So, returned from a trip to Son #1's dentist this morning...
At our last visit ~6 months ago, he was found to have areas of decalcification ("almost-cavities") between his molars. At that point, he was still not the best at cooperating with tooth-brushing and used to swallow the toothpaste, which meant that we couldn't use fluoride-based toothpaste. We were instructed to optimize the brushing, start flossing, and switch to fluoride toothpaste.
We did great! Well, the flossing could have been a little better, but otherwise, we did great! Twice a day, without fail, spending plenty of time focusing on the molars. Very limited juice, candy only on Halloween and birthdays... our only weakness was ice cream, but he always drank water afterwards.
Despite our best efforts, half of the areas of decalcification have progressed to cavities, and now we're facing having the teeth fixed with a pulpotomy and the placement of ugly stainless steel crowns, which will remain until the baby teeth fall out (probably another 6-8 years from now).
Needless to say, I feel as though I have failed in my motherly duty to keep my kid healthy. Being a pediatrician makes the failure all the more acute, because after all, aren't I supposed to be a parenting and health expert? I felt only marginally better when the dentist told me that his own child required the same treatment (his wife was really mad at him, or so I'm told)...
I agree with our dentist that we can't allow to decay to progress unchecked... children's enamel is much thinner than adults, and the oppositional surface area of the molars is also larger than in permanent teeth- this means that this risk of cavity progression and abscess formation is theoretically larger. I'm not keen on waiting until it hurts to eat, drink or brush. A root canal? No, thanks!
However, the thought of replacing my child's beautiful little smile with a mouthful of gray metal is decidedly unappealing. My son's dentist (a pediatric specialist) does not offer esthetic (tooth-colored) posterior crowns, because he feels they are not as durable as stainless steel.
I'm incredibly disappointed, and concerned that a mouthful of metal is going to affect my son's self esteem at a very sensitive time in his social development. I know I should be more concerned about his health than his appearance, but I can't help it.
I am going to look into a second opinion, and will post updates as I learn more.