Expert: Stephen J. Moss - 12/22/2009

Question
   I just took my 5 year old daughter for her regular dental check up.  Her teeth are healthy with one exception.  Her last toddler molar on the lower right side has been steadily sinking back into her gum line.  I wasn't notified of this problem at any previous check ups, but the dentist relates that they have been "watching it."  It's apparent that something is going wrong with this tooth, but I find the treatment a bit scary and would appreciate some advice.

Her dentist has recommended putting a cap (taller than usual) on the tooth.  He says that the tooth is possibly fused to the jaw bone, and that the cap would provide a corrected bite that could possibly loosen the tooth and raise it up again.  In order to put the cap on, he will have to go down into the gum line to prepare the tooth for the cap.  He is suggesting sedation along with local anesthesia for the procedure.  This is the part that I find particularly scary.

I'm thinking logically, that something has to be done.  We can't have that tooth sink farther in and cause additional problems.  I'm just wondering if this cap therapy is the most common and successful treatment.  Also, there is not decay on the tooth.  Additionally, the xray hasn't shown the bottom of the tooth and the bone; it doesn't show the area that low below the gum line.  But the tooth has visably moved downward.

Answer
Dear Charia,

there are two parts to my answer,
first what should be done and second the question of anesthesia.

What to do:
First and foremost if you can find a pediatric dentist to look at the tooth and it's x-ray.
The concern is not the primary tooth or your daughters occlusion now...The concern is the permanent tooth under the last molar, under the one that is ankylosed.
The majority of times in my experience the ankylosled tooth should be removed it should be done now,  not later,.
Remove it because it interferes with the proper development of all of the permanent tooth.
Placing a cap on the tooth is not the way I would treat the situation.

Second,
at five years of age your daughter is quite able to have local anesthesia.
You are quite correct, sedation is most likely not necessary and caries with it some complications which you should avoid if possible.


Again the condition is ankylosis of the primary tooth, it is not too unusual and it has no permanent problems associated with it if treated quickly.

Hope this helps a little,
all the best,
Dr. Moss