As mentioned in a previous post, this too is a highly controversial question. The general consensus by orthodontists today is that the presence or removal of wisdom teeth have no effect on the crowding of permanent teeth. This is what is taught in dental schools currently. So, of course I will tell you that I agree with this. However, I will add in a bit of the general public’s view on the matter as I have seen it in my practice.

I cannot tell you how many patients I have encountered who swear to me that their teeth have shifted since their wisdom teeth came in or were removed. Since I cannot remember everyone’s teeth exactly and don’t have before and after photos, I have no way to verify this. I am not in the practice of taking random dental photos for no apparent reason and so I have none to reference. I do believe, however, that most people are greatly in touch with their bodily happenings and as such wouldn’t make the statement up for no good reason. So, this will remain a question that I cannot answer with absolute certainty. One thing I have learned is, that science can change and so I can’t always be sure of what is absolute and what is not. So, maybe in the future, new studies will reveal that the presence of wisdom teeth do have an impact on crowding and straightening!

Believe it or not, this situation is relatively common. This too tends to run in families, but not always. This brings back the important topic of x-rays. This situation is usually first noted when they child has the panoramic film taken around age 5-7. Typically, though not always, teeth will be missing in pairs. They are also usually missing the same tooth but on different side of the jaw. For example, the child might be missing both lower first premolars/bicuspids on the right and left bottom, but not on the top.

When this does occur, most dentists will give you the same advice: Do everything you can to take care of and keep the baby tooth so it can maintain the space and function of the missing permanent tooth. This is because it holds the space open for future treatment (if needed), which may otherwise be complicated by loss of the space.

If the tooth cannot be maintained, the dentist may suggest the use of a space maintaining appliance (discussed in the general questions section). There are situations where the baby tooth may actually be better of being extracted. For example, if the child already has abundant crowding, then this may actually alleviate the need for braces.

So, always talk to your dentist or orthodontist about what the best option for your child may be. If the baby tooth is unable to be retained permanently due to looseness or an extensive cavity, there are options to replace the tooth in adulthood if necessary. A few examples of what those options may be are: Dental implants, fixed bridges, denture or retainer with a tooth on it. Again, discuss these options with your dentist and see which one will best suit your child.

A very frequent question indeed, and one which you will likely be relieved by the answer! This is a very common situation and is usually at its worst between the ages of ten and twelve, depending on the child. It is so common in fact, that it has been given a name by orthodontists. It is called the “ugly duckling” phase of dental development.

Most times, the gap will resolve on its own once the permanent canine teeth come completely in ( around age eleven). This gap is caused by the canine teeth pushing on the roots of the front teeth as they make their way down into the mouth. This pressure pushes the teeth in the front apart temporarily and will start to close as the canines come further into the mouth. It can be a little embarrassing for teens until it resolves. So, reassure them that many of their other friends are likely to go through it also, and that it usually goes away on its own.

Occasionally, however, the gap remains slightly. This will depend on the skeletal and dental relationship of your child. If the canines have come in, and have been in for awhile but the gap still remains, talk to your dentist or orthodontist. There are many options for treating this if your child is unhappy with the final appearance of their smile. Some of those options may include anything from a small, tooth-colored filling placed to widen the appearance/close the gap, to brace or other appliances. Each child and situation is unique.

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.

This is a question I get asked frequently and has an answer which provides a huge relief for many parents. In most cases, these yellower teeth are completely normal. It’s actually considered to be an optical illusion! You see, baby teeth, as mentioned earlier are actually nick-named “milk-teeth” because of their bright, white color. They are beautiful, delicate and oh-so adorable. Then, our permanent teeth make their appearance right beside those beauties. Permanent teeth are actually much yellower than baby teeth and often appear big and “gangly.” So, when sitting adjacent to something so spectacular such as baby teeth, they can appear downright ugly at times.

