r/Dentistry • u/UglyAndTired9 • 1d ago
Dental Professional How would you treat this child? Extraction of those roots or something else?
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u/WolverineDDS 1d ago
I'm a pediatric dentist and see this all the time. There is no "something else" here.
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u/zeezromnomnom 1d ago
How “all the time” are we talking? And do you refer to CPS when it happens?
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u/arabmoni 1d ago
Speaking as a peds DDS- CPS is a judgment call. Would see this regularly in residency and it wasn’t an automatic CPS situation every time- lack of education isn’t always neglect. And “all the time” would be weekly, but now in my career it’s a lot less frequent… maybe a few a year
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u/Outrageous-Ad-6093 1d ago
Getting to this stade is neglect (in a free healthcare country like mine).
How do you not see your kid teeth rot ?
They already saw a dentist for this who told them how to correct things. Or worse, they never took the child for care and looking at the photo they're no way this was painless.
When i see cases like this is always the school who made a report and parents were forced to make an appointment because of cps surveillance.
(I don't make reports because here CPS is way underfunded and worse than a neglectful house).
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u/arabmoni 1d ago
Lots of recent immigrants for one, who’s parents’ teeth immediately tell you that they do not understand.
A lot of people also simply grew up without access to dental care, and don’t put a premium on primary teeth because “they fall out”.
Not saying it’s right for anyone to get there, but I try to take it case by case, and I personally feel it’s pretty easy to tell when the parents actually care and understand vs when they don’t.
Negligence has to, by necessity, assume that the negligent person understands what the right thing to do is. If educated/aware and they still do not take the proper steps- outside intervention may be necessary.
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u/matchagonnadoboudit 18h ago
You mean to tell me they know how to make babies but don’t know how to see that their kids teeth are rotten?
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u/arabmoni 17h ago
Kind of like all the non-human animals out there, yeah. That’s why education matters. It’s not about seeing the decay, it’s about understanding.
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u/panic_ye_not 1d ago
I disagree. Neglect is neglect. Ignorance excuses nothing. "I didn't know I was supposed to feed my child, so they died" is the logical extreme of that kind of thinking.
It's just like the law. Ignorance of the law has no bearing on whether you've broken it.
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u/arabmoni 1d ago
This is the legal definition of negligence we were taught in residency that reflects the way the courts process it when these situations escalate. Neglect and negligence are not the same thing.
It’s sad, but it’s not the same as eating. Whether we like it or not, people go years without brushing and survive, unlike eating. The degree of severity does play a role medico-legally2
u/panic_ye_not 11h ago
I see. I looked up AAPD's definition for neglect and it does specify that it is "willful."
That may be so from a specific American medicolegal standpoint, but in all other contexts, neglect has no such requirement. Here's Merriam-Webster: "to leave undone or unattended to especially through carelessness." So you can see that this definition emphasizes carelessness as a defining quality of neglect, which is in a sense the opposite of willfulness.
So for my own personal definition, I'll stick with what I said before. But thanks for the info on how it works medicolegally, I didn't realize the difference before.
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u/arabmoni 11h ago
No one said willful- but in order to be negligent, you need to understand what options are right or wrong prior to failing them. This is regardless of whichever definition you subscribe to. Otherwise it’s simply ignorance- you cannot be negligent if you aren’t educated on what you’re being negligent of.
Also once more- neglect is NOT negligence- they are seperate. I am discussing negligence, not neglect.
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u/WolverineDDS 1d ago
Few times a month? I accept medicaid so I see a decent amount of bottle rot. No CPS report unless there is neglect which means they know theres a problem and are refusing to treat it. Typically if theyre coming to see me its because they want the problem solved. For particularly bad cases or if I have neglect/abuse concerns we follow up to make sure treatment is being pursued and if not then I make an anonymous report.
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u/ashareif 1d ago
general anesthesia, extraction of all primary teeth and report the parents.
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u/Micotu 1d ago edited 1d ago
why you pulling the second molars?
Edit: Why is this getting downvoted? The primary second molars look fine. I don't even think #K is fully erupted yet.
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u/Brian_K9 1d ago
Are second molars primary teeth?
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u/ashareif 13h ago
If all the other teeth are rotten. Then the second molar has a cavity, that is guaranteed. We can’t diagnose from a pic but it’s highly likely that it is cavitated.
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u/Acrabat321 1d ago
That child has gone through so much pain to get to that point. Christ
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u/melatoninaintworkin 1d ago
That’s what i would try to explain to mom’s. They can’t tell you how bad they have been hurting. But they would do it to any siblings that followed as well.
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u/stefan_urquelle-DMD 1d ago
This is a specialist case 100000000%
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u/safeDate4U 1d ago
I did these routinely in my gpr and afterwards.
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u/seeBurtrun 1d ago
Can you elaborate on how you handled these?
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u/safeDate4U 12h ago
Sure
Booked time in the OR and after the child is intubated I infiltrate some local and removed the teeth1
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u/Arathrya 1d ago
Children dentist here: please do bitewings to see if any of the teeth has apical, then it needs to be extracted, same if you see a fistel or abscess. Stainless steel crown on 5th ( without pulp, they seem not to destroyed, maybe you could use hall techni) 4-4 upper and lower jaw extraction I would suggest from the look, but X-rays for final decision are needed. Off possible loose space maintainer, if wanted prosthetic teeth on space maintainer.
