Oral Health
Question: My daughter has not been a fan of going to the dentist, and it is now coming back to bite her. She has a toothache and did let me take her to the dentist. It is the result of a cavity where the decay has reached the nerve. It sounds like the options are: 1) have a root canal and likely a crown 2) have the tooth pulled and get a bridge with a fake tooth 3) have the tooth pulled and get an implant. The issue is that my daughter can barely tolerate a regular dentist visit. I am not sure that she could tolerate a root canal, unless they can give her general anesthesia. I assume an oral surgeon would give her general anesthesia, which would make that easier. But I am not sure whether she could handle having an implant for the same reason. I would appreciate any insight from one of the CdLS dentists.
Answer: I am a pediatric dentist. I have been blessed to be affiliated with CdLS for many years. Your daughter’s story related to her oral health status is a common one for our children and adults who have been diagnosed with CdLS. Oral hygiene practices at home and in the dental office can pose many challenges. Having mouth discomfort caused by a cavity is not unexpected. The treatment options presented to you are all appropriate. All of them do, however, require a very comfortable and cooperative patient. Any one of the three would need to be your daughter being sedated or under general anesthesia. The objective is always to do what one can to preserve the tooth. If there is enough of the tooth to do a root canal and place a crown on it, that would, in my opinion, be the best choice. If the tooth cannot be restored or saved, other options would be considered. Extraction of the tooth would take place, followed by either a bridge or an implant. The implant is a much more invasive treatment and would involve multiple encounters. The implant itself would demand excellent oral hygiene practices at home to maintain its healthy state. Not having photos of the X-rays and not knowing exactly which tooth is involved makes it difficult to guide you on which option is ideal for this specific case. If extraction is the only possible choice, after your dentist assesses the situation and sees that restoring it would be impossible, then it depends upon where the tooth is in the mouth (front—sides or way in the back of the mouth) There are esthetic considerations to take into consideration if the tooth is in the front or near the front along the side. If the tooth involved is the last tooth in the upper or lower jaw, there would not be an esthetic concern, and the loss of one tooth back there will not diminish Rebecca’s ability to chew her food adequately, and thus it might not be too important to replace the teeth.
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