6-year old with hypoplastic first molars

[NY Mom]

My 6-year-old son had his regular checkup with the pediatric dentist
today. To my surprise, the dentist told me that his first molars were
hypoplastic and undercalcified. There is actually a small cavity in
one of them. He said that the enamel is weak and pitted. The teeth
have a little brown staining in the crevices, and a few white spots.
When I asked him what caused the problem, he said that the most likely
cause was stress at the end of my pregnancy. He could not tell me how
likely it is that other permanent teeth have been affected. My son has
one of his lower front teeth partially in, and it looks all right to
me. It has come in behind the baby teeth, which don't seem to be
budging. We have to come back in a month to check on this situation,
and he will have sealants on the molars and a filling for the cavity.

I've been reading everything I can find on the internet about the
enamel problem, but I didn't find much information. The only unusual
stress during my pregnancy was at 7 months, when my older son had to go
to the emergency room in an ambulance. My husband, my older son, and I
all have normal teeth. My younger son has been very healthy. He did
have jaundice during his first week, but it was never serious enough to
require treatment. He was exclusively breastfed for the first year,
with very few solid foods (my older son has serious food allergies and
this was a preventive measure), and breastfed for the second year as
well. He did have a fever for a few days when he was an infant, I
can't remember exactly how old. He's never had fluoride supplements,
we drink bottled water, and I didn't even use fluoride toothpaste on
him until he was about 5.

I'm wondering whether I should take him to an academic practice. We go
now to a suburban pediatric dental practice with two dentists. I'm
worried about the health of these molars, and about whether other
permanent teeth will be affected. His baby teeth are beautiful, white
and straight.

Any information or advice would be greatly appreciated.

[Steven Bornfeld]

Frequently it is difficult to pinpoint the exact cause of focal
hypoplasias. Occasionally severe fluorosis will cause something like
this, but it is unusual in first molars. There are also some genetic
conditions causing hypoplasia, but with most of these you or his dad
would be aware of a family history.
Absent that, it is unlikely the other teeth will be similarly affected,
unless there was a chronic excess fluoride ingestion.

Steve

>

--
Cut the nonsense to reply

[Peter Meiers]

NY Mom wrote:

> ... He's never had fluoride supplements,

> we drink bottled water, and I didn't even use fluoride toothpaste on
> him until he was about 5.

Did you check the label of the bottled water? Some are worse than
fluoridated tap water, regarding the fluoride content (apart from other
contaminants and bacteria).
If the label says nothing about fluoride, that doesn´t mean it has none!

Best,
Peter

--
-History of fluorine, fluoride and fluoridation-:
--- http://www.fluoride-history.de/index.htm ---
----------------------------------------------------

[NY Mom]

I hope you're right about the other teeth not being affected. I guess
I'll be biting my nails for a while until they come in. I don't see
how he could possibly have gotten any significant amount of fluoride,
and a genetic problem seems very unlikely.

Thank you for responding.

[nys...@gmail.com]

Of course, the hypoplastic teeth don't have to be fluorosis. However,
since your signed on as NY Mom, it's possible you've used cold mist
humidifiers with tap water (NYC and 70% of NY State is fluoridated).

Coal heated buildings, such as many NYC schools emit fluoride air
emissions. Other fluoride emitters are power plants and other
factories.
Living near these buildings increases fluoride intake

Inhaling ocean mist (which is fluoridated at about 1.2 or 1.4 ppm
fluoride) is another air borne source.

Baby food meat products have lots of fluoride in them from the
mechanical de-boning process which gets fluoride-rich bone dust in the
finished product.

Some grape juices have very high fluoride levels because of fluoride
containing pesticide residues that remain on the fruit.

Teflon cooking pots and utensils pass fluoride into foods. And some
medicines contain fluoride.

Now that sulfuryl fluoride has replaced sulfuryl bromide as a fumigant,
lots of fluoride in many more products.

