My Toddler’s Cavities | our Silver Diamine Fluoride and Surgery experience
May 28, 2018
Cavities. There is so much conflicting information out there about what causes them, what prevents them, how to treat them and even if they can be stopped or reversed. I’m going to share my son’s journey, including his experience with Silver Diamine Fluoride treatment. Hopefully this can help or comfort someone going through the same thing.
How it began
Both of my younger children have had very bad dental caries in their baby teeth. Robert, my youngest, had his first tooth break through around 7 months old. At the time, he was still nursing (he nursed until 2 years 11 months old) and was not on many solids. Here are some details:
- I was on antibiotics while pregnant with him, there are some studies which link prenatal antibiotic use with enamel deficiencies
- I did take Prenatal Vitamins almost daily, perhaps I missed a handful of days
- Garden of Life Raw Prenatal Vitamins
- I had no restrictions on my diet. I haven’t drank (is that a word?) straight cow’s milk since my middle daughter was born, however, I made up for it by eating tons of cheese and other dairy.
- I drank quite a bit of tea during my last two trimesters of pregnancy, it was Stinging Nettle, Red Raspberry Leaf & Peppermint blend (sweetened with honey). Said to tone the uterus and ease labor. *[I did not drink this tea during my daughter’s pregnancy]
- No other medications or supplements were consumed during this time.
- Several routine Ultrasounds and one optional/routine 4D Ultrasound were performed during this pregnancy.
- Robert was born naturally, no medications or interventions, underwater at a birthing center.
- He was full-term, completely healthy.
- Other than Vitamin K he is 100% unvaccinated and in compliance with our family doctor.
- We didn’t introduce solids completely until 12m although he had nibbles after 6m.
- He would eat sugary snacks and drink juice, etc when his older siblings had it. I tried my best, but it’s difficult when not everyone is on the same page.
- We didn’t use fluoride toothpaste until he could effectively spit out – per the dentist’s recommendations.
- At 12m. old he did not have any signs of dental caries (cavities)
- Some time between 12-18m. he developed significant and quickly progressing decay in almost exclusively his top teeth.
What were our options here? Our daughter, who had significant early decay as well, ended up having her teeth fixed under GA. We tried several things to “heal” them (for a short period) and nothing seemed to work. We also put her through some traumatic dental office visits where we held her down as a dentist attempted to drill & fill her cavities. It’s not an easy thing to have your little one put under anesthesia, but our options were exhausted. I felt completely defeated because 1: this already happened to our daughter, and now our next child was going through the very same ordeal, and 2: everyone seemed to be blaming me, stating that breastfeeding was the ultimate cause. I considered radically changing my diet since I was still nursing him, cutting out all carbs/sugars and basically following the Weston A. Price diet protocol for myself and my son, but honestly I couldn’t handle the extra stress at the time, nothing we tried previously for my daughter had helped, and I didn’t even know where to start – so as quickly as I considered it, I dismissed the thought.
A friend of mine mentioned that her son (a few months older than Robert) had very early dental caries. She, too, was breastfeeding, and also was on antibiotics during pregnancy, similar history. Although his weren’t as significant or fast moving, she wanted to stop them in their tracks. She told me about a semi-local dentist that used a fairly new treatment called Silver Diamine Fluoride (will be referred to as SDF from here). SDF will basically arrest the decay. Her son’s caries were limited to a few of his top front teeth, and only near the gumline. The black staining was minimal at best, and this seemed like an answered prayer. I did some quick research on the safety and effectiveness of SDF, then proceeded to call the dentist she recommended and got an appointment immediately.
Application of Silver Diamine Fluoride
I like to explain things to my children, so that they know what to expect in various situations. So, I had been reminding my son for the weeks leading up to the SDF application that we were going to see a doctor to look at his teeth instead of his body. He was slightly apprehensive, but didn’t start to cry until we were in the room with the dentist. He had to straddle me and lay his head back onto the dentist’s lap. This was scary for him because it was a new experience and with someone he’d never met before.
He was slightly over 1.5 years old at the time he got his first application. The dentist explained that it would indeed turn any active decay black, and could also temporarily stain lips, gums and surrounding teeth if it came in contact with them. He wiped Vaseline around his lips and gums, took the tiniest little brush I’d ever seen, and went to work. First he dried the area very well with gauze. Then he applied a very minuscule amount of SDF to any area where he saw decay. The application process was simple, and I’m sure painless in every sense of the word – unless you’re a 1.5 year old who thinks they’re being tortured unnecessarily. From my understanding it may not taste that great, but I think most of the crying and screaming was due to fear.
