My wife took our two youngest, a two and a half year old girl and a four year old boy, to the dentist for a dental exam. The dentist says that these children need extensive dental work - the youngest has some decay on her front teeth (it’s the kind that looks like a whiter-than-normal patch), and the boy has some cavities on his molars. The dentist wants to put caps on the 4 year old’s molars, and put a sealant over all the teeth on both of them. This will take two dental appointments and probably require general anaesthesia for both children. She also said more caps may be necessary for both of them.
I’m concerned that this is a lot of work to be done for teeth that are going to fall out in a few years, and I’ve heard that dentists love to do a lot of work on children on Medicaid because they are guaranteed to get paid. When I grew up, I don’t remember preschool age kids getting dental work done very often, but when I got older I noticed that the children of poorer families in my apartment complex often had a mouthful of metal. Is this really normal?
I always feel the capping of baby teeth for other than extreme problems is ridiculous. For parents that have money to burn, feel free to waste it, you’re not in the majority.
My brother had brownish black teeth from a medicine the doctor gave ma while pregnant. That was a rather important missing side effect not to be listed on the medication. I wish he could have had the teeth capped back then. One day he came home and used White Out on his teeth which was then noticed at the supper table.
Aren’t Medicaid payments usually lower than other insurance programs? He’s guaranteed to get paid, but I don’t see that as an incentive to do unnecessary work – not unless he’s a crappy dentist with no patients.
Around here, all dentists get paid. They won’t see you unless you have insurance or pay up front.
A former co-worker of mine said her dentist used to have her kids come in for checkups. He said he’d look around in there with the mirror, poke and clean a bit, but his real objective was to teach them that going to the dentist wasn’t awful. “These are just baby teeth so there’s nothing worth doing, like fillings etc.,” he told her, “but we can start them off with some positive experiences so that later they won’t avoid the chair.”
Thinking back on my first experience (many, many fillings), I thought her dentist was pretty smart. Why people would do anything more than her dentist with her kids, though, is a mystery to me.
Some insurance companies will only pay part of a treatment if it’s considered cosmetic, and require a lot of documentation to prove that it’s truly necessary. Sometimes they will deny a claim after the work has already been done and the parents are responsible for a part of the cost. My understanding is that Medicaid has a fixed schedule of what they’ll pay for what, they pay promptly and never deny claims on children’s dental work.
I’ve known lots of people with insurance from their work, and I don’t recall any of them having extensive dental work done on their preschool-aged children. The only people I’ve known to do that have been people on government assistance.
I’ve been doing some looking around with Google and I see that a lot of dentists have been accused of, and in some cases had criminal action taken against them, for unnecessary dental work done on young children on Medicaid. How do I find out what would be considered necessary?
For instance, the “decay” my youngest daughter has is a kind that looks like a brighter white on the upper surfaces of her teeth, and I’m reading that this is just the beginning of enamel erosion and can be stopped with careful brushing and regular flouride treatment, yet the dentist wants to put sealant over all her teeth.
The boy has cavities between two of his molars, and I’m seeing some people say that fillings should be done if it looks like the decay could cause the loss of the tooth well before the adult teeth come in, but the dentist wants to cap them and apply sealant to all the others, which do not have decay yet.
They’ve talked about general anaesthesia, which is scary enough, but I’m reading that a lot of these dentists will just strap the child onto a papoose-style board and work on them with just local anaesthesia while the child screams, and parents are not allowed in the room where the work is done. I don’t want to traumatize my kids if it’s not necessary.
The dental appointment is this Saturday, and I’m getting more and more nervous about this.
IAMADentist, but it could be several years before the affected teeth fall out. That means if they decay past a certain point, it could lead to infection and pain. And if they have to be removed prematurely, it could affect the spacing of permanent teeth. Still, putting sealants on baby teeth seems very odd to me.
Sealants are VERY common nowadays, and they were recommended for my son (who has pretty bad decay) and his best friend (who’s never had a cavity) at the same low-cost, city run dental clinic which doesn’t make a dime per patient - the dentist is paid hourly. She’d get paid whether she was doing a sealant, a filling or filing her nails. I don’t think it’s a Medicaid thing, I think it’s a “now more popular than ever” dental procedure.
I had Eastman Sealant put on back in the very late 60s, on my baby teeth and then again on my adult teeth in the 70s. It was sort of still experimental the first time - but other than the tooth I cracked falling off my bike, i didn’t have any cavities after the sealant went on. I didn’t have any cavities in my adult teeth until the sealant wore off. I would really REALLY recommend it.
I’m starting to think the sealant may not be that bad. I am worried that she wants to put my 31 month old under general anaesthesia for the process though - is that really necessary for applying sealant? I’m worried they may decide while they have her under to stick a few caps on as well, and I’ve heard too many horror stories about people who go under and never wake up.
Is it also normal to cap molars in a 4 year old? Why can’t they simply put in a filling?
I haven’t heard of sealants being used so much on baby teeth, though they’re standard on permanent teeth of course. Capping? That’s usually a cosmetic thing. Could he have meant crowns? I’ve got several of my molars crowned, as they were just too decayed to fix with fillings.
Baby teeth are often let go, as another poster said, unless they’re likely to be lost too early (that can impede adult teeth coming in properly).
My daughter did require a fair bit of dental work on her primary teeth - apparently hers were made of low-grade chalk rather than enamel and dentin, and she had at least 3 of them removed due to severe decay, and others had to be patched up.
It sounds like maybe you should see if you can find another dentist to do a look-see, if you can (I know it can be tough to find someone who takes Medicaid).
