Cavities, Fillings & Tooth Decay

Parent Q&A

  • I have a 2 year-old who was seen this past week for cavities on her front 4 teeth. The pediatric dentist recommended silver diamine fluoride ("SDF"), a type of fluoride applied onto the cavity-part of the teeth that turns the cavity-part BLACK. The result would be teeth that looked white and speckled black. The other option was general anesthesia at Children's Hospital Oakland where all 4 teeth would be filled. Does anyone know of a NATURAL or more conservative dentist who is not quick to recommend such a harsh choice between these two aggressive options? I have heard of fluoride varnish which is largely clear and not black. I live in Oakland but I'm willing to travel for the right person. Also I am not looking for advice on preventing further cavities or the dangers of fluoride or advice like "baby teeth will grow out." 

    Maybe just try getting a second opinion? When my daughter was little we went to a couple of dentists who recommended some really invasive procedures. I called my insurance and got approval for second (and third) opinions, and just looked on the insurance provider's dentist list to find someone else. Sometimes there were other options and sometimes there were not. I've done the same for my own dental care. You can also look for "family dentist" rather than just pediatric.

    I took my son to Pediatric Oral Wellness in Albany for the first time earlier this year.  He is 4-1/2, and while he didn't have any cavities, they were able to get him to cooperate with all the procedures without any issues.  Their entire practice is to treat children.  If there's an alternative or "second opinion", I would definitely call/see them.

    My daughter got her first cavities --and fillings-- at age 2, and Dr. Meeta Doshi was so gentle that it was completely non-traumatic. After many subsequent visits, she never had any fear of dentist visits. When she was 8 she said "my dentist doesn't give shots" -- Dr. Doshi was so adept at numbing with a topical andvthen hiding the needle that in 6 years my daughter had never realized she got a shot with each filling. 

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Root Canal for a 5 year old's baby tooth?

Nov 2009

I took my son to our dentist a few months back (he is 5) and the dentist said he had to small cavities on his back molars. I had to wait a few months to take him back in and they where able to fill one cavity no problem, but they took an x-ray and said that one of them is to big now and it touching his nerve. They are recommending a root canal!

I have never had a cavity myself, or a root canal. It seems pretty extreme for a 5 year old and a baby tooth. They said that he wouldn't loose that molar until around 12 and it could cause him major discomfort down the line. They don't recommend pulling it because it could affect the new adult tooth coming in. I honestly wouldn't want to have it extracted either.

My question is have any of you had to get a root canal for a 5 year old or young child? Is this inevitable or should I just get a second opinion? They showed me the x-ray and it definitely looks like it is touching the nerve, although I am no dentist. Just nervous to put him through that or not do anything and end up with an even worse situation down the line. Any advice or similar experience would be greatly appreciated. Anxious mom...

Hi - I would probably get a 2nd opinion. My daughter is 4 and is in the same boat - the dentist filled a cavity in the spring that was apparently very close to the nerve, and when we went in for a checkup this week, the tooth had an abscess (I could see something was wrong) and it has effectively killed the tooth.

She said she COULD do a root canal, but in most cases, it won't take, and she'll end up pulling in in a year or two. She recommended just pulling it now & putting in a spacer, which she'll have until the adult tooth shows up at 9 or 10 years old.

It sounds to me that getting a root canal on a baby tooth is a waste of money. Would you also have to get a crown for it (I assume so? given that's what you have to do for an adult tooth).

I take my daughter to a pediatric dentist & I definitely trust her opinion. Laura

It's very important to take care of your child's baby teeth. Tooth decay not only causes pain, but can lead to life-threatening systemic infections.

There was an article on Slate recently in which the author talked about growing up in Britain in an area where no one even brushed their teeth. It took her years of dental work to correct all her problems, as she details in the (long) article. One quote stuck with me:

''I prefer not to think about the excruciating pain that decay and resulting abscesses caused--pain that you can hear, that stops the world, that makes listening to the teacher or concentrating on homework impossible.''