It looks like this child is very young, 5th are not even completely there. Also prognosis is very bad if there teeth that are not long in mouth already look like this. That treatment is a lot to handle in this age, I personally would favour general anesthesia. But if cooperation with X-ray is perfect, you could try sedation with dormicum for treatment - then you have to finish everything in one sitting (fast crowns in Hall technic), after those much extractions child will not come freely on your chair again, still very high risk of trauma.
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u/Arathrya 1d ago
I personally would not recommend pulp and crown in the front - the nerve is already visible and have been open for a while, infection even after root treatment is likely and with it harm on the adult teeth laying underneath, 4th teeth you could try to save with pulp if bitewing is apical ok, but personally I would not recommend taking chances with that high risk profile and under general anaesthesia - you also want to avoid a second treatment in general anaesthesia in one year or so, that is why in severe cases that need general anaesthesia or multiple extractions I commonly decide more radical to be sure treatment will work.
And please identify the cause (bottle, juice, brestmilk?) and give oral health education and practical training to the parents.
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u/HgnX 1d ago
As a non dentist; what is happening here
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u/TheFriendlyBean 1d ago
All of the kid’s baby teeth have totally rotted out, due to a combination of poor diet and poor hygiene.
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u/itsmeagain24 1d ago
Jesus Christ, how bad does diet/hygiene need to be to get here so young??
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u/Alieges 18h ago
(I'm not a dentist, but this is a bad case of Bottle rot).
Basically teeth get washed in sugar and acid repeatedly, day in day out. Perhaps the parents gave them a bottle with pop or juice or milk constantly.
Don't use a bottle as a pacifier!!!!
Bottle is for drinking while stationary in a reasonable timeframe. Not actively drinking? Bottle goes away. Going to be moving around? No Bottle. Crawl all you want with a pacifier.
No bottle when sleeping. No bottle when taking a nap. No bottle for two hours while parents/grandparents go gamble their kids future away.
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u/Lobster_Can 1d ago
I would probably be referring to pedes, but yeah pretty much full mouth clearance is the only reasonable treatment here. I joke about pediatric dentures but unfortunately that might be part of the discussion here.
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u/ThelIIusion0fSeIf 1d ago
It’s really hard witnessing this type of abuse/neglect and with the way things are going especially with respect to reproductive rights, contraception, healthcare affordability, and education I’m worried it will only get worse.
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u/Wide-Chemistry-8078 1d ago
Refer to Pediatric dentist. I would want a colleague that sees this more often to treatment plan. Maybe some pulpectomies and ss crowns, or its a full mouth extractions but under general anesthesia. (Dependant on xrays and the experience of the dentist that does treat.) I'd imagine they might try to save the 4's and 5's for chewing.
Ugh poor kid. They will be in school with practically no teeth for awhile.
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u/Get_off_critter 1d ago
What a punch to their confidence 😞
I assume you cant denture a child?
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u/RobertPooWiener 1d ago
You can make a denture to fit a dog if you wanted. Whether they will wear them and whether they will fit for any meaningful length of time is a different story
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u/Excel_Document 1d ago
what is this even is? i've never seen something like this and i hope i never do
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u/Sharp_Oral 1d ago
See it all the time in the South. The amount of people that put soda or energy drinks in a sippy cup is… wild.
One mom explained “Red Bull is the only thing that calms him down.”
Medicaid patients are… yeah… half are normal people down on their luck… the other half… is this.
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u/Isgortio 1d ago
How old is the child? Do they have permanent successors?
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u/melatoninaintworkin 1d ago
Prob 2 to 2.5 no reason to think they won’t have permanent teeth. But when you extract all the baby teeth at once the perm ones can take a while to come back in. They start school toothless. Pitiful
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u/Honeybadgerdds 1d ago
Stainless steel crowns (with white veneer) and pulpotomies. If you can have enough tooth structure left after decay removal to crimp a crown on to. You would be surprised what you can do with subgingival crimped stainless steel crowns.
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u/Mohammadhilal 1d ago
GA or sedation
E's: looks fine
D's: (check mobility, Radiograph) if indicated Pulpectomy + composite core + SSC (although unlikely but if mobility grade 2 or more or periapical pathosis/radiolucency then extract)
C's: (check mobility, Radiograph) Pulpectomy + composite core + Bioflex (although unlikely but if mobility grade 2 or more or periapical pathosis/radiolucency then extract)
Incisors: Extract
Upper: Modified Nance appliance to replace missing teeth, + monitoring growth of the maxilla
Lower: 🤔🤔 nothing could be an option, partial denture or lingual bar would necissate monitoring and will be very annoying to the patient
Follow up.
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u/Independent_Drop4317 General Dentist 1d ago
Ext under ga. Extensive oral health education to the parents.
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u/chocoloco08 1d ago
Not a dentist. This is truly shocking. Makes me wonder how long the child has been in pain before taking to a dentist. Wow. 😳
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u/Negative-Lobster3873 1d ago
Keep it in for space maintenance if there is no active infection or pain.
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u/petmaster 1d ago
I know leaving the teeth can lead to infection, but would any of you guys consider ext only symptomatic teeth, PARL/abscess and then keep the remaining teeth so the patient can eat?
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u/Outrageous-Ad-6093 1d ago
Because of negligent parents : no oral hygiene and bad diet will result in multiples infections and pain. You'll get to see the kid on emergency only to perform extraction in a bad context.
You can even doubt the child will be taken to the dentist if it hurt. It hurted before and it seems they didn't care.
So you sedate, extract everything and explain to the parents that's the last second chance they get because if things doesn't change their kid will be toothless at 25 yo.
The patient is already eating on his gums anyways.
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u/ASliceofAmazing 1d ago
Full mouth clearance and a call to CPS