No dental expert here, but a mother of three children, the second of whom goes in for sealants in November (she will be six and a half, roughly the same age as when the first kid got her sealant). I’ve never heard of anesthesia for sealants–that seems crazy to me. The sealant substance gets painted on to the back molars (which AIUI stay in place until the late teen years, allowing for plenty of time for lots of potential decay and problems, which is why sealant is pretty standard on kids nowadays, as WhyNot said). It is painless and takes less time than a cleaning. Some dentists shine a light on the teeth that hardens the sealant super-quick. Ours didn’t do this, but the kid could still eat pretty much right away.
Is it possible that a dentist would use anesthesia in order to keep a young child still?? Surely there are less drastic measures to accomplish this!
She said she would try valium and nitrous oxide first, but she found that a lot of the time children that age would still wiggle and fight too much - it depends on how they react to the drugs. She said that she would try to do the work, but if she couldn’t, she’d refer her to a dentist who would use general anaesthesia (I got some clarification tonight from my wife when I got home - I thought they were going straight to general anaesthesia).
If it were me & my kids, I’d never go for capping of first teeth unless they were absolutely horrible. In fact, I’d not go for it if there were any alternative. It’s expensive and uncomfortable.
You do have to watch cavities, though, even in first teeth. Back when I was a child (when dinosaurs ruled the earth) dental insurance, let alone Medicaid, simply did not exist. You paid for it or you did without. My first molars started getting cavities. It was decided to let them go as they were certainly going to fall out within a year. Eventually ALL of that set of molars developed deep cavities, and abscesses. The abscesses had to be lanced, treated with antibiotics, and then when the infection subsided, the teeth had to be extracted. This happened with eight different teeth, one by one. Would have been FAR less expensive, not to mention painful, to have filled them.
You might ask the dentist, “What will happen if I don’t follow your recommendations? What is the likeliest outcome? The worst case?”
I would never permit my child to be treated by any doctor or dentist who would not permit me to be in the room if I wanted to. Ever.
I don’t know how Medicaid works for dental care. Is it possible for you to get a second opinion? It seems like a lot of work for such youngsters, and both kids at that. I would certainly be thinking about how well I knew the dentist and whether my kids were at higher risk for dental problems for some reason. If I didn’t have some reason to trust the dentist here, I’d certainly try to see someone else. That said, I don’t know if Medicaid would pay for it.
Small anecdote: Many years ago my mother’s dentist basically told her that all of her back teeth were messed up and needed fillings and all kinds of other work. He completed the work on one side of her mouth, and then life got in the way and she never went back to him. Some years later she told her subsequent her dentist about it. He told her there was nothing at all wrong with those teeth, and there never had been. It was pretty clear her old dentist was suggesting unnecessary work, and she probably went through a lot of unnecessary pain and expense.
Good luck with whatever you end up doing. I’m very sympathetic to any kind of dental issues. I hope your kids get the treatment they need, but only the treatment they need, and without much pain or trauma.
TBH… internet advice is all well and good, but for the sake of your children (and your wallet), go get a second opinion.
Not to say a single thing about your specific dentist, but dentists are people too, and have their own failings. My folks used to see a dentist back on Long Island, and without fail, my mom would always be told that she had a cavity or this or that, and it absolutely had to be dealt with then and then. Lo and behold, if she put it off, the next time she saw her dentist the X-rays wouldn’t show a thing, and he would have ‘forgotten’ about her needing anything done.
Later, after he was arrested, it turned out that he had a major cocaine habit he was funding.
After my entire life with ‘perfect teeth’ and nary a cavity, I went to a new place where my fiancee lives, and was told that I had not one, but two cavities in my molars. Of course, it would be several hundred dollars if I wanted to schedule an appointment, but I could get a discount if I had her do the procedure then and there.
Yep, went to a new dentist my family was using and, gee whiz, the X-rays showed my teeth had no problems, at all. Subsequent dental visits with different dentists have confirmed that fact.
All I’m saying is, if you speak to a specialist (doctor, dentist, car mechanic, whatever…) who tells you something that sets your bullshit detector pinging, well… it (generally) can’t hurt to wait a little and get a second opinion.
My little sister had extensive work done on her mouth when she was still quite young–that is, young enough to put herself to sleep with a bottle of juice. Unsurprisingly, that was a contributing factor. But the fact was, she was going to be stuck with those teeth for another 4-6 years, and that is a long, long time when you have bad teeth. The last time I went to the dentist was in 2000, and I’ve always had bad teeth. I lived with being unable to handle hot and cold food, being unable to chew hard things, being wary of nearly all candy or anything sweet. I can’t eat corn on the cob, chew steak, or do anything that’ll make my teeth do their actual job. I’ve lived with decay in almost every tooth, and a sort of constant ache (the dentist won’t even tell me how much work still needs to be done, but I’ve got 2 more appointments this month and probably 3 or 4 to go–on reread, it might sound like he’s scamming me. I trust him because I’m going through the university dental clinic, and also, I’ve seen my x-rays. They’re…not good. Oh and my mouth hurts like a bastard all the time). I did that to myself, because I’m an idiot. I almost let it all go too long, but I’m getting it fixed now, and I’ve realized something…it is totally freaking worth it. All of this expense is worth it for one normal day.
So, while I don’t disagree with getting a second opinion, please don’t just shrug it away with “they’re just baby teeth!” Sure, it’s not going to be a long term investment, and they get a second shot. But it is an investment in a general quality of life. Don’t put your kids at risk of going through that type of pain when it’s utterly out of their control. (Incidentally, my sister does not have ANY of the problems I have now. She just went to the dentist and got a clean bill of health).