The full article is at:

You need to get this taken care of. By all means, get a second opinion, but take care of your child's tooth right away. Baby teeth matter

I would get a second opinion. My five year-old son just had two fillings put in his baby molars a few days ago. The pediatric dentist said the decay was very close to the nerve in one tooth so we will have to watch that tooth and if at some point the decay gets to the nerve, they'll extract it. I don't believe in giving kids general anesthesia for dental work and neither does my pediatric dentist, and now I see that they aren't in favor of root canals because they never brought that up. (These are also teeth that won't be lost until he is 10 or 12 or so.) You could try our dentist to see what she says. Her name is Ameneh Khosrovani and she is at the office on Ensenada Avenue at Pediatric Dentistry in Berkeley: Amenah is a fantastic dentist! Andi

Hello! I manage a dental specialty practice that performs root canals. First, I'm sorry that your little one needs a root canal and has to go through all these dental appointments and procedures. I wouldn't want my little guy to have to go through this either. Second, it is not uncommon for younger kids to need a root canal. I am not a practitioner and I am ethically and legally bound to refrain from commenting on diagnosis/treatment nor would I ever comment about what your child's dentist recommended. However, it sounds as if you have faith in what he/she is advising you. Cavities are not uncommon and they do lead to painful conditions if left untreated.

If your child's dentist is referring you to a specialist, you can look up some reviews on Yelp! or Berkeley Parents Network or the specialist's website. You can call the specialist and make sure that you are comfortable with them. Make sure that the staff is friendly. You will most likely have to make an appointment for an initial evaluation/consultation--you may ask all of your questions at that time. You can ask them if your child can watch a movie or listen to his favorite music (with an ipod, etc.)

If you want to avoid taking him out of school, or if your schedule would be more available, know that some specialty offices are open on Saturdays.

If you have dental insurance, makes sure that the specialist is ''in network'' with your carrier in order to keep the cost down (these procedures are very expensive.)

Finally, don't be too hard on yourself. You appear to be a very conscientious parent--your anxiety is warranted. He will have to endure sticks of needles and be under bright lights for an extended time. Just know that you are not alone and you haven't ''failed'' your son in any way. A diagnosis for a root canal (no matter what age) can happen to the most diligent, vigilent, tooth- brushing, flossing, water-pik'ing patient.

Good luck with the treatment. You might want to ''reward'' him with the promise of going to the movies afterwards (but skip the gooey candies!) anon

I have been in the dental profession for many years as a hygienist and i know why your doctor is recommeding the root canal for your child.. It is not a complicated procedure (not like the old root canals you have heard about...even those are improved thanks to new technology). It's called a pulpotomy on the baby teeth and it sounds like the only way to save the tooth. The tooth should be saved because it is holding the space for the permanent tooth that may not come in until he is 11 or 12. His bite may suffer if you take the tooth out..I wouldn't chance it if I were you. Good luck.. experienced in teeth!!

My best friend went through the same type of thing this summer, with her then 3- year-old daughter. She was having a tooth ace and they took her the dentist. The dentist did a root canal on almost all of her teeth, and she was in good shape for about a month. Then she was complaining about her teeth again, we took her back in to the dentist (a new dentist this time because our old dentist had moved out of our area). Then new dentist said the old dentist was a miracle worker and that they would never do that much to save a baby tooth. The new dentist wanted to pull out her front two teeth due to nerve damage and the infection going up into her forming permanent teeth. After two second opinions and discussions with a speech therapist we finally got the teeth removed. About a month later another tooth was removed. All of this dental work was done right around her 4th birthday, and it involved many different forms of Anastasia and lots of dentist visits.

So after helping my best friend deal with all of this here is my two cents for you:
* First, go get a second opinion. ItC,bs your childC,bs teeth and you will always be worried if you are doing the right thing or not. So go spend the extra money to see another dentist, maybe they will say the same thing or have a different idea.
* Second, know that a root canal isnC,bt the worst thing for your 5 year old. And if they can save the tooth without if hurting the adult teeth that may be what you want to do.
* Third, fight for what is best for YOUR child! Trust your thoughts, feels, and feel free to say no! ItC,bs your child! This includes being there for the exams, procedures, and giving of Anastasia. It is doesnC,bt feel right stop, try again another time, or go see a different dentist.