If you don’t make mention of it to your child, they often don’t even notice and therefore won’t become self conscious. The issue is that some people truly do have naturally darker teeth than others. Color and whiteness shades are highly variable and can also run in families. This is why whitening products have become so popular in our culture today. Once your child’s permanent teeth have all come in, re-evaluate the color then and see how they appear to you. My guess is that they will not appear as yellow/dark as they first did while next to the “milk-white” teeth. If they are, and if the child is self conscious, whitening toothpaste and possible whitening agents can be considered once the child is at the age appropriate time.

There is also another cause of yellow teeth in children which can be a quick fix-depending on your child. Often times the discoloration is caused by poor oral hygiene. If the child does an inadequate job at brushing, or refuses to brush regularly, a thick layer of yellow plaque builds up on the teeth. This can make teeth appear up to 3-4 shades darker than they actually are. So, look at your child’s teeth carefully. If you see a layer of “fuzzy” looking film that looks as if it could be scraped off, then you likely have your culprit.

There are generally not many foods or drinks that will cause staining at this age, unless you are allowing your child to have red wine or coffee! Iced or hot tea can also cause staining which is easily removed during regular dental check-ups. If your child has the dreaded “fuzzy’ layer and also drinks sodas frequently, the staining may be exaggerated. Smoking can also cause staining, but if your child is smoking at this age, then I suspect you have bigger worries than yellow teeth!

One last note to mention here. There are other causes of darker teeth and if you feel that these above are not the reasons for it, please see your dentist for an evaluation. There are multiple genetic disorders and diseases which can affect tooth color. These disorders can cause yellowing, but more importantly can affect the overall integrity of the teeth.

Examples of these disorders include but are not limited to: Amelogenesis Imperfecta and Dentinogenesis Imperfecta (each with sub-type categories). These disorders, cause defective enamel or other tooth tissues, can give a “flaking away” quality and appearance of tooth, rather than yellowing alone. There are ranging severities of the disorder and thus the appearance will vary from person to person. Though yellowing alone is uncommon in these disorders, it still can be the only obvious sign. When in doubt, check with your dentist, as these disorders need special attention in order to keep the teeth healthy. If the teeth appear red, green or brown or any other abnormal color, please see your dentist or physician immediately.

Congratulations! At this age, you have passed many dental milestones and hopefully have few remaining! This age range has a lot of variability in terms of where your child might be on the dental spectrum. This is because this age group has both baby and permanent teeth for several years, and so may have many over-lapping characteristics. It may be prudent to glance at the general questions section before reading further. This may assist you in understanding some of the questions and discussion in this segment.

You may notice that this catagory is considerably shorter than the previous ones. This is because not a whole lot happens in this age range that we haven’t already addressed. Hopefully this will be a relief to you, because if you are reading this section, I am sure you have many other things to worry about besides their teeth!

This answer is very similar to the one above. Let’s face it. We all have a crutch that helps us get through the tough times. Some people rely on faith, others on food and some on other addictions.
So, it should come as no surprise to you that our children have their own little “fixes” to get them through the tough times. One of the biggest of these is thumb-sucking or finger-sucking, with or without the use of a “blankie.” I would never dare ban the coveted “blankie.” In fact, I know several adults who still sleep with theirs! I sucked my thumb as a child, and oh, the relief was amazing! But again, at some point certain addictions have to end before they have damaging consequences.

Generally it is safe to let your kids suck away until age four. Before age four, you may notice the effects of sucking on their front teeth. What you will likely see is that your child’s front teeth are “bucked out” and perfectly fit the offending thumb like a key in a lock. Prior to age four, if the child stops, the teeth will usually drift back into their normal position. After age four, however, the effects become more permanent and may also affect the path of eruption of the permanent teeth and shape of the palate (roof of the mouth). This can result in your child’s permanent teeth also appearing “bucked,” crowded, spaced or some combination of these. And, you guessed it, an expensive trip to the orthodontist!

Spaces between baby teeth are indeed normal as well as helpful. However, occasionally a child has a much larger than normal space between the upper two front teeth. This large space is what we call a “diastema,” which really just means a large space or gap. They are usually caused by the presence of a little extra muscle tissue between the underside of the top lip. This muscle attaches the lip to the gum tissue between the top two front teeth. We all have this muscle attachment, but occasionally the attachment may be a little excessive or attach a little further down toward/in between the teeth than usual. This slightly different attachment is sometimes just enough to keep the two front teeth from coming together. If not corrected, this attachment can stay present as an adult and may or may not cause other problems.

