Patient Questions

Patient Questions and Answers

Dr. Howard receives hundreds of patient questions via email monthly. He does his best to paste some of his answers. Do you have a question?
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My 7 yr old daughter just got hit in the mouth with a baseball! Her front tooth is bleeding and loose however it did not fall out.  It is her permanent tooth and I want to know if it is loose will it heal and tighten back up?  What should I do?

Around age 7 a child exchanges the upper two front baby teeth for their adult teeth.  This may occur earlier or later in life and is related to the time that the very first baby tooth erupts into the mouth, i.e., the earlier the first baby tooth erupts, the earlier the first adult tooth erupts.

Bleeding is normal.  The mouth is very vascular and easily subject to bleeding from trauma.  Compression and ice in the affected area should control the bleeding.  If not, see your child’s dentist asap.  The mobility will decrease with time.  Obviously the initial amount of “looseness” is the key factor.  Have your child avoid chewing/biting with the front teeth for several days.  You can check the mobility by using your finger nail – not the skin of your finger (it moves).  Once the tooth stabilizes it is ok to resume biting with the tooth.

Finally, it is important that your child sees his/her dentist if there are any questions, or if the area does not resolve within a few days.


I have been told that my 3 year old son needs 6 extractions ( his 4 front teeth and two lower molars.  and 3 root canals.  I have not been given a diagnosis.  Or other options.  I have never heard of a 3 year old needing to be put out to have oral surgery.  I am mostly concerned about him being put out and I don’t understand why if these are all baby teeth and going to fall out on their own and be replaced by new teeth in a few years, why would he need all of them pulled when it can affect his speech learning process now?

Broken down teeth can lead to infections within the bone surrounding those teeth.  The breakdown of the teeth themselves was /is due to tooth decay which is a disease and can spread to other teeth within the mouth.

If the diagnosis is removal, I assume that the dentist felt restoration of the involved teeth is not an alternative.  These teeth should then be replaced by space maintainers.  Upper front tooth space maintainers usually have teeth on them which allow for esthetics – chewing – and proper speech.

Should a baby tooth be removed prior to the time it’s adult replacement is due to grow into the mouth it may be expected that bone will grow over the unerupted adult tooth.  This will delay the growth of the adult tooth into the mouth, which under normal circumstances is not until 7 years old.

As far as sedation during the visit;  should your child be able to sit through a multiple extraction visit without it, wonderful.  But more than not, this is not realistic.  It is very important to try to provide the most comfortable and non-threatening visit for all forms of dental treatment for all patients.  The use of sedation is one such tool.


I have a son that is four. A couple of month he jumped on a ball and of course the ball moved and he hit his mouth on the floor.  The fall knocked his front teeth loose. I took him to the Dentist the next day and they said he was fine and the teeth will harden up in two weeks.  That they did. No problems since, but one of the teeth are a darker shade now. But today, I noticed a pimple like bump on the top of his gums, where the tooth is the darker shade. I pressed on it and asked him did it hurt, he said no. I bursted it and it was filled with blood, but he said it still didn’t hurt. Can you tell me what this is?

It is not uncommon for the nerve of a tooth to degererate subsequent to a traumatic episode.  The discoloration of the tooth is due to blood cells dying within the chamber of the tooth.  Just like a black and blue on your skin.  The color may darken, stay the same, or get lighter.  In and of itself, this is not a sign of tooth pathology.

The “pimple” above the root of the tooth is an abcess.  The nerve within the tooth has died, and the tooth has become infected.  The sooner this is treated, the  more likely the tooth may be saved.  The procedure is a root canal on a baby tooth.  No local anesthetic is required – the nerve is already dead.  The decision to treat such a tooth is based on several factors.  First and foremost, an xray is necessary.  So a trip to the dentist asap would be highly recommended


My 4 year old son’s teeth are rotting…  I had his 4 front teeth removed at the request of his dentist (at the time), because they were causing him pain.  The dentist also cleaned and filled in 3 other teeth that were not as bad, but required this procedure.  The teeth that were filled have now started to rot and the fillings have fallen out. I thought that the rotting it was due to the bottle, however I am beginning to wonder because he has been off of the bottle for about two years and it looks as though the rotting is continuing.  Could this be some sort of medical problem? And what can I do to stop this horrible process?

For youngsters who seem to have problems with maintaining a cavity free environment there are several recommendations:

Your dentist can prescribe a “high powered” fluoride toothpaste which I like to have used for the nighttime before bed brushing; an example of such a product is Prevident Toothpaste. Brushing should be done three times a day; after breakfast, lunch and diner.  Additionally, if there is a “sweet meal” during the day (chocolate bar for example), brush then. To insure that all the plaque is being removed, purchase from the pharmacy “disclosing solution” (or tablets).  read the instructions – use before the nighttime brushing.  An example of such a product is “Red Cote”. Warning:  this product can stain – please supervise it’s use. Flossing before the nighttime brushing can be easy with the use of “floss sticks”.

There are several types, but the easiest seem to be the ones that look like little “hack saws”.  While flossing your child’s teeth every night may be a pain – try three times a week for starters. Limit the amount of soda in your child’s diet.  The bubbly stuff in carbonated beverages is caused by the presence of carbonic acid in the product.  Acid !!   That’s what dissolves the enamel of teeth.  The internet is wonderful – information, tons of it, is available.  But realistically, your child’s dentist should be providing this info and guidance.  If not, find your child a children’s dentist who does.


