AboutDr. 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.
Question I've read several other Q & A's, but I want to be as specific as possible. Our two-year-old daughter fell in the bathtub and broke her two front teeth; they are broken from the top center down to the outer corners, like curtains. We took her for X-rays and there seems to be no 'permanent' damage; at the time of the incident, the teeth weren't loose or discolored, they just bled easily and seemed to hurt when she ate and drank. The pediatric dentist she saw a week and a half later said the teeth were loose, discoloring (because of a dead nerve, I assume?) He said we could wait and see if they would fall out on their own, but it was his opinion that the teeth might possibly abcess before then. I chose the second option, which was to extract them. She has an appointment Thursday (gulp!) to have both teeth pulled, with only local anesthesia in his office as opposed to an oral surgeon at a hospital. I'm scared for her and the procedure--is pulling them the right way to go? If so, does she need different anesthesia/more care? I"m also concerned about her speech development, as she talks quite a bit, and the broken teeth already seem to be affecting her speech somewhat. Would it be wise to try a pedi-partial, as I"ve read here, or possibly rebuild her broken teeth with crowns? Maybe crowns aren't the best option because the teeth are already loose and have dead nerves. He didn't mention her nerves being damaged, how would he check for that? I just want to do what is right for her, without causing unnecessary pain and anxiety and messing up her teeth! Any suggestions or opinions you could provide would be appreciated. Thank you.
Answer There are two potential treatment paths that can be taken with this kind of trauma. Either the teeth can be saved or they can be removed. If it is possible to save the teeth, then they would probably require root canal treatment if the nerves have died and crowns to build up the proper form of the teeth. The prognosis for this depends upon just how loose the teeth are and whether or not they will firm up. This decision can only be made on the basis of an examination and x-rays with your pediatric dentist.
The alternative treatment plan is to extract the teeth. This should be followed by placement of a pedi-partial.
In either case the less sedation or anesthetic that is used the safer the procedure will be...to a point. Some sedation may be necessary to provide a safe treatment situation and local anesthetic to numb the treatment area will be necessary. If it is possible to avoid general anesthesia in a hospital setting that would be recommended.
