Dentists gone wild!

Christina did not have a very pleasant experience with her child at a dentist. She posted: “We are questioning what we feel is some aggressive pushing of unnecessary procedures at pediatric dentists. Mainly, do preschoolers really need x-rays and extra fluoride at such a young age? I watched as a tech tried to jam huge x-rays wings into my then-2 year old’s tiny mouth, clearing hurting him until he started whimpering, and I said enough, and against her protests, made her stop. Then they insisted he had to have a fluoride treatment. Again, my instincts said no, he didn’t need that. (He does drink tap water.) My husband was horrified at what they tried to do, and insisted that not only is this kind of thing their money-maker, but that unnecessary x-raying and fluoride for a small child is downright dangerous. (I myself had too much fluoride given to me as a child, and have white spots on all of my front teeth as a result, and obviously don’t want my son to have the same thing happen to him.) To top it off, the dentist then told me that I must get him to stop sucking his thumb, his main comfort/calming habit. Besides being near impossible, I feel this ultimately needs to be his conscious decision. I am due for another apt. soon with my now 3 y.o. son and clearly, I want to do the right thing for his dental health. But sadly, I find myself feeling less than trusting of pediatric dentists, their higher-than-average costs and ‘mandatory’ procedures. What are your thoughts on what (and when) a healthy preschooler should have done at the dentist?”

I’m not a dentist—but I’d welcome any dentists out there to comment on this question. I can’t really say whether x-rays are definitely required at 2 years, but I’ll give you my two cents worth.

Keep this in mind: they’re baby teeth. Sure, you should try to keep them clean and healthy, but in the long run children’s overall relationship with dentists and dental hygiene is much more important than what procedure is done at what age. In other words, I would never want a dentist (or parent) to do things to baby teeth that are in the long run going to scare kids away from dentists and teeth cleaning forever. For example, I always tell parents to start brushing teeth at age one, but I tell them that they don’t have to do a “good job.” I want parents to start a healthy habit that’s fun and that kids will continue to do throughout their lives. If parents push and kids fight, it’s always best to back off rather than make teeth brushing a nightmare that will be long remembered.

Regarding fluoride, in the past cities were less exact about the amount of fluoride in drinking water, and some kids got too much—that does lead to teeth staining. We don’t see that much anymore. Whether a child needs extra fluoride treatments should probably be an individualized decision, based on questions like: Does he already have cavities? How well does he brush? Is there a family history of gum disease and cavities? Is he a mouth-breather? Is his enamel weak or cracked?

My opinion of thumb sucking: it’s not such a terrible thing, and it’s a way that many kids relax and work through their anxieties. It’s not like he’s smoking or drinking or gambling on dog fights. It’s true that it might cause or worsen his bite in a way that might need orthodontics later, but most kids end up in braces anyway. Besides, I’m not sure there is a good way to stop a two year old from sucking his thumb. I might be a softie on this issue, but I really don’t press parents to get concerned about thumb sucking in any way until at least kindergarten, when there are methods that might help stop the habit.

So: not being a pediatric dentist, I can’t comment on exactly what procedures are really necessary. Certainly, whatever is done should be done with the patient in mind first.

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