My 2 year old son started to have grey color on his eight front teeth when he was 1 1/2 years old.  And now they turn into black color.  I’ve been using orajel (the swallable) to blush his teeth twice a day, and the black color wouldn’t go away.  Is he too young to see the dentist or is there any recommendation?  I know he wouldn’t open his mouth to the dentist  I tickle him till he laugh and I am able to blush his teeths.  How did he get the black color on his teeths?  Are they plaques, gingivitis, cavities?

Without actually looking at you child’s teeth it is not possible to diagnose the problem.  What I can do is provide you with several possibilities.  Generalized discoloration may be due to nothing more than something in your child’s diet.  Food may not be the only culprit.  Are you giving your child any supplements?  Iron is the most common supplement that stains the teeth black.

It is the “job” of a children’s dentist to diagnose and treat very young children.  I would recommend that you get a referral from your child’s pediatrician or a friend who has taken their child to a children’s dentist.


My son who will turn 3 on the 9th needs 5 cavities filled. What is the difference or risks with IV sedation versus nitrous oxide?


Provided by a properly trained, experienced practioner (in California IV sedation requires  a special license), either form of sedation can be very successful with little risk.  All forms of sedation caries some form of risk, and you should review a “Consent for Anesthesia” form prior to the sedation.

The size/complexity of the five restorations would influence my decision.  Even with Nitrous, large cavities require local anesthesia.  Not necessarily so with IV sedation.  How many locales will require injected anesthesia?

What’s your child’s emotional state?  Will he require a “high” dose of “gas” over a long period of time to maintain composure?  This verus the steady “low” dose used for the IV sedation.

Finally, with Nitrous, the “recovery” is fairly rapid, while with IV sedation there is a more prolonged “recovery” (both based on the length of exposure to the drugs consumed).


My son had a dental exam in December, and the dentist found 4 cavities in his teeth! (He had none a year ago!) We were referred to a pediatric specialist to have them filled. This specialist recommended crowns for the 2 cavities in the lower teeth. Is this a common practice? It seems extreme to me. The fact that he did not have these cavities a year ago, and was not being bothered by them lead me to believe they were not large. I want to be sure I am doing the right thing!

The type of restoration placed on any tooth is a judgement call by the given dental specialist.  If you are not comfortable with the treatment plan I would you suggest that you get a “second opinion”.

The use of a crown is usually indicated if the amount of tooth remaining after the decay is removed is insufficient to “wrap around” the filling material.  The crown, conversely, wraps around the remaining tooth structure.  This relationship is accurate for both baby and adult teeth.


My son will be 6 this month and has 6 cavities. One is so deep that they want to do a “baby root canal” Is this fesible or do I have it pulled? It is a back molar. Also if I decide to do the root canal will it last 6 years or so til the perment tooth comes in? Or will it break and he will have to have it extracted anyway? My son is a klinefelters boy. Also someone suggested giving him Prevident or Etherdent once a day. First thing is I don’t have a clue what these are. And do you think it would help him?

The successful treatment of a baby tooth with “root canal” therapy allows for the retention of this tooth until the appropriate time for the adult tooth to grow in and replace it.  This tooth should also be treated with a stainless steel crown to protect it from breaking apart. While not always successful, should the treatment fail, the tooth may then be removed and a spacer placed to maintain the “slot” for the adult tooth to erupt into.

Obviously, removal of the baby tooth from the getgo eliminates the possible necessity of two procedures (along with the expense), and the necessity of requiring your child to sit through two procedures. Prevident, in toothpaste form, is a great idea for individuals with high cavity incidence.  It is a prescription item.  Prevident has a high concentration of fluoride & should be used for the nighttime brushing. Two additional points:  evaluate you child’s diet – eliminate the foods which promote cavities;  make sure you brush your child’s teeth after each meal – every day!!  Cavities do not occur by accident.


My three year old day-care kid has very yellow teeth which seem to be getting worse.I’m worried this could be because of a nutritional deficit. Her mother has her on a fairly restrictive diet,esp. concerning dairy, although she does give her calcium chewies. Any thoughts?

Yellow teeth:  this may be no more than poor oral hygiene.  Just like an adult, a child’s teeth should be brushed twice a day (after breakfast and before bed).  A three year old should also have had his/her first visit to the dentist.  Sometimes the buildup of plaque by this age is so thick that it cannot be removed by tooth brushing alone.>
Nutritional deficiencies, although a possibility, is only likely if you suspect that there are other physical abnormalities. My best advice: schedule a dental appointment for this young person.


Why would a root canal be needed on a baby tooth? What exactly is a mini root canal?

Each baby tooth holds a space for the adult tooth which will grow into the mouth.  Should the nerve of a baby tooth become infected a procedure can be done to remove the nerve & save the tooth.  This is called a root canal.  Should the affected tooth remain untreated, an abcess may form which could lead to the removal of the baby tooth. In this scenario a space maintainer should be placed (again the need to reserve a place for the adult tooth).

There are indications that the nerve within the crown of the tooth can be removed – vs. the entire nerve within a tooth.  This is often referred to as a “mini” root canal.


My stepson is only 3 years old and when his mother brought him for his first check up they told her that he needed 2 root canals, 4 teeth capped, and 2 teeth pulled.  she didn’t even take an x ray.  He has never complained about pain or even discomfort.  Could these procedures have adverse effects and what should we do?

It is possible to make an initial diagnosis from a clinical examination only.  However it would be poor medical practice to treat your stepson (or any other patient) without the appropriate diagnostic xrays.


Children with teeth which have cavities that involve the nerves of these teeth may not complain of discomfort.  It happens so frequently that sometimes I think it is for no other reason than the kids simply do not know they shouldn’t be feeling the discomfort they’re feeling.

