We in Kenora are fortunate to have a hospital that makes itself available for some dentistry. Most people will never need dental work to be completed in the hospital. Usually when a person is treated in the hospital, it is done because of management problems. Meaning, the person cannot be treated unless general anesthetic is provided. These patients include some developmentally disabled people, children who are very young or require very extensive treatment, or some patients with other physical or mental disabilities.
The most common hospital dental patient in this area is a child who is about 2-4 years old and has tooth decay (cavities) on just about every tooth in the mouth. This condition is commonly called baby bottle syndrome or nursing caries. Nursing caries consists of tooth decay that is so severe on the upper anterior (front) teeth that the teeth are brown stubs decayed off at or near the gum line. The upper posterior (back) teeth are extensively decayed, as well as the lower posterior teeth. The child is typically 2 or 3 years old. This condition is caused by nearly constant feeding using usually a bottle. The child is allowed to carry the bottle around constantly and the child sips the bottle all day and all night long. Nearly as much damage is caused by only night time constant use of a bottle. Severe damage will occur if a bottle is sipped all night long (or day and night) regardless of what liquid is in it. Only water does not cause damage. Soda pop is the usual liquid in the bottle causing this kind of damage. However, juice or milk will cause similar damage even though they are “natural”. As described before in this series, the bacteria on teeth (plaque) feeds on any of several kinds of sugar, whether natural or refined, and as the byproduct of its life process, deposits a weak acid on the teeth. The acid dissolves calcium and phosphorus in the tooth structure and leaves behind a sticky protein substance that is decayed tooth structure. The teeth cannot recover from this damage themselves. The damaged structure has to be removed and a substitute substance (filling material or a crown) has to be placed where the tooth structure was removed. If the damage is too extensive, the tooth cannot be restored to its former form and must be removed since teeth this damaged cause infection. As you might have surmised, this condition is usually painful.
The child requires general anesthesia because of the large number of teeth to be extracted or restored and the child’s young age. A medical doctor specially trained in delivering general anesthesia “puts the child to sleep”. There is sophisticated monitoring equipment in place to help the doctor monitor the “sleeping” child. The dentist performs the needed treatment usually with the help or one or two assistants. When the child wakes up, the unrestorable (un fixable) teeth are gone, and the remaining teeth are all restored (fixed). The care giver is given instruction on how to avoid further problems, and the child is discharged usually within an hour or so after the dental work is finished. Even though the teeth have been fixed, the work is not completely finished at this point. Baby teeth are used as sort of a path marker for the developing adult teeth to “know” where to erupt. Without the baby teeth in the upper anterior or elsewhere, the adult teeth will usually delay eruption for a year or more beyond the normal eruption times. Additionally, they will typically erupt in unusual locations. You guessed it, these nursing caries (baby bottle) patients usually require braces in their young teens. All of this can be avoided by establishing a feeding routine for junior that includes taking the bottle away after a few minutes or refilling it with water after the milk or juice is gone.
There is work done at the hospital for other kinds of patients as well. It has been reduced in recent years because of the inability of the hospital to maintain dental radiography (x ray) equipment. Because of this, most adults needing hospital treatment have to be referred to other centres for treatment in hospitals that maintain dental radiography equipment.
If your child has a bunch of deeply decayed teeth, ask your dentist what the options for treatment are.
This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)