After the application, he got a prize (surely not for being quiet) and the dentist told me he was very strong. The whole time he was resisting, trying to move our hands and wiggle free – my child does have some serious strength. I was told we’d need to return in about 6 weeks for a second application, which we did. We were told that this should hold things off, but there was no guarantee they’d stay this way for years until he lost his baby teeth. Things definitely slowed down at this point, and I have no doubt that if we had not gone with the SDF treatment, he’d have either lost some of his teeth completely, gotten an infection or needed surgery much sooner than he did. *I do want to note that although the decay slowed down immensely, his front teeth started to chip off in very small bits randomly. This was likely from the weakened enamel, and perhaps the [now] very slow progression of decay.
He ended up needing one more application. This was about 9 months later, because the decay had either spread or started in new areas. He now had a bit more on his upper back teeth, and a few small ones were starting on the bottom.
Appearance with Silver Diamine Fluoride
Again, in the interest of being very open and communicative with my children, I explained to Robert that he was going to need to have his teeth fixed. He did better with the consult than he did with the SDF applications, but he still wasn’t happy or compliant. As the day for surgery approached, he kept reminding me that, “he didn’t need them fixed. he liked his black teeth.” Our appointment was at 8am in the morning, one of the first. He wasn’t able to have any food or drinks, not even breastmilk or water the night before, after midnight. At this point he was 2 years and 11 months old, so he was obviously fine without nursing (had been for quite some time) but used it for comfort and usually falling asleep. In the weeks leading up to the surgery I slowly weaned him away from nursing. First, during the day I’d put him off and tell him he could nurse later before bed. Once he was completely off of days, he’d ask to nurse at night and I’d tell him “OK 20 seconds and that’s it.” He would agree and count along with me (by pointing his finger or nodding his head a bit. I think this was a very helpful strategy for weaning him fairly quickly, as this was one of my biggest concerns. He was always such a “booby baby”. The night before surgery I let him nurse a bit around 11:30 (we went to bed late so he’d sleep through the night), then we did the 20 seconds, and he fell asleep.
This is a big one, because as parents we obviously don’t want our child being picked on or ridiculed over their looks (or anything else they can’t control). SDF is very evident, especially when on the teeth front and center, which Robert’s was. I got tons of questions and comments such as “Why are his teeth black?” “Is that all decay?” “How did you let them get this bad?” “That’s a shame, he’s such a handsome boy.” And I totally get it. Prior to this experience, we had no idea SDF even existed. Had I saw someone with black teeth, especially a toddler, I’d have wondered myself (although, I’d likely have kept my opinions to myself.) I answered the questions gracefully, all the while hoping that my son didn’t pick up on them. I didn’t want him to feel self conscious. When he was around 2.5 and we’d pick up his sister from school, a lot of the little kids would wave to Robert or speak to him. Of course, naturally they’d also question him, “Why are your teeth black?” Kids (and adults sometimes) can be so [unintentionally] cruel. This confirmed what I already knew in the back of my mind: he’s going to need to get his teeth fixed under anesthesia. While I’m not a fan of general anesthesia, I didn’t want him growing up with poor self-esteem because of his teeth. Infection was also a concern since the decay was slowly spreading and teeth were chipping.
That morning, I carried him to the car half asleep, and he slept until we got to the surgical center. It was almost an hour ride. When we arrived, he woke up and didn’t talk much once we got inside. We didn’t remind him what we were doing, but when he asked we said “you’re going to see your dentist today again” We also explained that he’d get to drink a really yummy little juice and take a fun wagon ride. This was what my daughter did, and we knew the process would be the same. First we had to pay the out of pocket fee of $400 for the surgical center. Our insurance covered the surgery fee which was around $8,000, but the surgical center fee was on us. We filled out some paperwork and had a seat to wait. We didn’t wait long before we were called back to a small room where they gave us all matching wrist bands for identification.
A nurse came in first and asked Robert if he wanted to wear a gown with cute little characters on it, he declined politely. This was going to be fun! She said we could wait, and returned shortly after with the syringe of silly juice. My daughter’s was in a tiny cup, but I’m glad his was in a syringe because I’m not sure he’d have willingly drank it all. He took it quickly and she asked if we had any questions. I explained to her (and the original receptionist, the next nurse, the anesthesiologist AND the dentist) that our major request was to be called back as soon as he was out of surgery. We wanted to be in there before he woke up so he wasn’t afraid. My daughter woke up before we were called back and she cried for about 30 minutes, this was very hard for me to watch as I felt so bad that she woke up afraid around a bunch of strangers. They all agreed to try and do their best to get us back there ASAP.
