Dental Drama

We took Peeper to the dentist yesterday, because we were concerned about the looks of her four top front teeth.

She did about as well as could be expected with the exam, which was not all that great, but she got okay as soon as the dentist finished and the "no food or drink for ten minutes" waiting period after the flouride treatment was up and she was allowed to nurse.
 
(I don't think it was really ten minutes, but she was unhappy and asking to nurse, and when I asked if it had been long enough, they said it has.)
 
Unfortunatley, our suspicions were correct - all four of those teeth are showing some decay, and two of them have small cavities.

We were given three treatment options:

• a - "Just watch them." (Um, watch them continue to rot??)
• b - Fill the cavities at the office, using nitrous (which "sometimes works and sometimes doesn't" with kids her age) and possibly a local anesth (but "probably wouldn't need it") while Shrike and/or I restrain her.
• c - Fill the cavities at the hospital, under general anesthesia.

We're going with Option C, and in addition to the two fillings, they're going to put a sealant on her molars to protect them. (Unfortunately, they can only do that to molars, not the flat teeth.)

We've scheduled it for Tuesday August 24, 9:30 am - it should only take about 45 minutes, which I think includes the sedation.

The dentist we went to is about an hour from home (in the town where I used to work, and where our fertility clinic and perinatalogist were) and the fillings will be done at a hospitals that's about an hour and a half from home (but just a few minutes from the fertility clinic where Peeper was conceived, actually). 

I was just reading over the materials that they gave us from the hospital, and it seems that they have a special pediatric day surgery unit, and that "depending on your child's age and the type of surgery, one family member may accompany them to the operating room until they have been given anesthesia and are asleep" - so that makes me feel much better about things.

I'll feel even better when I talk to someone who can confirm that breastmilk falls under the category of the "approved clear liquids" that she can have until three hours before the procedure, and not the "food or milk products" that she gets cut off from at midnight.

When I googled "breastmilk before surgery" everything I found said that it's okay up to "three to four hours" before anesthesia, and four hours was the rule when she had her real surgery.

If that's the case, given that we're due there two hours before the procedure, and have an hour-and-a-half drive to get there, I think I can just give her "wake-up goody" then get her dressed and out the door, and we'll be okay. That's pretty much what we did today, actually.

If that's not the case, I have no idea how we will get through the night if she can't nurse.

I'm not even going to think about that, because I just can't.

It'll be three or four hours, and we'll be fine. It has to be.

Of course, the dentist would like to see her not nursing at all during the night, ever, but that's just too damn bad.

There are plenty of dentists who will tell you that night nursing causes cavities, because it's what they were teaching when they went to dental school, but the current understanding is that not only does breastmilk not cause decay, but actually protects from decay, thanks to lactoferrin, IgA, IgG and the high pH levels.

It also strengthens teeth by depositing calcium and phosphorus on them. Furthermore, unlike with a bottle, breastmilk only comes out if the baby is sucking, and if they're sucking, they're swallowing, so it doesn't just sit there, pooling around the teeth.

Also, studies have been done looking at the skulls of children from thousands of years ago through more recent times, and until about 1900, early childhood caries was almost nonexistent. Those kids were definitely breastfeeding and cosleeping (so nursing through the night), but they weren't eating the kinds of high-carbohydrate and processed sugar diet that we have today.

There are many studies showing that, unless there's another carbohydrate source, breastmilk itself does not cause cavities.

So, why does Peeper have cavities?

It's hard to say. Sure, there have been plenty of nights that we've forgotten to brush, or she's had some cheerios (a complex carb, that turns to sugar!) or another snack after brushing, but hell, the oldest of her decaying teeth has been around for less than a year, so how many times could it have happened?

One risk factor for tooth decay seems to be having been small for gestational age, which Peeper certainly was, so maybe her little teeth have just been weak all along.

Or, perhaps she's been infected (likely by us) with Streptococcus mutans, a bacteria that causes tooth decay in the presence of sugar.

We'll probably never know, and I'll probably never convince myself one hundred percent that it's not some how my fault, or that I could have done something differently to have prevented it, and there are probably some things we need to do to avoid having any more cavities, but the one thing I won't do is night wean her any time soon, not only because I truly believe that it wouldn't help her teeth a bit, but also because the benefits for Peeper and our whole family from cosleeping and breastfeeding through the night far outweigh even the probably-non-existent risk that the dentist warned us about.

(Information about breastfeeding and cavities is from The Womanly Art of Breastfeeding, 8th edition, pp 241-242. I've also read the same information in a variety of other places, including some of the actual studies, while researching the subject on my own.)

Obviously, we're not thrilled about the cavities, but given our options for dealing with them, we think that going ahead with the general anesthesia for the repair is the best route to take.

Doing nothing seems like a dumb idea, and doing the procedure with her awake at this age (even with nitrous) just seems like it would be quite traumatic for all of us, and given the way she remembers everything, could well result in a dental phobia, and very possibly an aversion to having her mouth and teeth messed with at all.

The anesthesia is always a bit of a concern, of course, but she had no problems with it before, and really, given what we've been through already, any procedure during which she gets to use her own heart and lungs through the whole thing looks pretty minor to us!

And, of course, it is very minor - if an adult were having the same procedure, we'd get a local (if that) and go back to work afterward - the only thing that makes it complicated is that she's (as I read somewhere while researching such things) "pre-compliant" because of her age.

But, minor as it is, I will sure feel better when it's all over and done with.