Nora is no stranger to medical check-ups and procedures. In the times she has visited the dentist (the first time for chipped teeth at the age of 2), she is a cheerful breath of frilly fresh air in the office. She is fascinated by the tools and procedures. She wants to be a doctor when she grows up. Her yearly check-up 2 weeks ago was no exception to her happy visits, but came with bad news: cavities. 4 cavities.

How, you may ask, does a child who eats no refined sugar and consumes 10 g of carbs per day, with only part of that in the form of natural sugars, get cavities? I am still asking myself that question, but the only answer seems to be genetics. My genetics. Ted has crooked teeth of steel. I have straight teeth of marshmallow. I always have cavities and always feel guilty, like I somehow should be able to prevent this, but even with my best efforts they still show up. When your kid has cavities, the guilt is magnified. What kind of parent has a 4 year old with cavities? Yes, as a matter of fact, I DO brush her teeth daily. Will they call child protection?  Although they do not say or suggest such things, I can’t help but feel at fault.

Now that Nora has cavities while consuming no sugar, I will forever attribute our cavities to genetics. The dentist conceded as much last time I was under the drill. Anders as escaped so far, he must have Ted’s iron teeth and they seem to be straight. Poor Nora will probably get the worst of our genetics, cavities and braces. Sorry, kiddo.

Nora was a peach at her checkup when they found the cavities, so they scheduled her for a cleaning and fluoride last week to get her used to working in her mouth. She was a super-star for the cleaning too. No problems at all. Before the cleaning, the dental office showed me the packages for the polish and fluoride varnish at my request. One had xylitol and another had sucralose. To be safe, Nora’s dietician recommended that we decrease her carbs by 3 g on the day of the cleaning to account for the tiny bit of carbs (or blood sugar effects) in those non-sugar sweeteners. Everything went smoothly and Nora stayed in ketosis. We were relieved.

The dentist recommended that we wait until January to fill her cavities because they were so small. That way she could have one more cleaning to get comfortable. But after her first great experience, I moved up the appointment to today. She was positive about the dentist, so I decided to just get it done this summer when we are less stressed by work and school.

With such small kids, the dentist prescribes an oral sedative that contains sorbitol (a sugar alcohol). Again, Nora’s dietician recommended decreasing her carbs by 3 g today to account for the carb-like affects of the sugar alcohol. This was a little more stressful because Nora was not allowed to eat for 3 hours before the appointment. She went into the office on an empty stomach, drank the sedative, then it was over an hour until we were home and could give her some fat to balance her ratio. She was also starving, on top of being miserable from the fillings. I made her 2 T of heavy cream mixed into a bit of vanilla tea as soon as I could and she sucked it down through a straw (spilling some from her numb lip). She also ate up 50 g of avocado and kept asking for more food. When I did a keto reading in the evening, she was still at a solid 160+; strong ketosis. Hopefully we averted any possible loss of ketosis, but we should know by morning.

After taking the sedative, it was like Nora was drunk. She couldn’t walk straight but demanded to be put down. When she got into the chair and chatted with the hygienist, she started listing her friends, “Sabina, Dalya but she moved away to a town for away and I can’t see her anymore, Connie, I play with her toys, and Kevin, he lives with Connie, and Ingrid, she has 2 beds and a big sister, and Cora and Mike…” She went from being kind of a belligerent drunk to a sentimental happy drunk to an angry drunk by the end of the appointment.

And I don’t blame her much for that. The dentist went as quickly as he could, but it’s still a long time for a little person to sit in the chair with her mouth held open. They gave her novocaine and nitrous oxide as well, so she had the “monkey nose” on her face the whole time. By the end she definitely felt something as he was working, but he was so close to being done that he finished with the filling and didn’t give her more novocaine. I know how she feels. It was agony to watch her have to endure it. I held her hand at the end and picked her up as soon as I could, but she was an unhappy camper. I’ve seen this kid through some torturous procedures for a little person, and I’m ready to be done with it. She’s ready to be done with it.

When he started with the fillings, he called me closer and said that there were 2 more tiny cavities starting in 2 other molars. She ended up with 6 fillings today, rather than coming back and do the next 2 more in 6 months or 1 year. These are baby molars, so she will lose them. I hate to be pessimistic, but that’s only an opportunity for more cavities. Now that we know this about Nora, I’m all about as much prevention as possible. Regular fluoride varnish, sealants, whatever it takes. I’m on prescription super-fluoride toothpaste myself now. Time will tell if any of it will make a difference. Maybe by the time Nora has kids, they can opt for bionic teeth from the get-go or do gene therapy to ensure iron teeth. I’d give that to my kids if I could.