After we spoke with everyone, we attempted to get Robert’s gown on again. He was just starting to get loopy so he was a little more compliant at this point and my husband was able to redress him fairly easily. He started to get silly and say random things we had no idea what he was talking about. It made me happy that he wasn’t nervous and to know that when he went in the back with the nurses shortly he wouldn’t be alarmed. My anxiety tends to bring up worst case / what if scenarios and I kept imagining in my head them wheeling him in the back, afraid of all the strangers, and them trying to set up the oxygen mask and IV with him still awake and afraid. Seeing him very relaxed definitely relaxed me and eased my mind about a lot of my concerns.
Shortly after, they came in with the little red wagon lined with pillows, and my husband transferred Robert into it from the lounge he was sitting (slumping) in. He laid there very peacefully, not seeming to have a care in the world as they rolled him away (and I reminded them – yet again – about calling us back before he woke after surgery!)
We sat in the waiting room about 80 minutes for what we were told was a 90 minute procedure. It felt like 3 hours to me. I read my bible and wrote in my prayer journal while we waited. This was definitely my comfort and strength. I felt complete peace the entire time, regardless of how long it seemed. The dentist came out and told us everything went amazing, but all I could blurt out was “Is he awake?!” hoping he wasn’t crying for me. It must have slipped his mind (he’s a busy dude, and does an amazing job, so completely understandable), and he immediately said “follow me!” When we got back there he was indeed still asleep, but had quite literally just come out of surgery. He still was all connected up to the tubes and IV/mask, and the nurse said sternly that we couldn’t be back there, told us to step out and scolded the dentist a bit for rushing us back.
I was a bit upset with her until she came to get us a few minutes later, she explained why and it made complete sense. They don’t want the parents to see their child still under anesthesia, limp and hooked up to tubes/wires. It can be quite a scary sight. Also, they are focusing on reversing the anesthesia medicine and unhooking everything, so it’s also a distraction for them. Honestly, who wants medical staff distracted while they are working on your dear child? She apologized with her explanation and I assured her it wasn’t necessary. She told me all children wake up differently, and just because my daughter woke up immediately out of surgery, some sleep for a good hour or so afterwards!
Robert ended up sleeping for another 25-30 minutes while we went over the discharge papers and instructions, then he peacefully woke up and looked around curiously, The nurse removed his IV, offered him a popsicle – which he gladly accepted, and told us we could leave whenever we were ready.
Honestly, Robert was a complete and total Rockstar with recovery. We were told he probably wouldn’t have much of an appetite when he came home, and possibly not the day after either. His mouth may be quite sore and his belly upset from the medications during surgery. This child ate more than he had in weeks! He wanted a sandwich, then another, several snacks and dinner. He was quite sensitive towards brushing (which we didn’t do for 24 hours after) for a few days following the procedure, but honestly, it was very easy and thank God there were no complications whatsoever.
I feel so much better for my son now, it’s true he is such a handsome boy, and he needed a smile to match. Now, I don’t feel embarrassed for him (or myself, for people thinking he was neglected in some way. I literally research everything, so this couldn’t be further from the truth) in public now when he laughs and smiles. All that people see is his beautiful soul and handsome face. We are so thankful that Silver Diamine Fluoride held his teeth off long enough so that he could wait until he was close to 3 (recommended minimum for general anesthesia) for the surgery. I am also thankful for the dental surgeon and surgical center/team who made us feel so comfortable and safe and took amazing care of my son.
If you’re considering SDF treatment for yourself, your child, someone with special needs or an elderly family member in a nursing home setting, it will stain the teeth – so if you have cosmetic concerns you’ll want to keep this in mind. However, in my experience, this treatment – done properly under the supervision of a qualified dentist – can significantly arrest and/or delay further tooth decay and buy you some time to consider if and how you want to save the affected teeth. Keep in mind, also, that the packet information for SDF states that only active decay will turn black, SDF will not affect healthy tooth structure. Also, at the time of this posting (mid 2018) I could not find much info at all about SDF – including any potential complications or side effects, please do your research!
All of the information in this post is and was based on my family’s experiences. Nothing in this post is to be taken as medical, legal or any other type of advice. Please speak with your doctor or health care provider if you have any questions or concerns considering medical care, and to decide if SDF treatment and/or surgery could be right for your situation.
If you have any questions about our experience or story please don’t hesitate to contact me or comment below! I’d love to hear from you!