Good luck! And know there are lots of parents out there in similar situations.

My son had a root canal when he was about 3 (he'd fallen and damaged a front tooth, and our dentist was concerned about possible infection). For my son, it was a pretty quick procedure and not that big a deal--he didn't have any of the preconceptions/fear I do about root canal! They gave him some gas and I got to be with him the whole time. You might get a second opinion if you're not sure. In our case, two years later that baby tooth is still intact, and we expect that it will fall out normally. Anon

Three year old with tooth decay

May 2008

My son has allergies to dairy, wheat, soy, eggs, peanuts, and tree nuts. I am concerned that he is getting enough nutrition. His central incisors are browning on both top and bottom. He doesn't eat any refined or processed sugars however he does have high starch diet (potatoes, brown rice, rice milk,quinoa) I've taken him to his pediatrician and she believes that he is in wonderful health but attributes his teeth decay to nursing. He has been weaned a year and his teeth seem to be deteriorating in last few months. He brushes his teeth twice a day and both his father and I help him. He is also under the care of a pediatric dentist. I thought perhaps he was not getting enough calcium in his diet. He also takes flovent twice a day via a spacer for his ashtma. Could this be causing brown stains? Does anybody have any suggestions on who I could take him to for a second opinion? concerned mama

Hello, We had the same problem. You need to brush the teeth very well immediatly after Flovent. No more cavities. My child has also a lot of allergies, I give him 4 gummy bears a day from L'ilCritters Calcium that I buy at Costco. Good luck.

I would take him to another dentist, just for another professional opinion. There are good recs for pediatric dentists on the BPN page. Also, rinsing with water after eating is good, in addition to brushing often. Look into mouth rinses, tooth wipes, and toothpastes with xytitol, a natural sugar that actually helps repair and prevent tooth decay. A lot of the studies coming out now also point to genetics, and there's not much you can do about that. Do take him for a second opinion, though. brushy mama

You said he eats a lot of starches - I believe some starches are actually worse than sugar for the teeth, especially sticky and milky starches. Cheeses and milk are especially bad.

Water laser in pediatric dentistry?

Feb 2007

I've heard of a new proceedure for use with kids who need to have cavities filled in baby teeth (and others): water laser. A laser is used to get rid of the decay instead of drilling. No novacane is needed. Does anyone know if there are any dangers, side effects, or other reason not to do this? Parent of kid with cavities

The ''water laser'' (Waterlase)is perfectly safe - no dangers, no side effects. It is a tool, and like many tools, it has its place. The main advantage is that it can be used to prepare teeth for fillings without the use of local anesthesia in most patients. It makes a bit of noise however, but the noise is probably less bothersome than the high pitch whine of a drill to most folks. It uses a water spray that most will find is similar to the water spray from a standard high-speed dental drill. The only disadvantage I think is that procedures may take a little longer for the dentist to do. Especially if the cavities are rather small, it would be great if the dentist uses the Waterlase since chances are injection with local anesthesia can be avoided. Rebeka

Fillings in baby teeth? Why?

April 2006

Our almost seven year old just had two fillings done. The dentist wants to fill 3 more at $161 a piece plus $66 (each time) anasthetic over two more visits in the next couple of weeks. It apparently can't wait. They also want to schedule appoints every 6 months rather than annually. As a kid, I never heard of filling baby teeth (maybe I just wasn't listening about others) and we never went to the dentist more than once per year. We must pay for all of this ourselves and are already really struggling. Why do they insist on filling teeth that are going to fall out any time now? Thoughts please? thanks! waiting

When I was a kid I went every six months and I had 4 baby teeth filled and a root canal on one. My dentist said it was to protect my adult teeth. I am 36 now and have no fillings or cavaties so maybe he was right. Jo

Yes. Because cavities hurt. -Ouch.

Baby teeth cavities are probably a matter of diet, habit (are you brushing teeth twice a day?), and genetics.

That said, I've always refused additional fluoride treatments for my kids at the dentist, because they can cause permanent brown deposits on the enamel (we know kids with those brown spots). My kids have always drunk the local fluoridated water and they've had no fillings, at 15 and 12 years old. Maybe kids in areas without fluoridated water need the fluoride treatments.

