Why is my child having so many dental problems?
It’s not uncommon for children to get cavities that require fillings, crowns or even extractions. Scott Balzer, DDS, explains more about these various treatments, as well as how to prevent cavities in the first place.
Scott Webb: Those of us with kids know that it can be a struggle to get kids to brush their teeth, cut down on sweets, and look forward to going to the dentist’s office. But my guest today has some great suggestions for those issues and more. And I’m joined today by Dr. Scott Balzer. He’s a dentist with Prisma Health. This is Flourish of podcast, brought to you by Prisma Health. I’m Scott Webb. Doctor, thanks so much for your time today. I was just mentioning that I have a couple of kids. They’re a bit older, 15 and 19, but today our focus is gonna be on children and when we should get them started and everything in between. So, as we get rolling here, when should children start having dental care?
Dr. Scott Balzer: When children should first start going to the dentist, really the ideal time is when they first start getting teeth. When teeth come into the mouth, these teeth can get cavities. So, even though you’re a small child, that doesn’t mean you’re exempt from that. So really as early as six months is okay, certainly by the time they turn one or around that time period would be great. Really what’s important is those visits. You think for parents, it’s just a waste of time. My child has one or two teeth, why would I take them to the dentist?
For us, we understand that it’s really just kind of getting them sensitized to the dental clinic – the smells and the sights and the noises. So just coming in and showing them that this is not a scary, intimidating place and just making sure that they feel comfortable from a young age is really important so that they, continue their dental care and good oral health down the road.
Scott Webb: Yeah, for sure. Just sort of getting them acclimated to all of it and just sort of the culture of going to the dentist’s office and that there’s really nothing to be afraid of. Wondering how serious cavities are in kids and I’m sure all of us parents have been through this where we think to ourselves, well, it’s a baby tooth. It’s gonna fall out anyway. Do we really need to fill it? Do we really need to go to the dentist? And I’m sure you have some thoughts on that too.
Dr. Scott Balzer: Yeah, absolutely. That’s actually a fantastic question and I just had a patient today where this scenario went on. So, how serious are cavities and kids? I mean, they can be very serious. This is very extreme, but there are reported cases of children with dental abscesses and dental infections where these infections do spread and they can be fatal. While that’s, you know, very, extreme and not super common, it can happen. There are plenty of children that we see in the emergency department with massive facial swellings due to teeth.
These are not things to sleep on. Not only are they very dangerous for you health-wise, but they’re also painful to your child. So really getting these things before they get to be serious is super important. The question that you asked, which is a common one to think about – is this tooth is gonna fall out? Why am I gonna pay the money for this filling? And actually that’s a fair question. And honestly, there are times where that does make sense to leave the cavity be and let that tooth fall out without treatment. That all depends on timing.
Depending on how deep that cavity is and how close it is to, to potentially causing pain to your child versus when it’s gonna fall out is a big thing that dentists keep in mind when making those recommendations. Certainly, I’ll tell patients, let’s try, but the second your child notices some type of pain or you notice any type of swelling, please, come in and we’ll handle it.
Scott Webb: Definitely. That’s great advice. And I know the answer to this because my son needed one at a very young age. But for everybody else who hasn’t been through this before, can kids get crowns, of course? And what age would you recommend them? What, types of crowns are available for children?
Dr. Scott Balzer: Kids can get dental crowns. there’s really no age restriction, that a child can get a dental crown, certainly. The ideology that I was taught was that baby teeth should be treated one time, and if a crown is gonna give us the longest, treatment option to make sure that tooth doesn’t need treatment again before it falls out, then we’re gonna choose that option most of the time. So, this is a big topic for a lot of parents because the traditional one that people know about and they hear about or have seen are those silver caps that people call them. My kid got a silver cap. And a lot of parents hate, they hate ’em, you think the things are ugly and there’s a stigma to them. The reality is, these teeth are gonna fall out and we understand parents’ wishes for better aesthetics. They’re stainless steel, these silver caps, by the way. So the stainless steel caps do a great job of sealing off around the tooth to keep the additional bad things out. They’re also super, super durable and they’re very easy to use and quick to use.
In terms of kids and treating kids, as you can probably understand that, you know, attention spans, are short and they hate sitting still. And in order for a dental crown to be placed, it requires some speed. And these stainless steel crowns are a great option for that. If we do have parents that are ultra concerned with the looks and aesthetics, there are options out there that are more similar to crowns for adults. They’re more expensive. It’s gonna be for a tooth that’s gonna fall out. And this requires more time and cooperation for you and your child and for you to take off work to bring your child and, all the things that go with that. But there certainly are multiple options for crowns out there. It’s not just those caps.
Scott Webb: Yeah, time and cooperation for sure. And I sort of feel like the old fashioned looking and I’m sure they’ve improved and changed a lot over the years, but that classic sort of silver teeth look in your mouth, I feel like that’s a rite of passage. It’s sort of like a rite of childhood, you know? It’s like, yeah, it’s, you look in a kid’s mouth. Right. Exactly. I mean, I’m all for aesthetics, especially for adults, but for kids, the silver’s fine in my opinion. And certainly you are the expert.