Most importantly; a diagnosis should be made as to why your stepson has so much tooth decay.  It could be due to poor oral hygiene – poor diet – nursing bottle use (also referred to as Nursing Bottle Caries).


My 5 yr old grandson needs extensive dental work.  root canals etc. Why is this necessary in teeth that will he will be loosing in a year or so?

Great question!

Each baby tooth in the mouth holds a space for the adult tooth which will eventually grow in and replace it.  The premature loss of a baby tooth, as from tooth decay, would require the placement of a “spacer“.  This functions to hold the space open for the adult tooth.  While spacers are simple appliances, they do require additional maintenance.

Treatment of decayed baby teeth removes the decay which would continue to progress if left unabated.  This could result in toothaches, infections, and unsightly looking teeth.

Finally, while preservation of one’s teeth is important for chewing and making proper speech sounds, removal is sometimes necessary.  Consider the length of time before the adult tooth will replace the baby tooth under consideration.


My 9 year old daughter has an abscessed primary tooth.  The symptoms started Saturday morning so we contacted the dentist on Sunday because the all of the sudden swelling.  She was put on antibiotics and seen the dentist on Monday.  He made a small hole in the tooth so the infection could drain.  I cant get her to because of the bad taste that is in her mouth.  Is this from the infection and is there anything I can do to make it better?

The drainage from the infected tooth usually tastes very bad.  Rinsing her mouth several times a day will help.  Choose anything that is palatable to your child’s taste buds to rinse with.  The drainage will stop once the pressure is reduced around the root of the tooth.

This will occur when the amount of infected material is reduced (drainage) and when the antibiotic starts to kill the bacteria causing the infection.


My 7-year-old boy hasn’t started loosing any of his baby teeth
yet (no loose teeth.) I believe he didn’t start getting teeth till 10 months
old. Any concern?

He often complains of sore gums. He says they hurt when he eats certain fruits. He fights whenever I tell him to eat fruit, but is always looking for sugary sweets. I am constantly battling this issue, but I do it. He also has a small flap of gum which has grown over one of his back molars.

My almost 9-year-old girl has been loosing and growing adult teeth at what seems to be a normal rate. She has 7-8  adult teeth now.  One of the teeth (right next to front tooth) fell out over two months ago, It started growing in, but seems to have stalled, and looks stunted. Is there any concern about this?

Late eruption of baby teeth will usually be followed by late eruption of adult teeth.  Conversely, early eruption of baby teeth will be followed by early eruption of adult teeth.

Swollen gums and sensitivity to sweets is something that should be evaluated by a dentist.  Plaque build-up and decay may be involved.  This may also apply to the gum growing over his back baby molar.  I suspect it is nothing more that the adult first molar erupting (no baby teeth are lost prior to the eruption of these teeth).

Your daughter’s “stunted” tooth may be a peg lateral incisor.  A common dental malformation of adult teeth is the skinny, pointed appearance of the adult tooth that erupts next to the front teeth.  This would need to be confirmed by your dentist.  It may be corrected by placement of bonding material during the child’s early growth and development

stages, & restored with a porcelain crown when the child gets to be 16-17 years old.


My son just turned 5 and has several fillings and caps.  They say he was born with a dental defect.  One of his forward molars has had a filling and been capped.  It is now abscessed.  I took him in and the dentist wouldn’t pull it.  She removed the cap cleaned the tooth and sound nothing wrong and put a new cap back on.  Everyone is telling me the tooth needs to come out. My son also has to be heavily sedated to have any work done to him so I can’t just go anywhere.  Please advise.

Sounds like your child should be seen by a pediatric dentist (children’s specialist). I can’t speak to the dental defect issue without seeing xrays of the teeth prior to treatment.

The demise of a tooth , or teeth, subsequent to their restoration happens when the nerve degenerates (abcesses).  Whether these teeth can be salvaged  is a function of the root structure of the tooth, the anticipated length of time the tooth is expected to remain in the mouth, cost involved, and obviously, the ability of the child to sit through a given procedure.

Finally, management of a given child’s behavior is a function of the dentist’s selection of management techniques – not all dentists manage difficult to treat patients the same way.

As in all difficult decisions in medicine, please consider a second opinion.


Hi – my son lost his “fang” tooth a few month ago and the new tooth has not come in yet.  Should I be concerned that no tooth will come through?

Whereas most adult teeth erupt into the mouth shortly after the baby tooth falls out, there is  a phenomenon of delayed eruption of adult teeth.  It often happens when an adult tooth grows into the mouth and the root of the adjacent baby tooth resorbs (think pac man gobbling up dots).  When the root of the baby tooth shortens, the tooth falls out.  If the adult tooth that is supposed to replace it is not matured (it’s crown &/or root is not developed) the bone heals and closes the channel that the adult tooth would normally follow to grow into the mouth.  It now takes the adult tooth longer to grow into the mouth.

The same principal applies when a baby tooth is extracted prematurely.  The bone heals over & the adult tooth can take longer to erupt into the mouth.


Hi, I have a daughter who is 3 years old.  She has ground her front top 4 teeth down to stubs, maybe 5-10% of their original size or less. It hurts to consume hot and cold foods, but acid from that she can use the stubs to eat pretty well, she even eats apples.  Do you recommend pulling them out or leaving them in?

Extraction of baby teeth prematurely allows for the bone to heal over and thus delay the eruption of the adult teeth/tooth that will replace it.  In this case, as long as shes eating, I’d leave them in place..

