The Dentist and the Alligator

I've never taken Matthew to the dentist. That task has been delegated to Bill since it would be easier for him to hold Matthew in the dental chair than it would be for me. His first appointment was 6 months ago.



The 2nd visit to the dentist for a routine check went fairly well. He was calm when in the waiting area. But Bill needed to sit in the dental chair with him and hold him still. The dentist looked in Matthew's mouth while he screamed in protest. The screaming stopped shortly after the dentist was done checking his teeth. And I think he forgave the dentist when she gave him a giant toothbrush and toothy alligator to play with. He enjoyed using the giant brush so much that he even tried to brush Bill's teeth with it.





The good news is he has zero cavities! I'm hoping Matthew inherited Bill's genes for good teeth and not mine. I had lots of cavities while growing up while Bill is 30+ and he has not had a single cavity in his life. Bill drinks soda everyday, a few times a day. Unbelievable but true (and so not fair)!

As Matthew gets older and his language skills increase, I foresee us not needing to hold him down at the dentist anymore. But that will probably be several years from now when he can understand why it is important to see the dentist.

Until then, I'm thinking of ways to help him cope. I've put together some pictures from his recent dental appointment to show Matthew using an iPhone app called "Stories2Learn" which allows me to create short stories using my own pictures and words and record my own voice. Since he's a visual learner, maybe this will help him cope better at his next visit to the dentist. Showing him pictures of himself at school to help him adjust to preschool seemed to work so maybe it will work for the dentist too. Or maybe it won't make a difference. But it doesn't hurt to try and is certainly worth the effort.

Matthew's 1st Visit to the Dentist

We spent months contemplating when to take Matthew to the dentist. My dentist had given me a brochure with information that a child should first be seen by a dentist as soon as the first tooth erupts. Matthew's first tooth sprouted when he was 7 months old. Other dentists suggest that kids should be seen when they are 2, 3 or 4 years old, sooner if needed.

I looked up pediatric dentists near our area and asked friends for recommendations. I also looked through a list of pediatric dentists recommended by other parents in our local Down Syndrome Association (DSA). The list, which is available at the DSA, is a wonderful resource based on recommendations from other parents who have kids with Down syndrome. It was put together to help other parents like me find doctors who have a keener understanding of Down syndrome in relation to their specialties because they have patients with Down syndrome.

Chronological Eruption of Teeth
Some studies cited in an article on the ds-health website report that individuals with Down syndrome tend to get teeth later than usual and in an unusual order. Apparently, the delay can be as long as two to three years.

Matthew is 2-1/2 years old. He had a full set of primary teeth by the time he was a little over 2. I chronologically charted the order in which his teeth erupted except for his second molars. He has them but I wasn't exactly sure when they appeared so I never noted the dates.

According to primary teeth eruption charts at MedicineNet and All Day All Night Dental, Matthew's teeth appeared in the usual pattern of primary tooth eruption within the usual timeframes, except for his upper lateral incisors. I read somewhere that it isn't uncommon for some kids to teethe out of the usual order, whether they have Down syndrome or not.

Upper Teeth
Central Incisor (8-12 months) - Matthew (11 months)
Lateral Incisor (9-13 months) - Matthew (15 & 17 months)
Cuspid (16-22 months) - Matthew (18 months)
First Molar (13-19 months) - Matthew (14 & 15 months)
Second Molar (25-33 months) - Matthew (approximately 27 months?)

Lower Teeth
Second Molar (23-31 months) - Matthew (approximately 27 months?)
First Molar (14-18 months) - Matthew (16 months)
Cuspid (17-23 months) - Matthew (17 months)
Lateral Incisor (10-16 months) - Matthew (14 months)
Central Incisor (6-10 months) - Matthew (7 months)

Common Concerns
We decided it was time for him to see a dentist to check for cavities and plaque build-up. We knew he didn't have any missing primary teeth so that wasn't a concern for us. We scheduled an appointment with a lady pediatric dentist and Bill took him to his first dental appointment a couple of weeks ago.

The Dentist's Report
The dentist was able to get a fairly good look in Matthew's mouth when he was pinned down and screaming. The good news is Matthew doesn't have cavities. He has a little bit of build-up though. His tooth alignment is decent with some spacing between his teeth, which just means he has room in his mouth to accommodate the bigger permanent teeth later on. There was no mention of when he will need to be x-rayed. We're guessing it'll be done when he can cooperate willingly during the dental exam and doesn't need to be held down for it. He'll be seeing the dentist again in 6 months.

Related post:
This is the Way We Brush Our Teeth

This is the Way We Brush Our Teeth

Who likes to go to the dentist? I know I don't, yet I should especially since my teeth aren't the greatest unlike my husband who never had cavities. I eat a lot of chocolate though and I could've done better taking care of my teeth when I was growing up. Then again, my husband drinks a lot of soda and has seen the dentist fewer times than I have within the past 5 years. Sigh, so unfair. I hope that Matthew takes after his dad in the dental department. However, everything I've read so far about dental health of children with Down syndrome indicate that kids with Down syndrome are predispositioned to develop problems with their teeth and gums (so what's NOT on that depressing long list of health issues associated with Down syndrome??)

Good basic dental care is important to maintain a healthy mouth, Down syndrome or not. I brush his teeth twice a day with a non-fluoride kid toothpaste but I often wonder whether I'm brushing his teeth well enough. He likes to bite and suck on his toothbrush. I can never seem to get to all his teeth. Maybe I'm an anomaly, but my guess is many parents have a hard time with thoroughly brushing their children's teeth too, especially when they're less than 2 years old. Matthew is also on a fluoride supplement since the water in our town doesn't have fluoride in it. I imagine that should help cut down on cavities. But then again, according to the experts, periodontal disease is a greater concern than cavities in individuals with Down syndrome.

So when should we take Matthew to the dentist? Two articles I've read, "Dentistry in Children with Down Syndrome" by Dr. Elizabeth Mueller, DDS and "Caring for the Teeth and Gums of Children with Down Syndrome" by Dr. Jonathan Sierk, DDS, recommend the first dental visit between 12 to 18 months of age or within six months of the eruption of the child's first tooth. Matthew's first tooth, lower left central incisor (lower front tooth), came in when he was 7 months old. At 19 months, he has the upper cuspids half way out and has yet to get all his second molars. So it seems we are overdue for a visit, aren't we? Matthew's pediatrician recommends starting dental visits at age 2. I also called a pediatric dentist today said they said their rule of thumb is generally age 3, but they see kids younger than that too when necessary. I guess it's really up to us when to take him. The articles I read make the process sound so easy. Even if the first visit is just a consultation, no cleaning(?) or x-rays(?), how do these pediatric dentists expect kids so young to open up and cooperate despite sitting on mom or dad's lap in the dental chair?

At this point, I'm hoping other parents would chime in about their kids' dental visit experiences and suggestions for making it a fairly painless ordeal. Also, how different is dental treatment and care for children with Down syndrome? More regular x-rays? More frequent visits required - maybe every 3 or 4 months, not the usual 6 month interval? I'm sure a pediatric dentist can answer all my questions, but I'm interested in personal experiences. It doesn't hurt to ask, does it?