Cavities Waiting to Happen
Rose McGrath never noticed anything unusual about her children's teeth. The mother of four from upstate New York was just simply trying to do the right thing when she took her oldest son, Michael, for his first dental checkup when he was about 4 1/2.
"He asked if he could go in with the dentist by himself and I let him," McGrath says. "So there I was, sitting in the waiting room flipping through a magazine when the dentist came out and said he had nine cavities. I almost fell off the chair."
Over the course of the next six months, Michael had six of his cavities filled. But right before he was scheduled to have work done on No. 7, his 4-year-old sister, Kasey, woke up in the middle of the night complaining of a toothache. When the dentist examined her teeth the next day, he found eight cavities.
Seventeen cavities between two children who still have a mouth full of primary teeth is a bit unusual, especially if the children brush and floss regularly, which the McGrath children do. And, like the dentist did at first, you might think that McGrath is the kind of mom who lets her children down sweets like air, but she doesn't. That and Kasey's cavities led her dentist to believe that what the McGrath children actually suffer from is a condition known as "soft" teeth, a genetic pre-disposition to getting more cavities.
What's Going On?
"There isn't really one generic term for such a condition, but several, although it is actually referred to as enamel hyperplasia," says Dr. Jim Lacedo, a family dentist who occasionally sees children with this disorder. "Basically, the enamel is a bit weaker than it should be." He also says that it is quite common in families whose primary water source is from a well, which means it is not usually fluoridated. "There are certainly genetic disorders and tendencies that cause a predisposition to cavities, and there are all different degrees of resistance to cavities," he says.
Although there isn't a definitive test that can be done to confirm the condition one way or another, McGrath says Kasey's diagnosis seemed to immediately point toward genetics. "My husband has very bad teeth – he's even had two of his teeth pulled," she says. "Everyone in his family has bad teeth, too. He also has a nephew who had multiple cavities on his first visit."
But even though genetic dental difficulties do exist, some dentists, like Dr. Malcolm Foster, a pediatric dentist in Maine, believe that inherited bad teeth occur only in a very small percentage of the U.S. population. "Usually, dietary and oral hygiene habits play a more important role in the number of decayed teeth a child may have," Dr. Foster says. "Granted, there are certain illnesses and syndromes that are inherited, by the effects they have on teeth are secondary in nature. In other words, [heredity] only increases the chance of the teeth becoming decayed. [These conditions] do not cause cavities. Only sugar causes cavities."
Dr. Foster also says that some children, even though they practice good dental hygiene and avoid sugar, do tend to get more than the average number of cavities. There are also children who hardly ever floss, eat sugar enough for 10 children and still get few – if any – cavities at all. "There will always be a few born with a good set of teeth," Dr. Foster says. "One thing, though, is certain – inheriting bad teeth is rare."
"But family history is important," Dr. Lacedo says. "If other conditions like baby bottle syndrome have been ruled out and the family is brushing, flossing and avoiding the bad things, it might be a big factor."
So what if your children fall into that small percentage who will almost certainly get a mouthful of cavities despite your best efforts?
"I personally believe in fluoride supplements and prescribe them to patients whose water is not supplemented with it," Dr. Lacedo says. He says his own three children – the youngest of whom is 7 months old – take fluoride drops daily.
McGrath says that her dental hygienist also recommended systemic fluoride treatments (those taken internally) like the daily drops to help prevent more cavities from forming. "There are also fluoride rinses, but they don't seem to be as effective and they don't do much to help protect the adult teeth growing beneath the gums," she says.
Of course, avoiding sugars and brushing immediately after eating anything sweet also help. "Basically, in addition to the brushing, rinsing and flossing, we have to be a bit more vigilant with them," McGrath says of Michael and Kasey. But, after so many trips to the dentist, the children are becoming more pro-active about their dental health.
"Kasey didn't even want her Easter candy this year," McGrath adds. "She walked around telling everyone, 'My dentist says not to eat sugar.'"
For Kasey's cavities, which are deeper in the molars than her brother's, McGrath says her dentist used medicine fillings as a way to help the decaying teeth live as long as possible. Still, the major concern is that the teeth may not survive long enough to hold the space for the adult teeth that will eventually erupt. And since the family's dental plan only covers preventive dentistry (initial cleaning and X-rays), the cost of filling the cavities is adding up – close to $600 for Michael's while Kasey's medicated fillings are expected to cost a bit more, even though she has fewer cavities. Because of that, the fillings are being completed one child at a time, although the visits are regularly scheduled.
"Mikey probably won't have his other cavities filled until Kasey is done, since her problems seemed to be more urgent," McGrath says. "And she is a twin. Her other brother hasn't had his first visit yet, and we still have one to go after him. Who knows how many cavities we'll have then?"
Although genetics may play a role in conditions like "soft" teeth, here are some ways that you can help keep the number of cavities your children get to a minimum:
- Watch the sugar. Not only are candy bars, cookies and soda loaded with sugars, but many seemingly healthier products like chocolate-covered granola bars and yogurt also contain lots of the sweet stuff as well. Read the labels and know what your child is eating at home and school.
- Brush after every meal. Even when brushing isn't possible (like after school lunch), remind your child to rinse with water after he or she eats. This will help keep the sugars – as well as the bacteria that eats it and causes decay – from forming.
- Floss every day. Most dentists advise that flossing begin as soon as your child has two adjacent teeth. "Most cavities form in the pits of the molars or between teeth, spots that the bristles of a toothbrush can't get to," Dr. Foster says. Flossing helps get rid of plaque and bacteria in hard-to-reach areas.
- Visit the dentist regularly. The first visit should be around your child's 4th birthday. That way, problems can be spotted early and treatments can begin before things get too out of control. Subsequent visits are usually set at six-month intervals, unless there is a problem that requires a more frequent examination.