Enamel Problems

Hi Ellie,

We have a three year old daughter with significant dental problems, possibly due to another health concern (Pyruvate Kinease deficiency, with resultant high bilirubin- I found a reference that suggests it causes enamel hypoplasia.?).

We have started her (and all of us) on your system, however her paed dentist wants to operate ASAP, putting stainless caps on two molars, various other fillings and sealants, and removal of three teeth.

We weren’t on your system when we last saw him in Jan this year, however I suspect he wouldn’t endorse it for , as her problems are quite widespread.

As they cause her no pain, or problems eating, we are very relucant to have a GA, and such invasive work.

I was wondering if you would be able to recommend a dentist in Australia who is aware of, and works with your principals?

If not, do you think we should just come over to the States and see someone you recommend there?

Thank you for your advice.

And thank you also for your book, it’s been amazing to finally understand all this, we just wish we’d known earlier when we first noticed the enamel problems two years ago!

Hi A,

I am sorry your daughter has dental problems fortunately it sounds as if they do not cause her pain at this time, which is good. I believe the use of xylitol and dilute fluoride rinsing will be the main components that stop the progression of problems for her. Strive for five exposures to xylitol each day the newest research shows frequency is as important and getting 6 grams xylitol a day.

Your goal now is to establish a healthy oral ecology before her permanent teeth erupt. Permanent molars in these cases are often pitted and with poor quality enamel, so they deteriorate quickly. You may be able to prevent this by acting now before they erupt. Fingers crossed since healthy adult molars will make a huge difference for her adult dental future.

I wonder if your dentist is suggesting treatment that NEEDS to be done, or simply prescribed routinely for any cavity they see. Some UK studies indicate it may be less important than believed, to fill or
fix baby teeth. If the teeth are not infected or dead, and you have no more “disease and damage” then repairs would be more for cosmetic reasons.

I assume from your description of treatment, that the removal of three teeth may be upper front teeth?
I have seen situations where front teeth with decay were not treated and the permanent teeth erupted at around 7 years old no problem.

The two stainless crowns are probably on two lower baby molars with damage on the back side of the teeth.
If so, you do not have to worry about space loss since only baby molars at the back of the mouth hold space not the ones in front. So treatment may not be urgent. ….but obviously I cannot diagnose.

If this is the case perhaps you can defer the treatment until your daughter becomes a little older and easier to treat. Many children have crowns put on the baby molars ( if necessary) with local
anesthetic around age four or five. I agree that general anesthetic is a big and worrisome step.

This is a link to a list of WCMID dentists in Australia – (Minimally Invasive Dentistry). I would talk to them on the phone and ask if they would give you a second opinion You want to know if treatment essential now, or could you wait a while.

Hope this advice is helpful. Please let me know the outcome I am always interested and it helps me help

Best Wishes


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Rochester, NY 14623

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