Updated May 3, 2019: As a parent there is nothing as humbling as hearing your child has four cavities, especially when this news comes at the end of an hour-long negotiation-turned-wrestling-match with your toddler that leaves you disheveled, thirsty and questioning your parenting skill.
That bad news is followed by the worse news: 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. 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 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. 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: 3. (Meet the teen CEO of a cavity-fighting candy company.)
As for brushing her teeth, 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 of good drive-bys with the toothbrush.
My biggest mistake was thinking kid teeth are more resilient than adult teeth. Toddlers have been fighting toothbrushing 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.
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 need to defend my child's reputation. 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 tedious things like sleeping, toothbrushing and eating are barbaric torture techniques. So 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 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). There's no clear explanation for our predicament, but I've got to guide my daughter through it.
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.
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 the first dentist didn't do like X-rays or fluoride.
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 3-year-old.
I get back on the phone with my dental insurance. They won't cover the nitrous but they will cover a percentage of the fillings. I call the dental office to set up the appointment and then — this is important — I ask them to get preapproval from our dental insurance.
Getting preapproval 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 preapproval, your dentist's office submits their best estimate of the bill to the insurance company. The insurance company responds with the amount they will cover. This way, before the procedure, you have 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. It takes 30 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 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 early in the morning at the dental office. He runs me through his procedure. The most important part is that he will use gas to put my daughter to sleep first so she doesn't struggle through an IV insert.
He finishes by telling me that I will owe him $600 and asking if I had questions.
"Yes," I say. "Does insurance ever cover anesthesia?"
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. 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.
Many states require medical plans to cover anesthesia for dental treatment for young and special needs patients, according to the American Academy of Pediatric Dentists. The requirements differ from state to state. Check the AAPD website for details.
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.
Friday morning my girl and I arrive at the dentist's office at 6:30 a.m. 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 30 seconds after they put the mask on her.
At 7:45 she's waking up in my arms. The anesthesiologist informs me 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 is what I am doing differently with my 1-year-old to prevent this from happening again:
As soon as he got his first tooth, we started brushing it. The dentist also said 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 2 so he can start using fluoride toothpaste. (Let's hope he keeps the spitting to the sink.)
He brushes twice a day. It's 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 why it took me so long to notice the problem.
We are on the lookout for white spots on his teeth. White spots are the first signs of tooth decay.
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Image: Saptak Ganguly