Addressing Tooth Loss in Children: Common Concerns and Solutions

Tooth loss in children?

Hello, doctor.
My child is 12 years old, and he has two missing permanent teeth in the lower front row.
There is one baby tooth in the lower front row that has not fallen out yet, and currently, one molar is erupting (lower right).

1.
Should we wait until all four molars have fully erupted before considering orthodontic treatment?
2.
Since there seem to be no gaps in the lower teeth, should we first extract the lower baby tooth to allow the molars to come in, giving the lower teeth a chance to align themselves?
3.
Recently, my child has been occasionally experiencing a tingling discomfort in the remaining baby tooth.
We have seen a family dentist who found no cavities, and the dentist believes it might be due to the resorption of the baby tooth root, and that my child is just sensitive.
Is this situation common? Have you encountered similar cases, and could there be other underlying causes? The family dentist only suggested pain relief if the discomfort becomes significant and did not mention other treatment options.
Although it is not very painful, the persistent discomfort is concerning for us, and we worry about overlooking other potential issues.
Thank you, doctor!

Feifei, 30~39 year old female. Ask Date: 2021/10/24

Dr. Zeng Guanghui reply Dentistry

1.
The four permanent molars should fully erupt around the age of 6 to 7 years.
If one is delayed until the age of 12, it is advisable to consult a dentist for an examination.

2.
If there are no gaps between the lower teeth but the permanent teeth have not fully erupted, this indicates insufficient space.
It is necessary to consult a dentist for further evaluation on whether to extract primary teeth to allow for the eruption of permanent teeth.
3.
If there is discomfort after eating hard objects, and if there is significant mobility, it is recommended to extract the primary teeth to facilitate the proper eruption of the permanent teeth.

Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2021/10/24

More Info

Addressing tooth loss in children can be a complex issue, especially when it involves the transition from primary (baby) teeth to permanent teeth. In your case, with your 12-year-old child experiencing missing permanent teeth and a retained primary tooth, there are several factors to consider.

1. Timing for Orthodontic Treatment: It is generally advisable to wait until all the permanent molars have erupted before starting orthodontic treatment. This is because the molars play a crucial role in establishing the proper alignment of the bite and the overall dental arch. If your child has one permanent molar that has erupted, it may be beneficial to monitor the situation until the remaining molars come in. This allows the orthodontist to assess the overall alignment and spacing of the teeth more accurately.

2. Retained Primary Tooth: The presence of a retained primary tooth can sometimes hinder the eruption of the permanent teeth. If the primary tooth is still intact and there are no signs of decay, it might be worth considering extraction. This can create space for the permanent teeth to erupt properly. However, this decision should be made in consultation with a pediatric dentist or orthodontist who can evaluate the specific situation and determine whether extraction is necessary.

3. Discomfort from the Retained Primary Tooth: It is not uncommon for children to experience some discomfort from a retained primary tooth, especially if the roots are resorbing as the permanent tooth is trying to come in. The sensation of "tingling" or discomfort can occur as the body naturally prepares for the transition. However, if the discomfort persists or worsens, it is essential to have a thorough examination to rule out any underlying issues. While it is possible that the discomfort is due to normal physiological processes, it is also important to ensure that there are no other dental problems, such as infection or abnormal root resorption.

In terms of management, here are some recommendations:
- Regular Dental Check-ups: Ensure that your child has regular dental check-ups to monitor the development of their teeth. This will help catch any potential issues early on.

- Pain Management: If your child experiences discomfort, over-the-counter pain relief, such as acetaminophen or ibuprofen, can be used as directed. However, it is crucial to consult with a healthcare provider before administering any medication.

- Consultation with a Specialist: If the discomfort continues or if there are concerns about the alignment of the teeth, consider seeking a consultation with an orthodontist. They can provide a comprehensive evaluation and discuss potential treatment options.

- Oral Hygiene: Encourage good oral hygiene practices, including brushing twice a day and flossing, to maintain the health of both the primary and permanent teeth.

In conclusion, while the transition from primary to permanent teeth can be a challenging time, with proper monitoring and care, most children navigate this phase successfully. It is essential to maintain open communication with dental professionals and address any concerns promptly to ensure your child's dental health remains on track.

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