4-year-old Savannah receives a silver surprise

A couple weeks ago, media sources shocked viewers and readers with the story of Savannah White. This 4-year-old girl was put under general anesthesia to have stainless steel crowns put on all of her remaining primary teeth. However, her mother thought she was only going in to have four cavities filled and was horrified and irate when she looked in her daughter’s mouth for the first time.

Savannah SSCs

Mrs. White stated “I didn’t expect for her entire mouth to be covered in silver. We went in to have a couple of cavities done”. She also told reporters that her daughter complains daily that she doesn’t like her teeth, which is “really kind of hard to hear every single day”. When this story hit the media, the public was outraged. Comments criticizing and denouncing the dentist were left on online news sources and reporters painted the dentist as a heartless villain.

I for one think this dentist was unfairly represented.

Photos of Savannah show that she is already missing many anterior teeth that wouldn’t have fallen out on their own by age 4. Presumably, these teeth were lost due to severe decay. This shows that Savannah has a very high caries risk and it is likely that the remaining teeth in her mouth also exhibited significant decay.

The treatment rendered by this dentist is not uncommon and is an economical way to preserve what is left of severely decayed teeth in the mouth. In fact, this dentist’s work probably saved Savannah’s remaining teeth and prevented further and more severe oral infection. Dr. Richard Chaet, former president of the Arizona Academy of Pediatric Dentistry, backed up the treatment rendered for Savannah saying that the stainless steel crowns were probably very necessary.

However, there is still no excuse for what happened with Savannah White and this is great example of a moral dilemma we can learn from.

The Dentist’s mistake:
He should have done a better job with informed consent and made sure the parent(s) understood what he would be doing first. Clearly this mother did not realize what Savannah’s dental treatment would entail, and so certainly couldn’t have given proper consent for care. Other options, like SSC veneers or SSCs with esthetic windows should have been presented. This case should serve as a reminder to us all that we need to take the time to discuss risks and benefits of treatment options and not rely on paternalism. Patients, and/or their parents, should be involved in the decision making process and need to be well informed before we ever pick up an instrument.

The Mother’s mistake:
The other glaring problem is this child’s lack of proper home care. In my opinion, it is the child’s parents who should be reprimanded rather than the dentist. Savannah’s teeth were lost or crowned because of poor oral hygiene and poor diet, which for such a young child is the parent’s responsibility. There is no excuse for a four year old to have this extent of decay. With proper diet and eating habits, recommended fluoride dosage, and effective daily brushing at home, this entire incident could have been prevented. If you are a dental student or a dentist, make sure to educate your patients and their parents on the importance of home care. And please, if you are a parent, take your child for their first dental visit by age 1 to learn how to prevent this kind of rampant tooth decay!

Savannah veneers
Savannah pictured after another local dentist offered to veneer her SSCs free of charge

What do you think of this surprise “coronation”?

Ashley N. Phares, Connecticut ’13, contributing editor

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Comments (6)

  1. Jesse Dictor

    While she might not like her teeth, and it might hurt me with the ladies, I think those teeth actually look pretty cool.

    It definitely raises the point of “What was going on in this girls home?” for her teeth to get so bad. I can’t help but feel that there is some side of heredity or something like that is at work here and not explained.

    Reply
  2. Armaghan Amirian

    Dentist should have explained the treatment plan thoroughly, in the first place! YES it’s obvious to us that this treatment plan is appropriate for the kid, but this is not enough.

    Reply
  3. Sanish J Thottan

    dentist may have done the best treatment but he should have definitely explained to the patient about the appearance of ssc especially since it is bit unesthetic,its a lesson for all of us,thanks for sharing this

    Reply
  4. Dave L.

    While the parents hold significant responsibility for her status, that does not relieve the dentist of properly communicating his treatment with the parent and obtaining proper consent for the SSC’s. The article states the child went under GA, there must have been some consent obtained. The unspoken problem is that many medical assistance plans only make it profitable to provide SSC’s instead of composites or glass ionomers. If SSC’s are not placed, quite often the dentist loses money on the case due to very low MA reimbursement rates. The MA system pushed the issue. So the dentist has to decide, let the child lose teeth, have pain and future issues due to premature tooth loss or place SSC’s all around. Composite windows in SSC’s are not covered and the parents likely have no ability to pay for that cosmetic treatment. There are tooth colored SSC’s avail which if used in the front would have likely solved the issue for the parents. The parents just don’t want everyone to see they don’t take care of their kid. No, I do not think it is hereditary. That is a micro-fraction chance. Likely it is sugar soda in a bottle at night, poor home care and no preventive treatment. It would not surprise me at all if the parents had drug issues as well. This looks like long term neglect. That is much more likely than hereditary issues. I did not see pre-op radiographs but expect there was rampant decay. The dentist could and should have more clearly explained the treatment plan but the parents need to get their act together for the child’s sake. If her dental health is this bad, what is the rest of the picture this child has to try and overcome to survive in that house. Some may think this a bit harsh but it is not, It is just a cold dose of reality.

    Reply
  5. sarah seckman

    Well said Dave. In my opinion, and as a mother, I feel that this should be considered child neglect to a certain extent, and should raise concern for SS to look further into what goes on in this household.

    Reply

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