On 12/31/2014 4:31 PM, Carrie Cohen wrote:
> Hi all, I have permission to post and would love your recommendations and thoughts.  Here is the scenario: the mother writes: "{baby} turned one in November and has cavities so bad on her top four teeth that the first dentist she saw said the only option was to pull them:( the second dentist is a little more hopeful but said if she were his kid he'd ween her immediately. What is your opinion about that? I really don't want to wean her right now but also don't want to have her teeth pulled."  She is working on night weaning currently.

Happy New Year to everyone!
Here is my take on the situation:
As a pediatrician who is doing the dental varnish applications as a part 
of the routine care I will recommend concentrating on two major factors:

- Possibility of the lip tie. Extremely common to cause decay of the TOP 
FRONT teeth because of the pockets to collect the milk there. See that a 
lot, especially it was very dramatic several years go, when I just 
started doing dental varnish. Going back in the chart and seeing some 
minor or not so minor problems with the breastfeeding as well was an eye 
opener for me.

- Caregivers with hx of dental caries. Caries is an infectious disease 
after all and mother's caries is one of the very strong predictors of 
the kid's problems.

Stopping night time feedings without addressing these two issues most 
probably would not solve the problem
Depending on the degree of caries teeth removal can be the only option 
as again, dental caries is the infectious disease and by trying to avoid 
the procedure one can potentially risk the destruction of all her baby's 
baby and permanent teeth.

While on the subject, I will also chime on the need for routine dental 
care for infants - routine dental care for the caregivers, starting to 
brush baby's teeth as soon as they do erupt, dental visit by the first 
birthday and assessment for the need for fluoride supplementation (if 
someone wants to flame about the last recommendation, please do it off 
list on my personal e-mail address).
Routine evaluation by pediatrician and/or dentist for the presence of so 
called "white spots" should alert parents to the presence of the problem 
way before the process will become irreversible.

Hope that helps,
Alla

-- 
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine

Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Education Initiative
NJ Chapter Breastfeeding Co-Coordinator, American Academy of Pediatrics
Satellite Symposia Sub-Committee Chair, Academy of Breastfeeding Medicine

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