To insist on a referral?

[WaveorCheer]

When DS2 was nine months old, I noticed that the enamel on his top front four teeth was patchy. Over the next couple of weeks I realised it was crumbling off so I took him to the dentist sharpish. She confirmed it was coming off but didn't seem particularly worried. She asked me to go back in six months.

Three months and lots of visible loss of enamel later (chips a couple of millimetres big flaking off, loss of about two millimetres off the bottom of the two front teeth), I took him back and asked to be referred to the hospital. She declined and said he only needed to go there if the teeth disintegrated to the point that they had to come out, but that this was the worst case scenario. Losing the teeth isn't just cosmetic, they also act as place markers for the adult teeth and without them he could end up with poor spacing. She stared him on a course of fluoride painting every three months.

Two months later and I'm wondering whether to go back again. Those four teeth are basically stubs. He is highly averse to having his teeth brushed. But the worst thing of all is his sleep, which is appalling. Last night he woke up maybe 20 times. On a good night he wakes every 1-2 hours. When he wakes he often rubs at his face. Now obviously I can't prove he's in pain (dentist seemed to think it shouldn't hurt) but it seems a reasonable assumption to think he is. I'm a physical wreck.

Should/can I insist on a referral? The rest of his teeth are perfectly fine btw, the only explanation I've heard so far is that I might have been ill at the point in pregnancy when the enamel formed.

[TweedleDi]

Yes you should insist. Try your GP.

[roofio87]

Enamel not forming properly on teeth is also an indication of Celiac disease. its how milk cousins dcs were diagnosed. not too bad if it is, but far better to catch it asap so I would definitely want a referral too!

[Imnotmadeofeyes]

I would contact the dental hospital myself and try to get advice from one of their specialists. Ime generally it's quite common to hear of people finally getting a referral and having a specialist comment that they should have been reviewed a lot earlier.

If you have a look on the nhs website for the hospital you can usually narrow down which is the best department/Dr to approach. Maybe also worth seeing if you can find the appropriate NICE guidelines to see if your pathway is being followed correctly.

Saying all of that, is it worth maybe seeking a second opinion with another dental surgery first? Do any in your area have children listed as a speciality?

[WaveorCheer]

No, no one sees children specially (children are listed under our current practice).

I'm feeling stuck because they're very nice, the dentist is lovely and seemed a teensy bit miffed that I asked for a referral when she clearly believes it to be within the realms of her professional competence. Even though her first question when I took him in at nine months was to ask if he had a lot of sweets or sugary drinks . Those would have been the fastest forming caries in the history of the world.

Roofio, thanks for highlighting that - I suspect it's not really one for us to worry about as the rest of his teeth seem to be properly formed, but I will definitely get it ruled out.

[WaveorCheer]

His poor teeth :(

[WaveorCheer]

Well, he's woken four times since he went to bed at 6.30.

[superbagpuss]

if it makes you feel any better I had no front teeth from birth to my adult feet forming at approx 7

did have to have braces on the NHS as a teen but have straight teeth now, it hasn't adversely affected me that much

[Ponkypink]

Yes, insist on referral. My dd2 was seen be a consultant dentist (not sure what they are actually called) at dental hospital just for having an extra tooth- it wasn't causing her pain or any issue and they said they would do nothing, and in fact I hadn't even noticed it until dentist pointed it out, so they do see people for far less than your poor son's problems!

[slowcomputer]

Yes you should insist. Try your GP.

Please don't try your GP! I'm a GP, in the course of medical school I think we may have had one lecture on the teeth, or it may have just been ten minutes in a more general lecture about the mouth. We aren't qualified to assess this and you will be wasting your time as they will just tell you to see a dentist. If you want a second opinion, see another dentist.

Hope you get it sorted.

[Minorchristmascrisis]

Lol at adult feet forming, sugar!
Ds2 had baby teeth where the enamel crumbled but not to this extent. I'd insist on a referral.

[BrianTheMole]

Yes you need to insist. Swap dentist, see if you can get referral through them. My friends ds has exactly the same thing and he sees a specialist for it. Although, like you, they were let down by the first dentist and swapped to another to get a referral.

[WaveorCheer]

Thanks all. Another night of being woken every 30-90 minutes. Not sure why I bother going to bed any more.

Right, I'm going to take him back one last time and ask for a referral. If we don't have any joy, should I see another dentist in the same practice, or should we go elsewhere?

[NoArmaniNoPunani]

Where in the country are you? You need a dentist who specialises or has a special interest in paediatrics.

[WaveorCheer]

We're in essex.

Why is the dentist being so blasé? Is this really common?

[Wabbitty]

The dentist is being blasé as you call it because there is nothing more that the hospital can do that your dentist isn't already doing.

[Methe]

My ds has patchy enamel on his teeth and has dome since they came through. In his case it was caused by antibiotics during pregnancy and that is apparently quite common, certainly several of of friends children have poor baby teeth attributed to pregnancy issues.

Our dentists wasn't concerned and he's 5 now and on the verge of them falling out so we'll have to see what his adult teeth are like.

[WaveorCheer]

Thanks wabitty - what would the point of referral be then? Are you a dentist?

Is there really no more help when a child is suffering constant discomfort? When his sleep is disrupted to the point that both he and I are waking up to 20 times a night?

From a selfish perspective, I'm really struggling to manage at work when I'm so tired, and with no end in sight. From a non-selfish perspective, it's stressful to think of my poor baby in discomfort or pain all the time.

[MontyDonnsgirl]

Another vote for coeliacs. That's how my neice was diagnosed.

[WaveorCheer]

It's not patchy enamel anymore methe. Those four teeth are literally crumbling away. If you look at the picture above (and I appreciate it's hard to see), the longer tooth with the crescent moon shape missing is the last to go, and the points are where the teeth all used to reach to.

[MontyDonnsgirl]

Ask for a referral to paediatrician Dr Than Soe at Princess Alexandra Hospital in Harlow. He also sees private patients and is an expert in gastro related things which I reckon explain the teeth, the rubbing his mouth and the crap sleep.good luck.

[Wabbitty]

It is not likely to be coeliac as that affects the permanent teeth. It is likely to be amelogenesis imperfecta or dentinogenesis imperfecta or something that happened during pregnancy.

[CerealMom]

If you can't afford to self refer, either go back to your original dentist and ask again (I would write/email the practice outlying your concerns) for a referral. If they refuse, ask why and ask for this in writing.

Try another dentist and again if you get no joy, send in pictures of your child's teeth to a paed consultant (up thread). Again outlying your concerns, also mention you are having no luck getting a referral. The departmental p.a are usually very helpful if you explain the situation.

Before you do this though be honest. How regularly are you brushing DC's teeth and how much fruit/yoghurt/juice/fizzy drink/sweets etc... is he/she having? If you're confident it's not this (how are the other teeth?) then proceed.

[NoArmaniNoPunani]

I'm a dentist, I see a lot of children. Can you take a better picture? You have to remember that 9 times out of 10 these problems are due to sugar and your dentist has to ask you those questions to rule it out. Nursing caries is a particular pattern of decay that affects babies and young children and is far more common than amelogenesis imperfecta.

Unless the situation is much worse than your picture suggests I doubt he's in pain. Even large open cavities in baby teeth don't cause children much pain, it's only when they develop abscesses that there is pain

[CerealMom]

Also, what about a dental teaching hospital?

[NoArmaniNoPunani]

This picture, for example shows nursing/bottle caries and looks similar to the one you've posted