Tuesday, January 02, 2007

advice wanted -- teeth

Well, I told you I'd tell you when I wanted advice!!

As I posted recently, Jacob needs to have a couple of cavities filled. We went back to the dentist today to have his 6 year molars sealed, and for the dentist to experiment around a little with what he can and can't get away with. It was a good visit -- I heard a slew of "good boy, Jacob"s coming from the back (which always makes me cringe a little -- I really should do a post about praise and how detrimental it is to a kid's development -- but my attitude at the dentist's office is WHATEVER WORKS, DO IT!), and both the dentist and hygeinist gave him a glowing report, and Jacob himself told me he had fun. (FUN?! How the heck is getting your mouth propped open and a gooey substance painted on your teeth fun?) The dentist said that he's fairly confident that he can get the cavities filled in the office, and wanted me to set up the first of the two appointments (he can't do them both at once, as they are in two different parts of his mouth, requiring numbing him in two locations). So I swallowed hard and set it up for later this month.

Then he presented me with the choice that has me stymied. Shall he fill them with amalgam (the old standard "silver" fillings), or composite? I hadn't even thought ahead to having to make this choice, I had just assumed we'd do composite. He strongly reccommends amalgam -- it means less time in the chair for Jacob, less drilling and grinding needed, he just sticks it in there, grinds it off, and he's done. With composite, there's layering, drying, lots of additional grinding and polishing -- up to 10 extra minutes of torture (it's a 1/2 hour appointment, so we're talking either 20 minutes or 30 minutes). He pointed out that these are teeth that will be falling out when he's 10-12 years old anyway.

In case any of you have been living under a rock for the past 15 years and wonder why I'm so concerned about this, amalgam has mercury in it, and mercury is implicated (strongly) in the development of Autism. Does it make any sense whatsoever to purposely put mercury into an Autistic kid's head??

Well, as it turns out, there's a pretty good argument in it's favor. First, the danger with the amalgam fillings comes when they get old and start to deteriorate, leaching the mercury from them. (Until that point, the mercury is locked within a solid.) These fillings won't get a chance to get old, they'll be out of his head when he loses those teeth, at most 6 years from now. (The silver fillings I had removed recently were in excess of 25 years old!) Second, it means increasing the likelihood that the fillings will actually get done. Third, it means potentially decreasing the amount of trauma Jacob has to endure in that chair. Fourth, it's less expensive (but that's a far distant fourth -- the cost isn't THAT much more for the composite, and even if it were, I wouldn't hesitate to use that instead if it were the right choice).

But still, despite all that, you can't deny the fact that I would be purposely choosing to expose my son, my AUTISTIC son, to mercury. A poison by any definition. Something I purposely choose to avoid (and just spent a small fortune that I don't even have to eliminate from my own mouth). Something that I never in a million years would have imagined myself considering.

But the trauma of all that extra dental work when I could make it simpler for him....

And ultimately, getting the cavities filled is the most important part.

So here it comes -- HELP!!!!!! What should I do? What would YOU do? I'm sure others have been in this boat, what have you done? I welcome any and all perspectives on this, just click on the "comments" link at the bottom of this post, then type your comments in the box, either sign in or click the "anonymous" button, and retype the code it gives you (to prevent spam -- my gosh, the best invention EVER!).

THANK YOU so much!


At 5:57 PM, Anonymous Katie said...

Shelley, this is just IMHO, but if it were me, I'd get the composite fillings. It's only a few more minutes per tooth and Jacob's done so well with his dentist visits so far, what's an extra 10 minutes? You've done a great job of preparing him so far and maybe you can promise him an extra-special reward this time, since it's going to take longer and be more difficult than usual. (I bribed my 4 yo with a new Thomas train when he needed to get his blood drawn- he did GREAT! The nurses said he was the best kid to come through there all day!)
Though I realize the greatest risk is from leaching of old amalgam fillings, there is also some potential risk from inhalation of mercury vapors during the time they are actually being put in. Studies have shown that atmospheric levels of mercury are high in dentists' offices after procedures involving amalgam fillings. Also, some studies have shown that blood mercury levels are higher than normal in dentists, dental assistants, and others involved in handling and processing amalgam fillings. Do these elevated levels of mercury pose a health risk? Who knows? Maybe, maybe not, but I personally wouldn't want to risk it if there were a safer alternative.
Best of luck to both of you, whatever you decide! I hope future visits continue to go as smoothly for you as these past visits.

