At an age when most kids would have started losing just one or two milk teeth, five-year-old Jasper (not his real name) will be entirely toothless by the time you read this.
The kindergartener has such severe tooth decay that almost all his milk teeth have rotted down to the gums and are beyond repair, except for a few lower front teeth.
The dentist would have extracted his decayed teeth via surgery performed under general anaesthesia. Jasper’s gums would also have been stitched up due to the sheer number of teeth involved.
By sharing Jasper’s horrific tooth decay experience, his family hopes to raise awareness on severe dental caries in young children. They have asked to remain anonymous due to the stigma involved.
“We’ve known about his tooth decay for some time but were still shocked (to learn that he would have to remove almost all his teeth). We are also very worried about what would happen after the surgery. I was told he might be in pain for some time,” says Jasper’s father, Michael, 30, a sales executive.
While rare, such extreme cases of tooth decay are not unheard of. Last year, the National Dental Centre Singapore (NDCS), a referral centre for the treatment of severe tooth decay, saw six young patients who required all 20 baby teeth to be extracted.
NDCS saw more than 1,800 new child patients last year, of whom 106 children had more than 10 baby teeth extracted in the operating room.
Dr Bien Lai, a consultant at the paediatric unit, restorative dentistry at NDCS, has even encountered a 11-month-old baby whose both upper central incisors (top front teeth) were decayed all the way to the gums.
In babies and young kids, dental caries develops due to multiple factors, Dr Lai explains.
Some causes include drinking milk in a bottle at bedtime, not brushing teeth after milk feeds, eating sweetened food and drinks too frequently – all of which had led to Jasper’s severe tooth decay.
The road to extreme tooth decay
During the early years of his life, Jasper spent long periods of time overseas, travelling from one foreign city to another, while his father took on various job stints.
The frequent changes in his every day routine meant that oral hygiene was overlooked and often the last thing on the minds of his parents, who were struggling to make ends meet.
As a baby, Jasper was bottle-fed. While he loved his formula milk, he especially disliked plain water. To quench his thirst, he was given sweetened drinks between his milk feeds.
“To pacify him at night, he was given a milk bottle, which wasn’t removed after he had fallen asleep,” shares his grandmother, Hui Ling, 60, who is currently one of Jasper’s main caregivers.
Jasper became so addicted to milk and sweet drinks that he did not drink any plain water until he was around three years old.
Sharing how her grandson would refuse to drink water even when thirsty, Hui Ling advises parents and caregivers to think twice before introducing sweet drinks to their babies and toddlers.
“There’s a tendency for caregivers to entice babies and young children to drink more fluids by sweetening their drinks without realising that once you start, it’s really hard to stop (the habit),” she says.
By the time they noticed that Jasper’s teeth were turning black from decay around the age of three, Hui Ling knew they had to put their foot down to wean him off the milk bottle and sweet drinks. It took almost a year before he could finally accept plain water willingly.
“We started by diluting his sweet drinks, and gradually increasing the amount of water until he could finally accept drinking plain water,” she shares.
They also stepped up efforts to brush his teeth more frequently, but the damage was done.
When asked why the family did not take Jasper to see a dentist at the first sign of tooth decay, Hui Ling says they had been “ignorant” of its potential consequences.
Back then, Jasper was also struggling with some speech delay and learning issues, so oral hygiene was not a priority, she adds.
“We did not realise the severity of his tooth decay as he did not complain of any pain at all, and continued to be active and well,” Hui Ling shares.
By the end of last year, however, the family could no longer ignore the red flags when Jasper started complaining of tooth pain and refusing food. That spurred his grandmother to take him to see a paediatic dentist in private practice.
“The dentist couldn’t handle him although he was supposed to specialise in paediatric dentistry. When he finally saw Jasper’s rotting teeth, he referred him to a tertiary dental centre, which is more equipped to handle severe tooth decay in children,” says Hui Ling.
When the second dentist found that most of the teeth could not be salvaged, Jasper was scheduled to undergo surgery to extract them. However, the surgery appointment was cancelled twice when he came down with fever.
When all teeth are beyond repair
Tooth decay is typically treated with fillings, pulp treatment, crowns and extractions. Teeth are usually removed when there is serious infection in the gums and bone, and when they are decayed beyond repair, Dr Lai shares.
In cases where all teeth are to be extracted, the child will need to adjust to biting with the gum pads and be on a soft diet until new teeth grow, she says. Speech may also be temporarily affected.
“However, in this kind of severe case, where the teeth are decayed all the way to the gums, most of the teeth are already in a devastating state for a period of time and the child may have already adjusted to chewing the root stumps,” says Dr Lai.
Additionally, the early loss of baby teeth may lead to minor space issues for growth of the adult teeth, she says.
But once infected teeth are removed, the child will be relieved of pain and infection. “Some children may even eat better than before,” Dr Lai says.
Hui Ling is concerned that her grandson’s schoolmates will tease him after the surgery, but shares that she is far more worried about him adapting to a soft diet and the lack of teeth affecting his speech.
“Getting him to take his meals daily is trying enough, and we’ve spent a lot of time training him to eat a variety of food. I’m worried that the pain after the surgery will undo everything and he’ll stop eating,” she says.
For now, Hui Ling is training Jasper to adapt to a softer diet of rice and soup to prepare him for the post-surgery recovery.
The family has also doubled their efforts in preventing further infection of the decayed teeth by not giving him sweet drinks and having him gargle with salt water regularly, which seem to have worked to control the severity of his toothaches.
Thinking about his son’s severe tooth decay fills Michael with regret. If he could turn back time, he would have restricted Jasper’s intake of sweet drinks and treats, and ensured that he brushed his teeth regularly, he says.
He advises other parents not to take their children’s milk teeth for granted and to go easy on the sweet treats.
“We should not indulge our kids. Short-term happiness will always lead to long-term problems,” he says.
Next page: Why milk teeth are important