Bilirubin-stained teeth

We have been making the circuit with dentists, trying to find out what to do to improve the look of Peter's teeth.  We've been to three so far, each one further away than the last.  The last one took two hours to get to, but has a great reputation and I know him from years ago.

Peter's front top two teeth, and bottom four teeth, are slate-gray, with some tea-brown color at the tips.  These are his permanent teeth.  His baby teeth are discolored as well, but not quite as dramatically.  The discoloration is due to sustained elevated bilirubin that occurred during infancy as his teeth were still in formation.  He had high bilirubin for many months, sometimes with levels in the mid to upper 20s range sustained. 

The latest dentist took photos of Peter's teeth and gave a copy to me.  I'll post them with this blog one of these days soon.

Omegaven helped his liver, thereby bringing down the bilirubin levels, and ultimately kept him from needing a multivisceral transplant.  Usually a child with this level of bilirubin has either succombed to the liver illness or has gone on for liver transplant. 

The dentists are puzzled with what to do for someone like Peter who has pulled through such a long illness.  We may be looking at veneers, but there is concern that in a six year old child they will not have a long life before needing to be redone where the gumline becomes visible as the child grows.  There is also concern that the veneers will pop off and he could aspirate them.  The veneers would be done without the usual preparation so that they will be stronger and able to withstand the probable braces he needs as well.  Bleach is not an option unless it is done after a root canal so the teeth could be bleached from within.  That then leaves a person with dead teeth though, and that is not a great option either.  As an adult, he will likely get veneers or crowns and they will last many years, but as a child the gumline apparently recedes some every year until adulthood.  (In addition to ostomies, wound vacs, TPN, and such,  I am learning a lot about teeth through Peter's illness too!) 

The latest dentist suggested that if Peter is OK with his teeth color, which he is so far, then maybe just let the teeth be until he becomes concerned about it.  As I type that, I realize that advice sounds cold, but he did not mean it that way.  His concern was that it may be in Peter's best interest to leave the teeth be so that when he is able to have something done for them on a more permanent basis, he has strong teeth to work with.  Meanwhile, both dentists that gave us advice are continuing to look for more solutions to this problem.  They have been consulting colleagues across the country and have been very compassionate about Peter's situation. 

With both of the pediatric dentists we have seen over the last 3 weeks, I have been close to tears with their kindness and empathy.  They both clearly have that great quality that we have seen in Dr. Kamin and Dr. Jennings, which is to take that child's situation and own it and repeatedly work on finding a solution, regardless of the inconvenience to oneself.  God has put such kind, compassionate people in our lives and it is humbling as well as reaffirming of the goodness of others.

UPDATE:  I realize that I never did end up posting this and it has been a month now.  The dentist  who suggested that we do nothing contacted me late last week and said that he has had Peter on his mind since he saw him, and has called colleagues all over the nation.  He said that he still thinks our best bet to save Peter's teeth so they can make it into adulthood in good condition and ready to crown would be to do really nothing for now.  He said there is an appliance called Snap-on-Smile, which would cosmetically cover all of his teeth, but not actually change them.  He then offered to call the other more local dentist to discuss it with him as an option instead of veneers.  I'll keep sharing what I find out.