See: "How Much Fluoride Did You Eat Today?"

http://www.suite101.com/article.cfm/11749/112620

There are many hidden sources of fluoride. And as Peter said, you have
to call the bottled water company to find out if there is or is not a
fluoride content. There's no requirement to put fluoride content in
any foods - unless it's been purposely added

NYS Coalition Opposed to Fluoridation
http://www.orgsites.com/ny/nyscof

[NY Mom]

Thanks for the information. I checked out the brands we've used on the
web, and they seem to be all right in that respect. In any case, my
son was breastfed until he was 2, and didn't get any water directly, so
this seems an unlikely source of the problem.

[Mark & Steven Bornfeld]

nys...@gmail.com wrote:

> Of course, the hypoplastic teeth don't have to be fluorosis. However,
> since your signed on as NY Mom, it's possible you've used cold mist
> humidifiers with tap water (NYC and 70% of NY State is fluoridated).
>
> Coal heated buildings, such as many NYC schools emit fluoride air
> emissions. Other fluoride emitters are power plants and other
> factories.

Do you really belive that coal-burning furnaces are still legal in NYC?
My understanding is that coal-burning furnaces, as well as residential
incinerators have been illegal in the 5 boroughs for many years.
I will try to find a reference.

Steve

> Living near these buildings increases fluoride intake
>
> Inhaling ocean mist (which is fluoridated at about 1.2 or 1.4 ppm
> fluoride) is another air borne source.
>
> Baby food meat products have lots of fluoride in them from the
> mechanical de-boning process which gets fluoride-rich bone dust in the
> finished product.
>
> Some grape juices have very high fluoride levels because of fluoride
> containing pesticide residues that remain on the fruit.
>
> Teflon cooking pots and utensils pass fluoride into foods. And some
> medicines contain fluoride.
>
> Now that sulfuryl fluoride has replaced sulfuryl bromide as a fumigant,
> lots of fluoride in many more products.
>
> See: "How Much Fluoride Did You Eat Today?"
>
> http://www.suite101.com/article.cfm/11749/112620
>
> There are many hidden sources of fluoride. And as Peter said, you have
> to call the bottled water company to find out if there is or is not a
> fluoride content. There's no requirement to put fluoride content in
> any foods - unless it's been purposely added
>
> NYS Coalition Opposed to Fluoridation
> http://www.orgsites.com/ny/nyscof
>

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

[Mark & Steven Bornfeld]

Mark & Steven Bornfeld wrote:

> nys...@gmail.com wrote:
>
>> Of course, the hypoplastic teeth don't have to be fluorosis. However,
>> since your signed on as NY Mom, it's possible you've used cold mist
>> humidifiers with tap water (NYC and 70% of NY State is fluoridated).
>>
>> Coal heated buildings, such as many NYC schools emit fluoride air
>> emissions. Other fluoride emitters are power plants and other
>> factories.
>
>
>
> Do you really belive that coal-burning furnaces are still legal in
> NYC? My understanding is that coal-burning furnaces, as well as
> residential incinerators have been illegal in the 5 boroughs for many
> years.
> I will try to find a reference.
>
> Steve

I quickly found this reference, wherin the remaining 114 remaining
coal-burning furnaces were to be converted--during the Giuliani
administration.
I do not know when this may have been accomplished, so it is possible
that during this child's early years, some coal-burning furnaces were
still on-line:

http://www.nyc.gov/html/records/rwg/html/2001a/weekly/wkly0129.html

Steve

[NY Mom]

We live in Westchester Co., and there are no coal-burning buildings
anywhere near here. I don't use humidifiers, and only gave him Earth's
Best baby food. I think it's extremely unlikely that my son was
exposed to anything but minimal levels of fluoride. My older son, who
is now 12, actually took fluoride-containing vitamins as a baby (that
was the recommendation then) and his teeth are fine.

Is this condition common?

[Dr Steve]

The kid probably ran a fever as a toddler when the enamel was forming.
These white blotches seldom are a problem. Forget about it for now. Deep
pits are genetic and are best treated with a sealant or preventative resin
filling. Don't stress out over this for Pete's sake {pun intended Peter
:-) }

--
~+--~+--~+--~+--~+--
Stephen [What's a Temporary?], D.D.S.
Michigan, USA
....................................................

