As a parent there is nothing quite as humbling as hearing that your child has four cavities, especially when this news comes at the end of an hour long toddler negotiation-turned-wrestling-match which has already left you disheveled, thirsty and questioning your parenting skills, as you speak with the female Doogie Howser of pediatric dentists. (If you don't get this reference, do yourself a big favor and look it up. You won't regret it.)
And that bad news is followed by the worse news that since your child is panicking over a basic cleaning and exam, there's no way to get her to sit still through X-rays. Without X-rays, there's no way to know if fillings are an option, but even if they were an option there's no way your child would sit through four fillings, so... there's really nothing to be done. Just look out for signs of infection in the gum and then those teeth will probably have to be pulled. All four of them. Her top four front teeth. And then she'll just be a jack-o-lantern for three or four years until the permanent teeth come in.
You might be wondering why I didn't take her to the dentist sooner or thoroughly brush her teeth twice a day. But it's not that simple.
We did everything "right" (or at least we didn't do anything obviously wrong) and my daughter still ended up with four cavities. She does not have a lot of juice or sweets. She never slept with a bottle. We took her to the dentist at the age my dentist told us to bring her—three.
As for brushing her teeth, well, we did the best we could. There were phases where "the best we could" meant gently holding our daughter's head between our knees as we got a couple good drive-bys with the toothbrush.
My biggest mistake was thinking that kid teeth are more resilient than adult teeth. I mean, toddlers have been fighting tooth brushing for centuries, and they're not all going around with gnarly teeth. But after a little research, I discovered that kids' teeth are in fact more susceptible to problems than permanent teeth.
And, yes, we tried it all. Different toothbrushes, different toothpastes, different songs to brush our teeth to, different places to brush our teeth (in the living room, on the bed, while riding the stuffed horse and brushing his teeth too). Some of it worked for a while, but some nights, if the toothbrush made even a second of contact with a tooth, we considered it a victory and called it a night.
If you are the parent of typical toddler, I need not explain myself, but if you aren't yet in that phase, or you're out of it and your brain has wiped itself of those memories to preserve your sanity, I feel I may need to take a moment to defend my child's reputation here. My daughter is a wonderful little human. If you met her, you'd like her a lot. She's smart, charming, funny, and gracious. And she is a toddler, which means sometimes she thinks that tedious things like sleeping, teeth brushing, and eating are barbaric torture techniques. So something like going to the dentist for the first time and having a stranger get inside her head with loud equipment and sharp objects, which actually is a form of torture, understandably elicits a panicked response.
And now we had to figure out what to do about four unusual cavities all along the gum line of her four front teeth. The usual cavities for kids appear on the back of the front teeth or in the molars (I learned this from the dentist). So there's no clear explanation for our predicament, but I've got to guide my daughter through this.
I call and make her an appointment with another pediatric dentist. No way am I trusting something this big to one doctor I just met (even if she was highly recommended and I liked her and it took her and her entire staff an hour of patience and moral support to get my kid in their chair).
Then I call our dental insurance and ask about getting a second opinion. They won't cover another exam, but they will pay for anything that the first dentist didn't do (X-rays, fluoride, etc.).
By a miracle, my daughter sits through a thorough cleaning, exam and X-rays at the second dentist's office. I don't know if she likes the vibe there better, or she does better because my husband takes her, or she got her nerves out at the first office, but for whatever reason she's a perfect patient through this visit. X-rays show no infection. This dentist thinks she can save all four teeth. Because my daughter was so calm and easy, this dentist also thinks she can do two fillings at a time using nitrous (laughing gas) on my three-year-old.
I get back on the phone with my dental insurance. They won't cover the nitrous but they will cover the fillings at a certain percent. I call the dental office to set up the appointment and then (this is important) I ask them to get pre-approval from our dental insurance.
Getting pre-approval is a trick I learned from prior experience. My husband's dental office told him a procedure would be about $200, and we ended up paying $600 because our insurance didn't cover as much as the office thought they would.
With pre-approval, your dentist's office submits their best estimate of the bill to the insurance company, and then the insurance company responds with the amount they will cover. This way you know, before the procedure, a very accurate estimate of what you will owe out of pocket.
Cut to two weeks later at the appointment for the fillings. It is a no go. I repeat, a complete and utter no go. It takes thirty minutes to calm my daughter down after we leave the dentist with zero work being done.
This means that general anesthesia is our only option. My heart sinks. I hate the idea, but eventually she'd have to be put under anyway to pull the teeth if we don't fix them now, so I schedule the appointment as soon as possible.
The anesthesiologist agrees to meet us bright and early in the morning at the dental office. He runs me through his procedure, the most important part being that he will use gas to put my daughter to sleep first so she isn't struggling through an IV insert.
He finishes by telling me that I will owe him $600 and did I have any questions. "Yes," I say. "Does insurance ever cover anesthesia?"
So then he tells me to check with my medical insurance. I think maybe I misunderstood.
"My medical or my dental insurance?" I ask.
"Medical," he says. And he gives me the code numbers so I can be specific when I talk to my medical insurance.
I call my medical insurance and the woman tells me to check with my pediatric dental insurance. "No," I say, "The anesthesiologist said to check with you." She puts me on hold for a minute and sure enough she comes back on the line to tell me that general anesthesia is covered by my medical insurance for certain dental procedures if the child is under age 7.
Apparently, under certain conditions, it is the law in many states that medical insurance has to cover general anesthesia for kids' dental work. The requirement differs from state to state, and your state's requirements may have changed since this map was made in 2012 (pre-ACA), but here's a map of which states require insurance companies to pay for pediatric general anesthesia.
Who knew? I wish no one had to know that because I wish no kid had to go through this, but we saved hundreds of dollars because I asked. The anesthesiologist did not offer up the information. He would have been very happy to take my $600 and not have to file any paperwork.
So Friday morning my girl and I arrive at the dentist's office at 6:30 am, she's amazingly brave and only begins to get upset when I set her in the chair. Luckily, the gas is quick and she's asleep thirty seconds after they put the mask on her.
At 7:45 she's waking up in my arms. The anesthesiologist informs me that it took longer than he expected and now I owe him $750. If insurance weren't covering a big chunk of it, this news would be upsetting, but most of it will be covered, and more importantly, I've got my little girl waking up in my lap.
Though the dentist couldn't tell me exactly why my daughter had these cavities in an unusual pattern, here are the things I am doing differently with my one-year-old in hopes of preventing anything like this.
As soon as he got his first tooth, we started brushing it. The dentist also said that a washcloth around the finger works to wipe down the teeth before bed.
He will be visiting the dentist before his second birthday.
I will teach him to spit and rinse as soon as possible after he turns two so he can start using fluoride toothpaste. (Let's hope he keeps the spitting to the sink.)
He brushes twice a day. It's so very much easier with him because he wants to do what his big sister is doing.
I lift his upper lip to brush his front teeth. You can't see the tops of my daughter's teeth when she smiles, which was the reason it took me so long to notice the problem.
We are on the look out for white spots on his teeth. White spots are the first signs of a problem.
The first thing my daughter mumbles as she wakes up post procedure is, "Is it done?" and she lifts her lip in a little groggy smile so that I can see her four beautiful top teeth.
"Yes, Sweetheart, it's done." And let's hope we never find ourselves here again.
Photo: Andrew Bardwell