Tuesday, December 27, 2011

Wren's Teeth

This morning Wren had his first crown.  It is silver and he is quite proud of it.  Joshua said "you are now a cyborg because you have a metal tooth"

While we were scooting Wren asked:  "Mom, is my tooth made of metal?"

I replied that it was made of surgical steel.

"It IS made of metal Dad!" he said gleefully. 

"I have a metal tooth!"

Enthusiasm aside, Wren is just five years old so its very unfortunate that it came to this and you are probably thinking is this dentist on crack?

She is not.  She is a really most excellent and kind dentist.  When we first started attending her practice five years ago we could only get an appointment for preschoolers because she was so highly regarded and fully booked during school hours.  Years later we have caused her to come in twice on holidays to deal with Wren's dental issues.  So, she is nice and skilled but we are rather weary of seeing even the most lovely dentist.

So, how did we come to this?

Kids with heart defects have to be careful with dental care and hygiene.  You may have heard the urban myth about human bites being the most infectious?  It is most likely untrue but while being less toxic than a dog's bite, a human mouth has plenty of thriving bacteria.   People with various heart conditions are at higher risk of getting bacterial endocarditis from bacteria in the bloodstream, released during dental procedures.   As a result, Wren's must get more aggressive dental treatment and take amoxicillan at every appointment.  Yes, I know that's an antibiotic by the way. 

Because we live in the progressively anti-antibiotic environment of naturopathic Seattle, I am going to give you the longer answer about dental care so you don't blanch when I mention Wren has had antibiotics 8 or 9 times in the past 4 months, that's with every filling.  But wait, I am getting ahead of myself.

"Certain heart conditions and structural defects increase the risk of developing endocarditis (heart valve infection) following dental procedures. Bacterial Endocarditis means infection in the heart, specifically the heart valves (bacteria = germs; endo = inside; carditis = heart inflammation). It occurs when bacteria spread through the bloodstream and land inside the heart and grow there. Usually, if there are bacteria circulating in the bloodstream, they don't stick to the inside of the heart: the blood flows smoothly. If the heart is abnormal due to certain types of surgery or other defects, there may be rough surfaces causing turbulent blood flow (known as a murmur) to which bacteria can attach and cause infection. Antibiotics are used to try to prevent this dangerous infection in some cases. The decision whether to take antibiotics depends on two major factors: first, is the procedure likely to cause a significant number of bacteria to enter the bloodstream; and second, is the heart particularly subject to infection."


Wren required 5 fillings when he had his first dentist visit.  We don't know why he had so many cavities.  He and Frost eat a similar diet but Frost has had only one filling by age 10.  These things are sent to try us, I suspect.

Unfortunately, for reasons not fully understood, some of Wren's fillings in the lower molars keep falling out, cracking and coming loose.  Since October, we have been to the dentist for a cavity replacement every second week - for one of two fillings.  Finally, when the right cavity fell out for (what feels like and may well be) the 5th time, we decided to try something else.  Wren has been doing very well with the new fillings, the doctor does them quickly with a dental dam or cotton rolls, but he grinds his teeth at night and for that or some other reason, they are not remaining in.

The new plan is to crown all the teeth that have recurrent filling loss.

Today, for the first crown, it took about an hour for the whole appointment and the worst part was getting on the "tooth raincoat" or dental dam to keep the tooth dry.  Wren has a strong gag reflex and so dental work causes him to panic when his open mouth causes him to retch.  Coupled with some drama and discomfit from the analgesic shot, he was very sad and stricken.

Sadly, a third filling which had not been replaced to date had looked odd to me the night before.  I asked the dentist to look at that too and she said it has also cracked.  She gave me the option of a crown next week or another temporary, done today.  I picked the temporary as it may give us a few weeks of wear and allow Wren to do some forgetting of the trauma before the next crown.  One down, two to go.

He watched two episodes of MAD TV on the iPad and I had a core workout to balance on the dentist's chair and hold the iPad above him while not getting in the way of the dentist and her assistant.   At the end of it, Wren was sad and needed a smoothy so Josh went to Whole Foods for one.

Peanut Butter Moo'd and Minecraft helped during the recovery and he is now a happy cyborg.  Till next time.


Anonymous said...

I am sad to hear he has to go through this:( the dentist is no fun. he is very lucky to have a mommy like you who stands strong by his side. good idea with the ipad-kindra-

Wendy said...

I'm glad that you have a fantastic dentist that understands the importance of being pro-active with heart kids and their teeth. We had to switch dentists to one that wasn't going to argue with me over the need for prophylactic antibiotics each visit. And that gag reflex is familiar around here too....glad the little cyborg is feeling better and those crowns will give you peace of mind that his heart will be protected.

Shannon said...

Thanks Kindra. We loved the gifts by the way - the magic boosters are wonderful, they really enjoy them. I hope we don't see the dentist again soon.

Shannon said...

I am sorry you had dentist issues. I think that new advisory that antibiotics are not required for all heart patients made some dentists overreact and deny the meds to patients who need them. Our dentist instituted special checks in her office because they often forgot to check that Wren had taken his pre-med. I mentioned it to her and we are now asked at the front desk, by the assistant and the dentist to make sure it was administered an hour before! I was so impressed. However, my little chap is going to look dramatic with 4 silver molars before long.