Dr. Scott Balzer: It also might be that reminder to the child that, hey, this is what happens if you don’t take care of your teeth. So, you know, hey, I don’t want the of this happen to me again. So maybe that’s what it takes and it’s funny and a little story. When you treat kids, you use funny terms and words that you don’t use with adults, but for a little boy with a silver cap, you can kind of spin it and be like, that’s your Iron Man tooth. It kinda, you turn it into something fun for them and most kids have zero issues with it.
Scott Webb: Yeah, dentists do have a way of making things fun. I remember that with my kids, we were joking before we got started here, that for them it was really about cooperating long enough so that they could go through the toy bin or the toy chest on our way out. And the dentist, depending on what she did and how long they were there and how cooperative they were, then that would determine how many toys they were allowed to take.
And I sort of remember that whole experience and kind of miss that, you know, now that my kids are going to the adult dentist, so let’s talk about severe cavities in kids. And we’re gonna get to prevention later, but let’s assume that a child has a severe cavity. What are the options? Is it almost always gonna need to be pulled and extracted? And if so, what’s that extraction process like?
Dr. Scott Balzer: Severe cavities, basically the options that exist depend on one thing really – is after we get all these cavities out, and all the bacteria out of the tooth, how much of the tooth is left? If there’s a good, solid foundational tooth structure that remains, then, you know, let’s go ahead and see if we can put a crown on this thing. Now there are cavities that are so severe that by the time you get all that stuff out of there, you’re not left with anything to put a crown on top of. And so, kind of have no choice but to pull it. In addition to cavities, you talk about teeth, you know, that can become infected and get abscesses and swelling as accompanied with that.
Now, when something like that happens, there are other options other than just pulling things. We talk about root canals. You know how tough and how bad of a stigma root canals have with adult patients. Imagine trying to do it for a child. It is tough, but you can do it. There are ways to do it. It goes back to, hey, risk reward. How long is this tooth gonna be in the mouth? Is it actually worth trying to do a root canal? Should we just pull it instead? But there are multiple options out there. So just as a parent, I would just say, ask your dentist. They’d be happy to share with you their opinions and what’s out there. And at the end of the day, and at least how I practice is I’m here to guide you. I want to give you the choices that you have and let you know what I would do. But at the end of the day, it’s your decision. And autonomy is important in decision making.
Scott Webb: Yeah. And, it probably important that we talk about pain relief. Obviously kids different than adults. And so what sort of pain relief, medications might be available? Let’s talk about sedation in dentistry. Is it safe for children? I do remember doctor back in the day, I grew up in the seventies, so I remember gas and just sort of flying around the room and not feeling much pain and I’m just not familiar. What do you do for kids today and what’s safe and all that good stuff?
Dr. Scott Balzer: Yeah, that still exists. The nitrous oxide, the laughing gas that we talk about is a great, great adjunctive, makes you less anxious. It makes the child less anxious. And a lot of times especially now in dentistry, it is painless. Our local anesthetic are your lidocaine, or people typically say Novocaine, that’s not really used anymore. It’s typically lidocaine. But we use that and when the child’s numb, and then the pairing that with your nitrous oxide, your laughing gas, that’s just that one thing that distracts the child, makes them ultra relaxed and they kind of just don’t care what you do at that point. They’ll let you get in there and do the work that needs to be done. So that’s number one. And nitrous oxide is super, super safe. Most offices do offer that at this point.
If we wanna talk about steps up in terms of sedation, we have general anesthesia sedation, and that’s where your child is put to sleep in an operating room setting, and they’re being monitored by anesthesiologist and that is their job to make sure they’re comfortable and asleep. And then it’s the dentist’s job to do the work. So that option does exist. It’s more reserved for super, super extreme anxiety cases. And for those children who have so much work to get done and it would just take tons and tons of appointments. And it’s one of those places in the operating room where you kind of get it all done at once. It’s a one stop shop, get a good cleaning and get all the fillings that need to be taken care of, all the crowns. So that does exist.
Not everyone’s a great candidate for that. There are some things that would prevent you from being able to have sedation in an operating room setting. And, there are always risks with general anesthesia. So while I say it’s very safe and monitored, there are risks that go along with it and definitely should be talked about and in detail with your dentist before you go through with that option.
The one thing I think is important is that with children, we might err more on the side of using these sedation options and even some of the surgical general anesthesia options. Because as a child, if your first experience at the dentist is traumatic and miserable, because you had to go through whatever procedure it was that can really ruin people and scar people for their future dental appointments into adulthood. You’d be surprised the number of adults that I see they come to me and say, I hadn’t been to the dentist since I was 11 because I had such bad experience. And you don’t think about it at the time, but we want to see what we can do with kids without going on that next step sedation. But we do want to ensure they have a good experience. We’re not trying to make this an awful experience for a child to remember.
