Remember that nighttime nursing is not to blame for the problem.  The decay would have occurred anyway.  Your job now is to figure out what to do going forward.  Arm yourself with research and resources.

Find a dentist whom you can work with.  There are several factors to consider:  Does this dentist have a history of working with families who wish to continue night-nursing while being treated for tooth decay? Is the dentist familiar with the latest research on breastfeeding and ECC? (3) What kinds of procedures does the dentist do, and where (dental procedures using anesthesia outside of a hospital are very controversial and, in my opinion, the risks outweigh the benefits)?  You will want to ask questions about use of sedation, anesthesia, papoose board restraint, etc. What is his/her overall approach with children and with adults?  Is s/he gentle, playful, and respectful with your child?  Does your child respond well to him/her? 

 Start using Xylitol products.  If you haven’t already, start using tooth gel/paste and tooth wipes with Xylitol.  We like Spry Infant Tooth Gel and Spiffies tooth wipes.  See "Xylitol: A Amazing Discovery for Health" on Xlear's website for more information about the incredible promise of xylitol, a natural sweetener found in birch trees, fruits and vegetables, to fight tooth decay.  Not only is there toothpaste, but for older kids, gum and candy that are good for teeth!   More and more dentists are becoming aware of and recommending xylitol to their patients.  I would consider it a red flag if a dentist is uninformed about xylitol; it indicates a lack of interest in cutting-edge research and practice.

Get support from other parents.  Your local chapter of La Leche League and Attachment Parenting International are both good places to start to find other parents who may have found themselves in a similar predicament, or at the very least, who understand your desire to continue night-nursing.  There is a wonderful Yahoo group dealing with the issues surrounding childhood tooth decay for breastfeeding and attachment-parenting families:  Very Young Kids Teeth.  The Mothering.Commune message board also has had many threads about childhood tooth decay, although some appear to have been deleted from the archives due to an internal reorganization. 

Consider alternative treatments and products.  Another Yahoo group, Alternative Kids Teeth, is a tremendous resource for exploring alternative therapies – including medical therapies that are cutting edge as well as traditional “alternative” stuff.  The following list is my compendium of alternative treatments you may want to research on your own:

• Prospec MI Paste with Recaldent (vanilla flavor is recommended in the package insert for treating caries).  This remineralizing paste is safe for young children to ingest.  It contains xylitol and another cavity-preventing sweetener, sorbitol, and strengthens teeth by adhering to tooth enamel and depositing calcium and phosphorus.  My thinking on this is that it can’t hurt, and my daughter loves the “yummy vanilla marshmallow stuff.”  (Note:  MI Paste is also known as CG Tooth Mousse outside the USA.)
  
  
• HealOzone treatments administered by dentists.  A very small number of dentists in the United States are using a painless procedure of exposing teeth to ozone gas.  This is a common and effective treatment in Europe but has not yet been embraced by the mainstream dental community in the US.  For more information, contact Dr. Chris Kammer in Madison, WI, whose practice uses HealOzone.  You can also read more about the HealOzone on the website of CurOzone, the company that manufactures the equipment. 
  
  
• Chamomile tea.  While searching the web to find out if chamomile tea was considered bad for teeth, I found several websites claiming that it is good for treating tooth decay.
  
  
• Cranberries.  According to a study by Koo in Caries Research, Jan.-Feb. 2006, cranberry juice inhibits tooth decay.  The study included only unsweetened cranberry juice.  I use 100% organic cranberry juice and dilute it with water, since it’s way too potent to drink straight.
  
  
• Emotional Freedom Technique (EFT) is a therapeutic tool comprised of affirmations and tapping on the endpoints of acupuncture meridians throughout the body.  I know it sounds strange, but if you’re like me, when you’re in this situation, you’re willing to try anything!  I am in the beginning stages of learning about EFT and have not yet applied it directly to teeth concerns, but I am greatly intrigued and have had success in treating some of my own minor physical ailments with this method.  At worst, it is completely benign.  At best, it's a stunning exemplar of the mind-body connection.
  
  
• Other alternative strategies that I have not tried, but you may want to investigate on your own:
  Swishing with ozonated water
  Swishing with water containing diluted hydrogen peroxide
  Topical use of sea salt
  Topical use goldenseal
  Periodically painting teeth with providone iodine, a topical disinfectant used in surgery prep (Note:  a quick Google search turned up a PubMed article from 1975 linking providone iodine use with genetic mutations and cancer, so please proceed with caution and consult a medical provider.)

Research fluoride.  There is enormous controversy about the use of fluoride and whether it helps or hinders tooth decay.  Do your own internet research, talk with your dentist, and make your own decision.  A February 2006 study in the Journal of Dental Research found that as little as one fluoride varnish treatment per year can cut the cavity rate in half for infants and small children, and one treatment every six months provides even more protection.  We have seen four dentists and each one had a very different perspective when it came to fluoride:  one prescribed Colgate PreviDent, 1.1% fluoride gel (so strong that the other dentists were shocked when we showed it to them); one prescribed OMNI Just for Kids .4% Stannous Fluoride Gel; one suggested discarding the fluoride gels and brushing with a pea-sized dab of fluoride toothpaste (I chose Tom’s of Maine Apricot flavor with xylitol); our fourth and final dentist said that our Spry Infant Tooth Gel (no fluoride) would be fine, and that since our water is fluoridated we didn’t need extra fluoride, though he said it would be fine to continue using the Just for Kids product. 

Everyone acknowledges that there is a danger of fluorosis – discoloration of the permanent teeth – when a child swallows too much topical fluoride.  Tap water is often fluoridated, as well, depending on your community.  The opponents of fluoride use – both internal and topical – insist that fluoride is a toxin that actually makes teeth more brittle.  Certainly, they argue, there must be a reason that the human breast filters out fluoride and does not pass it along to an infant.  The proponents of fluoride are backed by solid studies showing its efficacy as a topical treatment in reducing tooth decay.  They also point out that adding fluoride to drinking water began after observations that people drinking naturally-occurring fluoridated water had a lower incidence of tooth decay.  Recent studies have shown that fluoride may have an antimicrobial effect on the bacteria.  Be aware that many, if not most, brands of bottled water do not contain fluoride.  A helpful post from Google Answers includes a list of fluoride content of several brands of bottled water, with info on the ideal amount.

Make any necessary changes to your child’s diet (and yours if you are breastfeeding).  Remember that anything that goes into the mouth has the potential to alter the pH of the mouth to make it more acidic (lower pH) or more alkaline (higher pH).  The lower the pH, the more likely it is that s. mutans will thrive.  Therefore, it makes sense to avoid or minimize foods that create a particularly acidic environment in the mouth, especially high-density refined carbohydrates.  In addition, Xylosweet can be used instead of sugar in recipes and makes a great sweetener for drinks.  In addition, explore Weston Price diet , which emphasizes consumption of animal proteins and supplementation with high-vitamin butter oil and cod liver oil.

Add rinsing with water and tooth-wiping to your routine.  After every snack or meal, have your child drink or rinse her mouth with water (which has a neutral pH) and/or wipe her teeth with a Spiffies tooth wipe or a small cloth with Spry infant tooth gel.

If your child needs fillings, consider finding a dentist who does ART.  Atraumatic restorative therapy (ART) uses a glass ionomer material that continually releases fluoride into the cavity.  These fillings are designed to be temporary but can last for years.  The upside is that they can be placed relatively easily, even with wiggly toddlers. 

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