In general however, this is not something to be overly concerned about until the child is older. Your dentist may choose to have your child evaluated by the orthodontist, as sometimes the space will not close on its own. It is fairly easy to fix, sometimes requiring reshaping and or relocating of the attachment to a better cosmetic place with or without the help of orthodontics. Typically no treatment is performed to fix it until the child has all or almost all of their permanent teeth. If you and your child decide not to fix it, there is usually no problem associated with leaving it other than having the space there permanently. Occasionally if left alone, (this is usually when the problem is on the lower front teeth) the attachment can cause a defect in the bone and gums, causing a host of other problems. So, it is always best to have your dentist evaluate the area regularly during check-ups or if you have concerns about the space.

The great news is that your child is perfectly normal! Spaces between baby teeth are a great thing-especially for your wallet! As I said earlier, the body is amazing and the design of teeth is no exception to the rule. Those little gaps are the body’s pre-built mechanism to allow enough room for the larger, later erupting permanent teeth. Those spaces (called Leeway spaces) are your hopeful chance that you will avoid having to pay for braces later on.

The time to be more concerned is when your child has teeth like a supermodel. In other words, they have no spaces and perfect alignment. Beautiful as they may appear now, you are pretty much guaranteed that without any orthodontic treatment or strategic preplanning, your child will have crowded teeth as a teenager and adult. The good news is that dentistry has advanced in ways that now make it possible to understand the relationship between baby teeth, permanent teeth and skeletal growth in children. This knowledge now allows us to pre-plan in certain situations, possibly avoiding braces altogether. For further information, please refer to the “general questions” section of this book. More information will be found under the question: “How early should my child be placed in braces. How do I know if my child needs braces?”

This is perhaps the most commonly asked questions about children’s teeth. In fact, parents who have children in the 0-6 year old range often wonder if they even need to worry about their kid’s teeth at all. I would like to stress that this age range is one of THE MOST IMPORTANT times in the care and maintenance of your child’s teeth. Repeat after me: “This age range is one of THE MOST IMPORTANT times in the care and maintenance of my child’s teeth.” You are officially now more informed than 98% of the world.

I want to first dispel a major dental myth that we touched on briefly in the general questions section. You know, the one that says, “They’re just baby teeth, they are going to fall out anyway.” WRONG. Those cute, milk-white, little-bitty, ankle-biting pearly whites are the foundation that will determine whether or not you may have to pony-up $5000 for braces several years from now. Baby teeth are crucial in holding the space in the dental arch for the future permanent teeth. They predict and help guide the underlying permanent teeth into their future locations and thus will have a huge impact on both the appearance and functionality of adult teeth. Extracting them rather than filling them in many cases can cause mild to severe crowding, spacing and asymmetry of adult teeth that may not have otherwise occurred.

Without those baby teeth, we lose many opportunities to prevent later orthodontic problems. Not to mention when you extract teeth, adult or otherwise, you greatly affect the ability to chew. I think it is only fair that we allow our children to experience the delight of eating as we do, but children need to eat for nourishment to allow for proper growth. The ability to chew can limit what a child is able to eat and thus have effects on both their mental and physical development. So, we can see that in most cases it is better to try to save a baby tooth rather than extract it.

Too often parents consider baby teeth “disposable,” since they will fall out anyway. They are far from disposable and almost always benefit the child most by doing what it takes to save them. There are exceptions to this rule. For example, if a baby tooth has a cavity but no infection present, and the tooth is within 6 months of falling out, your dentist will probably recommend the baby tooth not be treated. This makes sense as it would be pointless to waste money on a tooth that will very soon come out on its own. In addition, removal of baby teeth can sometimes actually help prevent braces altogether. While braces may be unavoidable whether you maintain baby teeth or not, you’ll see that there are other extremely important reasons to keep baby teeth healthy. So, with this new paradigm shift in thought of caring for your child’s baby teeth, let’s go into more detail about these curious topics!