Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

Dr. Hall, I had a question for you. I was doing research for my 5 year old daughter and her dental needs. She has 4 upper molars that need work done. Her two first molars have small cavities, but they are pretty deep. The two se! cond molars have both lost some tooth structure due to decay – I believe about 30% of the tooth is lost. My first question is: What is your take on this? I wanted to know what what I can do for this. I don’t want her two second molars pulled unless that is my only choice. She has stated that the 2nd molar on the right side hurts when she chews down on it. I want to thoroughly do my research before I send her to a pediatric dentist. Every single dentist she has had, she has not let them do any work on her mouth, which is why its escalated to this point. She will most likely have to be put under sedation to get this done. I am not sure if she needs white fillings, bonding, or onlays. How should I proceed? Thank you and have a great day.
Colleen from Brooklyn

Colleen,

At the age of 5, she has only baby teeth in her mouth, but those teeth are needed to help her eat now, and also to hold the spaces for the permanent teeth. If those teeth are lost, she will need space maintainers or her permanent molars will drift forward and crowd out her permanent teeth, and her mouth will end up being a huge mess.

So go with the sedation, if that’s what it takes to get this done.

Your care and concern for your daughter shows in your questions. Your daughter now has gotten to a point where she needs some tough love, maybe tougher than you’re used to. The reason children at this age get so many cavities is because of their frequency of eating. Decay of the type you are describing, at her age, requires constant feeding all day long. If you give in to every request for food or treats, this is the result. But if you let your daughter go hungry for three or four hours so she can build up enough appetite for a regular meal, and do that consistently, you will guide her into a more healthy eating pattern, and you won’t have to deal with recurring dental disasters like this. Otherwise, plan on going through this ordeal on a regular basis.

Dental work on baby teeth is usually geared toward short-term maintenance of those teeth, because the teeth will fall out around age ten to twelve. So when a large portion of a baby molar is missing, a dentist will usually place a stainless steel crown or some other type of prefabricated crown, which will cost considerably less and take much less time than the precision crowns that are made for adult teeth.

Dr. Hall

Related links:
Preparing your child for a dental appointment

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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I was a thumbsucker up until I was 13. Now my teeth are shaped in a hideous way. I don’t have a typical overbite but my top teeth are shaped in an upward curve. I wish to know which procedure I need to go through to get my teeth fixed to the way they should be.
– Ellie in Trinidad

Ellie,
To correct the mal-alignment of your teeth after thumb sucking, you need to see an orthodontist. There are other possible options to make them look better, but from what you’re describing, the teeth are in the wrong position plus they have an incorrect inclination. Braces could solve both problems.

And, for the benefit of parents who see their children sucking their thumbs. My advice, after working with many parents on this issue during my dental career, and also working with my own children, is to play it cool. If you make too big an issue of it, you will actually reinforce the practice by creating a complex in your child. I would advise doing nothing until the child starts school. Thumb sucking causes no permanent harm when only the baby teeth are in, which is the case up until about age 7. And, if you “play it cool,” usually when the child starts school, peer pressure will help them quit. Notice that Ellie sucked her thumb until age 13. If she had quit when she was 7, she wouldn’t have had this problem.

If their permanent front teeth are coming in and they are still thumb sucking, you may need to intervene. But my warning is to use encouragement, not force, shaming, or other high-powered techniques, to avoid creating an emotionally complex issue for your child that could backfire. If your child finds the habit tough to break, there are aids that can help them break the habit. But they generally only work if the child wants to quit. If that is your child’s situation – they want to quit thumb sucking but find it is an ingrained habit, tell them you can help and buy Thum or another product to help them. Thum is a bitter liquid that you paint on the thumb. It makes thumb sucking unpleasant, and will help, provided you have not made it an adversarial situation with your child.

Dr. Hall

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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My 6 year old daughter has two broken baby teeth that are molars. The teeth have broken because of cavities/decay. The dentist we took her to is recommending that we extract the teeth immediately. Is this the right thing to do?
– Kristina from Wisconsin

Kristina,
When an adult tooth is infected, we do a root canal treatment. However, when a baby tooth is infected, root canal treatments rarely work, and never for baby molars, so the tooth has to be extracted. So your dentist is right to recommend they be taken out. The infection can spread in the bone and affect her developing permanent teeth.

You didn’t mention space maintainers. But I assume that your dentist is also recommending putting in one or two space maintainers, depending on which baby molars are involved. That is critical to prevent serious problems with her permanent teeth. At age six, her permanent first molars are either just about to erupt or have just erupted. They will drift forward and block out her permanent premolars, which could then erupt sideways or not at all. When baby canines and incisors are extracted, they don’t need space maintainers. But for baby molars, unless the patient is around ten to twelve years old (when the permanent premolars are erupting), they do. If your dentist hasn’t recommended that, you should find another dentist for your daughter.
– Dr. Hall

Related links:
Click here for basic information about pediatric dentistry.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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Dr. Hall,
I have baby tooth that won’t come out and there is another tooth pushing on it, and it’s coming out the side of my gums. It doesn’t hurt but my dentist says that he should pull it out. So this has me thinking about a few things.
1. What will happen if I do NOT get it pulled? and
2. Does it hurt to get a tooth pulled? I know that a numbing agent is used, but when they inject the agent, does the needle hurt (mind you I am terrified of needles)? I am 14 years old a pretty scared. Thank you for your time and any help would be appreciated.
– Amanda from Michigan

Amanda,
My you write well. You sound better and write more clearly than many adults who write to me.

If you don’t get this tooth extracted, you could make the permanent tooth crooked and you’d have to get that fixed with braces later. So you really should have it taken out. It’s so much easier to prevent these problems than to fix them later. Generally the rule is that if the permanent tooth starts to show in your mouth and the baby tooth hasn’t fallen out yet, that you should have the baby tooth extracted.

And generally when you have a baby tooth pulled that is just about to come out, it doesn’t take a lot of novocain. Most dentists will use a novocain ointment to numb the surface, and then they’ll give you the injection. Depending on the situation, and who the patient is and which tooth is coming out, sometimes the injection doesn’t hurt at all and sometimes it hurts a little. Sometimes the patient doesn’t even know they’re getting an injection. My best advice is not to think about it–that’s when it goes the best.

I hope this is helpful.
Dr. Hall

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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Question:
My son (age 4) injured front teeth and have become discolored….is there any way they will regain original color? Anything I can do to help…diet?
Teri in Pennsylvania

Dear Teri,
Your son’s baby teeth are so small, there really isn’t anything practical to get their color back. Diet won’t have any effect. And they are already starting to lose their roots, if they are the very front teeth, and doing too much will make them grow loose prematurely. I’d advise just waiting until they’re ready to fall out. It’s probably only another two or three years before they fall out.
– Dr. Hall

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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Dr. Hall –
My 6 year old has his second set of teeth that have come up but the baby teeth are still there and have not loosened up. Should I wait till they do loosen up or should he have them removed? I have not taken him to the dentist because I thought they would fall out on their own. Help what should I do???
– Mona from Michigan

Mona:
If you can see the permanent teeth coming in but the baby teeth haven’t fallen out, and you can’t jiggle them out yourself, I’d take your son to a dentist and have the dentist take them out. The baby teeth can deflect the permanent teeth if they’re not coming out the way they should.
– Dr. Hall

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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