Last night I received an email, and this was part of the message:

>>I read one of the articles on your blog about teeth brushing, or lack thereof of doing it frequently.  I was very thrilled by this, as I am so bad at getting them to brush.<<

I don’t want people to think that not brushing kids teeth is recommended, and in the absence of an exellent diet and regular check-ups, issues are likely to crop up.  Let me update you on my own very recent experience.

For the last three weeks, I’ve been taking different kids to the dentist to get everyone checked before we go to Israel.  I figured that there would be more than enough things to do close to our moving date this summer, so I’m trying to do as much as I can in advance.  I am SO glad that I did this. Because our dental situation is a disaster and it would have been impossible to fit in all the appointments in the last few weeks. 

First I took ds12, who broke a front tooth when playing last year.  We had it repaired, and when playing (with the same friend) several months ago, he broke it again.  We got it taken care of again, but were told that the root had been badly damaged.  So I started off this recent round of dental visits with dd12 getting a root canal.  And he has three cavities.  Since our kids have hardly ever had cavities, this shocked me.  We’ve gotten the cavities on one side of his mouth taken care of, so I have just one more appointment for him until he’s finished (4 appointments total).  

Then I took ds8.  Nine cavities.  No, that’s not a typo.  Two appointments left for him.  Oh, and he needs palette expansion (which wasn’t a surprise), but after a trip to the orthodontist, I was told I should wait until moving to Israel to begin that.   Then dd16 (who brushes and flosses regularly) – 3 cavities and a broken tooth.  Oh, and she needs to have her wisdom teeth removed.  I juggled around the appointments I had already scheduled for the younger kids to fit her in before she leaves, since there were no open slots before her departure date.  So she had two visits her first day home (fun, fun!), and one more this week.  Then ds5 – thank G-d, two teeny tiny dark spots that I’d usually just keep an eye on and wait for them to fall out, but because of the upcoming move I want to get them taken care of.  Ds17 – can’t remember the details, but I do know that I scheduled one follow-up for him. 

And lastly (not all the kids had appointments yet) is ds3.  I could see there was some decay between his two front teeth. His teeth are very closely spaced and food gets stuck there. But I really didn’t expect anything more.  Oh boy. The dentist took a look in his mouth, then looked at me and said, “He’s got a lot going on in there for such a young child. At least four cavities.”  He recommended taking him to a pediatric dentist where they practice sedation dentistry.  So I took him to a pediatric dentist.  (Did I mention that all of these appointments were taking place in the two weeks immediately prior to Pesach?)

The pediatric dentist took xrays and before telling me the results, asked me a series of questions like these:  Does he drink juice?  No, only water.  Does he drink milk before bed?  No, only for breakfast.  Did he ever use a bottle at night?  No, he never had a bottle at all.  Does he eat a lot of sugary foods?  Aside from some snacks (from older sibling), I don’t use sugar and minimize other sweeteners.  When she finished, she  told me that he has 15 cavities in his 20 teeth.  Since his eating and brushing habits are just like ds5, this was hard for me to understand.  She attributed it to his teeth being so close together – the cavities are almost all between his teeth, not on the surface, and even if I had been more regular about brushing, it wouldn’t have helped; flossing would have made the difference.  She also said some children have bacteria in their mouths that are different than other children, and this can be a big contributing factor as well.

She explained that it will take 6 visits to take care of this , and told me what was involved in sedation dentistry.  Basically that it doesn’t always take, sometimes it partially takes, and sometimes it fully takes – but there’s no way to know.  (It made me think of an epidural.)  And so she recommended that because of his age and the amount of work he needs done, the likelihood of trauma is high, so it might be better to have it taken care of under general anesthesia at the hospital.  After weighing the pros and cons, we decided to go with this suggestion.  I have an appointment scheduled for him in June, with a pre-op physical scheduled at his pediatrician a few weeks before that.   (Lately I have been on the phone a LOT making appointments!)  Update just a few hours after writing this: I just learned that our insurance company refused coverage for ds3’s dental work.  I can’t tell from the wording of the letter if they’re refusing the hospital part or something else, so now I need to do some more research and decide what the best options from this point on will be.  We might end up doing the sedation option after all.

Though I continually have felt grateful for our dental insurance that minimizes the cost in dollars of all of this to us, I was really struggling with feeling guilty. Guilty, irresponsible, inadequate -I felt embarrassed for my children to have cavities like this, and along with that was the guilt that I know so much about diet and how it relates to dental health, that I should have done all the things I know are important to do.  You know how a mother’s brain has a hard time shutting off once the guilt button gets pushed?  That was me.  My consolation was that our dentist sent us to the same pediatric dentist that he sends his children to.  😛  It reminded me that all parents do their best, and regardless of their knowledge or convictions, sometimes things fall through the cracks. 

Practically speaking, after so many kids and so many years of very few cavities, what do I attribute this big change to?  A few things.  1) This year I really haven’t been as on top of our diet as I usually am.  This wouldn’t matter as much (since our not so great diet is still pretty good) if not for one older child who regularly started bringing home snacks and treats to share with younger siblings.  As a result, snacking has become much less controlled and more frequent.  You can’t compensate for this with a decent diet alone.

2) This dentist is new to us, and because his approach is more aggressive than our past dentist, I suspect that he may define cavities more stringently than she did.  Whether that’s the case or not, there definitely are issues that we need to address, so I’m not complaining or pointing fingers.  Just saying that I wonder if we’d have been told there are as many as there are. 

3) A very big factor, I think, is that it’s been over 2 years since I took the kids to the dentist, since our beloved dentist stopped accepting our insurance, and I procrastinated about finding someone to replace her.  If we were doing our checkups every six months, we would have found signs of decay when it was beginning, and for most of the kids (not ds3), it wouldn’t have reached this point. 

4) Lastly, I think brushing your teeth is valuable even if you have a good diet, but definitely if you have a lousy or even so-so diet (taking into account the added snacks the kids were given, it would downgrade our diet to so-so).  I don’t think brushing will prevent cavities if you structurally weaken them with a lousy diet (dd16 attributes her cavities to the junk she was eating at the beginning of the year when she first was away), but I definitely think it’s a good thing to do.  So please don’t stop brushing your childrens’ teeth because of me!

Avivah