Pediatric Dental Second Opinion?

[HLAuburn]

DD will be 6 this week. A couple weeks ago, we went in for a "routine" dental visit and came out with a big shock - one of DD's baby teeth that should have come through around 3 has still not made an appearance and doesn't seem to have plans to do so anytime soon.

The problem with it is that 1) the adult tooth behind it wont be able to come though and is basically blocked in and 2) the baby tooth that is supposed to be there will not be there to act as a "guide" for the tooth behind it. Anyway, the ped dentist recommended extracting the tooth and placing a "spacer" appliance in until DD is about 12-13.

Needless to say, this is a big decision, not only about the oral surgery, but the gadget she'll have to have in for 6+ years. I'm pretty confident in the dentist's suggestion and I feel comfortable with her doing it (if we decide to), but I think we would be remiss not to get a 2nd opinion.

So my question is...how do I go about getting one? Do I call the insurance company and ask them how to proceed? Or should I call the dentist and ask them to forward the xrays to another dentist? Since it is such a big deal, I hope they wouldn't be offended that I'm asking for a 2nd opinion, but I'm just not even sure where to begin.

Thanks for reading and for any advice!

 

[abdmom]

Meh. DD11 had a tooth removed when she was 4 and a spacer put in. It was no big deal. You couldn't even tell unless she opened wide and said "Aaah". She had the spacer for about 5 years.

 

[HLAuburn]

Meh. DD11 had a tooth removed when she was 4 and a spacer put in. It was no big deal. You couldn't even tell unless she opened wide and said "Aaah". She had the spacer for about 5 years.

That's good to hear! So the procedure itself wasn't a big deal? (Was the tooth still embedded in her gums?) And it's good to know the appliance wasn't a big deal. I kinda thought of it like having to wear braces for 6 years, but as long as it's not a huge PITB for her, we can deal.

Thanks for the reply.

 

[bumbershoot]

While searching for a sane ped dentist, we saw 3 inside of a year. Insurance paid for it all, and I really didn't care if any of the dentists had a problem with it.

The one we found, who is AWESOME, has told me several times that there's really no way of knowing how long it might take for a tooth to come in. He said that on DS's next appt he'd be happy to take a big series of xrays to show me where the adult teeth are, but it's not necessary and we'd just wait it all out.

I personally couldn't possibly go along with what your Dd's dentist is saying. I had braces based on "what your teeth will be like at 40" and it was the most ridiculous waste of money ever. Had teeth extracted, had a spacer, etc...now I have room in the back of my mouth (so much for a tiny mouth), my closed-mouth smile barely changed, but my mom was out a few K. I have a very very hard time doing things based on what might happen in the future...

So I would absolutely get another opinion.

The other part of it is...this dentist has been seeing your DD, I assume. Why did it come up *this* time? Knowing healthcare providers as I do, I would bet he'd just been to a seminar where they taught this, and now he's trying it out. My experience made me *extremely* cynical.

 

[HLAuburn]

The other part of it is...this dentist has been seeing your DD, I assume. Why did it come up *this* time? Knowing healthcare providers as I do, I would bet he'd just been to a seminar where they taught this, and now he's trying it out. My experience made me *extremely* cynical.

Thanks for your thoughts. Actually, we just moved to Florida and this is the first time we have seen this dentist. DD has been to a ped dentist in the past, but honestly, it's probably been a year, and no one mentioned it before. I don't think she's ever had x-rays done before this, but frankly, it's pretty obvious to notice if you're looking for it.

I do see what youre saying about what "could be" a few years down the road. The problem is this tooth (which should have emerged years ago) is showing no signs of coming in and is actually growing sideways. It's not only affecting the adult tooth behind it, but the one next to it too, which *should* come in within the next year. All this was pretty evident on the x-rays.

That said...I still want a 2nd opinion.

 

[luvmythree]

I have 3 kids.....2 who had dental problems and 1 of them needed braces at the ripe age of 12. The other needed a cement sealant between 2 teeth to "hide" a space that could have been fixed with braces but it cost $45.00 to fix it. If I were you I would look at your dental providers, find one who is a pediatric dentist OR a pediatric Ortho and get a 2nd opinion. Most of them will do free xrays on new patients and see where it goes from there. If they don't I wouldn't care about the dentist......it's in your and your child's best interest to get a 2nd or 3rd, 4th etc opinion.

My son had the same problem as your dd though his baby tooth finally fell out and the adult tooth came in behind it all ugly and twisted. After 3 months of spacers, 4 teeth being pulled and braces I can say at 15 he has a beautiful smile and it was worth it all. I had 6 opinions before I finally relented and let them do what they did and I'm glad I did.

 

[aprilgail2]

I would go to an orthodontist- they do free consults and take panaramic xrays and go over them with you- My daughter went to the orthodonist for years (started at about 5) before they felt she was ready to get braces on- but they will tell you if there are any issues with the incoming (or NOT incoming in your case) teeth

 

[disneydentist]

The problem is this tooth (which should have emerged years ago) is showing no signs of coming in and is actually growing sideways. It's not only affecting the adult tooth behind it, but the one next to it too, which *should* come in within the next year. All this was pretty evident on the x-rays.

That said...I still want a 2nd opinion.

