Tue 23 Jul 2013
Many people kept telling me to get a second opinion before subject Allie to IV anesthesia and giving her a root canal on her broken front tooth, and crowns on both broken front teeth. Finally, it took Rebecca saying that she doesn’t like the dentist Allie saw and that the dentist is more interested in making money than doing something that’s in Allie’s better interest, and insisting that I NEED to get a second opinion because Allie doesn’t need work done at this point, for me to finally call the dental insurance to ask how they address second opinions and then to find another dentist. The dental insurance will cover 2 checkups a year, so Allie has another one left. I did more research online and went back to the other office I was considering when I was picking Allie’s first dentist, and noticed an Asian male dentist that piqued my interest for whatever random reason. He’s about my age, did his undergrad at Cal (UC Berkeley), went to UCLA dental school, did his residency at Harvard, volunteers in going and treating children in third-world countries (kind of like Doctors Without Borders, but dental). He reminds me of my peers. I really didn’t look into the backgrounds of any of the other 3 male doctors there. One reason I’d eliminated them first go-round is because Allie does better with females, but maybe an Asian male would be okay as it’d remind her of me and my parents. She does seem to acclimate to Asians faster. I called that office, they were very nice and I finagled a same-day afternoon appointment out of them and they were nice enough to squeeze us in.
Allie LOVED that office visit. She got to explore the office and play before she was called in. Here she is in their photobooth.
She sat in the x-ray chair on her own for the single x-ray of her upper teeth, kept the lead vest on and didn’t cry (like she did in the other office). She also sat in the patient chair by herself, again didn’t cry. The hygienists, nurses, assistants were all playing with her and she talked back with them, and Mr. W and I were surprised how comfortable she was with all of them, so quickly. When Dr. Wu came and met us, he TOTALLY reminded me of a friend I would’ve had from UCLA, he was like my childhood friend Dentist Andy, like our friend Eddie, easy-going, informative, casual. And he didn’t treat Allie like a baby. He talked to her, showed her a hand-held mirror, let her hold it, explained what he was going to do by demonstrating on her hands, and she opened her mouth and showed him how she brushes her teeth, and she let him put his little mirror in and fingers and everything! She seemed captivated by what he was telling her. I was happy she was so cooperative and had so much fun.
So this is the 2nd opinion: He said (and showed us on x-ray) that Allie’s teeth, gums, roots, nerves, are all totally healthy. She’s not in pain, she’s asymptomatic, the teeth are in there nice and tight, no damage aside from the fractures. He says these are deep fractures, and is more severe on the upper left tooth where the tooth broke in a sort of “sheeting” in the back, which did thin out the tooth from behind so a little pink is visible behind that too, but that her nerve is NOT exposed. That’s why she doesn’t have discomfort. He said he has a “difference of treatment opinion” with the 1st dentist — he says this can be a watch-and-see. He says kids this young have tremendous ability to heal, and that he would’t be surprised if her nerve (presently big, which he says is a great thing and means it’s healthy) and internal structure of the tooth actually healed itself. He says potentially, with good care and no further trauma to the teeth, these two teeth will just stay like this and hold until they fall out on their own when Allie’s 6-7 years old. In the very least, he’d like to keep things good and healthy until she’s 3 or so, so that work can be done without having to put her under the risks of IV anesthesia. He says work “has” to be done if the nerve were exposed, giving her extreme pain; if we see discoloration inside the tooth which means decay or bacteria has infected the hallow internal cavity of the tooth; if we see inflammation/infection of her gums; if we see a bubble on her gums which indicates abscess. Absent those and any signs of discomfort, Allie’s teeth are strong and fine and should be left alone. He said if we want, when she’s a little older and can tolerate it better, he can just rebuild the teeth and fill in the gap. He doesn’t want to grind it down and do a crown like the other dentist, he said, because there’s so much healthy tooth still left, it makes no sense to get rid of it. If the sharp points bother her and we start seeing puncture wounds on her lower lips, he said we can bring her in and he’ll round off the points a little which would take 10 seconds, and otherwise, we can totally leave it alone and just clean it well and keep a good eye on it, don’t let her eat things that require a front bite-and-pull, such as pizza. He wanted us to schedule another check-up and x-ray at 6 months so he could compare her teeth then to the baseline he’s now got on file, and if the area around the roots (he pointed on the x-ray) gets bigger showing the tooth is loosening from gums drawing back or getting sick, or if signs of decay/problems occur, to bring her back and they can always do whatever the most conservative, mildest intervention is good for that situation. Meanwhile, he says something so aggressive as a root canal or extraction are not called for.
