Concerns about decay treatment

My two-and-a-half-year-old son has baby bottle tooth decay. We have taken him to two dentists and have been unhappy with the results. The first dentist wanted to extract the four teeth and was unwilling to do any work to attempt to save the teeth. The second dentist wanted to put my son in the hospital under general anesthesia and perform two pulpotomies on each lateral tooth and drill and bond the two central teeth. We were concerned with the treatment and as we asked questions, we did not receive any answers. We are not willing to go forward with any treatment plan if our questions/fears are not addressed.

As parents, we want to do whatever treatment is best for our son, the least traumatic but also the least intrusive. My question is this. How do we find a dentist who is willing to answer our questions, address our fears and do what is best for our child? We would like to, at the very least, save our son's central teeth. These two are the least damaged.

Question:

It is definitely important to seek and follow through with treatment for these teeth as your son's permanent teeth will not erupt for several more years. If these teeth are left untreated, he will most likely have pain and/or infections, which could damage the permanent teeth developing underneath the primary teeth.

The extent of the treatment will depend upon the extent of decay in the teeth. If the decay has entered into the nerve chamber of the tooth, the only two choices are to extract the tooth or do a "baby root canal" (pulpotomy or pulpectomy). If you elect to save the teeth by having the pulpotomy done, some type of restoration will need to be placed. The type of restoration needed will depend mostly upon the amount of healthy tooth structure remaining after removal of the decay and the pulp tissue. If a fair amount of tooth structure remains, fillings might be possible; otherwise, stainless steel crowns may be necessary. Occasionally, the removal of the nerve tissue is not successful. If this is the case, or if the tooth is non-restorable due to extensive decay, extraction would be the only option. If the teeth need to be extracted, an appliance with artificial teeth can be placed for esthetics. This appliance will also serve as place holders for the permanent teeth.

Depending on the cooperation level of your son and given his age, you may want to consider some type of sedation or general anesthetic during treatment. In this way, it may be possible to complete it all at once, and your son will have little or no memory of treatment rendered. (The final placement of an appliance with attached teeth may have to be done later, but sedation may not be necessary for this phase of treatment.) Doing the treatment under general anesthetic may sound frightening to you, and it does carry some risks, but it may the easiest for your son in terms of tolerance of treatment and future anxiety regarding dental treatment. I have had some other questions about general anesthetic and they are posted here. Please, check the archive for more information regarding the use of general anesthetic.

If the dentists you have mentioned are general dentists, you might ask one or both for a referral to a pedodontist, or you might ask your general dentist for another referral, if he has not given you one already. If there is a dental school locally, especially one which has a post-graduate program in pedodontics, this would be an excellent source for the dental care of your son. If the school is not conveniently located, you could call the pedodontic department and ask for a recommendation. In addition, the local dental society may be a good resource for locating a pedodontist.

I agree with you -- your questions should be completely addressed so everyone understands the risks and benefits of the procedure deemed best to treat your son's condition.

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