More importantly, try to diagnose the cause of the grinding. Grinding of children’s teeth is usually a response to allergies.  Pollens, animal dander, dust, even food.  Anything that causes the mucous membranes within the sinuses to swell.  Easy places to start:  keep the cats and dogs off the bed;  stuffed animals belong anywhere but on the bed;  buy an inexpensive air purifier for your child’s bedroom.  & for really bad allergies and grinding, get rid of the carpeting!!


How necessary is it really to have ones wisdom teeth removed when a problem has not yet surfaced?

Wisdom teeth: Removal without symptoms may be indicated if the angle of growth of any one of the teeth is such that the direction is anything but vertical (into the mouth).  Typically, partially or fully impacted wisdom teeth are on their sides to some degree.  This posture can cause the bone surrounding the root of the adjacent molar to “erode” thereby setting it up for the possibility for it’s loss.

If there is insufficient space for a wisdom tooth which has partially erupted into the mouth, & it is currently asymptomatic, evaluate the soft tissue around the exposed crown of the tooth for possible gum problems.  Typically, food could become impacted between the gums and the tooth creating inflammation (pain & bleeding) & subsequent damage to the bone in this area.


My 3 1/2 year old son needs cavity treatment-possible root canal. I am considering Nitrous sedation this time because of what he went through with a bad dentist a few days ago. According to what that dentist described, I had a feeling that Nitrous might not help so much. I did some research and I heard people saying that they still felt and remembered every minute including “Pain”. I am afraid that my baby will still feel the pain as much as when he is sober but just couldn’t express himself because he will lose his motor skill to talk or move his limbs. Wouldn’t it be more traumatic? He might wake up with aweful memories that will haunt him for the rest of his life. Do the dentists use the gas for their convenience to make their job easy and it looks better to the parents than tying the kid up? And the parents believe that the child is not in pain because they don’t see him scream and cry. Please, if you have any thoughts on this, let me know.

By the way, he had one numbing shot to treat 3 cavities in bottom right molars. I wonder why he felt so much pain towards the end of the procedure.

1)  Nitrous oxide analgesia only works if the patient understands that he/she must breath in from their nose, ie, a crying child won’t have a successful outcome because of the air exchange through the mouth
2)  proper administration of nitrous with local anesthetic should eliminate any discomfort during treatment
3)  patients do not loose motor control, and can speak during nitrous oxide therapy
4)  while I’m sure some dentists use nitrous for their convenience – it really is for the benefit of patients
5)  do not use a dentist who ties up a child – I doubt that it’s legal, and is certainly disrespectful to the child
6)  if the anesthetic was short acting, there might not have been enough longevity to cover the length of the procedure, hence discomfort at the end of the procedure.


My 9-year old African-American daughter is concerned about her discolored/dark gums.  Is it normal or should I be concerned.

The key to your question is you child’s heritage.  Thank you for being attentive to detail.  The coloration you speak of is normal, & no you do not have to be concerned.  If your child’s teeth are protrusive, ie, stick out, then the gums supporting those teeth may also stick out.  In this case, orthodontic therapy would reduce the fullness of both the teeth and gums, thereby reducing the effective appearance of the gums.


Are panoramic x-rays recommended, or even necessary for 7 and 9 year-olds who have no present dental issues?

A panoramic xray is a single xray that provides an overall view of the entire mouth.  Properly taken, a dentist can see the upper and lower  jaws, and the sinus area.

Diagnostically, it is not used to define tooth decay.  It is a wonderful tool to provide information as to the number of teeth present (either erupted into the mouth, or still within the bone).  It can identify the position of developing teeth.  Anomalies of bone structure are visible.  When questioning growth & development tendencies of a child, a dentist can make judgments that allow for preventive/interceptive treatment.  This is very important if we wish to minimize the  severity or degree of orthodontic problems as our children get older.


I have a 3 year old son who went to the dentist for his first cleaning today.  They told me he has two small cavities and needs to have fillings.  I am questioning why this is needed for baby teeth.  Please explain.

Why fill baby teeth? A cavity is caused by a bacterial invasion into the structure of a tooth.  Left untreated, the bacteria can continue to multiply & during this process produce an acid that eats away the tooth.  This is why cavities get bigger.  Bigger cavities require bigger fillings.  Bigger cavities can cause damage to the nerve of the tooth (as in root canal damage) and cause pain.

Baby teeth are meant to maintain spoce for their adult replacements, chew food, aide in speech, and provide that cute smile.  Depending on which tooth we’re referring to, baby teeth remain in the mouth until 12 years old.

Please, provide your child with the opportunity to have small fillings, without the problems that can occur with a tooth that has a big old hole in it.


My baby is 8 months old.She has not yet started teething though she sits,crawls and stands holding on to something.From age of 5 months she has been chewing on the teething ring or anything that she gets vigorously.Our pediatrician suggested to wait till she turns 1 and then see the dentist for X-ray.Incase she doesn’t teeth till one,what is the treatment for it?

Delayed eruption of baby teeth is not an uncommon phenomenon.  There is no treatment.  Patience is recommended.  Look back in your family history.  There is usually a trend in prior generations, ie, late eruption of baby teeth.  I concur with your child’s pediatrician.  Xrays around age 12 months will provide information as to number of teeth & degree of maturation.


My five year old son recently hit his two front teeth off our ‘dado’ rail traumatising these teeth.  They have subsequently turned black.  We have visited our dentist who suggested that we keep them in until his adult teeth arrive.  However, what I am concened about is that his adult teeth will also be traumatised and black in colour.  I am very worried for my son (and any name calling he might experience)Can you please advise.

