Really Need Advice on Chipped Tooth on Toddler

[elbenn]

I posted a few weeks ago about a chipped front tooth on my toddler DS. I took him to the dentist and they did x-rays and the dentist said that the front tooth is very close to a nerve and we will either need to extract the tooth or to fill it with a resin type of cap. I am having a hard time deciding which one to do.

With the extraction, the dentist made it seem like it would be a little easier on DS because it is quick but then DS will not have a front tooth for years. I worry about if not having a front tooth for so long will cause problems with eating or speech.

With the resin cap, it is not so much a cap as a filler added to the tooth--similar to a filling. The dentist said that it could possibly chip and if so, we could extract if it did, but I think the cap would be fairly strong. With the cap, the dentist said we would need to do a "baby root canal" to test for nerve damage, which he said would take about 5 minutes. This procedure seems much more involved and DS is only 2 and because his tooth is so sensitive, he doesn't even want us to brush his teeth. But with this procedure, he would keep his tooth.

I really need to make a decision and get it fixed. I would really appreciate any advice on this matter.

[Katigre]

I would personally get a second opinion b/c both options sound rather extreme. Was the tooth cracked in half or just had a chip off of one side?

Some pediatric dentists are VERY intervention-happy. I had ours tell me that both of my DS's front teeth needed to be extracted b/c he had fallen as a toddler and they got knocked slightly out of position (color of the teeth is fine, they're not loose, and the fall happened 3+ years before the appointment). He told me that it could lead to an absess infection or the tooth root would dissolve which would cause problems with the permanent teeth. It was also going to be an $$ procedure and quite invasive to remove a child's two front teeth a good 3-4 years before their permanent ones would grow in.

I said "We're going to wait on this" and I checked with my regular dental assistant (who is on the low-intervention side of things) and she said she's never heard of such a thing and wouldn't do it to her own child.

It's been 18 month since that appointment and DS's front teeth are *still* fine - they're crooked but solid in his mouth and I have no plans to pull them. I'm glad I didn't listen to the dentist's advice.

(FYI - sometimes dentists recommend expensive invasive procedures that are unnecessary instead of the 'free' wait-and-see approach b/c of financial incentives - so keep that in mind).

[Katigre]

Post #2: I just went back and read your first thread. If the tooth has not turned grey and does not seem to cause your DS discomfort I would take a wait and see approach and just ask for it to be filed.

[wellyes]

In your shoes,mI'd endure the rough couple of hours from the procedure vs not having a front tooth for 4 years. Anyway how can having a whole tooth pulled be less painful/stressful than getting a cap?

I chipped a tooth as a grown up and got a resin 'filling', not doing so was never an option. Aren't dentist always reminding us to take good care of kid teeth -- just because they're baby teeth doesn't mean they are less important to treat than grown up teeth!

On the other hand, my brother had to have many of his teeth extracted as a toddler due to a medication reaction, and that had no long term effect that I can see. No childhood eating/speech issues. So if it must be pulled, I would not worry too much.

[fedoragirl]

I would get a second opinion. Something similar happened to DD recently although she didn't chip her tooth but the dentists (we got two opinions) were very low intervention and didn't even do x-rays because they don't think that's beneficial before age 4 or so. They did a thorough checkup and everything was fine.
I now view dentists as car mechanics. They tell you a host of problems that need to be fixed and you have no idea whether they're telling you the truth or not. I almost always get a second opinion if it's invasive or $$ or both. I really like my current dentist and hope he stays in the area for a while. He is honest but won't sell me a house.

[elbenn]

The dentist first took an x-ray and said the chip was pretty bad but the nerve was not exposed so we might not need to do anything and to come back in a few weeks and do another x-ray. The dentist is fine with just doing a wait and see with no need to do anything unless the tooth is bothering DS. The tooth is very sensitive and is bothering DS. He won't eat apples unless they are cut (he used to bite into a whole apple) and he cries when we brush his teeth. However, other than that, it doesn't seem to affect him much. As soon as we're done brushing his teeth, he immediately stops crying. It's just that when we brush his teeth and he cries and protests that it hurts, it makes me think we need to get it fixed.

ETA: My older DS chipped his front tooth when he was a toddler and we didn't even take him to a dentist. It was not a big chip and never caused him any discomfort. It's because this chip has made his tooth very sensitive that I think we need to get it fixed. This dentist doesn't seem overly interventionist. He just gave us the options for fixing it if it continues to bother DS.

[Kymberley]

See Smilequeen's post.

[smilequeen]

Personally, if saving the tooth is an option, as a parent I would opt for that. You just have to know that it's still possible that after trauma the tooth could abscess and still need to come out earlier. But the longer it stays in the better IMO. As a dentist sometimes I have to extract as there are parents who would not choose to spend money saving a baby tooth and sometimes the chances are not great for saving a tooth.

It sounds like he is having discomfort and you are not in a wait and see situation.

And FWIW, it seems quite popular here to make out dentists as money hungry, intervention happy, apparently on par with car mechanics instead of the healthcare professionals with years of education that we really are. And if you get a second opinion that's always great, but the person who goes for the lower intervention, wait and see approach is sometimes the one who is wrong too...The vast majority of us are actually, believe it or not, looking to do the right thing for our patients.

[indigo99]

I had some VERY negative dentist experiences as a child (one of them should have been reported but my mom was young and didn't know what to do), and I love my dentist now. I think that you really do have to shop around just like with many other things to find a good one, but there are some that are really great and wouldn't ever recommend something more expensive or difficult than necessary.

I agree to get a second opinion on this but would probably go ahead and do something about it since he is in pain. I still remember having teeth pulled as a child (and actually have nightmares still) so that is something I'd try to avoid if possible.

[Kymberley]

Originally Posted by smilequeen

Personally, if saving the tooth is an option, as a parent I would opt for that. You just have to know that it's still possible that after trauma the tooth could abscess and still need to come out earlier. But the longer it stays in the better IMO. As a dentist sometimes I have to extract as there are parents who would not choose to spend money saving a baby tooth and sometimes the chances are not great for saving a tooth.

It sounds like he is having discomfort and you are not in a wait and see situation.

And FWIW, it seems quite popular here to make out dentists as money hungry, intervention happy, apparently on par with car mechanics instead of the healthcare professionals with years of education that we really are. And if you get a second opinion that's always great, but the person who goes for the lower intervention, wait and see approach is sometimes the one who is wrong too...The vast majority of us are actually, believe it or not, looking to do the right thing for our patients.

And I'm going to delete my previous statement and agree with you completely.