Children’s for a consultation. To make an already overly long story somewhat shorter…we’re not having that cavity on his molar filled right away. This dentist said there is a hole that has developed there, but it’s not a “gaping hole” (as she worded it), and it’s not causing Shane any discomfort or pain at this point. So she’s going to watch it, and hopefully we can buy some time until Shane’s a bit older before filling it. He does qualify to take part in a study on early childhood caries, which has a focus on lowering children’s risk of caries by preventing cavities before they form, and stabilizing the cavities they already have. We were sent home with a fluoride toothpaste to use two times a day, and since we brush his teeth upon waking, before bed, and after every meal, snack, or nursing session, we use a xylitol toothpaste for those additional brushings. We’ll be heading back into Boston once a month for a check-up and he’ll get regular cleanings and fluoride varnish treatments, until he’s deemed to be at a lower risk.

It just breaks my heart that he has to go through this.

On the bright side…we went back to Boston yesterday for our second visit with this dentist, and Shane’s teeth have gotten no worse.  In fact, she stated that his teeth are looking very good, she can tell that his dental hygiene is “superb”, and there’s no further decay.  No further decay…now that is music to my ears!

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Photos taken after last month’s appointment (before his recent haircut!)
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7 Comments leave one →
  1. December 12, 2009 11:02 pm

    You have far from failed him, your observations, your knowledge of your own child, your dedication to his health, and your informed decision-making have ensured that a condition Shane probably would have had, regardless, has had as minimal an impact on him as possible.

    As someone who can barely get her kid to brush ONCE a day (in fact, Aaron does it 99% of the time), you are my hero.

    • December 13, 2009 7:46 am

      Oh — you made me cry (in a good way)! That was really sweet. I do have to learn to let go of the Mama-guilt on this one, and as the months have passed, I am…most of the time.

  2. December 12, 2009 11:18 pm

    How timely that I clicked over to read your newest post… I’ve worried for the past year about Itty Bit’s teeth. He nursed until 20 months old and I noticed his teeth becoming discolored. The original dentist assumed we were using fluoridated toothpaste. When I said we weren’t, he said we must have fluoridated water. I said we were on our own non-fluoridated well water. “Well he must be getting it from his daycare”. Umm… WHAT DAYCARE? We have him at home…

    It was guilt-wracking to see his teeth look like we never brushed them, even though we did. Still hoping for good news on our next visit.

    (Don’t let anyone knock you for making the right decisions for your child… I heard plenty of comments about nursing til 20 months… whatever).

    Thanks for the informative post!

    • December 13, 2009 8:00 am

      I hope all goes well for you at Itty Bit’s next appointment. It is heart-breaking when thier front teeth get discolored, and it looks like you have been neglecting thier dental health, even when you’re doing all you can.
      One thing I was advised to use for Shane is xylitol. We use floride toothpaste 2x/day (usually before nap & bed), and use a natural, xylitol paste the rest of the time. Xylitol is a natual sugar, but it actually inhibits the growth of the bacteria (Streptococcus mutans) that cause cavities, because these bacteria cannot utilize xylitol to grow. We use the toothpaste, and then swipe a xylitol-syrup around his teeth as well. You can buy the syrup pre-made from various online retailers, but we just prepare our own each time with the crystals. If this is ever anything that you decide to try, let me know and I can send you the links I’ve found.
      Best of luck!

  3. December 18, 2009 4:09 pm

    I feel for you. You sound like a Mum who is trying very hard to take your little boys health seriously. I never knew that little children could get cavities for any reason other than poor teeth brushing. I’m so glad to have learned from your blog. I’m sure it will make me less judgemental if I come across this in the future. We are so lucky to have found a wonderful female dentist not far from where we live. My kids are 7, 9 11 and we had our 6monthly check up today which went well thank goodness. I hope you continue to contain Shanes current small cavities. It sounds like you are working very hard to prevent more.

    • December 19, 2009 9:36 am

      Thank you — I really appreciate this. I’m still so broken-hearted over this, and still can’t help but blame myself, and wonder what I did wrong. Thankfully we’ve found a great dentist, as well — that’s a wonderful thing, isn’t it, to have a comfortable working relationship with your child’s health care providers! I’m glad your children’s check-up went well. We’re hoping with frequent check-ups, much more frequent brushing, and the use of floride & xylitol, Shane’s decay doesn’t progress any further. Fingers crossed…

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