Traumatized upper front teeth may elicit several symptoms.  The presence of pain is diagnostic for nerve damage & indicates the need for treatment.  There may be no pain, but the presence of  a “gum boil” or swelling above the crown of the tooth indicates an abcess (an infection due to nerve death).  This also indicates the necessity of treatment.

Finally there is color change.  Traumatized teeth may get yellow, stay that way, or lighten up.  In and of itself, these changes are not diagnostic of pathology.  Color may go to brown or black.  This change results from bleeding within the tooth.  The iron from the blood cells leeches out into the hard structure of he tooth causing it to stain from within.  This color change is not pathologic to either the baby tooth in question, or the adult tooth that will replace it.

Traumatized teeth need to be xrayed every 12 to 18 months, or sooner if pain or swelling occurs.


My 6 year old’s two front teeth are almost falling out.  He has two new teeth very visable underneath.  The baby teeth will not fall out, we have even tried pulling on them. How much time should they take to fall out?  Can this damage his new teeth in any way?

Apply an ice cube to the gum tissue around the base of the loose baby teeth – it will act as a numbing agent.  Use your finger nail to wiggle the teeth.  Your time frame is limited to the growth of the adult teeth into the mouth without the baby teeth becoming fixed in the soft tissue.  If that occurs you’ll have to see a dentist to remove the baby teeth.


I hope that you can help me. My 22 month old baby needs four crowns and two root canals in her top four front teeth. I’m devastated. My dentist wants to use general anesthesia in a hospital setting. Is this safe for her? Are there any other options? Also, what would have caused this? She was exclusively breastfed (no bottles). She does not drink juice or soda and she very rarely has sweets. I brush her teeth twice a day. I stay home with my daughter, Melanie, I never let her cry, she is very shy and I don’t think the procedure could be done with her being awake, but general anesthesia scares me. She’s not even two yet. Please help me.

Breast Feeding Can Cause Tooth Decay

It is an unfortunate misconception that breast milk does not cause decay.  It does !!! Perhaps not all the time, but as it contains “milk sugar”.  It has the capability of feeding the bacteria in a child’s mouth.  These bacteria in turn produce an acid that erodes the surfaces of teeth, ie, tooth decay.  Combine this with multiple feedings throughout the day, and you have a recipe for nursing caries.

Dental restorations on a 22 month old child typically have to be preformed with some form of sedation.  General anesthesia is one form.  Provided by a hospital staff, it allows the dentist to concentrate on the dentistry.  The same may be said of sedation provided by a licensed anesthesiologist who provides anesthesia within the confines of the dental office.  Not all states have licensed anesthesia in the dental office however.  The choice of venue must be made carefully.  The health of the child, and the length of the procedure must be weighed.


I fell over last august, I hit my two front teeth. One tooth was
fractured and needed to be extracted, im now going through the implant
procedure. My other tooth is a little sensitive to hard pressure (not
temperature), i wouldn’t want to eat an apple with it. My dentist said
he could see nothing wrong with it, and just to keep an eye on it in
case it dies. My question is…how with I know if it has died and how
long roughly does it take a tooth to fall out after it has died? Is
there a certain amount of time that once passed means im in the clear
and my tooth will be safe???
It gives me no pain at all. When I was younger I fell over and hit the
same tooth, luckily it was the baby tooth, and it went a dark grey
color, it seems like I had it for ages…strange how history repeats
itself! But I simply cant remember how long I had it, and Im worried
about saving for another implant…which may seem strange as I have no
pain…just paranoia..or caution!

Broken front teeth

Pressure sensitivity is usually a sign that the nerve within  the tooth is degenerating.  This would be a good time to have the tooth evaluated by an endodontist – a dentist who specializes in nerve removals from teeth.  Having a root canal on a tooth does not mean that you’re going to have to have the tooth removed.  Quite to the contrary.  This procedure to your tooth can save the tooth, although it may require a crown afterwards.  All in all, better than an extraction -implant-crown.

As an aside, the damage to your baby tooth, and the subsequent sequelli is different than that of which may occur to your adult.  If the nerve were to die in an adult tooth, it does not automatically follow that the tooth will fall out.  That progression happens if there is infection within the bone allowing the tooth to loosen.

Infections may be treated with antibiotics – and root canal therapy.


My 8 year old’s top lateral incisors are coming in forward of her front
incisors, is this ok?  Her baby teeth did fall out so it’s not because they
are in the way.  They are probably 1/4 – 1/3 of the length of her front
teeth currently (so you know how long they have been coming in).  Can they shift back to sit next to the front teeth?

You’re describing the beginnings of an orthodontic malocclusion.  The side two teeth probably will not realign by themselves.  My best advise is to see an orthodontist or pediatric dentist who specializes in early interceptive treatment.
Very often, early intervention into an orthodontic problem minimizes future treatment.  Of particular importance here could be the elimination of adult tooth removal.
Early treatment can also provide for better long term stability by building corrections into the growth and development of the jaws.   Needless to say, children with straight tooth smiles may have better self-esteem than those with crocked teeth.


My 21-month old daughter had a table fall on her at a restaurant which hit her front left tooth along with the other two teeth on the left side. She had major swelling (lip area) for five days but never complained any after the swelling subsided.

It has been 3 weeks and I just noticed that the top of the left front tooth (near the gumline) is starting to gray. Is this a sign of nerve damage? Should we consult a pediatric dentist?

Our family dentist does not see children under 3 so we are not sure of next steps. Any advice is appreciated.