Dr. Wu spent a lot of time chatting with us and making sure we understood everything, answering questions, projecting into the future for possible scenarios and how those would be treated. The other dentist was kind of vague. Probably cuz she knew she was upselling and was fudging the truth, making things seem more emergent and dire than they really were, pushing for surgery. (I called that office to cancel Allie’s oral surgery scheduled for 8/14, explaining that because it’s been a week and Allie’s been asymptomatic, I wanted to hold off doing something drastic like the root canal & crowns. The receptionist said that’s fine and it’s up to me, but re Allie having no pain or discomfort, “This doesn’t happen overnight. And just so you know, when it happens, it’s usually at night.” Okay, thanks. I still want to wait.) Dr. Wu said all their dentists are available and on-call 24/7 for emergencies in case Allie suddenly develops any dental-related problems in the future. Oh, and I always wondered how the heck she fractured her two front teeth at an angle in the center, did she crash into a point? Jayne said she just tripped and fell down and didn’t hit anything. Dr. Wu asked with a knowing smile, immediately after examining Allie, if she’s a thumb-sucker. I said she is. He said the way it’s broken suggests that her teeth had a slight outward turn, usually from frequent bottle/pacifier use and/or thumb-sucking, so the center of her upper teeth made the impact first. Oooooh.
All 3 of us walked out happy. Allie was given a lot of stickers and a pretty princess toothbrush that she really liked and kept talking about “Doctor, doctor, nice doctor, mouth, teeth, fish (she got to play with a stuffed fish with what looked like dentures glued in), sticker, ball (they let her play with all the toy “rewards” they give kids).” Mr. W said, “I like this dentist office SO MUCH BETTER than the other one.” And I was just happy I got a prescription for “wait and see.”
We celebrated after the appointment with Allie’s first sushi dining experience. She didn’t have any fish, but did have some dissected California rolls and a bunch of steamed gyozas. Here she is outside the sushi restaurant.
She’s been to this lakeside sushi restaurant before, but had her own food. Here’s a flashback for photo comparison; the sushi chef remembered our last visit a year ago and asked about my parents.
I followed Dr. Wu’s instructions last night and this morning and brushed and flossed Allie’s upper front teeth for the first time since the injury (I’ve been avoiding just those 2 teeth), and he was right…she kept her mouth open and had NO reaction whatsoever.
I’m so relieved.
if you frequent dooce.com, her 4 year old daughter also got her front teeth chipped very similar to what Allie has when she was around 2. When I read your initial post, I had a big question mark in my head because I was wondering why Dooce’s daughter is still sporting those teeth with no side effects a good year or so, yet Allie would need such drastic statement. I’m glad it works out.
Oh, I’ve never heard of dooce. I’ll go check it out. Thanks!
My guess is that her 4 year old also did not have exposed nerves. That is apparently what the key problem is. The first dentist said her nerves are exposed, the 2nd dentist said it wasn’t, and showed and proved it to me. Since Allie’s front left tooth has a sheer vertical break, it thinned out the back of her tooth so it’s kind of a gamble with that one whether we can maintain it, but if we can just keep it health for a year, the 2nd dentist can patch it up without having to put her under.
I did a search on her site for “broken teeth” and nothing that came up had anything to do with her daughter’s broken teeth. 🙁
here’s the original post on that matter http://dooce.com/2010/07/21/susan/