I've also read that the areas (in Texas?) with fluoridated water where the protective effect was first noted also had water that was high in other minerals (magnesium, maybe?), which at least raised a question about what was really helping. I don't know if there's been more study on that.

I strongly recommend that you ask your dentist about ''sealing'' the adult teeth when your kids' adult molars come in, I think at 10 and 12. It costs as much as a filling, but it protects the tooth. The sealant can't be applied to baby teeth because it doesn't stick to them for some chemical reason. brush and floss

3-year-old needs a filling

Sept 2002

I have a 3 1/2 y.o. who has had a cavity on one of her molars for about 2 years. I took her to the dentist over a year ago, who said we should put off filling it as long as possible, due to the complications of the procedure and a small child. She said to try to hold out until (at least) she complains about it...well, the time has come and I'm terrified! The tooth is pretty much eroded and she complains ocassionally that it hurts. My problem now is, what next' My insurance will cover a most of the filling costs, but as far as ''putting her under'' we'd be responsible. Are we talking thousands of dollars here' And, do we have to put her under, or would not doing it traumatize her for life' Also, has anyone heard of Dr. Laston in Berkeley' He comes up as a doctor who would best work with the insurance I have. distraught mom

This happened to me, and it's very important that you find a great pediatric dentist. There are many schools of thought about pediatric dentistry, and going with the wrong one can cause a lot of future trauma.

When my daughter was 2, we had no dental insurance and I was stuck taking her to a dentist who was extremely anti-breastfeeding and judgemental. He physically kept me out of the room and pulled her tooth under local anesthesia while restraining her on a board. I found another dentist the second time through, someone who was trained for pediatric dentistry. There were some improvements: she discussed treatment with me and used valium for major treatments. However, my daughter was understandably fearful by this time, and the new dentist's solution was to punish her for crying by restraining her and threatening to keep me out of the room. By this time, it took weeks of preparation to get my daughter into the exam room without restraining her.

The next time we had a dental problem, I was more careful. We found a very capable dentist who understood that we were faced with overcoming my daughter's terror in the long term, not just a quick fix. She was frank about the problems (and a little judgemental) but created a treatment plan that took the trauma of dental work into account. We used valium and nitrous oxide for the treatment and although it was scary at the time, my daughter didn't remember a thing about it, which is the best possible outcome. The dentist was able to complete a root canal, cap the tooth, and clean the other teeth in a short time, all with me in the room. She said that pulling the tooth could have led to major problems when the adult teeth came in unless she inserted a spacer. She was in LA, or I'd give you her name.

When I moved here, she suggested that I contact the American Academy of Pediatric Dentistry, then interview the dentists I located. Ask about what strategies the dentist does with fearful patients, if they let you be in the room, their policy and experience with medication, etc.

Finally, don't go to a dentist who tells you or your child that you're at fault. A little sermon about brushing and flossing is ok, but that's it. Good luck! Sarah

My daughter has had cavities since at least age one. We first took her to the dentist when she was almost 1 1/2, where they felt the best thing to do at that point was to put flouride varnish on and brush religously. That was at Wampler et al. Due to changes in insurance we went once to the UCSF clinic and had a horrible and tramatic experience with pre-doc students with no apparent experience with children (we picked that clinic because it offered pediatric dentistry).

Since then we've gone to back to Wampler et al. and worked with ''Dr. Arnold.'' I think they do a great job of building trust with children to be able to do work without general anesthesia. Our three and a half year old (despite her earlier fears) recently sat through a ''scoop and fill'' filling without local (it was pretty big, but not to the nerve). She's looking forward to going back to the next 2-3 appointments for her other cavities. We're paying for it out of pocket because they don't accept our insurance plan (Health Families Delta), but if the alternative is to pay a huge chunk out of pocket for anesthesia, it might be cheaper. It's actually been quite reasonable. Even though we've had quite a bit of work done, I suspect it's costing us less than a private plan that would cover dentists of this quality.