If I understand you correctly by behind, you mean under or below. It then sounds like you're describing a primary (baby) second molar that hasn't erupted yet. The permanent tooth next to it would be a permanent first molar. If the primary second molar remains unerupted then the permanent first molar will erupt without guidance and you'll have space loss. Sounds like your dentist wants to put in a distal shoe spacer to guide in the first molar and save you some headaches later. Good plan if your description is accurate.

 

[disneydentist]

Knowing healthcare providers as I do, I would bet he'd just been to a seminar where they taught this, and now he's trying it out. My experience made me *extremely* cynical.

Conversely, patients like you are what make many healthcare providers cynical.

 

[abdmom]

That's good to hear! So the procedure itself wasn't a big deal? (Was the tooth still embedded in her gums?) And it's good to know the appliance wasn't a big deal. I kinda thought of it like having to wear braces for 6 years, but as long as it's not a huge PITB for her, we can deal.

Thanks for the reply.

Her baby tooth had a bad cavity, so the dentist decided to extract it. Putting in the appliance wasn't a big deal, it's like a brace for one single tooth - not a whole mouth full of braces. It didn't require any adjustments or maintenance. The only issue was when DD decided to eat sticky candy and the spacer came out.

 

[LBAK]

No real advice here. My DD had horrible baby teeth that were capped, pulled,oral surgery, spacer put in, palate expander at 7, braces later. Thousands in all and now at 15 she has a radiant smile because she loves her teeth. That makes it all worthwhile. Every dollar was well spent and we don't have insurance. Would I do it again? To see how happy she is, you bet I would!!!

 

[HLAuburn]

Thank you all for the replies!

If I understand you correctly by behind, you mean under or below. It then sounds like you're describing a primary (baby) second molar that hasn't erupted yet. The permanent tooth next to it would be a permanent first molar. If the primary second molar remains unerupted then the permanent first molar will erupt without guidance and you'll have space loss. Sounds like your dentist wants to put in a distal shoe spacer to guide in the first molar and save you some headaches later. Good plan if your description is accurate.

That sounds like what they explained to me. One more question...is that something that you would expect a (ped) dentist to do or might I be better off with an oral surgeon? The dentist I called today to get a 2nd opinion gave me the impression that an extraction like that might be out of their scope of practice and they'd probably refer us to an oral surgeon. That had me wondering if a ped dentist is the best person to do the procedure.

Thanks again!

 

[minkydog]

Thanks for your thoughts. Actually, we just moved to Florida and this is the first time we have seen this dentist. DD has been to a ped dentist in the past, but honestly, it's probably been a year, and no one mentioned it before. I don't think she's ever had x-rays done before this, but frankly, it's pretty obvious to notice if you're looking for it.

I do see what youre saying about what "could be" a few years down the road. The problem is this tooth (which should have emerged years ago) is showing no signs of coming in and is actually growing sideways. It's not only affecting the adult tooth behind it, but the one next to it too, which *should* come in within the next year. All this was pretty evident on the x-rays.

That said...I still want a 2nd opinion.

Yeah, this would be a bit of a red flag to me. Not saying that your new dentist isn't right, but I would want to get another opinion. If the tooth is truly stuck in there and is affecting the growth of permanent teeth,then I suppose it will have to come out. But I'd want more than one dentist to tell me that before I'd put my child through it. When you make the appt don't tell them what your other dentist said. You want to get a real second opinion, not just an agreement with the first dentist.

ETA: Christian had very delayed dentition. He lost teeth late and gets them in very late.At one point he had NO teeth on top except his baby molars. And he still hasn't gotten some of his canines and he's 15! God help us when he gets his wisdom teeth.

 

[disneydentist]

Thank you all for the replies!



That sounds like what they explained to me. One more question...is that something that you would expect a (ped) dentist to do or might I be better off with an oral surgeon? The dentist I called today to get a 2nd opinion gave me the impression that an extraction like that might be out of their scope of practice and they'd probably refer us to an oral surgeon. That had me wondering if a ped dentist is the best person to do the procedure.

Thanks again!

The extraction wouldn't be out of their scope of practice. It might well be outside of what they are comfortable doing. It would be a surgical rather than a simple extraction. No problem if the first pedo is comfortable with it, otherwise the surgeon is a good choice.

 

[disneydentist]

ETA: Christian had very delayed dentition. He lost teeth late and gets them in very late.At one point he had NO teeth on top except his baby molars. And he still hasn't gotten some of his canines and he's 15! God help us when he gets his wisdom teeth.

Even allowing for delayed development I'd double check on his canines. An X-ray to see if they're impacted at his next checkup wouldn't be a bad idea.

 

[minkydog]

Even allowing for delayed development I'd double check on his canines. An X-ray to see if they're impacted at his next checkup wouldn't be a bad idea.

Thanks. I"ll ask them about that. One of the biggest problems we have with this is that Christian is profoundly mentally handicapped. He has a hard time cooperating with Xrays due to extreme sensitivity of his mouth. Just brushing his teeth at home is an ordeal. Cleaning his teeth at the dentist office is a real experience. Our hygienist is a saint. So far he has had only 2 cavities, both in the back molars. Thank goodness he doesn't eat candy or gum. ANd he rarely gets a soda. Lord knows how many cavities he'd have.