At 7:58 PM, Blogger Rachel said...

Hi Shelley, I've been reading your post for a while - I have a 5 adn 3.5 y/o ASD boys and we are getting ready to start RDI. Anyways - I totally agree with Katie - I would do the composite fillings. Ben, my 5 yo has had 2 fillings and I did the composite b/c I couldn't fathom putting mercury in his mouth. An extra 10 minutes is not that much. Our dentist didn't even use novocaine for Ben, just laughing gas and topical anesthetic (sp). Each time they told me he got a little bit irritable at the end, but did great. Like Katie said, offer him an extra treat of some sort at the end. Ben gets to ride the elevator after he is done at the dentist (the office is on the first floor). Good luck!

At 9:50 PM, Anonymous kyra said...

well, our dentist drilled and filled two of fluffy's teeth using the composite and it took a total of 10 minutes--for both. so, either our guy was a quack or it doens't HAVE to take as long as your guy says it does.

i wouldn't put silver fillings in my own mouth so i wouldn't put them in my son's. just me, though.

i was in the room with fluffy when he had his teeth filled and we took lots of well-time breaks. once the pain of the novacaine had past (it was more the shock of how many shots he needed), he didn't feel anything and he was a champ. and he LOVED the chocolate ice pop i stashed in the cooler for the moment we left the office!

good luck!!!

At 11:26 PM, Blogger Harvest Mom said...

OK, a couple more pieces of information that might be helpful based on the responses I've gotten so far:

1. I trust this dentist.

2. Jacob has extreme Sensory Processing Dysfunction, he especially has problems with sound. So 10 minutes of those things going on inside his head is going to be a lot like torture. So 10 minutes is a pretty enormous deal. (Plus we're really talking about 20 minutes, see below.)

3. Jacob is not bribable, so offering him something special for withstanding this is not going to be a successful approach.

4. His dentist won't use laughing gas without an anesthesiologist present, which would mean a visit to the hospital (and his hence not an option).

5. These cavities are deep between molars, so require novacaine according to our dentist, and also will require two different visits (in two different parts of his mouth), so it's 10 extra minutes for each tooth. (Will take about 20 minutes per tooth with the amalgam, 30 minutes with the composite -- this is certianly in line time-wise with what my own dentist did while filling my recent holes in my head.)

Thanks for your thoughts, guys, I'm not trying to defend using amalgam, I just want to make sure everyone's got all the information I do so that we're all working with the same package. :-)

At 8:13 AM, Blogger Rachel said...

A few thougths...Have you tried using headphones while he's in the dentist chair? Does your dentist have videos playing in the ceiling so the child can watch while he's doing the work? (ours - a pediatric dentist who specializes in special needs does)

I personally would still use composite vs. amalgam. LikeI said, I couldn't imagine putting amalgam into my ASD son's mouths.

At 5:24 PM, Anonymous Anonymous said...

ok, um, well, here is what I did. Noah has a cavity in between a molar, that was filled with a composite filling. He had had two cavities with baby teeth, in which they did amalgam fillings. They also tried to tell me how much monger it would take, but it didn't really take much longer. BUT Noah had already had two other times experience with fillings, and he got the laughing gas.......
With jesse, well the kid sucked everything till 4 years old, so at 3 his whole mouth was pretty much a mess. He has some amalgam and some composite, once he got used to the dentist more. Honestly, I have heard about the mercury issue, but since Jes has never had a vaccine and was DX with infantile Autism at age 1, It was just not that big of an issue with me. right or wrong, I was more concerned with Jes comfort. Not that I do not take different opinions regarding mercury seriously, but with my child, like I said, he was never even vaccinated. I tend to believe in our case, I have two children on the spectrum and 2 NT, we are dealing moreso with genetics.
Sorry, not sure if this helps, but I do believe that without lauging gas, it will be alittle more difficult. Faster may be better...

At 6:36 PM, Anonymous Karen Lepak (Archie's mom) said...

Shelley, after reading David Kirby's book mercury scares the hell out of me. If there is any evidence, the slightest little bit that the MMR poisoned our Benjamin I would go with the composite fillings. We don't know and that is the frightening part. You will make your own decision for Jacob, but all of this feedback is so valuable. I spoke with both of my daughters, one with a typical 2.5y/0 and Ben's mom. both advise the composite. Ben wouldn't go for a bribe and he would need anesthesia. After class tomorrow evening, I would like to talk to you about RDI. for a short time.


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