Two more things:

We've avoided Laston because we've heard negative things about him from friends and neighbors, and if I remember correctly had a phone conversation with him that left us underwhelmed. You might look at the other feedback about him on the website.

Also, although it might not help you're specific question, there's an interesting piece in a recent issue (July? 2002) of Mothering magazine that talks about recent research that's found that Early Childhood Caries (ECC) is caused by a particular bacterium, rather than primarily by the bottle or nursing or diet. Peter

5-year-old's first cavities

Nov 1999

Our 5 yr. old son has to have his first two cavities filled. They are small and are between two adjoining molars. We'd like to hear about other parents' experiences with kids' first cavities. Our son goes to Dr. Wampler but we were disappointed by the brief time the dentist spent with him at the most recent exam. He did not reassure either my son or my husband about the upcoming procedure. We would like to know what the procedure is like. How much it hurts, and if we can expect him to go to school afterwards.

My kid had 6 cavities filled at age 4.5 yrs. The first dentist, Dr. Mendoza-Sobel, used laughing gas, local anesthesia, a tooth dam,& jaw clamp. The latter items were uncomfortable and the actual procedure hurt because they hadn't checked that the local was properly administered. The second dentist, Dr. Katsura, used a local which they ensured took proper hold. They used the same instructions my dentist used for me, such as moving tongue away. There was virtually no pain. My child could not eat anything for 1 hour afterward while the fillings set, but otherwise there was no problem.

To the parent concerned about having her five-year old son's cavities filled, I understand your concern. My five year old also had his cavity filled recently, but before I agreed to it, my husband and I sent him to a different dentist for a second opinion. I wanted to make sure that in fact it was urgent that we get this done, and how bad it truly was.

I chose not to attend the appointment only because my son is more babied by mommy. But my husband, who did attend, said it was not as bad as he expected. Unfortunately he had to have his hands tied down for the fear that he might try to reach for the dentist's hand or move. But with my husband near, my son felt safe knowing that daddy was not going to let anything happen to him. First he was giving laughing gas, and then a local anesthetic was inserted into his gum. It was not very painful, according to my son, but it did frighten him when the doctor placed the mask over his face and the needle in his mouth. The procedure lasted for about 45 minutes, but my son was a little drowsy after wards. We kept him home so that his dad could supervise him and make sure he wasn't experiencing any side effects. Luckily we had nothing to worry about.

The price, after my insurance kicked in was $81. I am not sure what insurance you have or how much your dentist will charge for the procedure, but I can't see it being more expensive than $120. The only thing I suggest is that you find someone who has a lot of patience with kids and is understanding with a child's fear of needles and doctors. The only bad experience we had was the dental assistant, who my husband said was not very pleasant. Otherwise, the dentist was great! Good luck with everything.

Silver vs. tooth-colored fillings for 7-year-old

July 2002

My child is about to have his first three cavities filled. His dentist recommends tooth-colored fillings for the temporary teeth and then silver for the permanent tooth. This is actually the opposite of what I'd been thinking, so I wonder how others have made their decisions about this or what advice their dentists mayhave given them. I understand that tooth-colored looks better--but are also more expensive and take longer to put in--which is a consideration for a 7-year old. Thank you. LTR

I personally have both silver and tooth colored fillings. I don't know which take longer. I don't know which is better for young children. I do know this, and offer it for your consideration... I only have had temerature sensitivity issues with my metal fillings (''No ice please!''), and not with the white ones. Rose

Hi, Your dentist was probably thinking that since the tooth colored fillings don't last as long as the silver ones and are less toxic to a younger person (silver fillings contain mercury--yikes!), that he would use those for the baby teeth and use silver ones for the permanent teeth. If, however, the filling is not too deep or large and you aren't concerned about replacing the fillings every 10-15 years, I would go with the tooth-colored ones every time. I can't address the length of time it takes to put in (but I think it was about 15-20 minutes...?), but the material is less toxic to immune systems and looks worlds better. My only filling is tooth colored, and I have had it for about fifteen yearw. My dentist says it needs to be ''touched up'' now, but otherwise I have had no troubles. Good luck. elizabeth