Scott Webb: Yeah, I mean, there are definitely some procedures that are just hard to look forward to no matter what goes on in the office, no matter how much you love your dentist, but we don’t want it to, as you say, we don’t want it to feel like torture, of course. Let’s talk about dental spacers for children. I’m not as familiar with those, so it’s good to have your expertise. How are they applied? How long do they stay in the mouth and so on?
Dr. Scott Balzer: Dental spacers are an appliance or are types of appliances that are placed inside of a child’s mouth. The majority of time used after a tooth has been pulled or teeth have been pulled. And th epurpose of them is to maintain adequate spacing in those missing tooth areas so that the teeth that are already there don’t start to move and crowd into that space because that space is eventually gonna be taken up by the adult teeth that come in there. And so, as you can imagine, if you take out a baby tooth two or three years before it’s actually supposed to come out of the mouth, the teeth next door can start to crowd into that space.
And then as these adult teeth kind of come up from your gums and fill that space, that’s when you get crowding or can get crowding. And sometimes it can actually lead to teeth being impacted and having to be surgically exposed and brought into the mouth with braces and things. So these spacers, they can remain in the child’s mouth as long as that space needs to be maintained. So as soon as those adult teeth start coming up into that place and they’re solid enough to keep those other teeth from drifting in that space maintainer has done its job and can come out.
It can actually keep your kids sometimes from having to get braces. You know, every parent would love that. Braces are so expensive and kids hate them. It’s not a guarantee, but they certainly can help in that.
Scott Webb: Yeah, it would potentially be another podcast. But along the lines of braces, and we’re talking about extracting teeth and crowns and all of that. If a child needs that kind of work when they’re younger and smaller, does that increase their potential need for orthodontics like braces or Invisalign later?
Dr. Scott Balzer: It can. Not always, but it can. That’s why these spacers can be very important for your child. Like I said, not always a guarantee that you’re gonna be able to avoid braces, but certainly it helps and it helps guide teeth into where they’re supposed to be erupting into. So, we get that question a lot too with parents. A tooth needs to be pulled and they say, oh, is that gonna affect the adult tooth is coming in? And I hate to be so, gray area about it. But also the answer is, does pulling a baby tooth early affect an adult tooth that’s supposed to be coming in? Most of the time, no. So that’s, it’s not a huge concern that I spend a whole lot of time with parents explaining. Certainly it can. We want to keep baby teeth in the mouth as long as we can and as long as they’re, they were naturally meant to be in there. But once again, if, something’s abscessed and there’s infection, it needs to come out, we kind of have to do what we have to do. It just goes back to that, importance of getting that spacer.
Scott Webb: Yeah. And I’m sure there’s a lot of factors when it comes to whether a child’s gonna need braces or not. I’m sure. Family history, genetics, there’s a lot of things going on there. This has been really educational. As we get wrapping up here, doctor, I wanna talk about that when we think about preventing, right, prevention. I’m sure brushing teeth would be high on the list and not having things smash your kid face if they can avoid that. But from an expert, what’s the best way to prevent children from needing that extensive dental work?
Dr. Scott Balzer: Yes. Everything you just said is entirely correct. There’s not much you can do about your child having a bicycle accident or a basketball accident, and those are awful in themselves. But the things that we can control, you’re right, is oral hygiene. And so brush twice a day floss. Avoid a high, high sugar diet. We talk about cavities and how you get cavities. It’s three things, right? So you need to have the plaque that builds up on your teeth from not brushing. In that plaque is bacteria. That bacteria then eats the sugars that you eat. So you eat something sugary, it stays in your mouth. Those bacteria feed on that sugar and. Those bacteria, as a byproduct, make acid. And that acid is what forms these cavities. So if we can eliminate all those factors, aka, the plaque on your teeth, so, brush your teeth, floss your teeth. Number two, limit the carbohydrates, the sugars that come into your mouth. And some of the bacteria that’s out there, it’s hard to avoid. In your mouth you have natural bacteria that’s helpful. But we just wanna avoid as much as that harmful stuff as we can. So seeing your dentist, making it a routine to go to the dentist and get your exams and enjoy the experience. And do your homework at home are all important ways to prevent your child from the extent of dental work.
Scott Webb: Yeah, that’s perfect. Well, you and I were talking before we got going here. It was saying this should be educational for listeners and hopefully you and I would have some fun along the way, and I feel like we did. Hope listeners enjoyed it. Yeah. So doctor, thanks so much for your time and your expertise and your compassion, and you stay well.
Dr. Scott Balzer: You You do the same. Thanks for having me.
Scott Webb: For more information and other podcasts just like this one, head on over to PrismaHealth.org/Flourish. This has been Flourish, a podcast brought to you by Prisma Health. I’m Scott Webb. Stay well.Read More
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