Medical Forum / General / Dentistry / May 2005
6-year old with hypoplastic first molars
|
|
Thread rating:  |
NY Mom - 19 May 2005 03:29 GMT My 6-year-old son had his regular checkup with the pediatric dentist today. To my surprise, the dentist told me that his first molars were hypoplastic and undercalcified. There is actually a small cavity in one of them. He said that the enamel is weak and pitted. The teeth have a little brown staining in the crevices, and a few white spots. When I asked him what caused the problem, he said that the most likely cause was stress at the end of my pregnancy. He could not tell me how likely it is that other permanent teeth have been affected. My son has one of his lower front teeth partially in, and it looks all right to me. It has come in behind the baby teeth, which don't seem to be budging. We have to come back in a month to check on this situation, and he will have sealants on the molars and a filling for the cavity.
I've been reading everything I can find on the internet about the enamel problem, but I didn't find much information. The only unusual stress during my pregnancy was at 7 months, when my older son had to go to the emergency room in an ambulance. My husband, my older son, and I all have normal teeth. My younger son has been very healthy. He did have jaundice during his first week, but it was never serious enough to require treatment. He was exclusively breastfed for the first year, with very few solid foods (my older son has serious food allergies and this was a preventive measure), and breastfed for the second year as well. He did have a fever for a few days when he was an infant, I can't remember exactly how old. He's never had fluoride supplements, we drink bottled water, and I didn't even use fluoride toothpaste on him until he was about 5.
I'm wondering whether I should take him to an academic practice. We go now to a suburban pediatric dental practice with two dentists. I'm worried about the health of these molars, and about whether other permanent teeth will be affected. His baby teeth are beautiful, white and straight.
Any information or advice would be greatly appreciated.
Peter Meiers - 18 May 2005 20:23 GMT > ... He's never had fluoride supplements, > we drink bottled water, and I didn't even use fluoride toothpaste on > him until he was about 5. Did you check the label of the bottled water? Some are worse than fluoridated tap water, regarding the fluoride content (apart from other contaminants and bacteria). If the label says nothing about fluoride, that doesn´t mean it has none!
Best, Peter
 Signature -History of fluorine, fluoride and fluoridation-: --- http://www.fluoride-history.de/index.htm --- ----------------------------------------------------
NY Mom - 19 May 2005 13:26 GMT Thanks for the information. I checked out the brands we've used on the web, and they seem to be all right in that respect. In any case, my son was breastfed until he was 2, and didn't get any water directly, so this seems an unlikely source of the problem.
Steven Bornfeld - 19 May 2005 04:01 GMT > My 6-year-old son had his regular checkup with the pediatric dentist > today. To my surprise, the dentist told me that his first molars were [quoted text clipped - 30 lines] > > Any information or advice would be greatly appreciated. Frequently it is difficult to pinpoint the exact cause of focal hypoplasias. Occasionally severe fluorosis will cause something like this, but it is unusual in first molars. There are also some genetic conditions causing hypoplasia, but with most of these you or his dad would be aware of a family history. Absent that, it is unlikely the other teeth will be similarly affected, unless there was a chronic excess fluoride ingestion.
Steve
 Signature Cut the nonsense to reply
NY Mom - 19 May 2005 13:22 GMT I hope you're right about the other teeth not being affected. I guess I'll be biting my nails for a while until they come in. I don't see how he could possibly have gotten any significant amount of fluoride, and a genetic problem seems very unlikely.
Thank you for responding.
> > My 6-year-old son had his regular checkup with the pediatric dentist > > today. To my surprise, the dentist told me that his first molars were [quoted text clipped - 33 lines] > Frequently it is difficult to pinpoint the exact cause of focal > hypoplasias. Occasionally severe fluorosis will cause something like
> this, but it is unusual in first molars. There are also some genetic
> conditions causing hypoplasia, but with most of these you or his dad > would be aware of a family history. > Absent that, it is unlikely the other teeth will be similarly affected, > unless there was a chronic excess fluoride ingestion. > > Steve nyscof@gmail.com - 19 May 2005 13:25 GMT Of course, the hypoplastic teeth don't have to be fluorosis. However, since your signed on as NY Mom, it's possible you've used cold mist humidifiers with tap water (NYC and 70% of NY State is fluoridated).
