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Dentistry/3 year old Grandson knocked his front tooth out.

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Question
Dr. Myerson,

My 3 year old grandson tipped over in a high back swivel while eating at the breakfast bar and knocked his front tooth out roots and all.  My daughter called her dentist immediately and he said to bring him in right away that they could re-attach the tooth.  The dentist looked at it and said there was a small piece of bone fragment on the tooth so they couldn't put it back in.  He said nothing could be done and a temporary tooth was not an option because it would cause a problem with his other front tooth.  He is not a pediatric dentist so we wanted to get a second opinion.  Since he is only 3, it will probably be 3-4 years before he gets his permanent tooth.  Is there an option for a temporary replacement tooth and if there is, is it wise to go that route?  Will it cause damage to the other front tooth and the new tooth that will eventually come in?

Thank you!

Answer
A few comments would be in order.  First, we never re-plant a primary (baby tooth) for several reasons.  It is extremely difficult to splint the tooth in place to stabilize it, the chance of successfully re-attaching is extremely remote, and there are a number of complications that can occur if the tooth actually does re-attach.  So it's not such a terrible thing that the tooth was not re-planted.
As for the future, we very rarely advise a tooth replacement following loss of a single incisor.  It is rarely an esthetic problem for the child.  Actually, it's more of a concern of the parents than the child.  The loss of a single tooth does not usually create a problem with the development and eruption of the remaining upper front teeth.  We rarely hear of any problems with speech development in these situations either.  While it is possible to provide an appliance called a "pedi-partial", which we often recommend after the early loss of two or more primary upper incisors, there is little or no reason to do so with the loss of a single tooth.  When a pedi-partial appliance is in place it is necessary for the child to be seen at least every three months for the 3-4 years before the permanent teeth begin to emerge.  This is to certain that there are no problems associated with the appliance.

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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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