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
......................
"NY Mom" <km...@speakeasy.net> wrote in message
news:1116514876.4...@z14g2000cwz.googlegroups.com...

[NY Mom]

I'm expecting orthodontia. My teeth are straight, although I didn't
have braces, but my husband's are crooked. My older son is about to
get them for minor problems, probably for only 6 months according to
the orthodontist. I have the feeling that my younger son will need
more extensive orthodontia.

It occurred to me to wonder whether, if my younger son's orthodontic
treatment requires extraction of teeth and the first molars turn out to
be the only hypoplastic ones, they might take those out and leave the
good ones?

[NY Mom]

I am stressed out, not because there are white blotches but because the
dentist said that the surfaces were pitted, the enamel was
undercalcified and weak, and the child already has a cavity despite
meticulous brushing and flossing (by me, not by him) and a good diet.
The dentist is going to put on sealers, but he said that if the front
teeth were affected, my son would need cosmetic bonding. I've been
reading about crowns being needed on molars in this state. I'm
wondering whether my son is looking at a lifetime of serious dental
procedures.

[Dr Steve]

Find something better to obsess over.

--
~+--~+--~+--~+--~+--
Stephen [What's a Temporary?], D.D.S.
Michigan, USA
....................................................

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
......................
"NY Mom" <km...@speakeasy.net> wrote in message

news:1116516167....@o13g2000cwo.googlegroups.com...

[Dr Steve]

Often these teeth develop with such deep grooves that they begin to decay as
they erupt. Easily taken care of. Regarding the front teeth, the dentist
is simply giving you the worst case scenario so that you will not be upset
with him in the future. You simply get to live with whatever you get.

--
~+--~+--~+--~+--~+--
Stephen [What's a Temporary?], D.D.S.
Michigan, USA
....................................................

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
......................
"NY Mom" <km...@speakeasy.net> wrote in message

news:1116516488.3...@f14g2000cwb.googlegroups.com...

[Mark & Steven Bornfeld]

NY Mom wrote:

Yes. It sometimes affects multiple teeth, but probably more frequently
just one or two teeth.
Have his lower or upper permanent incisors come in yet?

[Mark & Steven Bornfeld]

NY Mom wrote:

It's way too soon to worry about this.
It's true that I haven't seen how bad the first molars look, but these
are important teeth. The decision as to whether teeth have to be
extracted will be based on what the orthodontists call an arch-length
analysis. If you get a consultation, this is certainly one of the
issues you will discuss.

[Mark & Steven Bornfeld]

NY Mom wrote:

Nah. Don't worry about it. Do what I did--worry about my kid's school
and teachers.

[NY Mom]

One lower front tooth is partially in, making its own row behind the
baby teeth, which are not giving up the ghost. The part that is peeking
out looks ok to me.

[Steven Fawks]

I'm
> wondering whether my son is looking at a lifetime of serious dental
> procedures.
>

I doubt it, but no one knows for sure at this point. Every once in a
while I will see a youngster with poor enamel formation on certain
teeth. The first molars seem to be the most commonly affected. Usually
I can deal with it by using bonded filling materials while they are
young and then I might crown any badly affected teeth around 18.

Since nothing lasts forever, they will need further treatment at some
point later in life, but I don't think I would use the word "serious".

In very severe cases, the first molars could be extracted and the second
molars guided into the first molar position, but I can't recall seeing
one this bad in my 26 years of practice.

Fawks

[NY Mom]

Thank you.

[Mark & Steven Bornfeld]

NY Mom wrote:

Since the lower central incisors and the 6-year molars begin to
mineralize at about the same time (in infancy), it is possible that an
event that caused a problem in mineralization of the molars (a high
fever, for instance) could also cause a problem for the incisors.
Typically, this is seen as a horizontal band around the surface of the
incisor(s). If the lower centrals come in clean, it increases the
chance that the first molars are an isolated problem.

[NY Mom]

Thank you so much.