Coal heated buildings, such as many NYC schools emit fluoride air emissions. Other fluoride emitters are power plants and other factories. Living near these buildings increases fluoride intake
Inhaling ocean mist (which is fluoridated at about 1.2 or 1.4 ppm fluoride) is another air borne source.
Baby food meat products have lots of fluoride in them from the mechanical de-boning process which gets fluoride-rich bone dust in the finished product.
Some grape juices have very high fluoride levels because of fluoride containing pesticide residues that remain on the fruit.
Teflon cooking pots and utensils pass fluoride into foods. And some medicines contain fluoride.
Now that sulfuryl fluoride has replaced sulfuryl bromide as a fumigant, lots of fluoride in many more products.
See: "How Much Fluoride Did You Eat Today?"
http://www.suite101.com/article.cfm/11749/112620
There are many hidden sources of fluoride. And as Peter said, you have to call the bottled water company to find out if there is or is not a fluoride content. There's no requirement to put fluoride content in any foods - unless it's been purposely added
NYS Coalition Opposed to Fluoridation http://www.orgsites.com/ny/nyscof
Mark & Steven Bornfeld - 19 May 2005 15:25 GMT > Of course, the hypoplastic teeth don't have to be fluorosis. However, > since your signed on as NY Mom, it's possible you've used cold mist [quoted text clipped - 3 lines] > emissions. Other fluoride emitters are power plants and other > factories. Do you really belive that coal-burning furnaces are still legal in NYC? My understanding is that coal-burning furnaces, as well as residential incinerators have been illegal in the 5 boroughs for many years. I will try to find a reference.
Steve
> Living near these buildings increases fluoride intake > [quoted text clipped - 25 lines] > NYS Coalition Opposed to Fluoridation > http://www.orgsites.com/ny/nyscof
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
Mark & Steven Bornfeld - 19 May 2005 15:53 GMT >> Of course, the hypoplastic teeth don't have to be fluorosis. However, >> since your signed on as NY Mom, it's possible you've used cold mist [quoted text clipped - 11 lines] > > Steve I quickly found this reference, wherin the remaining 114 remaining coal-burning furnaces were to be converted--during the Giuliani administration. I do not know when this may have been accomplished, so it is possible that during this child's early years, some coal-burning furnaces were still on-line:
http://www.nyc.gov/html/records/rwg/html/2001a/weekly/wkly0129.html
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
NY Mom - 19 May 2005 16:00 GMT We live in Westchester Co., and there are no coal-burning buildings anywhere near here. I don't use humidifiers, and only gave him Earth's Best baby food. I think it's extremely unlikely that my son was exposed to anything but minimal levels of fluoride. My older son, who is now 12, actually took fluoride-containing vitamins as a baby (that was the recommendation then) and his teeth are fine.
Is this condition common?
Dr Steve - 19 May 2005 16:16 GMT The kid probably ran a fever as a toddler when the enamel was forming. These white blotches seldom are a problem. Forget about it for now. Deep pits are genetic and are best treated with a sealant or preventative resin filling. Don't stress out over this for Pete's sake {pun intended Peter
:-) }
 Signature ~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA ....................................................
This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ......................
> We live in Westchester Co., and there are no coal-burning buildings > anywhere near here. I don't use humidifiers, and only gave him Earth's [quoted text clipped - 4 lines] > > Is this condition common? NY Mom - 19 May 2005 16:25 GMT I am stressed out, not because there are white blotches but because the dentist said that the surfaces were pitted, the enamel was undercalcified and weak, and the child already has a cavity despite meticulous brushing and flossing (by me, not by him) and a good diet. The dentist is going to put on sealers, but he said that if the front teeth were affected, my son would need cosmetic bonding. I've been reading about crowns being needed on molars in this state. I'm wondering whether my son is looking at a lifetime of serious dental procedures.
Dr Steve - 19 May 2005 18:04 GMT Often these teeth develop with such deep grooves that they begin to decay as they erupt. Easily taken care of. Regarding the front teeth, the dentist is simply giving you the worst case scenario so that you will not be upset with him in the future. You simply get to live with whatever you get.
 Signature ~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA ....................................................
This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ......................