Baby tooth nerve damage may suddenly show up several weeks or even months after the traumatic episode.  The discoloration may continue to proceed to envelop the entire crown of the tooth.  It may get to some level of darkness then start to lighten up.   In and of itself, color change is not the only factor to consider.
Unsolicited pain, or a gum boil over the crown of the tooth is an indication if irreversable damage.  These situations require treatment by a pediatric dentist.

Most importantly – there is no time frame for symptoms to occur.


I have an almost 4 yr. old child who needs repair work in between her upper middle front teeth.  I have 5 other children, all older than her, not afraid of the dentist. (None of them had cavities before age 8.) She will not open her mouth for the dentist to even look without touching her.  I need to have these teeth repaired!  I do NOT want her to have such a horrible experience that she will fear dental visits from now on.  What can I do?

If you can find a pediatric dentist (children’s dentist) with lots of patience and TLC, he/she may be able to provide the environment necessary to allow your child to settle with the required confidence necessary to get the treatment completed.   Typically, the dentist will use the tell-show-do technique (which proceeds just the way it says).
Most likely, you’ll have to use some form of sedation to get the necessary treatment completed in a timely manner.  Then the process necessary to allow for your child to adapt to the environment and treatment modalities may occur without any rush.


I have two dead teeth top front, ones has a creak right down the center and the other has one but is living on a partially nerve.  It’s been this way since the age of ten when I kicked In the mouth.  My mother at this point kept pushing my front teeth In to keep them In place, It wasn’t till I was fourteen before I was to see the dentist for the very first time, and he could believe that my teeth we’re still in place. But now I’ve been having throbbing in the front of my mouth and I have problems with my nose as if I have a cold all the time. What should i do?
An abcess at the end of the root of the tooth in question might be causing the symptoms.  A tooth abcess is caused when the nerve inside the chamber of a tooth dies and bacteria invade the inside of the tooth.  The bacteria feed on the dead tissue within the tooth and create pus and gas.

Consider having an endodontist (a dentist who treats the nerves within teeth) evaluate the tooth (teeth).  Should the nerve need to be removed, the tooth is then filled on the inside with bio-neutral material .  Once a tooth has a root canal it should be covered with a crown. These teeth become fragile due to the absence of liquid material within the center of the tooth.


I have a 4 year old grandaughter whose teeth and gums retrude in. She has a very thin top lip. Some of her words do not come out right. The little thing that hangs down in the back of our throat is long and narrow. Her throat is short and wide. A Ear/nose/throat doctor told us she had a hole in the upper part of her mouth. It seems like her top gum and teeth are going in and it seems like it is getting worse. Can something be done to help her?

Sounds like you should have your child evaluated by a “cleft palate team”. This is a group of doctors that treat children (and adults) with “holes” in the roof of the mouth.  These teams often function through hospitals that specialize in children’s care.  You have also not given me any information about your child’s general health.  There may be pertinent information.


My 10 year old son has lost the first molar on the right side and where the gap should be there is a big blue/red lump it dosen’t hurt him but it looks quite nasty. Do you know have any idea what it could be as my dentist in the UK doesn’t know what it is and have to wait 4 weeks for a hospital appointment and then it could be another 4 weeks to be seen. Please help.

What you are seeing is an Eruption Cyst.  Occasionally the tissue over an erupting tooth stretches and retains blood cells – hence the red/blue color.  Most often is pops by itself while the individual is eating.  Not to worry, there’s not that much fluid.

On rare occasions your dentist may have to cut an oval across the center of the cyst.  This will allow the fluid to drain & prevent the sides from reclosing.


Our daughter is 9 years old.  Her pediatric dentist has recommended that her baby molars be removed right away because they appear to be ankylosed.  (According to the panorex.)  Can you tell for certain that the teeth are fused to the bone on these x-rays?  Also, she is very thin and small for her age and we heard that bone growth impacts a person’s teeth.  We are afraid that she will have trouble eating certain foods without these teeth.  Her dentist said that her permanent molars will not develop properly with the baby molars present so we obviously want to make the right decision.  Thank you for your time.

You can read an x-ray & evaluate the presence of an ankylosed tooth.

Depending upon the number of teeth missing and their location it is unlikely that the absence of these teeth will affect her ability to eat.  After all, girls start to loose baby teeth at age nine & then grow their adult successors.

The choice to remove them may be based on the eruption path of the adult tooth/teeth.  If an adult tooth is ectopically erupting, that is growing into the mouth in a position other than where is should be, removal of the baby tooth precursor can alter the eruption path for the better.


My 4 ½ year old daughter was just diagnosed with 4 cavities.  I was absolutely shocked as I really thought I was doing a great job taking care of her teeth.  The dentist said that all the cavities are  in-between her molars which I understand will be there until she is al least 9/10 year old.  I am going to have all of them filled even though it will cost me $935.00 and thats with insurance. My insurance doesnt cover Analgesia and I would like to know if that is necessary?

OK – ‘laughing gas”  is nitrous oxide analgesia.  It is used as a transient drug to reduce anxiety in a patient during dental treatment.  It is transient because once the gas is turned off, and the patient starts to breath room air, the effects of the “gas” wear off.  In general it is very safe.  That presumes that the dentist providing the “gas” monitors his/her patient with the appropriate monitors.  These include (but not limited to) a pulse rate monitor & pericardial stethoscope.

As with any drug therapy, the more time you expose a patient, the more likely there can be an adverse reaction (it’s a numbers game).  My recommendation; try to complete as many fillings at one sitting as possible.

Is your dentist a trained pediatric dentist (dentist who specializes in children)?  Has he/she been trained in the use of nitrous oxide?

