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Dentistry/5yr old with adult tooth coming in on bottom

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Expert: - 11/14/2008


Question
QUESTION: My daughter is 5. She has perfectly straight baby teeth with no spaces. I just noticed that an adult tooth is coming in behind her lower front teeth. However, her baby teeth are not loose at all. She is not due for her first x-rays until 2/09.  What should we do?

ANSWER: You don't have to do anything at this time.  Usually we want to see spacing between the primary incisors.  Since the permanent incisors are much larger than their primary precursors the spacing allows the larger adult teeth to fit in place.  Without those spaces you can expect crowding as your child acquires more teeth.  In cases of future crowding like with your daughter we frequently see the permanent incisors emerge out of position and the baby teeth do not fall out.  In most cases the permanent incisor will gradually move forward and the baby tooth will loosen up.  If that doesn't happen in the next six months then it would be helpful to have the over-retained primary incisor removed.

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QUESTION: My daughter was seen by the dentist today and got a panoramic x-ray. He advised us to have her lower front 6 teeth removed because her jawline is small and that it would help her teeth move into position better. My husband and I are worried about the pain and difficulty eating afterwards.  Also, our daughter is a "princess", and we think that she will be very upset at her looks. Should we get a second opinion from a pediatric dentist? How do we explain this to her? She has never lost a tooth or had dental work done. We are not allowed to stay with her. The dentist said that he was going to use gas and local injections. What should we do?

Answer
In 30 years of practicing orthodontics and pediatric dentistry I have yet to encounter a case that required such treatment as your dentist has recommended.  Yes, a second opinion from a pediatric dentist or, better still, an orthodontist, would be a good idea.

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Dr. Randolph Myerson

Expertise

Please limit your inquiry to questions about orthodontics (braces) and children's dentistry. I am both an Orthodontist and a Pediatric Dentist, having been trained in both of these dental specialty fields. Orthodontics is the dental specialty that treats problems of tooth, bite and jaw alignment using braces and removable appliances. Pediatric Dentistry is the dental specialty also known as dentistry for children, which deals specifically with the dental problems of this special age group from infants to adolescents. I am also experienced in Forensic Dentistry, the application of dentistry to law enforcement and identification using dental records.

Experience

I have been in the private practice of orthodontics and pediatric dentistry for over 20 years. Prior to that I served for three years on the Cleft Palate and Cranio-facial Reconstruction team at Children''s Hospital of Philadelphia and was an Assistant Professor of Dentistry at University of Pennsylvania School of Dental Medicine. I also served as a dentist in the U.S.Air Force, stationed at Andrews AFB in Washington, DC.

Organizations
I am a Fellow in the American Academy of Pediatric Dentistry, and a member of the American Association of Orthodontics, as well as a member of the American Dental Association and the Dental Society of the State of New York.

Education/Credentials
I received my BA in Biology from Frankin & Marshall College in 1969, and my dental degree from University of Pennsylvania School of Dental Medicine in 1973. In 1978 I received both my Certificate in Orthodontics from University of Pennsylvania School of Dental Medicine, and my Certificate in Pediatric Dentistry from Children''s Hospital of Philadelphia after completing a three year Teaching Fellowship in Orthodontics and Pediatric Dentistry in 1978.

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