>I am stressed out, not because there are white blotches but because the > dentist said that the surfaces were pitted, the enamel was [quoted text clipped - 5 lines] > wondering whether my son is looking at a lifetime of serious dental > procedures. Mark & Steven Bornfeld - 19 May 2005 18:20 GMT > I am stressed out, not because there are white blotches but because the > dentist said that the surfaces were pitted, the enamel was [quoted text clipped - 5 lines] > wondering whether my son is looking at a lifetime of serious dental > procedures. Nah. Don't worry about it. Do what I did--worry about my kid's school and teachers.
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
Steven Fawks - 19 May 2005 19:51 GMT I'm
> wondering whether my son is looking at a lifetime of serious dental > procedures. I doubt it, but no one knows for sure at this point. Every once in a while I will see a youngster with poor enamel formation on certain teeth. The first molars seem to be the most commonly affected. Usually I can deal with it by using bonded filling materials while they are young and then I might crown any badly affected teeth around 18.
Since nothing lasts forever, they will need further treatment at some point later in life, but I don't think I would use the word "serious".
In very severe cases, the first molars could be extracted and the second molars guided into the first molar position, but I can't recall seeing one this bad in my 26 years of practice.
Fawks
NY Mom - 19 May 2005 20:14 GMT Mark & Steven Bornfeld - 19 May 2005 18:16 GMT > We live in Westchester Co., and there are no coal-burning buildings > anywhere near here. I don't use humidifiers, and only gave him Earth's [quoted text clipped - 4 lines] > > Is this condition common? Yes. It sometimes affects multiple teeth, but probably more frequently just one or two teeth. Have his lower or upper permanent incisors come in yet?
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
NY Mom - 19 May 2005 19:20 GMT One lower front tooth is partially in, making its own row behind the baby teeth, which are not giving up the ghost. The part that is peeking out looks ok to me.
Mark & Steven Bornfeld - 19 May 2005 20:40 GMT > One lower front tooth is partially in, making its own row behind the > baby teeth, which are not giving up the ghost. The part that is peeking > out looks ok to me. Since the lower central incisors and the 6-year molars begin to mineralize at about the same time (in infancy), it is possible that an event that caused a problem in mineralization of the molars (a high fever, for instance) could also cause a problem for the incisors. Typically, this is seen as a horizontal band around the surface of the incisor(s). If the lower centrals come in clean, it increases the chance that the first molars are an isolated problem.
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
NY Mom - 19 May 2005 20:41 GMT W_B - 19 May 2005 16:07 GMT >I'm wondering whether I should take him to an academic practice. We go >now to a suburban pediatric dental practice with two dentists. I'm >worried about the health of these molars, and about whether other >permanent teeth will be affected. Probably not.
>His baby teeth are beautiful, white >and straight. Sorry, primary teeth are meant to be spaced apart.
Likely orthodontics are in the future.
--
W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
NY Mom - 19 May 2005 16:19 GMT I'm expecting orthodontia. My teeth are straight, although I didn't have braces, but my husband's are crooked. My older son is about to get them for minor problems, probably for only 6 months according to the orthodontist. I have the feeling that my younger son will need more extensive orthodontia.
It occurred to me to wonder whether, if my younger son's orthodontic treatment requires extraction of teeth and the first molars turn out to be the only hypoplastic ones, they might take those out and leave the good ones?
Dr Steve - 19 May 2005 18:04 GMT Find something better to obsess over.
 Signature ~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA ....................................................
This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ......................
> I'm expecting orthodontia. My teeth are straight, although I didn't > have braces, but my husband's are crooked. My older son is about to [quoted text clipped - 6 lines] > be the only hypoplastic ones, they might take those out and leave the > good ones? Mark & Steven Bornfeld - 19 May 2005 18:19 GMT > I'm expecting orthodontia. My teeth are straight, although I didn't > have braces, but my husband's are crooked. My older son is about to [quoted text clipped - 6 lines] > be the only hypoplastic ones, they might take those out and leave the > good ones? It's way too soon to worry about this. It's true that I haven't seen how bad the first molars look, but these are important teeth. The decision as to whether teeth have to be extracted will be based on what the orthodontists call an arch-length analysis. If you get a consultation, this is certainly one of the issues you will discuss.
Steve
 Signature Mark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
|
|
|