Finally, if you are not comfortable, it is more important that you get a second opinion; have your concerns addressed to your satisfaction; then expose your child to the treatment protocol.


My dentist has told me to have my daughter’s frenum removed from between her upper front teeth.  What effect will this have on her teeth?  Is it ok to wait until her new teeth grow in?

The removal of a frenum in this location removes tissue that can interfere with the eruption of the upper front two teeth.  Choosing to wait and see is an option as long as you’re aware that should the teeth erupt into the mouth with a space between them, some orthodontic therapy may be necessary to condense the space.
Whether these teeth erupt straight or rotated may also be a function of the amount of available space before they erupt into the mouth.  A space analysis is a wise adjunct prior to a frenectomy.  Finally,  xrays of the upper front teeth will give you an indication of the potential alignment.


My 5 1/2 year old has an abscess on his gum above a crowned tooth in the front. He took amoxicillin for 10 days and it did not appear to help.  What else can I do to heal this.  I don’t want to pull it, it should fall out in the next few months. He’s had several BAD dental experiences already and I would like to avoid pulling it if at all possible. Any advice is greatly appreciated.

Tooth removal in the hands of an experienced practitioner need not be a traumatic experience.  Oft times a mild sedative can help the procedure go smoothly.
Your options are: A) leave the infected tooth – not really a great choice; B)  treat the tooth by removing the nerve tissue – which like an extraction requires your child to sit through a procedure; & C) removal.
Finally, in dealing with the existing infection; your child may need a stronger antibiotic to control the infection, but some form of treatment will in all likelihood be necessary.


I just took my 3yr old daughter into a pediatric dentist this morning.  It did not go so well she was scared and I had to hold her down.  He only had x-rays of her front and bottom teeth…no side views.  The dentist told me she would need to make an appointment w/the local hospital so the she could be put under anesthetics and have 4 fillings & 2 crowns.  My question is the hospital necessary, are crowns normal for young children and is that too much work to be done all at once?

Young children who are incapable of sitting for dental treatment on their own can be safely sedated in various ways.  Hospital treatment has been available for a long time, but an alternative in the form of “Monitored IV Sedation” (MIVA) is also now available in the dental office setting.  In either case there are risks which should be evaluated prior to sedation.  In either case, 3 years old is not too young.

While the safety factor for the sedation is very good, multiple sedations start to increase the risk of potential problems.  Therefore, complete all the treatment in one visit.  Again, the safety factor involves, in part, the length of time required to complete the treatment required.

As for the treatment plan; if a tooth is sufficiently broken down so that there is not enough tooth material to support a filling, then the filling (ie, crown) is placed around the tooth.  Again, 3 years old is not too young.


My three year old son has an open bite and I’m wondering how to learn more about this, what I should/can do about it and if there is any way to try to help his adult teeth to come in more normally.  I saw on this site how someone made a “tongue trainer” to try to keep the tongue from pressing into the teeth and wanted to know when can that be done and how do I know if it should?  how do you know if this can be corrected or needs surgery?

Your best bet is to have your child evaluated by a dentist trained in growth & development.  For the type of problem you’re describing, check with a pediatric dentist (that is one who specializes in treatment for children) or an orthodontist (that is one who treats problems of jaw &/or tooth alignment).

Briefly;  if your child has a habit, the open bite can be treated with some form of appliance therapy.  If the problem is related to abnormal bone development, then appliance &/or surgical treatment may be involved.


My daughter is 15 months old.  She has never had a bottle.  she is exclusively breast-fed.  I have noticed her front teeth seem to be missing the enamel. There even appears to be sporadic holes in them.  I also noticed the back teeth that are coming in have the same look. I first thought she bumped her tooth and chipped it in the front.  However with a closer look I noticed it is the enamel that is missing. Is this ok?

The fact that you are Nursing your child does not mean that your child will not get tooth decay.  In fact, the entitiy that used to be called “Nursing Bottle Caries” (from feeding your child a bottle during bedtime), was changed to “Nursing Caries” to reflect the damage caused by mothers who breast fed their children during he night.
The dark areas may in fact be tooth decay.  It would be prudent to have a children’s dentist (pediatric dentist) evaluate your child’s mouth.  Treatment to restore the teeth to a healthy state, and a consultation providing information on feeding should help to prevent further decay.


Earlier this week, it was discovered that my 4-year old son has three cavities in the upper right molars. Aside from feeling horrible and responsible for this, I am concerned about the proposed treatment.
I was told that at least one of the cavities, perhaps two, will need a ‘baby root canal’.  This seems extreme in itself, however, I was also told that the crown to be applied would have to silver; that white is not an option for baby teeth.  Is this true?  How does this all sound to you? Thank you so much for your time.

Cavities in the molar teeth of four year olds is not uncommon.  They may have been caused by diet, as in too much sugary foods that stick to the teeth.  They may have been caused by inadequate oral hygiene; do you brush your child’s teeth thoroughly at least once a day with a fluoridated toothpaste?  Or they may have been predisposed genetically, as in the structure of the teeth may have deep pits or fissures that can easily trap food.  Certainly, any combination will accelerate tooth decay.

The treatment protocol is based on the amount of decay present – how deep into the tooth structure does it penetrate?  How much tooth mass is missing?  An xray – preferably a digital x-ray which minimizes radiation exposure, is necessary to answer the first question.  If the nerve tissue is involved, a “pulpotomy” or “pulpectomy” may be required.  Once the nerve is removed, a crown is placed over the tooth to keep it from drying out & breaking (or to hold it together if too much tooth mass is missing).

