“We’ve got some sticky spots back here, Mom.”
Those were probably the last words I wanted to hear from the dental hygienist during my daughter Ruby’s appointment. A quick and sneaky chat with Toronto dentist Stephen Simpson, while Ruby played with toys in the waiting room, confirmed that my four-year-old had cavities that would need to be drilled and filled. I felt horrible, as if there were something more I could have done to prevent those cavities. She’s a kid who gets her teeth brushed and flossed well at least once a day, and gets limited junk food. So what happened and how would I prepare us for what was to come?
Grace under fire “Be cool. Be calm, confident and positive,” says Warren Loeppky, a paediatric dentist in Calgary. “Provide your child with very basic information, like ‘The dentist is going to clean the sugar bugs out of your teeth.’ Don’t frame the experience in terms of pain or punishment (‘You don’t brush your teeth and now you need to get a filling at the dentist!’).”
I took this advice leading up to Ruby’s appointment, but would have loved a children’s book to back up all of the cool, calm messages that my husband, Jason, and I were trying to prepare her with. Most of the books that Michael Casas, paediatric dentist and director of clinics in the department of dentistry at Toronto’s Hospital for Sick Children, has heard of don’t quite cut it when it comes to getting kids ready for the dentist. “The Berenstain Bears series has a book about going to the dentist that picked the word ‘yankers’ to describe the forceps used to extract teeth…an unfortunate choice,” says Casas. He advises keeping information to a minimum when it comes to preparing kids, since dentist-fearing parents could unintentionally impart their anxieties. “They may not accurately represent what will happen during the appointment,” says Casas.
Calmness should also be front and centre when you take your child for her filling appointment. That’s why I didn’t go. Jason, on the other hand, is fine with medical stuff. “It is definitely better to send the calmer parent to the appointment,” says Simpson. So with a little laughing gas, local freezing, earphones for the children’s show on TV and Daddy beside Ruby, Simpson completed all five of her fillings in about half an hour. Simpson says that if the teeth are a year away from falling out, he’ll likely opt not to fill them. But one thing to watch out for is if a cavity is on a baby tooth beside a permanent tooth, the decay in the baby tooth can spread. Simpson also says that if a two-year-old comes in with cavities in his front teeth, they will get filled because those teeth don’t fall out until age seven or eight. Sarah Hulland, a paediatric dentist in Alberta says that the treatment your child receives will depend on the extent of the tooth decay. "Early onset of tooth decay may only require the child or parent to be more diligent with daily oral care and the dentist will recommend flossing and use of a fluoride toothpaste," she says. If your kid's cavity has reached the dentin (the area just under the tooth enamel), a filling will be needed, says Hulland.
Quick and painless Laughing gas (nitrous oxide) can be useful for a child like Ruby who’s getting several teeth filled at once. It can reduce anxiety, provide some pain relief, distract from the pinch of the needle and help the child sit still—but it’s not appropriate for all kids.
“For younger children, an oral sedative may be more appropriate,” Casas explains. “Some children are fine having multiple fillings done over several visits. Others may not do so well,” agrees Loeppky. It really depends on your kid’s temperament. Check with your child’s dentist.
After the appointment, some kids are really bugged by that numb feeling. The best thing to do is reassure them that feeling will come back soon, and make sure that they don’t hurt themselves by biting, scratching or sucking on their lip, cheek or tongue while they are still numb.
Ruby’s appointment was at 1:30 p.m. By 2:15 p.m., she was phoning me from the car on her way to a special lunch with Jason. She sounded unfazed by the whole thing and was getting a good laugh from her crooked, frozen-face smile.
Cavity culprits Ever wonder why two kids can follow the same dental hygiene routine, yet one of them gets cavities while the other does not?
That’s because it’s not just poor teeth cleaning that causes cavities, explains Michael Casas, director of clinics in the department of dentistry at Toronto’s Hospital for Sick Children. Besides improper brushing and flossing, cavities can be caused by diet, lack of fluoride, the shape of teeth, parents’ dental history and the general chemistry and bacteria in the mouth. But, of course, we can’t control all of these factors, so dentists emphasize the things parents can control—diet and dental hygiene. Casas recommends taking your child to a dentist (general or paediatric) by his first birthday or within six months of cutting his first tooth.
Smile savers The Canadian Dental Association (CDA) recommends that we brush teeth and tongues twice a day with soft-bristle brushes. Here are a few more recommendations to help promote healthy teeth: Fluoride Don’t let your children use toothpaste with fluoride until they can spit efficiently, says Simpson. Swallowing fluoride can cause dental fluorosis (appearing as harmless white specks on teeth to severe discolouration), and has been linked to thyroid problems and certain bone cancers. Flossing According to the CDA, you’re missing one-third of the tooth’s surface if you don’t floss. Flossing should start as soon as teeth are through and close together, says Simpson. Sealants Applying resin bonding to the biting surfaces of the back teeth can help prevent cavities, but it tends to work better on adult teeth than on baby teeth, says Casas.