Sunday, August 2, 2009

What is that I see?

What is that I see?

Can it be?

A cavity?

Are you are kidding me?

A mother in medicine, a mother in pediatric medicine, a mother who has been trained in primary prevention of dental caries, a mother who has been trained in how to teach pediatric residents about primary prevention of dental caries...

Could this mother have a sweet little twenty-toothed three year old with a cavity? And one so large that it recently became blatantly obviously visible to this mother?

Couldn't be.

But it was.

And not 1 cavity, but let's just say more than one.

Self doubt, blame, shame, worry, sorrow, guilt.

Relinquish my hypothetical license to mother and my actual license to practice pediatric medicine?

With the MIM degree comes connections with pediatric dentistry division chiefs and friends in psychiatry and other caring colleagues who help me see the bigger picture, one that continues to contain a twenty-toothed (more or less) beautiful smile inside and out.

I think of all the things this is not, and feel better.

I think of all the ways this could be worse, and feel better.

I think of my own bad teeth and think no less of my own parents.

I think of my patients and their parents and feel more like them.

I think of my daughter with no holes in her teeth except the joyous one that is about to be there when her first loose tooth falls out (could be any day now).

I take comfort in realizing that Mothers in Medicine need not be perfect nor have perfect kids.

I seek to re-define perfect as a work in progress.


  1. Despite championing healthy eating (to the point our normal friends find us annoying) and toothbrushing (or gum brushing) b.i.d. since day #1, 2 out of my 3 kids EACH had more cavities than I could count on one hand before age 4. What can you do? Sometimes genetics reigns. And even if it's nurture not nature that's responsible, as my mom is fond of saying, "If that's the worst thing that ever happens to your kids, you did pretty well..."

  2. Could be worse. Praise the Lord and pass the flouride.

  3. I'm a Family physician..... my 3 year old doesnt have any cavities, but she has been constipated, got a laceration on her foot from knocking over a glass, and spends more nights in our bed than in her own..... we always know how to advise everyone, but somehow our reality is not the ideal that we encourage in our patients. such is life I guess!! and yes things could be worse

  4. It does help you relate to your patients (and more importantly their parents). Teaches humility and understanding. And sounds like she pulled through like a champ!

  5. That post was beautiful. Thanks for it.

  6. Out of curiosity, would people mind posting whether or not their local water has fluoride and whether or not their children have cavities? Thanks

  7. Thanks for the supportive comments. I have two kids with 2 very different mouths! As for Mommy Doc's comment, also see a Pediatrics in Review article on Fluoride from Oct 2003;24:327-336. And the AAP's Section on Pediatric Dentistry and Oral Health's article from Dec 2008 "Preventive Oral Health Intervention for Pediatricians" Pediatrics 2008;122:1387-1394.

  8. Oh my goodness, THANK YOU for posting this! I also have an adorable three year old with a mouth full of pearly whites that we brush religiously twice a day, and I've noticed what I think are 2 cavities in there, and I'm embarrassed to admit that I've been putting off taking him in because I'm afraid the pediatric dentist will think I'm the world's worst mother! Which is certainly much worse, and now I have the confidence to call and make that appointment!

  9. My parents had bad teeth, my sister has inherited the bad teeth from my parents... somehow i lucked out with very good teeth.

    Tempeh said it best with the genetics. sometimes all the brushing, flossing, flouride treatments, and other things are simply not enough to prevent tooth decay. you may want to talk to your childs dentist about sealing the teeth early to prevent decay.. or simply as soon as the adult teeth come in, as they come in.. if they have deep grooves or are predisposed to getting cavities, to have them pre-emptively filled. That way theres no/limited pain down the line when a real cavity pops up.

  10. Thanks for the article,T. We moved to an area w/o fluoridated water 2 years ago, and about a year ago, my son had his first cavity (despite using fluoride tablets). So I'm curious if having the fluoride in the water makes a difference vs. tablet form (which we do forget to give him occasionally)

  11. Thanks for the article,T. We moved to an area w/o fluoridated water 2 years ago, and about a year ago, my son had his first cavity (despite using fluoride tablets). So I'm curious if having the fluoride in the water makes a difference vs. tablet form (which we do forget to give him occasionally)

  12. Hello, mother in dentistry here. A few things to think about - all the prevention in the world will not fix a few things common to the toddler world 1) juice, particularly apple juice - (I whisper's worse than soda for the teeth) 2) hanging out with the sippy...all day long. If it's not water, it's not good. 3)snacking - even healthy food, if you eat at 30 to one hour intervals regularly, the teeth have no chance at remineralization.
    There, no guilt allowed. It happens.

  13. May a cavity be the only thing you need to feel bad about for your little one.

  14. I had high hopes for the sealant stuff they're supposed to put on permanent teeth to protect them.

    Then darn if one kid didn't get a cavity before we got it put on.

    I sound like such a mother saying to my almost-grown kids - have you made an appointment at the dentist lately?

  15. T it could be worse- I'm a pediatrician and my spouse is a dentist and of course our 33 month old just had her first cavity (despite visits to Daddy's office every three to six months since she had her first tooth!). She now gets brushed her three times a day!


Comments on posts older than 14 days are moderated as a spam precaution. So.Much.Spam.