Silver, or stainless steel, crowns are the work horses.  They are proven & work very well.  There are other, white crowns, but these each have their own particular ‘issues”.  If a white crown is what you want. check around with other pediatric dentists.

Finally, if you like your current dental provider, & he/she will only place a sliver crown, ask to have a white facing placed into the crown once the crown is cemented into place.

There will be an additional fee, but probably worth the esthetics.


My 6 year old daughter was told she needs a baby root canal and then a filling. I AM CONCERNED. Is this really needed?  Please explain?  I think pulling the baby tooth would be less traumatic.  I do understand that shifting is a problem. Are there alternatives to a canal?

The procedure for a root canal on a baby tooth need not be any more difficult than a filling.  Obviously, the age, temper & ability of the child to sit for any given procedure plays a big role.
Completing the root canal successfully allows for the baby tooth to remain in the mouth until the adult tooth is ready to grow into the mouth.  The percentage of success depends on the severity of the initial problem.  The natural tooth functions as a space maintainer; provides for esthetics in the front of the mouth; and aides in chewing.
Removal of a tooth requiring nerve treatment is an efficient treatment mechanism to eliminate an advanced decay problem.  However, there are several factors that must be considered:  a baby tooth removed prematurely can cause delay in the eruption of the subsequent adult tooth;  space maintenance for the adult tooth almost always is required;  esthetics for a front tooth scenario must be considered.


I have a 21/2 year old who’s front tooth is fractured and needs to be removed, is there something it can be replaced with so she doesn’t have to go toothless until her permanent teeth set in?
A missing front baby tooth can be “replaced” by an appliance called a flipper. This is a permanently placed appliance (it is cemented to a tooth on either side of the dental arch).  The replacement tooth can be color matched.

There is one important negative aspect to this appliance:  upper jaw growth can be restricted to some degree, because the appliance is of a fixed dimension.  This may be resolved when it is time to remove the flipper.  An arch developing appliance can be used (usually over a period of 5 to 6 months) to restore the proper dimension of the jaw.


I remember when I was in grade school there were tablets that you could chew that would show color in the spots you missed while brushing.  I was wondering if these are still available and what they are called or if there is something else that gives the same result.  I am asking because my 3 yr. old daughter is giving me a very difficult time about my helping to brush her teeth because she’s a “big girl”.  I was hoping that this type of example might help her understand why I must help her.

The product you’re looking for is called Disclosing Tablets (or Solution).  This product functions to stain the plaque red, thereby making it easy to “see”.  From that point it’s a no brainer to brush away the plaque.

Tablets can get very messy.  I would recommend the liquid.  Place 3-4 drops onto a q-tip; then paint the teeth; then have your child rinse.  The remaining “red” is plaque that is stained.

Please keep this product away from young hands – it can stain other things besides teeth (towels – counters – carpets – pj’s …..).


My daughter is 17.  A few years ago she cracked her front upper tooth in a hockey acceident.  She has also had braces.  Her teeth are yellow and the cracked front tooth we are told cannot be whitened.  My beautiful daughter will not smile any more. What can we do to restore her smile?

To whiten teeth you have the option of an in-office bleaching procedure, or over-the-counter products.  All bleaching products work.  They just work to different degrees.  Some products yield great results.  Others so-so.  From individual to individual each product will yield different results.  In general the in-office procedure is the most effective.

Once the teeth are bleached, have a veneer placed on the damaged front tooth.  A veneer is like an acrylic fingernail, or formica material for a counter-top.
The veneer will be shaded to match the newly whitened teeth.


My daughter will be 6 in Sept.  She lost her 2 lower anterior teeth already & I was wondering if children lose all their primary teeth?  ALso, 6 yr molars should come in, correct??

Loosing baby teeth happens sequentially starting roughly at 6 years of age & continuing until 11 to 13 years old.  The timing varies from person to person.  All of the baby teeth will be lost – assuming that there is an adult tooth to replace it.
At age 6 the lower two front teeth exchange, & the first adult molars erupt (without loosing any “back” teeth).  Age 7 the upper two front teeth exchange.  At age 8 all four of the side front teeth exchange.

There will be a time gap until age 9 or 10.  The lower cuspids & first baby molars, and the upper first baby molars will exchange.  This will be followed by the upper cuspids & all four second baby molars.  The adult 6 year molars are not lost.
The timing & sequence varies from individual to individual.


Hiya, Doc.

My son is about to turn two. Over the last eight months or so, he has developed a black “film” on his front teeth (top and bottom) between the gum and the middle of the tooth.

We took him to a pediatric dentist about a month ago who could not get it off with regular cleaning techniques and tried a pressurized water procedure (sorry, don’t remember what its called). That did get his teeth nice and white again. However, it is now a month later and his teeth are back to being black. We brush his teeth regularly, he does not sleep with his drinks, he rarely has juice (mostly milk and water). We do not give him candy or fruit snacks. WHAT THE HECK! Here is what we do do. He does eat a lot of fruit…apples, bananas, oranges. He also sleeps with a small (about a foot square) blanket that he consistently chews on at night. It is soaked in the morning.

OK, so, I think you have the whole story. Any advice?

Your initial thoughts about diet & hygiene is the rationale approach.  However, the problem may be due to chromogenic bacteria.  These are passive microorganisms (ie, they don’t cause disease) that have the unfortunate characteristic of creating a stain on the individuals teeth.  The color range may go from lite brown to ‘dark’ black.  Minimizing their effect involves “playing” with your child’s diet & hygiene to minimize the buildup at any one time.  And yes, occasionally eliminating the bacteria sufficiently to eliminate the staining.

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