Contemplating A-‘s enamel hypoplasia

| parenting

I get a little anxious about A-‘s teeth. She has enamel hypoplasia, and there are large spots where enamel didn’t fully form. I’ve taken her to the dentist a number of times, and I even got a second opinion. Both dentists recommended watching and waiting, trying to make brushing a pleasant habit instead of restraining her, holding off on fluoride toothpastes or varnishes until she can reliably rinse and spit, and playing the long game when it comes to minimizing anxiety about dental care – better to avoid potentially traumatizing kids. Most days I can get her to either use the electric toothbrush or let me brush her teeth. A- does like rinsing and spitting at home, but I’m not sure I can get her to do that at a dentist’s office after a possibly upsetting varnish, and she still sometimes drinks the water instead of spitting out out. It’s just a little nerve-wracking to watch the slow discoloration of the rear surfaces of her front teeth and wonder when she’ll be able to sit for treatment, while keeping things pleasant and worry-free for A- so that she doesn’t develop dental anxiety.

The research papers I’ve read recommend fluoride varnishes even for very young children, but I’m reluctant to push for something against the recommendations of two dentists who’ve seen A-. I think I can trust their experience and that they’ve considered the research findings, too.

It can be reassuring to plan for the worst-case scenario. Let’s say A-‘s teeth start hurting. We’d take her to the dentist to have a look. Let’s say the teeth most affected by enamel hypoplasia need to be filled or even extracted before A- can sit still for cleanings or less invasive treatments. We’d take her in for dental work under sedation. It would be expensive, but that’s something we can save for. She might have spacers to help with the growth of her permanent teeth. It would suck, but there shouldn’t be any long-term pain, and she would probably catch up in growth after that’s resolved. If she does end up with anxiety about dentists, well, maybe play therapy and psychotherapy can help. After all, she’s similarly unhappy with ocularists, ophthalmologists, cardiologists, pediatricians, and nurses, but we don’t let that stop us from doing what’s necessary.

I think I’m partly worried that A- might not be able to tell us if her teeth hurt. She’s pretty good at telling us when she bumps her elbow or drops something on her toe, though. She loves eating frozen blueberries and doesn’t have a fever. Her gums don’t look like they have abscesses, although her top front teeth do have dark brown spots on the back.

I’ll probably take her to the dentist when we get back from our trip, partly for familiarization and partly for peace of mind. Maybe we can plan it for a day when W- can take us in the car. Or maybe we’ll get proper snow pants for A- and gradually work up to regularly spending time outside, so then we can make it to the appointment by subway. We can deal.

Lots of people get cavities. I still need the occasional filling, even though I try to take good care of my teeth. Lots of kids get cavities, and the Internet says the cavities tend to bother the parents more than they bother the kids. It’s not the end of the world. It’s not fully under my control, either. All we can do is deal with things and try to build good habits. It’s going to be okay.

You can comment with Disqus or you can e-mail me at