This problem doesn’t occur too frequently, but when it does it leaves parents scratching their heads in curiosity. There are a few reasons this can occur and all will require a trip to the dentist for an x-ray and evaluation.

As mentioned in the second section, developing permanent teeth can be affected by a variety of things including high fevers, certain antibiotics and trauma to the baby tooth (transmitting trauma to the underlying permanent tooth). Permanent teeth can also be affected when they are traumatized directly once in the mouth.

How these “damaged” teeth will react really depends on the type and severity of the trauma. Some teeth will still “survive” but may appear malformed or have some kind of distinguishing mark on them. Others may not have been able to tolerate the trauma and eventually “die.” This “death” simply means that the living tissue inside the tooth (called the pulp) are damaged to the extent that they cause death to that tissue. That living tissue, or “pulp” is the nerve and blood vessels which supply the tooth sensation and sometimes, outward color.

When a tooth “dies” or is in the process of “dying,” the entire tooth undergoes multiple changes which can have many effects, many of which differ slightly depending on the individual.

Occasionally, a traumatized tooth may undergo a reaction with the fancy name of “calcific metamorphosis.” Wow-what a word! It simply means that the tooth felt the trauma and reacts to it by laying down extra layers of minerals within the tooth. This layering of extra minerals (which is really just extra tooth structure), results in a “squeezing” down of the pulp or living tissue located inside the tooth. This frequently, but not always, causes death to that living nerve tissue inside the tooth (the pulp).

This death doesn’t always occur, but does eventually in a high percentage of teeth. This strange process of laying down extra layers of tooth actually causes the tooth to turn more yellow that the other teeth. Treating these teeth can be complicated because though they usually do die, they don’t always do so, regardless of how yellow their color becomes.

Typically, if the tooth doesn’t reveal signs of death when the dentist evaluates it, they will choose to do frequent x-rays and re-evaluate at certain time intervals. They will also have the parent keep a watchful eye for any signs of tooth death such as, pain, change in tooth color (grey or further yellowing), swelling, a “bump” on the gum, or a foul odor coming from the child’s mouth.

If the tooth is confirmed to be dead after evaluation by the dentist, then a root canal is usually done to rid the infection that comes with the death. A root canal usually does not hurt, despite popular myth, and is simply the removal of the dead tissue from within the tooth. The tooth is usually numb for the procedure but doesn’t always have to be, depending on the situation. Once the dead tissue is removed, the inside of the tooth is cleaned and sterilized with tooth-friendly substances. The area is then filled with a special rubbery material to seal it off from other possible bacterial invaders.

Unfortunately, this usually will not fix the color change that has occurred, and occasionally it can become more exaggerated. There are several things which can correct the color change, including procedures such as, internal whitening of the single tooth, a veneer or crown. They may also be able to place a simple, tooth-colored filling that is layered on top of the tooth to mask the color. Each of these are too detailed to describe here and require that you discuss the suitable options for your child’s particular circumstance.

The first and most obvious answer is to take the child to the dentist as soon as possible so an exam and x-ray can be done.  A mistake I see parents make all the time is delaying a visit to the dentist because the tooth is “just a baby tooth.”  As we discussed previously, baby teeth are incredibly important to the overall health and relationship of the permanent teeth.  Not only are the baby teeth vital to future orthodontic relationship of permanent teeth, they can also have a devastating effect on the shape and color or the erupting adult tooth.  They also decay and abscess (the nerve in the tooth dyes, causing a localized infection) at a much faster rate than permanent teeth.

Baby teeth are no different from their permanent counterparts with respect to their ability to abscess and cause life threatening infections.  Of course we are worried about future orthodontics and damage to the underlying tooth, but I think we can all agree that a life-threatening infection in our children would rock our worlds.  Teeth can cause these scary abscesses because of their close proximity to the brain, spinal cord and neck.   These infections can be extremely difficult to treat because it is challenging to get antibiotics past certain barriers that are located in the head and neck.

So, if your child is complaining of a tooth ache, treat it seriously.  The dentist will generally take an x-ray to see if the baby tooth can be fixed or to see if it is due to fall out soon anyway.  If it is not close to falling out and the tooth looks to have a favorable prognosis with the proposed treatment, then your dentist will likely do whatever it takes to keep it.  I know it will feel like heroics for such a little tooth, but again, the goal is to save it for all the reasons we discussed earlier.  Some of the treatment options may be as follows: extraction of the tooth (with or without a space maintainer to hold the space for the permanent tooth), baby tooth root canal, and/or possibly a stainless steel crown.

If the dentist feels that the prognosis with treatment is poor and/or the chance for re-infection is high, they will likely opt for extracting the tooth.  If the underlying tooth is not due to erupt fairly soon after the extraction, the dentist may propose placing an appliance in the area of the extracted baby tooth to hold open the space.  This space is necessary in order to keep an open path for the permanent tooth to enter into normal alignment in the mouth.  Sometimes, the drifting of already erupted teeth into the extracted space can block the path of the permanent tooth and trap it permanently beneath the gums.  Once this occurs, extensive orthodontics and surgery are usually needed to bring it out.

This special appliance is called a “space maintainer” and is usually permanently glued to adjacent teeth so that the child can’t remove it.  If we gave them something removable, you would be throwing your money away due to noncompliance.  If you have had a teenager with braces who is now wearing a retainer, you know exactly what I am talking about!

There are many types of space maintainers and they are selected based on the needs of the child.  Some will only hold the space for one missing baby tooth while others may hold the space for multiple missing teeth and may even hold the space on both sides of the mouth.  Each space maintainer is custom built for the child’s particular needs.  The maintainer is usually removed once the permanent teeth make their appearance and the dentist feels confident that the space is no longer compromised

Two types of space maintainer devices: