Transforming Moments

Mariah’s Story

The Sweetest Smile

Three-year-old Mariah loves riding her big wheel, playing ball and jumping through her sparkle green hula hoop. Her blue eyes light up at the mention of Dora the Explorer, her dog Lola, and Friday night trips to the mall with Uncle Brian. So when her usually energetic granddaughter got sick this summer and told her “Nanny Mama” that her mouth hurt, Teresa said it was “the final straw.”

In the summer of 2006, immediately after Teresa gained custody of Mariah, she took her granddaughter to a dentist who recommended that the young girl have all her top teeth and some bottom teeth removed because of major decay. Because of transitions in Mariah’s family life and because she couldn’t find a dentist willing to develop a payment plan for her, Teresa continued her search for Mariah’s dental care.

When Mariah finally complained about her mouth this summer, Teresa said she thought Mariah had an abscess in her tooth and decided to “do whatever needs to be done to get her teeth fixed.” She eventually found Children’s Hospital and Elizabeth Bortell, Director of Pediatric Dentistry.

“When I first saw Mariah,” recalled Dr. Bortell, “she had three abscesses and facial celulitis due to decayed teeth on the right side.”

Celulitis occurs when an infection goes through the root of a decayed tooth into the soft tissue of the face causing an inflammation resulting in pain, redness, warmth and swelling. The dangerous infection can cause fever and pain and must be managed immediately by either draining the infection and/or removing the damaged tooth.

Because of Mariah’s age and the extensive work that needed to be done, Dr. Bortell recommended Mariah’s treatment be completed in the operating room. In August 2007, a week after her initial exam, Mariah had all 10 of her upper teeth and two of her lower teeth removed, two root canals and two crowns placed on her bottom teeth, and fillings added to the remaining four bottom teeth during the 90-minute procedure.

Mariah’s tooth decay, officially called early childhood caries and often referred to as baby bottle decay, was the result of drinking too many sugary drinks and going to bed with a bottle or cup of juice or milk as an infant and toddler.  Although Teresa weaned Mariah from this habit after she came to live with her, the damage to her teeth had already been done. 

Children’s Dental Health

The American Academy of Pediatric Dentistry recommends children visit the dentist by the time the first tooth erupts or no later than the first birthday. These early visits are designed to educate caregivers about healthy dental habits and help children become accustomed to visiting the dentist.

Yet Mariah is not the only child without easy access to dental care. In 2004, more than 50 percent of children without health insurance had not seen a dentist in the past year, and more than one in five needed dental care but did not receive it for financial reasons¹. Untreated oral diseases may lead to problems in eating, speaking and sleeping as well as poor performance in school, poor social relationships and decreased body weight². 

Outside of scheduling regular dental check-ups, caregivers can help prevent these problems by wiping a baby’s gums or brushing teeth after eating and before nap and bedtime. Children also should never be put to sleep with bottles or cups.

Expanding the Practice

Children’s Hospital’s treats children from birth through age 21 by providing comprehensive care ranging from standard pediatric services (regular checkups, cleanings and x-rays) to complex procedures such as dental surgery. Staffed by pediatric dentist Dr. Bortell and general dentist Deepa Simon, DDS, the two-dentist practice provides services for all children, including those with special needs. Dr. Simon, who joined the staff in January 2006, helped the Pediatric Dental Program double its patient volume and expand its surgical hours.

The addition of a second dentist as well as the 2006 expansion and renovation of the dental clinic was funded by a grant from the Virginia Health Care Foundation. This year, Children’s Hospital will receive a $75,000 grant from the same organization to continue supporting a second dentist and increasing access to dental care for children.

Looking Ahead

Teresa, who used to serve Mariah apple juice, said Dr. Bortell took time to educate both grandmother and granddaughter about healthy eating habits and proper dental care. Teresa now knows that apple juice is full of sugar, even if it’s labeled 100 percent juice, and that sippy cups can enhance dental problems by placing sugar directly behind a child’s top teeth.

“Mariah used to complain about her mouth hurting,” noted Teresa. “Immediately after her surgery, her overall health improved.  She can eat whatever she wants without pain, and she constantly reminds me to brush her teeth.”

Although Mariah didn’t see Dr. Bortell until after her third birthday, Dr. Bortell said her visit was early enough that she shouldn’t have problems with her permanent teeth. (Baby teeth keep space in the jaw for adult teeth so when baby teeth are lost too early, they can make adult teeth crowded or crooked.) And because her speech habits were already established, Mariah’s language should not be impacted by the absence of her top teeth.

“Mariah will come back every six months so we can care for the teeth she does have and watch her permanent teeth coming in,” noted Dr. Bortell.

“Mariah trusts [the dental staff],” said Teresa. “They were very nurturing and easy going. Right from the get go, Children’s Hospital stepped up to the plate and were willing to work with me. I can’t say enough about Children’s Hospital.”

¹ Child Trends Data Bank
² U.S. Department of Health and Human Services

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